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30 September, 2007

California: Medicare auditing program halted after it finds abuses

It wasn't supposed to do that: 'Pause' declared after procedure claimed rehab hospitals wasted tens of millions on unneeded care

Medicare officials have declared a temporary "pause" in a controversial auditing program that has put a strain on dozens of California rehabilitation hospitals forced to surrender tens of millions of dollars on allegations that the care they provided elderly patients was medically unnecessary. The pause, announced in a conference call to California hospitals Wednesday by the Centers for Medicare and Medicaid Services, is expected to last at least through October, said Patricia Blaisdell, vice president of medical rehabilitation services for the California Hospital Association, who participated in the call.

The association has been the leading critic of the program and the California contractor, Atlanta-based PRG-Schultz International, because of its rejection of almost all Medicare claims involving elderly patients treated at rehabilitation hospitals after knee or hip replacement.

The decision comes as the first wave of appeals of those cases is hitting administrative law judges for the Department of Health and Human Services. The judges are reversing many, if not all, of those decisions on grounds that it is impermissible under departmental rules for the auditors to call up cases more than a year old without good cause.

Blaisdell called Wednesday's announcement "an encouraging development." "We recognize this as an effort by CMS to step back and take a breath," Blaisdell said. But Rep. Lois Capps, D-Santa Barbara, who has led the state's powerful congressional delegation in complaining vigorously about the way the audit program has been carried out by PRG-Schultz, said she will introduce legislation soon to halt the audit program before it expands nationally by 2010. "We want to put a moratorium on this whole pilot program," Capps said in an interview. "We are not going to allow it to become permanent until all the problems that appear to be developing are fixed." Capps said she expects the legislation to be ready for introduction in a few weeks. Earlier, Capps and Rep. Devin Nunes, R-Tulare, orchestrated a letter signed by three dozen of the state's House members complaining about the way the program has been handled.

The audit program was established as a test by Congress in 2002 in an effort to reduce unnecessary Medicare spending. It took effect in 2005 in three states -- California, New York and Florida, all high-cost Medicare states. But rather than being paid a fee for their work, auditors are paid commissions of between 25 percent and 30 percent of the money they collect from rejecting claims as far back as five years. In the case of PRG-Schultz, its contract permits it to keep the bounty so long as its decisions are not overturned at the first and second stages of administrative review. The reversals, however, are coming in the third stage.

Andrew House, spokesman for Nunes, said PRG-Schultz told CMS that it will relinquish its right to keep its commission on all decisions reversed on appeal. Neither PRG-Schultz nor CMS responded to questions Wednesday. During the pause, CMS will have an independent contractor review PRG-Schultz's work, House and Blaisdell said. "We don't object to audits," said Blaisdell. "What we object to is the way it's being implemented. There are no physician reviews, and there are no individual case reviews. Ultimately, they are denying cases that were appropriate, and it will cause a hardship on providers and create a lack of access for patients."

That already is happening. The Rehabilitation Institute at Santa Barbara is being acquired by Santa Barbara Cottage Hospital in part because of financial problems caused by the audits. Officials at Glendale Adventist Medical Hospital said recently they are turning away Medicare patients because of the financial risk posed by the audits.

PRG-Schultz is struggling financially in its core business operations and is looking at the California Medicare contract and the expanded program as a promising source of continuing business. But in its quarterly financial report last month, the company alluded to problems on the horizon with the federal program, citing risks associated with "changes in the political, legislative and regulatory environment." Among the investors in PRG-Schultz is Blum Capital Partners, headed by Richard Blum of San Francisco. Blum is married to Sen. Dianne Feinstein, D-Calif.

Source




Australia: It's BYO nurse at collapsing NSW government hospital

But some people see where the problem lies

The family of a dying man was forced to use his credit card to pay for a private nurse in a public ward at Royal North Shore Hospital because there were not enough staff to look after him. Phil Lindsay, 87, a World War II veteran, had less than a week to live when his wife became disgusted with the lack of care. She hired an agency nurse for four nights because the family did not want him left alone.

His cash-for-care story comes amid a wave of complaints about lack of staff and resources at the hospital after Jana Horska, 32, miscarried in the toilets of the emergency department this week. A former doctor at the hospital said funding was cut because "people on the North Shore had money" and could afford private health care. Also yesterday:

* Dr Simone Matousek, a registrar at Royal North Shore, said there was "no commitment to care", and she could do three to four more operations a day "if I did not have to deal with this grossly inefficient system". "Many people work shifts in the hospital and leave when their time is up, not when the patient has been properly cared for," she said. "Fire all the middle management in hospitals who have created this environment and contribute nothing and you will have plenty of hospital funding."

* The federal Health Minister, Tony Abbott, ordered his department to investigate claims the NSW Government steered public funding away from the hospital.

* The Workplace Relations Minister, Joe Hockey, demanded the NSW Government launch a judicial inquiry into the claims.

* The NSW Health Minister, Reba Meagher, was forced to announce that pregnant women attending emergency departments would be transferred to maternity units rather than wait for treatment in crowded waiting rooms.

Budget documents, seen by the Herald, show the Royal North Shore/Ryde Health Service went $18 million over budget in the previous two financial years. Despite this its budget was cut by $13 million from $359 million to $346 million for 2007-08, the Opposition health spokeswoman, Jillian Skinner, said.

Mr Lindsay's case is one of many reported to the Herald. His daughter, Christine Rijks, said he had been suffering kidney failure when he was left in the emergency department for several hours in July 2005. The former Catalina gunner was later admitted to a four-bed ward, "causing my mother and my father more stress than his inevitable death". "It was so difficult to see him waiting," Ms Rijks said yesterday. "We knew he didn't have long to live. We became too frightened to go home at night because we just didn't know if anyone was seeing to him. We hardly saw any staff during the day and we were worried sick about what would happen when we went home."

Her mother, Hilarie Lindsay, said she had been asked to wash her husband, to crush his pills and dress him each day. "It was very distressing. I know the nurses are stressed out of their minds, but I was exhausted by the end of every day because we were the ones nursing him." Mrs Lindsay said she took her husband's credit card and booked an agency nurse, who stayed with him overnight. Ms Rijks said: "My parents were both under a delusion that his war service veteran's gold card would provide the best level of health care in Australia. Of more use was the American Express Gold Card."

Source





29 September, 2007

Australia: Another mother miscarries after being ignored by NSW government hospital

Two babies lost in one night

A SYDNEY mother has spoken of the harrowing ordeal of being shunned by nurses at Royal North Shore Hospital while miscarrying - just minutes after a 14-week pregnant Jana Horska miscarried in the waiting-room toilet. The shocking revelation follows a string of horror stories emerging from the hospital, which has been labelled one of the worst in Sydney. The Daily Telegraph can reveal that on the same night Ms Horska miscarried in the emergency department's toilet, another expectant mother was also forced to wait while miscarrying.

Leng Liu and her husband Steve arrived at the hospital emergency ward on Tuesday night not realising the horrific circumstances that had just unfolded only minutes earlier. In acute pain and eight weeks pregnant, Ms Liu, 46, of Chatswood was seen by a nurse at 9.30pm and despite bleeding heavily was told to wait her turn. After an agonising two hour wait, Ms Liu's husband asked the triage nurse why his wife had not been admitted. "We were told we needed an ultrasound but that couldn't happen until the next morning," he said. "I decided to take my wife home and that is where she miscarried. "That nurse would have been happy to keep us waiting till God knows when and had we have not gone home we would have lost the baby there in the hospital toilet."

The couple decided to speak publicly after hearing of Ms Horska's ordeal. The 32-year-old from Mosman miscarried in the hospital's toilet after being forced to wait two hours in emergency. The Daily Telegraph has been inundated with horror stories from patients seeking help at the hospital. Just 18 months ago Angi Milos, 30, was handed a nappy and forced to sit in the waiting room while she miscarried. She was 14-weeks pregnant and crippled with pain when she arrived at RNS. After going to the toilet three hours later, she discovered she had lost her baby in the same toilet Ms Horska lost her baby. "I thought I had been just left there to bleed," she said yesterday. "They could have showed a little bit of compassion."

The State Government is refusing to hold a full investigation into the hospital, instead calling for an inquiry only into Ms Horska's ordeal. In Parliament yesterday, Health Minister Reba Meagher defended her decision not to fully investigate RNS. The hospital's director of trauma Tony Joseph also hit the airwaves yesterday to defend his staff. He said Ms Horska's miscarriage could have happened "in any emergency department in this city, in this state and in this country".

"I feel extreme sympathy for the lady ... and I apologise on behalf of the health system for what has occurred but for us working in emergency it's actually not surprising that this would happen," Dr Joseph said. Dr Joseph refused to apologise on behalf of the hospital, instead blaming a lack of government funding. "We've been telling governments of various levels of this problem for a number of years and we don't see much solution for it," he said.

Ms Meagher's refusal to launch a full investigation outraged Therese McKay, whose husband Don died last May as a result of appalling conditions at RNS. Mr Mackay died the day he left Royal North Shore after being admitted a month earlier for what should have been a routine operation to have his lungs drained. Instead he was exposed to third world conditions and mistakes such as having his breathing monitor switched off. Mrs McKay and her daughter Melissa flew from their Port Macquarie home to confront Ms Meagher. She described Ms Meagher's response to her presence in Parliament as "disgusting".

Source

The class-war mentality behind the baby deaths

A FORMER senior doctor at Royal North Shore Hospital whose budget was slashed just before a state election says she was told people living in that area could afford to pay more. Dr Linda Dayan, who worked in the hospital's sexual health department for 11 years, said the cutbacks cost her her job. "Last year we had a massive budget cut in our area which was to halve the budget in two years," Dr Dayan told ABC Radio today.

"I called a meeting at the end of last year to speak with the deputy CEO and the woman who was directly under her ... to ask them why our budget was being halved," she said. "One of the women in the meeting said ... 'The new redistribution formula takes into account socio-economic class so everything has been cut in this area.' "She said, 'People in this area can afford to pay more'." [The North Shore is a generally affluent area of Sydney but not everybody who lives there is rich. So why should poorer people living there be discriminated against because some of their neighbouirs can and do use private hospitals? Is it to punish people for living in a somewhat nicer area? It probably is. Leftists think that only they deserve to live the good life. Witness the special treatment given to the "Nomenklatura" in the former USSR]

Dr Dayan, who now works in private practice, has called for a public inquiry into hospital funding. "I wonder if it was part of a political agenda as well - we were coming up to a state election and I was also told ... that maybe they didn't need votes in that area," Dr Dayan told Macquarie Radio shortly after speaking on ABC radio. "Things started to go from bad to worse. (The hospital) couldn't get new positions filled ... and at the last minute before the election those positions were filled so it looked on paper as if there new staff coming on board."

Services at Royal North Shore Hospital have come under the spotlight this week after a 14 weeks pregnant woman went without treatment for two hours and had a miscarriage in the emergency department toilets on Tuesday. Jana Horska was left holding her live foetus in the toilet, sparking outrage among medical groups and the community generally .

Dr Dayan spoke specifically about funding for the hospital's sexual health clinic, but said she was told there was an intention to cut budgets across all services. "Our figures were exactly the same as Western Sydney - they had $4 million, we were slashed to $2 million," she said. "Our figures were the same, our need was the same and yet the figures weren't taken into account. "I was told by an unnamed source that the guts of it was they had to cut $20 million of the budget."

A spokesman for NSW Health Minister Reba Meagher said hospital funding followed strict guidelines set out in the Australian Health Care Agreement, providing equal access to services regardless of where people lived. [Sounds like a barefaced lie]

Source




Doctor vetting blasted

AUSTRALIANS can't trust medical authorities to hire properly trained doctors, according to Federal Immigration Minister Kevin Andrews. Mr Andrews has made the claim while requesting the Medical Board of Queensland review its procedures for hiring overseas trained doctors. He has insisted on "stringent employment verification checks" before new doctors are employed.

Gold Coast doctor Mohammed Asif Ali was sacked last month for disgraceful conduct after lying on his resume about his medical credentials. In a letter to chair of the Medical Board of Queensland, Dr Erica Mary Cohn, Mr Andrews doesn't refer to the sacking directly. But he says "a recent case" had highlighted to the Australian Government the risk to Australians' quality of health care through "inconsistent registration processes across different jurisdictions".

Mr Andrews also refers to "less than thorough" employment vetting processes. "In order for Australians to have confidence in their overseas trained doctors, they need to have full confidence that these doctors have undergone a rigorous assessment process," he said. "Given this case, I do not believe that Australians can be fully confident in the assessment system that currently exists."

Mr Andrews said the Council of Australian Governments had implemented a new national system for registration of health professionals and the accreditation of their training, to be operational by July 2008. "Until this process is complete, I believe it would be beneficial to review the processes by which employment backgrounds and qualifications of overseas trained doctors are assessed," he said. "As part of this review, I am seeking your assurances that the Medical Board of Queensland is undertaking the most stringent employment verification checks and qualification assessments in order to ensure the integrity of this program."

Source





28 September, 2007

How The Swiss Do Health Care

Everyone knows our health-care system, superior as it is in so many ways, is too expensive, too bureaucratic and wasteful. Basically, we hand over about $2.2 trillion each year to hospitals, insurance companies and government paper-pushers -- and then we let them micromanage our health care like we are helpless babies, not rational consumers.

Everyone also knows by now that Canada’s “free” national health care system -- like its sibling socialistic systems in Britain and France -- is a just another Big Government fraud. So can any wealthy, modern country get health care right without resorting to socialism? Yes.

You never hear it touted by the media but Switzerland uses market forces, not government rules and red tape, to create a private, affordable, high-quality health-care system for its 7.5 million citizens. And it spends 40 percent less per capita than we do. Sen. Tom Coburn, an Oklahoma Republican, a fervent fiscal watchdog and a practicing physician, knows all about the Swiss system. Much of his proposed health-care reform bill -- the Universal Health Care and Access Act -- is modeled on it. Coburn’s plan, a major overhaul that can be found at coburn.senate.gov, is complicated, controversial and in no danger of becoming law anytime soon, if ever.

The bill's key elements include achieving universal health-care access by using tax credits to pay for individual or family insurance, phasing out reliance on employer-based insurance, allowing people to choose their own doctors and health insurance and stressing preventive care.

On Wednesday, Sen. Coburn explained why he likes the Swiss system, which operates sort of like our car insurance: You must buy health insurance but you can choose among many plans from many private companies. Since every Swiss is covered, Coburn said, there is no cost-shifting -- i.e., no hidden subsidizing of those who don't have insurance at all or don't have enough. Cost-shifting costs Americans about $250 billion a year, Coburn said. Ending it would save a family of four about $4,000 a year.

Another virtue of the Swiss way, Coburn said, is that it has fostered a range of innovative insurance products. For example, there are five-year policies that reward customers with lower and lower rates if they do the preventive things the company asks. A third virtue, he said, is a national high-risk pool that all insurance companies contribute to that essentially protects companies from suffering heavy losses in a given year.

Fixing America's health care won't take more money, said Coburn, who notes we already "pay too much. ... One out of every $3 we’re spending today didn’t go to help anybody get well and doesn’t prevent anybody from getting sick." "What we need to do is we need to start changing our paradigm to prevention instead of treating chronic disease. That’s what has happened in the Swiss system, and that’s why their costs are not going up."

Switzerland is tiny and doesn't have our social problems. But Coburn says its consumer-driven approach -- which is transparent to consumers in price and quality -- would work here. Coburn knows markets aren't perfect. But he knows why the Swiss system works so well: "It forces people to shop, it forces people to make decisions. ... The point is, markets work -- if, in fact, we’ll trust them."

Source




NHS rationing rife, say doctors

Rationing of NHS treatments is becoming more widespread, a survey of GPs and hospital doctors suggests. Doctor magazine asked readers about rationing. Of 653 answering questions on consequences, 107 - 16% - said patients had died early as a result. More than half - 349 - said patients had suffered as a result. This compared with one in five in a similar survey conducted nine years ago. The government said decisions had to be made on which treatments to provide.

The magazine asked 12,000 of its readers a variety of questions with between 473 and 857 replying to each one. Doctors said more debate was urgently needed over what should and should not be rationed. They reported not being allowed to prescribe drug treatments including smoking cessation drugs and anti-obesity treatment. They also reported that local NHS trusts had been placing restrictions on fertility treatments, obesity surgery and a host of minor operations, including those for varicose veins.

The magazine said the findings of the latest poll showed rationing was becoming more widespread. A similar survey nine years ago showed that a much smaller proportion - one in five, compared to half - were aware of patients who had suffered due to rationing.

Rationing has become a sensitive subject in the NHS. Independent advisory body, the National Institute for Health and Clinical Excellence, makes recommendations on new, expensive treatments. But with limited budgets, local trusts are often forced to cut back on other treatments to keep pace with the recommendations. Many experts fear the situation will get worse with increasing demands on the health service made by the ageing population and expected advances in medicines.

Richard Vautrey, deputy chairman of the British Medical Association's GPs committee, said: "There is not much honesty and openness about this. "The NHS could spend whatever you gave it, but it obviously works with a limited budget so we urgently need to have a debate about what can be provided. "Trusts are already being forced into this but the political parties are not talking about it."

And Dr Michael Dixon, chairman of the NHS Alliance, which represents NHS trusts, added: "Rationing is the great unspoken reality. "The only people who refuse to mention the 'r-word' are the media and the politicians, who continue to want to promise everything for everyone in order to win elections."

A Department of Health spokesman said it was not trying to avoid the issue. "The NHS has received an unprecedented funding boost in recent years but finance is not endless and hard decisions will always have to be made about which treatments to provide." But he added: "Doctors and nurses make these clinical decisions with patients - not managers or politicians."

Source





27 September, 2007

NY: Get a lawyer to deliver your baby

It was one of the saddest decisions of his life. Tamer Seckin, who had spent 20 years working as an obstetrician-gynecologist in Brooklyn, was faced with the prospect of a 14 percent hike in his malpractice-insurance rate, so he decided four months ago to stop delivering high-risk babies. "Just today, I had to tell a woman I'd been treating for years that when she goes into the delivery room, I won't be there," said Seckin, who is the chief of gynecology at Kingsbrook Jewish Medical Center. "This is what I'm trained for, but I can't afford to do it anymore."

And he's not alone. The American College of Obstetricians and Gynecologists and the Medical Society of the State of New York both say that, with malpractice-insurance premiums rising, the dwindling number of OB/GYNs who can afford to practice has become a crisis, particularly for risky patients such as older women or those with medical conditions. "The impact of these rate hikes is tremendous," said Donna Williams of ACOG. "We're seeing many OBs who aren't willing to stay in practice because they just can't afford it."

Nationwide, malpractice-insurance premiums for OB/GYNs constitute about 5 percent of expenses, Williams said. In New York state, they are 36 percent. According to an ACOG survey, in the past four years, rising malpractice premiums have led 8.7 percent of New York state OB/GYNs to stop practicing obstetrics; 12.6 percent have decreased the number of deliveries they perform. And although the total number of births in New York City was down by 6,697 between 1995 and 2003, those requiring a Caesarean section - and a trained obstetric surgeon - rose by more than 3,000. At the same time, the city's supply of practicing OB/GYNs fell by 6 percent.

Edward Amsler, of the Medical Liability Mutual Insurance Co., says most of the blame lies with the tens of millions of dollars New York juries award families of disabled children.

Gov. Spitzer has convened a task force to find a compromise involving the interests of insurers, trial lawyers, doctors and patient-advocacy groups. "The line between a disaster and a happy ending is very thin in the delivery room," Seckin noted. "Events turn rapidly in a way you can't always control, and having an experienced doctor there is the best way to avoid disaster."

Source




Another public hospital disgrace in Australia

Pregnant woman ignored: Miscarries in hospital toilet

A PREGNANT woman miscarried in a emergency department toilet while waiting for medical help at Sydney's Royal North Shore Hospital, her family says. Despite complaining of acute pain, the 32-year-old woman was not seen by a doctor or given painkillers at the hospital overnight, Macquarie Radio reported today.

The woman's husband, identified as Mark, said his wife, Jana, had already had one miscarriage this year. He said Jana went to the hospital about 6.30pm (AEST) yesterday because she was experiencing similar symptoms to when she had the earlier miscarriage. Mark said that after Jana had been waiting more than an hour at the hospital, he was told by a triage nurse there was nothing they could do, and they should just wait in the queue.

"In the course of our waiting, she's ended up on the floor in a squatting position .. with her hands wrapped around her legs ... directly in view of the administration section of the emergency ward. "She's grimacing in pain and nothing's being done."

Jana then went to the toilet and stayed there for a while, he said. "Next minute, I just hear a scream and a smash, and I jumped up, and I raced into the toilet, and ... I just couldn't believe the scene in front of me. "It is my wife ... sitting on the toilet, screaming ... an image in my mind I'll never be able to get out, the look on her face, screaming, tears, hysterical, pants around the ankles ... holding a live, live mind you, live fetus in her hands ... with blood everywhere."

The woman's husband complained to emergency staff about the pain his wife was experiencing, but was repeatedly told to sit back down and wait, the report said. The man's cousin, identified only as Peter, said on Macquarie Radio that the treatment they received was disgraceful.

"When we weren't looking she walked off into the toilet and had a miscarriage," he said. "People have come running (from) everywhere. "I can't go into the finer details, it's just so gruesome, mate. It's just something I wouldn't say on air. "She's holding the little fetus in her hand, basically, and was wheeled out of the toilet in front of this packed waiting room. "Not only that, but once they found her a bed they left her lying with the fetus between her legs for one hour."

Source





26 September, 2007

Walk-in health clinics flourishing, but many doctors skeptical of care

Tatiana Fredericks needed treatment for minor pain last week, only to learn her doctor had the day off. Mary Ann Arman just moved to South Florida from Texas and learned her kids needed more vaccinations to start school. Both ended up at a walk-in clinic in Pembroke Pines, one in a fast-growing but controversial breed of retail health outlets that promise convenience, speed and low prices. Offering a new choice to the uninsured, clinics are trying to carve a niche handling minor care such as infections, colds and burns. But the clinics — often in drugstores, supermarkets and discount stores — have drawn heavy fire from critics who say they undercut a pillar of m edicine: Patients do best seeing a doctor who knows them.

Some doctors argue that they lose touch with patients who go to retail clinics, that most clinics are run by advanced-trained nurses working alone, that they promote superficial care without follow-up and that they bring sick people near healthy shoppers.

Florida, with many uninsured and transient residents, has emerged as a key start-up area for walk-in clinics in retail stores. The concept is so untested that physicians are divided and not sure what to tell patients who want to go. "It's not really well defined when it's advisable to use these places or when it's not," said Dr. William Hazel Jr., a board member of the American Medical Association from Virginia. "We urge caution. We do see problems with this type of medical care. There's no continuity."

Fredericks sees a role for them. The day her regular doctor was gone, the office worker, 23, dreaded going to an emergency room to wait for hours and pay hundreds. For a sudden illness in the past, she had seen a doctor at a free-standing, walk-in clinic called Solantic, so she went back. "I believe in having a regular doctor. But I felt I needed to get this addressed immediately," Fredericks said. "The clinics, they're just an easy way. I waited 10 minutes and the price is right." She paid $50.

Free-standing walk-in centers have been around for decades, but the rapid spread of nurse-staffed clinics in retail stores in the past year has fueled more opposition to the walk-in model. At least 520 walk-in clinics have opened in U.S. retail stores, and their trade group, the Convenient Care Association, predicts more than 700 this year and 5,000 eventually. Florida has licensed 47 with 15 in the works, according to the Agency for Health Care Administration.

CVS is the biggest player with 262 clinics, including 12 in Broward and Palm Beach counties. Wal-Mart has 76 and plans for 2,000. The chain simply leases space to operators, including the tax-assisted North Broward Hospital District, which next month plans to open its first clinics in South Florida stores, in Lauderdale Lakes and Coral Springs. Publix has 33 clinics, including four in South Florida. Winn-Dixie has three in north Florida. Walgreens has 60 and Target 17, none yet in Florida.

Typically, the clinics are open seven days a week until 8 p.m. No appointments are needed and the average wait is 15 to 25 minutes, the trade group reports. Most have sprouted in suburbs where families usually have health insurance, and 50 to 70 percent of clinic users are covered. Insured patients face a co-pay of about $20. Uninsured or cash patients pay $50 for a basic visit and up to $250 for tests or procedures. Services such as vaccinations start at $20.

Clinics may boast service seldom seen in medicine. Some call patients on their cell phones when a nurse is available, so people can shop or get coffee instead of waiting. Some let patients call ahead to get on a waiting list. "They love that. It's kind of like retail applied to health care," said Karen Bowling, chief executive of Solantic, a Jacksonville chain with 10 freestanding clinics and three in Wal-Marts. Operators contend clinics may relieve crowded hospital emergency rooms in South Florida and nationally, where rising numbers of uninsured patients have boosted traffic.

Some walk-in patients have had no prior contact with a doctor and otherwise would not have bothered seeking treatment. Clinic operators said they urge all patients to get a regular doctor. "Patients need more than one access point to the medical system and our clinics are here if people need that access," said Michael Howe, chief executive of the CVS subsidiary MinuteClinic.

But critics — mainly doctors — say clinics fragment medicine as patients see multiple health providers, none of whom has a complete picture of a patient's health. That raises the risk of drug interactions or missed clues to a serious illness.....

Source





25 September, 2007

GOVERNMENT HEALTHCARE IN AUSTRALIA

Below are five reports from within the last week. QLD is the State of Queensland; VIC is the State of Victoria; NSW is the State of New South Wales; SA is the State of South Australia

QLD: Ambulance death coverup

A QUEENSLAND Ambulance Service report into the death of a young heart attack victim was shredded, rewritten and a new version given to the Coroner's Office. Sources have told The Sunday Mail the original report into the death of Burbank man Vito Catenaro, 39, was damning of QAS management and its handling of the controversial case. Mr Catenaro died in June last year after his wife Silvana tried in vain to get resuscitation advice from a Triple-0 operator, a nearby ambulance was sent to another address, and eventual medical help was delayed more than 30 minutes.

Mrs Catenaro said one of Commissioner Jim Higgins' assistants admitted to her that the service had bungled at every turn, and apologised. But ambulance insiders said QAS management was now trying to shift blame. "Unhappy with the outcome which revealed a huge system f--- up, the managers ordered that the report be rewritten," a source said last week. "When the ops managers refused, the report was destroyed and a new player brought in to rewrite the facts. "Interestingly, the ethical standards unit rep advised the original investigators to keep copies of the first report handy in the event that it leaked."

The source said management was "in a panic" after new Premier Anna Bligh ordered an audit into the service. The original report was written by highly respected QAS manager Stewart Merefield, an Australia Day Award winner with more than 25 years' ambulance service. Mr Merefield declined to comment yesterday.

A QAS insider said Mr Merefield was ordered by senior ambulance management to rewrite his 60-page report so it was less critical. When he refused, they said someone else would rewrite it and he would be forced to sign. "Mr Merefield refused to play their game because he did not want to perjure himself to the coroner," the source said.

The insider said management and legal counsel ordered that the original Merefield report and all email correspondence be destroyed. Another manager with no paramedic experience was brought in to do the rewrite. The second report was handed to Deputy State Coroner Christine Clements only recently - 15 months after the death - despite repeated requests from the coroner's office, police and Mrs Catenaro to speed the process.

A spokeswoman for Ms Clements said she had not had a chance to read the QAS report to determine whether an inquest would be held. A spokesman for the commissioner admitted a preliminary report was done. "However, the commissioner requested other matters be pursued to ensure all aspects of the investigation were fully canvassed before a final report was submitted to the State Coroner," he said. A spokesman for Emergency Services Minister Neil Roberts said the second report was more in-depth and produced significant recommendations, including counselling and retraining of some staff. He strenuously denied claims that there were orders to destroy the original report.

Mrs Catenaro said she hoped the coroner would investigate so "this sort of failure never happens again".

Source




VIC: Negligent public hospital treatment of injured woman

An 8-hour wait to deal with a serious head injury is inexcusable and the consequences have been severe

THE family of a critically injured Portland woman, forced to wait eight hours to be admitted to a Melbourne hospital, have joined a campaign for a rescue helicopter for Victoria's southwest. Carolyn Meerbach remains in a coma almost six weeks after she was struck by a car while on her morning walk around Portland with her husband, Joseph. While she was taken by ambulance to the Portland hospital almost immediately after the horror crash, the Melbourne-based helicopter that flew her to the city was not called until almost four hours later.

Her brother-in-law, Keith Meerbach, has joined a 10-year campaign for a rescue helicopter to be based at Warrnambool or Portland. He said he believed Mrs Meerbach's injuries had been worsened by the delay in her undergoing surgery at the Alfred. "There's not a lot of doubt she would be better off is she could have had the pressure in her skull relieved earlier," Mr Meerbach said. He said his 46-year-old sister-in-law had been bleeding into her brain and was now on full life support at the Alfred.

Metropolitan Ambulance Service Chief executive officer Greg Sassella said he was confident Mrs Meerbach's care was not compromised by the air ambulance being based in Melbourne

Source




NSW: Hospital keeping patients in old storage rooms

ONE of Sydney's busiest hospitals is so under-resourced that patients are being squeezed into storage rooms for treatment. Nurses at the Royal North Shore Hospital at St Leonard's report critical understaffing and that 100 positions for registered nurses and midwives are vacant.

The hospital has launched "treatment rooms'' to relieve the burden on emergency beds. But the new rooms are little more than a hospital bed stuffed into an old storage room. Frustrated nurses are threatening industrial action. They could call an emergency union meeting as early as this week, claiming they are being pushed too hard to pick up the slack. "It's a shambles," said one highly placed nurse, who did not wish to be identified. "There is barely enough room to walk around the beds, let alone treat people properly." The nurse said her colleagues were working up to 19 hours overtime every week to fill the gaps left by the vacant positions. "We are worked off our feet," she said. "We have to do so much overtime to meet targets." The nurse said her colleagues were seriously considering industrial action to improve their working conditions.

Ambulance officers, speaking through the Health Services Union, confirmed that patients were being treated in inadequate rooms with little room to move.

Northern Sydney and Central Coast Health acting chief executive Terry Clout said the hospital was actively recruiting to try and fill the vacant positions. "While international and national nursing shortages are impacting on our ability to fill these vacancies, extensive marketing and recruitment strategies are being put in place to ensure we fill (them) as soon as possible," he said.

Mr Clout confirmed the hospital runs treatment rooms that are used when the emergency department exceeds its capacity. "Clinical treatment rooms in wards at Royal North Shore Hospital are being used to accommodate patients, in response to periods of high-level demand," he said. "The use of these rooms was introduced as a capacity-management strategy in 2000, to prevent patients being kept in the emergency department when its capacity to meet demand has been exceeded."

Opposition health spokeswoman Jillian Skinner said that conditions at the hospital were "disgraceful". "I have had many phone calls and contact from staff about the lack of morale in that hospital. The nurses say the only thing that keeps them there is a commitment to the patients and each other," she said. "Royal North Shore is particularly bad. The place is disgraceful in terms of the physical condition. It's dirty, seedy and rundown."

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QLD: New heart defibrillators are duds

EXPENSIVE new life-saving defibrillators - which cost the State Government more than $1.5 million - do not work. The Queensland Ambulance Service confirmed yesterday the new defibrillators had to be upgraded before they could be rolled out.

It is another major embarrassment for the Government after Emergency Services Minister Neil Roberts boasted in State Parliament this month about the devices. "The message that I want to give to the community is that we need to extend and broaden the range of locations where we have defibrillators... (they) are life-saving equipment. "When you are talking about cardiac arrest, every minute and every second count," Mr Roberts said. He also said $2.5 million had been allocated in the 2007-08 Budget for 240 new defibrillators "to ensure our paramedics are able to access the most modern and reliable equipment for patient care".

A defibrillator, which costs between $10,000 and $20,000, administers electric shocks to try to restart a heart that has stopped. The Sunday Mail revealed in April that faulty defibrillators had been linked to at least three deaths in Queensland since 2005. In March, a 38-year-old Mitchelton man died after the defibrillator in the ambulance taking him to Royal Brisbane Hospital did not work. New devices became a priority and were part of the record funding for the QAS announced by then-treasurer Anna Bligh in her June Budget.

But there have already been problems with the first shipment of defibrillators. Paramedics told The Sunday Mail last week that they had tried to replace their faulty old devices, but had been refused. "People die due to lack of good equipment .... it is locked up... they have pallets of new ones in a warehouse," said a frustrated ambulance officer. A spokesman for Ambulance Commissioner Jim Higgins said: "the QAS has 83 new defibrillators on hold, which are awaiting an external cable upgrade."

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SA: Obstructive paramedic plus hospital delay kills man

Most surprising behaviour from a woman. Is she a lesbian or was she just hormonal?

A female paramedic with a "chip on her shoulder" actively discouraged a critically ill man from going to hospital hours before he died, an inquest has found. State Coroner Mark Johns has strongly criticised SA Ambulance Service officer Jennifer Bell over her dealings with Stefanos Markantonakis, 63, of Goodwood, who had a history of heart disease.

Ms Bell and another paramedic, Sarah Moore, were dispatched to Mr Markantonakis's home at 2pm on March 4, 2004, when he complained of chronic lower back pain. The pair decided he did not need to be taken to hospital and suggested he take painkillers. They returned at 5pm when his family said he had worsened.

Mr Johns said Ms Bell treated him in "a blunt . . . manner more calculated to dissuade him from going to hospital than to encourage him". "I had the impression that Ms Bell is a person with a chip on her shoulder," he said. Mr Johns said this attitude was evident in how she spoke to Mr Markantonakis, his wife and their daughter, Chrisoula, who said she told her it "was a case of poor me".

Mr Johns said Ms Bell left Ms Moore outside when they returned two hours later. "According to Chrisoula she came into the house and stomped through with the attitude she had and said to Mr Markantonakis 'come on we are taking you now'," he said. Mr Johns said Mr Markantonakis was driven to the Flinders Medical Centre, with Ms Bell allegedly telling him to "shut up" before they arrived at 5.24pm.

He waited until about 8pm, when he was examined by a doctor who diagnosed serious internal bleeding from a ruptured abdominal aortic aneurysm. He died soon after during emergency surgery.

Source.

The ABC adds that the bitch: "misdiagnosed the man as having a back ache and then failed to pass on to a nurse vital information about his symptoms. The man died five hours after an ambulance was first called. SA Ambulance medical director Dr Hugh Grantham says, since then, the service has conducted its own investigation and Ms Bell is no longer employed there".





24 September, 2007

Socialized medicine is broken and can't be fixed

Last week I pointed out that Michael Moore, maker of the documentary "Sicko," portrayed the Cuban health-care system as though it were utopia -- until I hit him with some inconvenient facts. So he backed off and said, "Let's stick to Canada and Britain because I think these are legitimate arguments that are made against the film and against the so-called idea of socialized medicine. And I think you should challenge me on these things."

OK, here we go. One basic problem with nationalized health care is that it makes medical services seem free. That pushes demand beyond supply. Governments deal with that by limiting what's available. That's why the British National Health Service recently made the pathetic promise to reduce wait times for hospital care to four months. The wait to see dentists is so long that some Brits pull their own teeth. Dental tools: pliers and vodka. One hospital tried to save money by not changing bed sheets every day. British papers report that instead of washing them, nurses were encouraged to just turn them over.

Government rationing of health care in Canada is why when Karen Jepp was about to give birth to quadruplets last month, she was told that all the neonatal units she could go to in Canada were too crowded. She flew to Montana to have the babies. "People line up for care; some of them die. That's what happens," Canadian doctor David Gratzer, author of The Cure, told "20/20". Gratzer thought the Canadian system was great until he started treating patients. "The more time I spent in the Canadian system, the more I came across people waiting. … You want to see your neurologist because of your stress headache? No problem! You just have to wait six months. You want an MRI? No problem! Free as the air! You just gotta wait six months."

Michael Moore retorts that Canadians live longer than Americans. But Canadians' longer lives are unrelated to heath care. Canadians are less likely to get into accidents or be murdered. Take those factors into account, not to mention obesity, and Americans live longer.

Most Canadians like their free health care, but Canadian doctors tell us the system is cracking. More than a million Canadians cannot find a regular family doctor. One town holds a lottery. Once a week the town clerk gets a box out of the closet. Everyone who wants to have a family doctor puts his or her name in it. The clerk pulls out one slip to determine the winner. Others in town have to wait.

It's driven some Canadians to private for-profit clinics. A new one opens somewhere in Canada almost every week. Although it's not clear that such private clinics are legal, one is run by the president of the Canadian Medical Association, Dr. Brian Day, because under government care, he says, "We found ourselves in a situation where we were seeing sick patients and weren't being allowed to treat them. That was something that we couldn't tolerate."

Canadians stuck on waiting lists often pay "medical travel agents" to get to America for treatment. Shirley Healey had a blocked artery that kept her from digesting food. So she hired a middleman to help her get to a hospital in Washington state. "The doctor said that I would have only had a very few weeks to live," Healey said. Yet the Canadian government calls her surgery "elective." "The only thing elective about this surgery was I elected to live," she said.

Not all Canadian health care is long lines and lack of innovation. We found one place where providers offer easy access to cutting-edge life-saving technology, such as CT scans. And patients rarely wait. But they have to bark or meow to get access to this technology. Vet clinics say they can get a dog or a cat in the next day. People have to wait a month

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Australia: Public hospital dubbed 'the killing fields'

A KEY Melbourne hospital has been labelled "the killing fields" at a high-level meeting of doctors. The damning indictment on the health system is revealed in a letter from a leading doctor to Premier John Brumby, obtained by the Sunday Herald Sun. In the letter Dr Peter Lazzari reveals how Maroondah Hospital has become known as "the killing fields", as it is forced to rely on under-trained doctors to manage life-and-death cases.

Dr Lazzari, chairman of the medical staff at Angliss Hospital, wrote to the Premier demanding action. In the letter, he says: "All the chairs of medical staff of Victoria's major public hospitals at the August meeting at AMA House were appalled to hear the Maroondah representative speak gravely of his hospital's reputation among doctors on rotation as the "killing fields".

Opposition health spokesman Helen Shardey said: "If we have doctors making these sorts of claims, the Government can no longer turn a blind eye."

But Maroondah Hospital general manager Zoltan Kokai categorically refuted the claims. The hospital was recently been accredited by the Australian Council of Health Care standards and its doctors were credentialed in accordance with Eastern Health policy and registered with the Medical Practitioners Board of Victoria, he said.

But Paul Hoek knows how things can go wrong in the hospital system. The 41-year-old truck driver broke his leg more than a year ago, but is still off work. When his plaster cast was removed 12 weeks after his initial operation at Maroondah Hospital, he was left with a painful, gaping wound near his ankle. Ten months later that wound has not healed. The initial operation saw 18 screws and a plate inserted in his leg but months later Mr Hoek was still complaining about pain in the leg. He says it took more than 30 visits before he was taken seriously and doctors discovered five screws holding his fracture together had broken and the plate was protruding out of his skin. "I am furious," Mr Hoek, of Lilydale, said. He said he was on a disability pension and struggling financially.

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23 September, 2007

Brits not allowed to prefer British doctors

The threat of unemployment among UK medical graduates is being blamed on the failed computerised recruitment system (MTAS), but an article in this week's BMJ argues that the real problem is government policy on medical immigration.

In the late 1990s UK medical schools produced nearly 5,000 graduates each year, considerably fewer than the NHS needed, writes Graham Winyard, a retired Postgraduate Dean. But in 1997, an expansion of medical school places began and the number of graduate doctors is set to rise to 7,000 in 2010, an increase of 40%.

The planners assumed that UK qualified doctors would replace those from overseas. But Government immigration policies have encouraged thousands of overseas doctors to compete for postgraduate training posts, and it is of course illegal for trusts and deaneries to discriminate on the basis of country of qualification when making appointments. Expanding medical schools makes little sense if extra graduates cannot pursue a career in medicine, says Winyard.

UK trained doctors began to voice concerns about possible unemployment in 2005 and these concerns were dramatically realised this summer, when MTAS was introduced to select doctors for training posts. While there were broadly sufficient posts to accommodate UK applicants, together with those from the rest of the European Economic Area, he argues, the inclusion of thousands of overseas doctors has transformed the prospects for all applicants and has made widespread failure to secure a proper training post inevitable.

The UK urgently needs policy coherence on immigration and medical training, he writes. The direct connection between policy on medical immigration and the likelihood of unemployment for UK medical graduates is inescapable. The most obvious action, he says, would be to suspend the Highly Skilled Migrant Programme - a scheme allowing highly skilled people to migrate to the UK to seek work without a specific job offer - as it applies to doctors, and establish a two stage recruitment process similar to that used in other countries, whereby overseas applications are considered after those of domestic graduates.

The rights of overseas doctors already in the system must be safeguarded, but if decisive action is not taken the situation will be worse next year, he warns. This muddle is in no one's best interests and needs open and honest discussion and clear leadership, however difficult that may be, he concludes.

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Australia: Surgeons say NSW public hospital unsafe

THE head of surgery at Mount Druitt Hospital says the hospital is unsafe and has accused the Health Department of covering up the death of a patient who waited 14 hours to be moved to another hospital because Mount Druitt has no intensive care unit. In a letter obtained by the Herald, Mac Wyllie said the department's claim in an internal report that the delay "did not affect the outcome" of the patient's condition was "'inappropriate" and "deliberately misleading". The 68-year-old man died of acute pancreatitis the day after arriving at Westmead Hospital's intensive care unit from Mount Druitt on March 3. "Our [surgeons'] alternative conclusion is that this delay did affect the final outcome of this patient who eventually died," Dr Wyllie said in his letter to the Sydney West Area Health Service, dated September 5.

Surgeons have been warning for the past three years that Mount Druitt Hospital's emergency department is unsafe because it has had no intensive care unit since early 2004, when it was closed due to staff shortages, and the high dependency unit, where the man waited for the transfer, has no full-time medical staff. They say even "remotely unwell" patients must be transferred to Blacktown or Westmead hospitals. They are concerned that local people, among Sydney's most disadvantaged, wrongly believe the "emergency" sign at the front of the hospital gives the impression it can admit acutely ill patients, which it has not done since October 2004.

The Premier, Morris Iemma, who was then the health minister, promised that patients would not wait for transfers as a result of the intensive care unit closing and that the high dependency unit would have consultant supervision. Apart from cardiology, rehabilitation and pediatric services, Mount Druitt has no acute medical beds and no full-time general staff physician, or even an on-call general visiting physician.

A patient presenting with conditions such as a diabetic complications, breathing problems, chronic arthritis or a stroke must be transferred. Accident and emergency specialists are confined to that department, which is also understaffed. A senior doctor at the hospital, who did not want to be named, told the Herald: "Since 2004 there has pretty much been a whitewashing at Mount Druitt Hospital." He said the man who died "had deteriorated quite significantly" while waiting for the transfer.

Critical cases were not brought to Mount Druitt, but for the "isolated cases" that do end up there, "there is no question that they are in danger - quite considerably - which has been shown by this case and others".

However, local residents are staunchly opposed to closing the emergency department and it would be a political nightmare for the State Government. The Government has ignored its own, independent General Metropolitan Clinical Taskforce, which recommended in a February 2005 report that the department be closed and noted that the community's "perception" that it was a 24-hour, comprehensive service "needs to be addressed". "Mount Druitt Hospital still remains unsafe and the clinicians find it increasingly difficult to fully exercise their duty of care to the patients of Mt Druitt," Dr Wyllie said in his letter, which he addressed to the deputy director of clinical governance at the Health Department, Dr Andrew Baker. Dr Wyllie did not supply the Herald with the letter.

He said the Sydney West Area Health Service Root Cause Analysis (RCA) report on the man's death had "fundamental flaws and omissions". It was more than 15 hours before the man saw an intensive care doctor, Dr Wyllie said. "To say that this delay did not affect the final outcome of the patient is not only inappropriate on the evidence put forward, but could be construed as deliberately misleading," he said. The report failed to take into account that the high dependency unit "has no dedicated residents and it has no direct supervision from either Blacktown or the Westmead intensivists". "I am advised that no intensivist has had a physical presence in the unit to supervise the treatment of patients for over three years."

The RCA report, seen by the Herald, said the man arrived at Mount Druitt Hospital emergency department at 7.30am on March 3, was diagnosed with acute pancreatitis and was to be sent to Westmead Hospital's intensive care unit. However, there were no beds available and he was moved instead to Mount Druitt's high dependency unit and did not arrive at Westmead until 9.45pm. He died early the next morning.

"It is unlikely that this delay altered the course of his illness." the RCA report said. Although the report said there were no intensive care beds at Westmead when nurses checked at 3pm and 5pm, when the man "began to deteriorate", it blamed the delay on "poor communication" within the emergency department.

Another senior doctor at Mount Druitt Hospital, who did not want to be named, said transfer delays were "inevitable" and "unnecessary". "The point is that you can't keep anyone who's even remotely unwell for monitoring at Mount Druitt," he said. "Politically, it's the right thing to say that you've got an emergency department but the fact of the matter is that this hospital has been so downscaled that if a person is really unwell, we can't keep them here.

But one of the authors of the General Metropolitan Clinical Taskforce report, Professor Kerry Goulston, said yesterday that the problem was not a lack of an intensive care unit but understaffing of the emergency department. "We said it was wrong 2« years ago to have a sign saying 'emergency department' and it wasn't functioning as a proper emergency department," Professor Goulston said.

Questions put to the Sydney West Area Health Service on Tuesday - including how it justifies keeping the emergency department open, whether patient transfers have been improved, what it was doing to increase consultant staffing levels, and what were the results of an audit on patient transfers - remained unanswered yesterday.

Source





22 September, 2007

Islamic abuse in the NHS

A Muslim dentist made a woman wear Islamic dress as the price of accepting her as an NHS patient, it is alleged. Omer Butt is said to have told the patient that unless she wore a headscarf she would have to find another practice. Later this month, Mr Butt will appear before a General Dental Council professional misconduct hearing, which has the power to strike him off. It is claimed that the 31-year-old dentist asked to speak to the woman in private after she turned up for an appointment at his clinic in Bury. According to the charges, he questioned her on whether she was a Muslim and told her that if he was to treat her she would have to wear Islamic dress. He is also said to have read out a number of religious rules to her. He then told his nurse to give the patient her own headscarf to wear, the accusation says. It is not known whether the woman was a Muslim.

The charges to be heard by the General Dental Council say that Mr Butt undermined public confidence in his profession by discriminating against a patient and failed to act in her best interests. Mr Butt is the older brother of former Islamic extremist Hassan Butt, who once declared he had 'no problem' with terror attacks on Britain and who said that September 11 "served the pleasure of Allah". He has since recanted and now calls for all Muslims to abandon violence.

The dentist also featured in immigration hearings involving an asylum seeker suspected of providing a safe house for Kamel Bourgass, an Algerian terrorist jailed for life for stabbing PC Stephen Oake to death in Manchester in 2003. Mr Butt, the immigration hearing was told, was introduced by his brother to the asylum seeker, who at various points claimed three different identities. The tribunal was told that Mr Butt was "a respectable and responsible person who wishes to help devout and practising Muslims in difficulty". He "did not regard the use of false names as unusual for asylum seekers".

The headscarf incident is alleged to have happened in 2005, at a time when between 4,000 and 8,000 people in Bury were unable to find an NHS dentist. According to the charges, Mr Butt "asked to speak to Patient A in private. "In the course of conversation with Patient A you: (a) asked whether she was Muslim; (b) told her words to the effect that, in order to receive treatment from you, she needed to wear appropriate Islamic dress; (c) quoted to her parts of the Ahadith."

The Ahadith is a series of instructions on behaviour attributed to Prophet Mohammed but not written as part of the Koran. The charge continues: "You told Patient A that, if she did not wear a headscarf, she would need to register with another dentist. You instructed your dental nurse to give Patient A her headscarf. "The dental nurse took Patient A to another room where she was given the nurse's headscarf to wear. "In seeking to impose an Islamic dress code on Patient A in order for treatment to be provided you undermined public confidence in the profession by discriminating against Patient A."

If the charges are upheld, the Porsche- driving dentist will be found guilty of serious professional misconduct. Penalties can range from a public warning to suspension and being struck off.

Tory MP Sir Paul Beresford, a former minister and a dentist, said: "When a patient comes to see me I have no concern with their religion. I do not ask Muslim patients to read the Bible. "My practice tries to respect religious belief. For example, during Ramadan we try to help Muslim patients by making sure they do not have to swallow water when they are fasting. We do not ask patients to become Christians."

Women staff at Mr Butt's Bury practice do not routinely wear headscarves while at work. One female patient said: "I think it is a pretty outrageous thing to ask but I have never felt as if I am being discriminated against at this practice as a Western woman. "If I was then I would certainly make a full complaint. If it is true then it shows a reverse prejudice bordering on racism."

Mr Butt was involved in another controversial incident earlier this year when police stopped his Porsche 911 and said they could not read its customised number plate. The dentist recorded the subsequent search of the car on his mobile phone and passed the video to the BBC, which broadcast it on a local news bulletin. It shows Mr Butt asking an officer: "Are you a racist?" The dentist was then arrested for racially aggravated behaviour. There were no charges, and a complaint against the police by Mr Butt is still being considered. Mr Butt was unavailable for comment yesterday. Staff at his practice said he was on holiday.

Source




HillaryCare's New Clothes: Different means but the same political destination

Hillary Clinton has been blasted for months by her Democratic Presidential rivals because, until Monday, she hadn't delivered her formal campaign promises for "universal" health care. But John Edwards and Barack Obama were unfair. She beat them to the punch by at least 13 years. The former first lady's 1993-94 health-care overhaul ended disastrously. Still, it poured the philosophical and policy foundations of the current health-care debate. As she unveils HillaryCare II, Mrs. Clinton likes to joke that it's "deja vu all over again"--and it is, unfortunately. Her new plan is called "Health Choices" and mentions "choice" so many times that it sounds like a Freudian slip. And sure enough, "choice" for Mrs. Clinton means using different means that will arrive at the same end: an expensive, bureaucratic, government-run system that restricts choice.

Begin with the "individual mandate." The latest fad after Mitt Romney's Massachusetts miracle, it compels everyone to have insurance, either through their employers or the government. Not only would this element of HillaryCare require a huge new enforcement bureaucracy, it is twinned with a "pay or play" tax on businesses that don't, or can't afford to, provide health insurance to their employees.

The plan also creates a new public insurance option, modeled after Medicare, and open to everyone, regardless of income. To keep insurance "affordable," HillaryCare II offers a refundable tax credit that limits cost to a certain percentage of income. Yet the program works at cross-purposes, because coverage mandates always drive up the price of insurance. And if the "pay or play" tax is lower than a company's current health insurance costs, a company will have every incentive to dump its employee plan and pay the tax.

Meanwhile, the private insurance industry would be restructured with far more stringent regulations. Mrs. Clinton would require nationally "guaranteed issue," which means insurers have to offer policies to all applicants. She would also command "community rating," which prohibits premium differences based on health status.

Both of these have raised costs enormously in the states that require them (such as New York), but Mrs. Clinton says they are necessary nationwide to prevent "discrimination" that infringes "on the central purposes of insurance, which is to share risk." Not quite. The central purpose of insurance is to price, and hedge against, reasonably predictable risks. It does not require socializing every last expense and redistributing wealth.

No liberal reform would be complete without repealing the Bush tax cuts of 2001 and 2003; Mrs. Clinton would foot the bill for her plan with this tax increase. The rest of the estimated $110 billion per year in new government spending would be achieved by "modernizing" health-care delivery and "promoting wellness," though this $35 billion in savings is speculative, if not fanciful. Further tax hikes would be required: That $110 billion is a back-of-the-envelope calculation, and Team Hillary is keeping the specifics in its pocket.

Given how poorly "universal" policies fared the last time around, who can blame them? Mrs. Clinton and Ira Magaziner headed a health-care task force with more than 500 members that eventually produced 1,342 numbing pages of proposals. It's hardly surprising this boondoggle died without so much as a Congressional vote.

Yet Mrs. Clinton insisted that the public had been spooked by Rush Limbaugh, an article in a marginal political journal and advertising campaigns such as "Harry and Louise." In other words, the lessons she learned were political, not substantive. She thought she had overreached with too-sweeping changes. So she and her husband began to slice their universal health-care ambitions into smaller initiatives like the 1997 State Children's Health Insurance Program (Schip).

This is her strategy now. HillaryCare II is designed to cause minimal disruptions to current private insurance coverage in the short run, while dressing up the old agenda with slightly different mechanisms and rhetoric. Rather than fight small business, this time she is trying to seduce it with tax credits for small companies that provide insurance. Only later when costs rise will the credits shrink or other taxes rise. To court large manufacturers, like the auto and steel industries, she'll offer another, "temporary" tax credit to subsidize their health-care liabilities. Her plan, in short, is HillaryCare I in better clothes--a transitional platform to shift people to the default option, which is government insurance.

What's striking about all this is how little new thinking there is. Like the other Democratic proposals, HillaryCare II would mark another major government intrusion into health care. It would keep all of the system's current problems, most of them created by government policies, and entrench and expand them. The creativity is all in the political repackaging.

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21 September, 2007

Snake Oil Medical Reform

Hillary Clinton's latest campaign pledge on health care reform is another of the chicken-in-every-pot variety we get from almost all politicians: Everyone in the United States will have top-flight, affordable medical care and it won't cost us more (unless one includes taxpayers, and those deemed "affluent" by Democrat standards).

This Plan covers every American - finally addressing the needs of the 47 million uninsured and the tens of millions of workers with coverage who fear they could be one pink slip away from losing their health coverage - with no overall increase in health spending or taxes.

She proposes tax subsidies to individuals and small employers to offset the costs of insurance, which will be required of all. She doesn't mention the high penalties that would be needed to enforce mandated coverage.

She proposes that Bush's tax cuts be rolled back, but doesn't mention the corresponding roll back in productivity and tax revenues that results from reduced incentive to succeed.

She proposes expansion of existing government programs to guaranteed coverage for all, but doesn't mention that the states that have instituted guaranteed coverage regardless of health condition, and community rating to provide the same premium regardless of age, location or condition, have seen sharp escalation in premiums for the younger and healthier, increased government costs, and have not reduced the number of uninsured. (See this multi-year study.)

She proposes that costs of health care won't increase because she will accomplish more than the current major efforts to increase efficiencies and effectiveness of health care delivery:

Most Savings Come Through Lowering Spending Due to Quality and Modernization: Over half the savings come from the public savings generated from Senator Clinton's broader agenda to modernize the heath systems and reduce wasteful health spending.

She proposes that all this will not come at increased government regulation, but ignores that her proposals would gut the private insurance industry while placing the remainder under tight government controls, in effect establishing a semi-private sham for nationalized health care.

She, also, doesn't mention the uniformity, sluggishness in keeping abreast of the latest developments and the squelching of the incentives to develop them, and ultimately treatment rationing that is inevitable when the overwhelming costs come due of the promises. But, by then, the promises' hollowness although seen and suffered will be virtually irreversible as the private market no longer exists.

Oh, and she doesn't mention that her and others' figure of 47-million uninsured is inflated by at least double, as it includes a majority who are here illegally or who can afford coverage but choose not to be self-responsible. Even nationalized health care apologist Ezra Klein notes that all her promises almost sound like she "washes your car."

The devil will be in the details, if Hillary, and others, ever get down to presenting complete honest analyses rather than stump rhetoric. Hillary keeps repeating the word "choice" in describing her plan. The New York Times' politics blog comments:

Her choice of words also reflects her evolution and her recognition that she needs to appeal to a broad spectrum of people who don't want their most personal decisions to be decided for them, and to try to assuage (or at least hold at bay) some critics. The "choice" word will be perceived as code, in an effort to address the absolute balking of people who don't want their personal physicians - even in the wake of health-maintenance organizations and beyond - taken from them.

The question is whether voters will choose to be fooled by her.

Source





20 September, 2007

Republicans Can Win on Health Care

A market-based system can give us freedom, innovation and health security

All around America, families are grappling with health-care concerns. They wonder if they'll have insurance at a price they can afford. They worry about how much out-of-pocket health costs take from the family budget. They question if they'll be able to pick their own doctor. Some feel trapped in jobs they don't like out of fear of losing their health insurance.

As the latest government-heavy plan announced by Hillary Clinton yesterday once again shows, the answers politicians offer on health care highlight the deep differences between liberals and conservatives. This is a debate Republicans cannot avoid. But it is one we can win--if we offer a bold plan. Conservatives must put forward reforms aimed at putting the patient in charge. Increasing competition will ensure greater access, lower costs and more innovation.

Liberals see the concerns of families as a failure of private insurance, and want the U.S. to move toward a government-run, single-payer model. This is a recipe for making problems worse. Socialized medicine inevitably leads to poor quality, inefficiency, rising taxes and rationing. The waiting lines and poor care that cause people from other countries to come here for treatment are not the answer.

Government can help poorer and older Americans get quality health care without sacrificing what everyone wants--the ability to choose their own doctor and health coverage that meets their family's particular needs. What reforms will do that?

* Level the tax playing field. People who work for companies get a tax break on the health insurance they get from their employer. Many small business employees, farmers and the self-employed are unable to benefit from the same tax advantage, because they or their employers can't afford health insurance. It's not fair or wise to penalize people who have to pay for health insurance out of their own pockets. They should benefit from the same tax advantage employees from bigger companies get.

The mortgage interest deduction made it easier for people to own a home and all America benefited. Similarly, every worker should get a deduction for health-insurance premiums. This would ease the burden on working families and make it possible for millions more Americans to own health insurance. Some Republicans in Congress support a tax credit rather than a deduction: that's reasonable, too. A deduction or a credit puts patients in charge by helping them get private coverage that meets their needs.

* Tax-free savings for health costs. We are encouraged to save tax-free for retirement and college; we should make it easier to save tax-free for out-of-pocket medical expenses, too. Tax-free savings accounts, paired with low-cost catastrophic health insurance, make coverage affordable for working families. For example, a youth minister told me his Health Savings Account (HSA) gave his family peace of mind because they now had insurance coverage for big emergencies and could save tax-free for everyday health expenses. That's why, in less than three years, more than 4.5 million families have set up HSAs. Some Democrats want to rein in HSAs because they fear HSAs put the individual--not government--in charge and once someone gets to pick a plan that meets their needs, they won't like being dictated to by government.

And when people see they can save money by eating better, exercising and making healthy lifestyle choices, guess what? They do. I met with workers at Wendy's Headquarters in Ohio who were eagerly taking steps to lead healthier lives because it saved them money.

* Portability. When you change jobs, you don't have to change auto insurance, but you may have to change your health insurance and even your doctor. That's important in a world where young Americans are likely to have 10 jobs before they are age 36. Too many people are locked into jobs they don't like out of fear they'll lose health coverage. The solution is obvious: People should be able to take their health insurance with them when they change jobs.

* Arming consumers through more competition. Rep. John Shadegg (R., Ariz.) argues that people should be able to buy health insurance issued by a company based in another state. Lack of interstate competition helps to explain why the same health policy costs $8,334 in North Dakota but $10,312 in South Dakota. If consumers in South Dakota could buy that North Dakota policy, prices for health insurance would go down.

* Pool risk, lower costs. Large companies get purchasing power and savings because they share risk across large numbers of employees. Sen. Mike Enzi (R., Wyo.) and Rep. Sam Johnson (R., Texas) believe small businesses should be able to join together to pool risk, too. It would mean more competition and lower costs, and more people able to afford coverage.

* Greater transparency.Today, patients rarely know what a procedure will cost or how good a clinic or hospital is, except by reputation and word of mouth. For example, a study of metropolitan hospitals found prices for services varied widely--by as much as 259%--even after controlling for geographic variations in the cost of doing business. Putting information about cost and quality in the hands of patients would lower the cost and improve the quality of health care. Patients making informed choices would create market pressures for lower prices and better care.

* Stop junk lawsuits. I've heard sad stories from doctors and patients. The doctor who had to close her clinic in her hometown and move across the state to work at a hospital that would pay her rising liability insurance premiums. The head trauma specialist afraid that when he retired, his community in one of the poorest regions in the country couldn't attract a replacement. The pregnant woman who drove 80 miles from home in Las Vegas to get prenatal care.

Communities are losing talented health-care professionals who simply can't afford the bigger liability premiums caused by frivolous lawsuits. More than 48% of all counties in the U.S. have no ob-gyn physicians. Hospitals are finding it tougher to provide obstetrics, emergency room care or neurosurgery because of frivolous lawsuits. And doctors, afraid of lawsuits, practice "defensive medicine," ordering unnecessary tests and procedures which add to the cost of health care. Whose interest does that really serve? If we want richer trial lawyers, let them keep filing junk lawsuits we all pay for. If we want better health care, curb frivolous lawsuits.

* Build on the progress already made by putting patients in charge and letting competition work. When Congress considered prescription drug coverage under Medicare, Democrats tried to have government set prices and deliver the drugs. When the Congressional Budget Office estimated the first year's monthly premium for seniors would be $35, Democrats tried to lock in that price.

Republicans disagreed, arguing competition would lower prices and provide more choices. They were right: Competition led to more options and an average monthly premium of around $23--an annual savings of $144 in the first year. Competition continues to save seniors (and taxpayers) money. When the bill passed, independent actuaries estimated the monthly premium for 2008 would be $41. Recently, Medicare officials announced that the 2008 average monthly premium will be around $25. Seniors would have paid over $4 billion more in prescription drug premiums the first two years of the program had Democrats mandated a $35 monthly premium. Taxpayers are saving also: This past January, the actuaries projected that the prescription drug benefit will cost $113 billion less over the next 10 years than estimated the previous year, primarily because of competition and low bids

In short, the best health reform proposals will be those that recognize and build on the virtues of our market-based medical system. Sick people around the world come here because they can't get quality care in their home countries. Many health-care professionals come here to practice, leaving behind well-meaning health-care systems where government is in charge, bureaucrats make the decisions, and where the patient doesn't have the choice he or she does in the U.S.

Mrs. Clinton may think Americans want to trade freedom and innovation for the illusory security of government regulation and surrender control of their health decisions to government bureaucrats. My bet is 2008 will teach us something different if Republicans make health care a centerpiece issue.

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19 September, 2007

Socialized medicine is already here

Congressional Democrats are trying to expand government health insurance to children who don't need public assistance, while their party's presidential hopefuls are concocting even grander schemes to achieve "universal coverage." "That's socialized medicine!" cry the Republicans. President Bush asks whether we want a government-run health care system or a private system. Republican presidential hopeful Rudy Giuliani accuses Democrats for lusting after the socialized systems of Europe, Canada, and Cuba. In a recent television appearance, Sen. Hillary Clinton (D-N.Y.) emphatically denied the suggestion that she supports socialized medicine. Was Clinton being disingenuous, or are Democrats really trying to foist socialized medicine on the American people?

The question seems silly once you consider how socialized our health care system already is. Government already finances about half of Americans' medical care, so you might say our system is already half-socialized. Yet we are much farther along the road to socialized medicine than even that would suggest.

Consider two distinguishing features of socialist economies. The first is that the government decides what individuals may produce, what they consume, and the terms of exchange. That is largely true of America's health care system. Government controls production and consumption by determining the number of physicians; what services medical professionals can offer and under what terms; where they can practice; who can open a hospital or purchase a new MRI; who can market a drug or medical device; and what kind of health insurance consumers may purchase. Government bureaucrats even set the prices for half of our health care sector directly, and indirectly set prices for the other half. When you read about Medicare over-paying imaging centers and hospitals, or that it's impossible for Bostonians to get an appointment with a general practitioner, it's largely because the bureaucrats got the prices wrong, and those rigid prices do not automatically eliminate shortages and gluts like flexible market prices do.

A second feature of socialist economies is that there is little incentive to make careful economic decisions, because government has put everyone in the position of spending other people's money. Canada may have the most heavily socialized health care system in the advanced world. Yet America's system is as much a tragedy of the commons as the Canadian system, where health care is ostensibly "free." In each country, only about 14 cents out of every dollar of medical spending comes directly from the patient. How can America's health care system be "socialized" when we rely on the private sector more than any advanced nation? Because it doesn't matter whether the dollars and the hospitals are owned publicly or privately. What matters is who controls how they are used.

In 2007, the average family of four will pay $25,000 for health insurance - nearly 30 percent of their income. About $14,000 represents taxes that fund health programs for the elderly and the poor. In other words, the government controls the lion's share. The remaining $11,000 purchases the family's own coverage, usually through an employer. Though we count that as "private" spending, the government largely controls that $11,000 as well.

Congress provides a substantial tax break for employer-controlled health insurance. That sounds nice, but it means that workers who want to control their coverage themselves face a tax penalty. That penalty often forces such workers to pay twice as much for less coverage. That benign-sounding "tax break" effectively requires Americans to let someone else control a large chunk of their incomes and their health care decisions. We may call that "private" spending. But notice the hallmarks: government denies individuals control over their economic decisions, and encourages them to act as if they were spending someone else's money - in this case, their employer's.

How can our system be "socialized" if we don't force patients to wait for care, as other nations do? America does ration by waiting - just ask any Medicaid patient - though we do so less often than nations where governments arbitrarily limit medical spending. But that's because we commit the opposite sin: our government encourages unlimited health care spending, which causes enormous waste.

For example, the federal Medicare program essentially makes an open-ended commitment to pay for whatever medical care seniors and their doctors demand. That may be why researchers at Dartmouth Medical School have estimated that Medicare purchases $60 billion in useless services every year. That's nearly one-fifth of all Medicare spending. It also may explain why we spend 50 percent more on medical care than other advanced nations without making ourselves noticeably healthier.

Surely, America doesn't have socialized medicine of the Canadian or British variety, or socialized medicine borne of some deliberate plan. But American politicians should stop pretending that socialized medicine is some far-off dystopia. To paraphrase Keyser Soze, the greatest trick that advocates of socialized medicine ever played was to convince the American people that we don't already have it.

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18 September, 2007

Canadian official refuses Canadian health care

Post below lifted from Don Surber. See the original for links

The woman who would-be prime minister of Canada had her breast-cancer surgery done in? A. Ottawa, B. Toronto, C. Montreal, D. Alberta, E. California.

Of course Liberal PM candidate Belinda Stronach went to California. The Canadian liberal elite (she is a billionaire’s daughter) do not wait in line like commoners for Canadian health care. The liberal elites travel to the United States for their medical treatment. The Toronto Star reported:

Stronach, diagnosed in the spring with a type of breast cancer that required a mastectomy and breast reconstruction, went to California in June at her Toronto doctor’s suggestion, a spokesperson confirmed.

“Belinda had one of her later-stage operations in California, after referral from her personal physicians in Toronto. Prior to this, Belinda had surgery and treatment in Toronto, and continues to receive follow-up treatment there,” said Greg MacEachern, Stronach’s assistant and spokesperson.

Speed was not the issue, MacEachern said – it was more to do with the type of surgery she and her doctor agreed was best for her, and where it was best performed. The type of cancer Stronach had is called DCIS, ductal carcinoma in situ, one of the more treatable forms.

If Canada’s health care is so good, why is it not doing this sort of surgery? Mind you, this happened in June and is only being made public in September. Her spokesman said the liberal elite loves the Canadian health system.

“In fact, Belinda thinks very highly of the Canadian health-care system, and uses it when needed for herself and her children, as do all Canadians. As well, her family has clearly demonstrated that support,” MacEachern said.

“This was about a specific health-care procedure, unrelated to any views about the quality of Canadian health care, a decision based on medical advice and a referral from her Toronto physicians, and just one part of several areas of treatment. Belinda has nothing but praise for the community of health-care professionals in Toronto who supported and treated her throughout the last six months.”

Sure, pal, sure. Whatever.

People like Stronach want the power to run a health system that they would never, ever use. The reason Canada does not have this sort of care is it devotes only 10% of its GDP to health care. America devotes 15% of its economic power to medical care. You get what you pay for.





17 September, 2007

NHS getting desperate about superbugs

Useless bureaucrats to be bypassed -- and there's nothing more desperate than that for socialists

THE health secretary, Alan Johnson, is to bypass hospital managers to give nurses and matrons the power to report directly to hospital boards in the fight against superbugs in the National Health Service. Nursing staff will be made accountable for infection control on their wards and promised a “hotline” to the top if management refuses to take ward cleanliness seriously.

Johnson will admit this week that poor infection control in hospitals has displaced waiting lists as the biggest problem facing the NHS and that tackling superbugs is now his priority. His decision to bypass the chain of command reflects frustration at the failure of many trusts to get to grips with infection control. More than 1,600 people die from MRSA, or methicillin-resistant staphylococcus aureus, in England and Wales every year. In addition, more than 3,800 people die from clostridium difficile.

Johnson believes matrons lack the power to take full responsibility for the state of their wards, because they must rely on management for resources. Nurses complain that their pleas for hygiene to be taken more seriously are ignored. Nursing staff will be told to inform trust boards directly if the hospital needs more isolation wards or cleaning equipment. They will be asked to update boards on cleanliness four times a year.

Johnson will make the announcement ahead of a public consultation on Tuesday in which more than 1,000 people across England will be asked how to improve the NHS. He will say fear of catching a hospital superbug has overtaken waiting times as the public’s most pressing concern about the NHS.

The consultation is part of a review being carried out by Lord Darzi, the health minister, at the request of Johnson and Gordon Brown. Darzi has also identified hospital superbugs as a serious problem. Darzi, a world-renowned surgeon at St Mary’s hospital, London, said: “We cannot avoid the challenge of better cleanliness and infection control in hospitals. I know, as a surgeon, that cleanliness and infection control are crucial to quality of care. “It is already clear from what I have found in the past eight weeks that this is a major issue of public concern, too. “We want to send a clear signal to patients that doctors, nurses and other clinical staff take their safety seriously. We want to give more responsibility to matrons and nurses.”

Source





16 September, 2007

Health "Rights"

By Theodore Dalrymple

Public affairs, said Doctor Johnson, vex no man: by which, I suppose, he meant that, if we are honest, only those matters which touch us directly and personally have the power genuinely to move us. The rest is ersatz or assumed emotion that we fake or exaggerate in order to appear more concerned with public affairs than we really are; and true it is that an argument with my wife causes me more genuine upset than a distant war, however bloody, though I am perfectly aware that in the scale of human history the war weighs a million, or a trillion, times more heavily.

This means, or ought to mean, that I should by now have reached such a state of serenity that even the weekly arrival of the medical journals should not upset me. After all, my personal situation is about as satisfactory as it will ever be. I please myself, more or less, what I do; my work is also my pleasure. I am indeed fortunate.

And yet The Lancet in particular, once one of the world's greatest medical journals, never fails to irritate me. Its sanctimony makes Elmer Gantry seem like a self-doubter. It propounds abject nonsense with the self-conceit of the assuredly saved preaching to the assuredly damned. Dickens would have loved to satirise it.

For example, it published a paper at the end of July entitled, "Is access to essential medicines as part of the fulfillment of the right to health enforceable through the courts?" The paper discussed whether, if individuals were denied access to important medicines, they could seek redress via the courts, particularly in Latin America, on the grounds that their rights were being denied.

The right to health was accepted in this paper as if it were a straightforward natural fact, like the roundness of the earth, for example, and no more disputable than the roundness of the earth. Yet the notion of a right to health is plainly ridiculous, at least until man becomes immortal. A man who is dying of incurable cancer is unfortunate, but his rights are not being infringed.

Perhaps the authors of the paper meant by the "right to health the "right to health care." But this is scarcely any better. A right to a material benefit implies someone else's duty to provide it, irrespective of whether he wants to do so or indeed is actually able to do so. This is not to say, of course, that the world would not be a better place if everyone who needed it were able to obtain health care; but the world would not be a better place because everyone's rights had been observed or complied with, but because avoidable suffering had been avoided. There are more and better reasons, after all, to treat people medically than that they have a right to such treatment.

I could not help but notice that among the drugs deemed so essential that not to make them freely available to people who need them amounts to a breach of their rights was buprenorphine, a drug prescribed by doctors to opiate-addicts in the hope that they, the addicts, will thereafter stop talking opiates of their own, and take those of the doctor instead. In a way this was odd, because there was an item in the very same edition of The Lancet entitled "Designer drug Subutex [buprenorphine] takes its toll in Tbilisi [the capital of Georgia]." There, at least, there was no danger that the people's right to burenorphine was being infringed.

The article starts with the following dramatic paragraph: "Crushed on pavements, tossed by the road, or in the corners of apartment-block entrance halls, the used syringes tell a story of rising addiction. The needles seen across Tbilisi are discarded by the addicts of Subutex, a treatment for opiate abuse that has ironically become the country's mostpopular drug."

The drug is manufactured in Britain and exported to France, where gullible doctors prescribe it to addicts who pretend to need it, and who then sell it on to dealers who smuggle it into Georgia at a profit of 600 per cent. Seven tablets in France cost $20, and $120 in Georgia. Among the smugglers of buprenorphine was the honorary consul of the Cote d'Ivoire in Georgia, who brought it into the country in his diplomatic bag. According to The Lancet, the problem is not a small one: 39 per cent of addicts treated in clinics in Georgia were addicted to buprenorphine, and the total number of drug addicts in Georgia was 250,000, which is to say one in twenty of the entire population. This represents an 80 per cent increase since 2003, and is largely due to the importation of buprenorphine.

Five pages later in The Lancet, the very same author wrote an admiring, even hagiographical article, about Dr Vladimir Mendelevich, a doctor who is trying to introduce the treatment of drug addicts in Russia, Georgia's neighbour and historical suzerain, with yes, you've guessed it, buprenorphine (among other drugs). Dr Mendelevich is described as a hero by the author without any hint of irony, or even of awareness of what he had written only five pages previously, or that to introduce yet another drug into a country notorious for its corruption and administrative chaos, contiguous with Georgia, is an idea that needs very careful consideration.

Just how essential is buprenorphine that, not to make it available to all who feel they need it constitutes an attack on their fundamental human rights? This question was in part answered by a paper in the New England Journal of Medicine that appeared in the same week as The Lancet that I have cited. The authors, who practised at Yale, wanted to establish whether extra counselling had any effect on the abstention of addicts who were prescribed a tablet containing both burpenorphine and naloxone.

This tablet is an extremely clever one. Naloxone when taken by mouth has no effect, but when taken by injection acts as an antagonist to opiates, and precipitates withdrawal symptoms. Thus its inclusion with buprenorphine discourages buprenorphine abuse (though I have little doubt that, before long, addicts and their acolytes will devise something to circumvent this precaution).

The researchers recruited 497 addicts for their study, but excluded 296 of them because (as addicts in real life tend to do) they took alcohol or other drugs as well as opiates, or behaved in a dangerous and antisocial way. A further 35 dropped out at preliminary stages, leaving only 166 of the original 497 for the experiment.

The 166 were divided, like Gaul, into three: those who received the drug on a once weekly basis, those who received it on a three-times weekly basis, and those who received it on a three-times weekly basis plus extra counselling. In the event, there was no difference in the outcomes between these three groups at 24 weeks.

What was most striking was that only 75 continued the experiment to the 24th week, which is to say that 422 addicts of the original addicts did not get that far: and 24 weeks is not exactly an eternity. The average maximum duration of abstinence from illicit opiates among the 166 sterling citizens who were treated was between five and six weeks. More than half their urine specimens tested positive for the presence of illicit opiates.

Nor is this all. It is well known that the results of clinical trials are better than results obtained in a "natural" environment, that is to say you cannot expect the same degree of success when you transfer a treatment that has been tried experimentally to normal, everyday practice. This is for several reasons, among them the enthusiasm and dedication of the staff involved in the trial, enthusiasm that often communicates itself to the patients who are therefore more optimistic and compliant with treatment than they would otherwise be.

It might well be that the very low compliance rate of the patients was caused by an awareness of the presence of naloxone in the tablets they received. It was precisely because the medication could not be abused, at least until someone devised a method of abusing it, that the compliance rate was so very low. But if so, it must cast in doubt on the motives of the addicts for seeking and accepting treatment in the first place. And it should be borne in mind that the patients were selected among 479 addicts for their relatively "good" behaviour: namely, their absence of additional substance abuse and lack of threatening, violent and criminal conduct. In other words, their prognosis was already better than average among the addicts.

Had the patients been prescribed buprenorphine alone, I think they might well have "complied" with treatment better, but only because it would have had some economic or abuse value to them. The criteria for completion of the study were not exactly stringent: those who did not miss more than three counselling sessions or missed their medication for more than a week were deemed to have completed it.

In short, the whole business was an elaborate and sordid farce, from which the authors drew the conclusion that there is "a need both to measure adherence in future research and to monitor and encourage adherence in practice in order to reduce the potential misuse of the medication and to improve the treatment outcomes." The idea that the whole notion of treatment in a voluntary condition such as addiction might be inappropriate was quite beyond the authors.

But let us return briefly to the question of the supposed right to health. Can it be the right of anyone to obtain a treatment that is marginally effective, if it is effective at all? In fact, this is often the case in modern medical treatment. The chances of anti-hypertensive treatment doing you good rather than harm are small, though the harm it can do you is slight and the good it can do you is enormous. How certain does the good that treatment does you have to be before it becomes a right enshrined in, and actionable at, law?

I am astonished at how quickly the doctrine of rights has colonised minds, like bacteria on a Petri dish. Not long ago, I asked a young patient what she was going to do with her life (I am sufficiently interested in my patients to ask such things). She said she wanted to study law. Any particular branch, I asked, thinking she might want to do criminal law, which is the most interesting, if least lucrative, branch? "I want to go into human rights," she said, with that semi-beatified smile with which a girl of her age might once have claimed to have a vocation.

"Oh yes," I said, "and where do human rights come from?" "What do you mean?" she asked. "I mean, are they just there, like America, waiting to be discovered by someone going out and looking for them, or are they conferred by mere human agency, in which case they can be repealed at the drop of a law?"

She looked appalled, as if I were a deeply wicked man who had suggested that, for example, racial discrimination was just the thing. "You can't ask that," she said.

I didn't explore the question of why not, because a medical consultation is not a dialogue by Plato. But after that, I did begin to think that there was something to Richard Dawkins' conception of a meme, namely an idea that enters minds and spreads from mind to mind as a gene favourable to survival in a population.

The problem with memes, of course, is that they don't have to be good ideas, only ideas that are in someone's, or some group's, advantage. And the ever-expanding concept of human rights is of advantage to regulatory bureaucracies, of course, for how can positive rights be enforced without them? Not coincidentally, the paper in The Lancet with which I began this article emerged from that bureaucracy of bureaucracies, that meta-bureaucracy, the World Health Organization in Geneva.

Source




Doctors for auction in Australia

Yet more of that wonderful government "planning". There are plenty of would be doctors but a very limited number of places in medical schools (Which are all run by Leftist State governments). The result: Much more dangerous circumstances for patients

A CRISIS in public hospital emergency departments has reached the point where they are forced to bid against each other for casual doctors who are already paid as much as triple the award rate. Doctors say patient care is at risk because emergency departments are forced to rely on often inexperienced locums with a "nine-to-five mentality" to plug gaps in the system. The Herald has obtained an email from one large NSW locum agency that describes 26 NSW hospitals as being at crisis point, 21 of them public hospitals, with some unable to fill shifts for senior emergency doctors the next day.

NSW Health estimates it costs $35.2 million more a year for locums than it would for permanent staff, but refuses to fund more permanent senior specialists. Rates for locums generally vary from $90 to $180 an hour depending on experience and type of shift, but can reach $250 for a senior doctor required at the last minute in a regional area or on a public holiday, or when the hospitals bidding against each other push up the price.

The vice-president of the Australasian College for Emergency Medicine, Sally McCarthy, said the use of locums was at "phenomenally high levels" and NSW Health did not support more permanent positions. "But the health service is happy to compete against other hospitals for locums, bidding up the price," Dr McCarthy said.

When the Herald contacted heads of emergency departments, they were highly emotional - one even tearful - and some called out of hours or while on holiday to express their frustration and desperation. They all refused to go on the record, fearing repercussions from NSW Health.

On Tuesday, vacancies emailed by Australia Wide Locum Placement included 41 shifts in the emergency department at Nepean Hospital from now to September 25, and 70 shifts at Blue Mountains Hospital to November 30 - 16 of which are in emergency just for this month. Camden Hospital had 85 emergency shifts to fill over the past month, all for senior doctors.

Royal North Shore Hospital needed 20 shifts filled in emergency up to October 14 and Fairfield needed 25 up to the end of next month, 13 of which were for senior emergency doctors to work overnight this month to fill vacancies every few days. Other public hospitals listed as in "crisis" - with shifts needing to be filled within 48 hours - included Concord, Mona Vale, Fairfield, Sutherland, Campbelltown and several regional hospitals.

Locums are often junior doctors, lured by the pay and far less stressful working conditions.

The emergency departments at Camden and Campbelltown hospitals are among the busiest in the state but are understood to have the heaviest use of locums. Of all doctors in Camden's emergency department, about 70 per cent are locums.

The director of Australia Wide Placements, Terry Keenan, said his company would fill "less than half" of the crisis shifts at public hospitals. His agency sought to fill 800 shifts in Sydney public hospitals on any given day. "The demand is enormous," he said. Hospitals are so desperate that they even offer a higher rate than is necessary, he said. "We sometimes get hospitals saying 'we can give up to $140 an hour', and we say we think we can fill it for less." He also said some doctors did not commit to a shift until the last minute, "thinking that if you don't the price might go up".

The use of locums in public hospitals has "increased alarmingly" in recent years, said a NSW Health report published in The Medical Journal of Australia last year. The head of a big Sydney metropolitan emergency department said it spent $1 million on locums last financial year. "It's virtually impossible to check how well they're going to perform, whether they're really as senior as they say they are and whether they can do all they say they can do and . you never have the organisational knowledge or the commitment," he said. "You end up with the more inexperienced, lower-quality employees . we regard it as a bit of a crisis."

A medical registrar at a Sydney public hospital emergency department said the use of locums could be "life-threatening for a patient". "You've got the people who are the least skilled, the least loyal and the least oriented who are the ones that are making more money than even the directors of the department. And you're sending them off to life and death situations." The head of emergency at a big regional hospital said he had to "fight tooth and nail for every doctor" employed there. "They just say no, no money. When you talk about safety they don't want to know about it."

The State Government blamed the doctor shortage on the Federal Government, saying it was not funding enough university places [But the universities are run by STATE governments!]. A spokeswoman for NSW Health said: "Clearly it is better to have full-time medical staff than to rely solely on the use of locums to backfill vacancies," she said.

Source





15 September, 2007

Cuba Has Better Health Care Than U.S.?

Cuba has great socialized medicine -- much better than the half-socialized system the United States has, according to Michael Moore and his documentary "Sicko." "They believe in preventative medicine," Moore says in his movie. "And it seems like there's a doctor on every block." To prove his point, Moore took some sick 9/11 rescue workers to Cuba. The group, with a camera crew tagging along, was treated at a showcase Havana hospital.

"I asked them to give us the same exact care they give their fellow Cuban citizens. No more, no less. And that's what they did," Moore insists in the movie. I asked him if he really believes that. "Oh, I know that's what they did," he told me. "One of the 9/11 rescue workers sneaks out of her hospital room, goes downstairs and pretends to be sick. She said the same exact process took place." I suggested that was because Cuban authorities send tourists and dignitaries to special clinics. "They didn't send us there. We went to a number of clinics," he said. It's an average hospital?

"Yes, they have a clinic in every neighborhood in Cuba. This isn't just me saying this, you know. All the world health organizations have confirmed that if there's one thing they do right in Cuba, it's health care. There's very little debate about that."

Oh, there's plenty of debate. Cuban-born Dr. Jose Carro, who interviews Cuban doctors who have moved to the United States, says Moore's movie lies. Dr. Darsi Ferrer, a human-rights advocate in Cuba, told us that Americans should not believe the claims being made. He describes the Cuban people as "crazy with desperation" because of poor-quality care.

George Utset, who writes The Real Cuba Web site, says Moore and his group were ushered to the upper floors of the hospital, to rooms reserved for the privileged. "They don't go to the hospital for regular Cubans. They go to hospital for the elite. And it's a very different condition," Utset says. For ordinary Cubans, health care is different. A YouTube.com video, posted by a woman from Venezuela, purports to show the two forms of health care, one for the privileged who pay in dollars and a far inferior one for regular Cubans.

Moore claims Cubans live longer than Americans. It's true that a U.N. report claims that. But the United Nations didn't gather any data. "The United Nations simply reports whatever the government in Cuba reports, so we have no objective way to know what the real statistics are," Carro says. Exactly. Communist countries are famous for hiding the truth. Twenty years ago, when I reported from the Soviet Union, officials insisted there were no poor people in Russia, but they refused to let me look for myself. Why would we believe the Cuban government's health statistics?

Cuba claims it has low infant mortality, but doctors tell us that Cuban obstetricians abort a fetus when they think there might be a problem. Dr. Julio Alfonso told us he used to do 70-80 abortions a day. And here's an even more devious way of distorting infant-mortality data: Some doctors tell us that if a baby dies within a few hours of birth, Cuban doctors don't count him or her as ever having lived.

Moore told me: "All the independent health organizations in the world, and even our own CIA, believe that the Cubans have a pretty good health system. And they do, in fact, live longer than we do." But the CIA does not claim that Cubans live longer than Americans. In fact, the CIA says Americans live longer.

When I pressed Moore, he backed away from the claims his movie makes about Cuba. "Let's stick to Canada and Britain," he said, "because I think these are legitimate arguments that are made against the film and against the so-called idea of socialized medicine. And I think you should challenge me on these things, and I'll give you my answer."

Source




Australian proposal: Unify health systems to free up $4 billion

A reduction in bureaucracy is a commendable aim but abolishing health bureaucracies altogether would be much better. The many high-quality private hospitals show that no government bureaucracy at all is needed to run hospitals

AN extra $4 billion could be available to spend on patient treatment across Australia if duplication and inefficiency in the health system were fixed. The Australian Institute of Health Policy Studies argues that the nation's health services are not just financially inefficient but they also place Australians in physical danger. "Our healthcare system is unnecessarily dangerous and causes needless deaths and injuries, most of which we never hear about," said Monash University professor of public health Brian Oldenburg, a member of AIHPS. "(And) $4billion could be transferred into treating people without an added cent of taxpayers' money if we improved the productivity of health services."

Professor Oldenburg said there were large differences in healthcare efficiency among the states and territories. "The gap between the most efficient state (South Australia) and the least efficient (the Northern Territory) delivering healthcare (per patient) in public hospitals is 35 per cent."

The AIHPS will today release a paper calling for business to become more involved in efforts to reform the health system. "They are just beginning to realise how important it is to the economy and that the more a consumer spends on health, the less discretionary spending they have elsewhere," Professor Oldenburg told The Australian. As well, he said, "business leaders know how to get things done and that's what we need to have in this debate."

The AIHPS points to a report by the Productivity Commission, released in February last year, that identified billions that could be saved across the health sector. "It's the duplication, the unnecessary tests being conducted. It's no communication between hospitals and doctors on the one hand and community services on the other. It's also people being in hospital when they should be either supported in the community or in the aged care service." Early intervention programs for health problems such as diabetes should also be encouraged, as they had the potential to save thousands of hospital hours.

Despite strong recommendations contained in numerous previous inquiries, virtually none had been acted upon, said Peter Brooks, executive dean of the Health Sciences faculty at Queensland University. "Every opinion poll indicates that health is one of the most important issues for consumers in who wins their vote in federal elections," he said. "It's time for both major political parties to give the public the detail on how they will reform the health system."

Source




Australian PM plans back to basics for nurse training

JOHN Howard has moved to dramatically overhaul nursing education, with a $170 million plan to build 25 privately operated nursing schools in hospitals. The radical shake-up, which will increase the number of nurses by 500 a year, involves a return to a traditional model of hospital-based training to supplement university-based degrees. The Prime Minister will reveal the plan in Sydney today in the first of a series of back-to-basics policy announcements aimed at battlers, the elderly and the bush, and designed to peg back Labor's huge poll lead.

The plan emerged last night with the news that the Government would also consider reviewing all pensions and offering retirees up to $30,000 in taxpayer-funded bonuses if they returned to work to help ease critical labour shortages.

The policy shifts came as the International Monetary Fund yesterday warned the Government against populist election initiatives, saying there should be no new government spending this year. In its annual review, the IMF praised the federal Government's handling of the economy as world-leading but cautioned against further stimulus to a stretched economy.

Coalition MPs were yesterday regrouping after a week of damaging leadership speculation that had many flirting with the idea ofdumping the Prime Minister and replacing him with Peter Costello. Having discarded the option of leadership change, the Government refocused yesterday, with senior ministers confirming Mr Howard would seek to turn the Labor tide by returning to his electoral roots with a large-scale policy revamp.

The new nursing schools will be modelled on the Government's 24 Australian Vocational Training Colleges, built by the commonwealth but run by community groups working with employers. The trainee nurses will provide immediate relief to hospitals suffering staff shortages. The courses will run for three years and students will emerge with a nationally recognised TAFE qualification - equivalent to university-based study. While they study, the commonwealth will subsidise their wages and also pay bonuses in the middle of their courses and at the end of their studies, to encourage their completion. Doctors, hospital administrators and private hospital employers will have input into the training programs to ensure the nurses emerge with skills sought by their industry.

According to a 2004 Australian Health Workforce Advisory Committee report, Australia will need up to 13,500 new registered nurses each year to meet the demand for nursing services over the next 10 years. In 2004 only 5631 nurses completed their training. Despite the shortfall, 2408 eligible applicants were turned away from university nursing courses last year because there were not enough places.

The Government's move is likely to be welcomed by the medical community because university training is often criticised as producing book-trained nurses with inadequate practical experience. The Government has already raised the plans with some hospitals and its announcement will come as the Australian Nursing Federation launches phase two of a four-week TV advertising campaign outlining the negative impact of the Howard Government's industrial relations laws on nurses working in aged care....

The new Government policy proposals followed heavy pressure from Labor yesterday. Kevin Rudd used parliamentary question time to pepper Mr Howard with questions aimed at convincing voters that the Prime Minister had no new policy ideas.

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14 September, 2007

Australia: Pregnant women with diabetes refused treatment

You can rely on your government to look after you

A Ballarat University study has found some rural doctors are refusing treatment to pregnant women with type one diabetes. Doctors are reportedly worried that rural medical services would be insufficient to deal with diabetic complications during pregnancy.

The seven women interviewed as part of the national study say there's a lack of information on managing blood glucose levels during pregnancy. They say they rely on websites for information.

Ballarat University lecturer, Associate Professor Rosemary King, says the woman are deflated by the attitudes of some health professionals. "Being told that they might miscarry or the baby might die or they might have abnormalities... particularly when you're pregnant or you're wanting to be pregnant you're pretty vulnerable to those sorts of messages," she said. "[The women] really thought that people were being not very helpful and more judgemental and negative than constructive," Associate Professor King said.

She says the results are not surprising given the shortage of specialists in country areas. "We probably need to be thinking about how to have accessible information available both for professionals and for the women... how do we go about sort of finding out what it is that people want to know, how do we make the information available?" she said.

Source




Australia: Foreign doctors 'avoiding security checks'

OVERSEAS trained doctors are avoiding police security checks and assessments of their medical skills because of holes in the system. And more than 1000 doctors employed as trainees in NSW public hospitals are being used to plug workforce gaps before they have been properly trained.

The Joint Parliamentary Committee on Migration last night exposed serious concerns about the scrutiny applied to the 2500 overseas trained doctors entering Australia each year. The committee found hospitals had been using the 457 visa to get doctors into the country quickly because a police security check was not required under this visa. And it called for urgent action to improve both the security and skills checks on doctors entering the country.

Alarm bells were first raised with when Dr Jayant Patel was accused of causing patient deaths in Queensland. Fears grew when the Federal Government this year cancelled the visa of Dr Mohammed Haneef who was related to UK terror suspects. A state and federal plan to improve the checks has foundered because not all states have agreed to them. The parliamentary committee also said the number of occupational overseas trainee doctors employed in NSW hospitals had doubled from 725 to 1326 between 2001 and 2006.

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13 September, 2007

NHS WASTED 43 Billion pounds

The money poured into the NHS has failed to produce a more efficient service, or to reduce unhealthy lifestyles. As a result even more cash will be needed in the future, says a new review by Sir Derek Wanless. It was published yesterday, five years after his review for the Treasury paved the way for the extra 43.2 billion pounds that the Government has since spent on the NHS.

Sir Derek, a former chief executive of NatWest bank, sees some improvements in the service, but also identifies a range of failings, including mismanaged structural changes; generous pay deals that failed to produce an obvious return; and a neglect of public health. He said at the publication of his report that the extra resources had undoubtedly improved patient care over the past five years. “But what is equally clear from this review is that we are not on course to deliver the sustainable and world-class healthcare system, and ultimately the healthier nation, that we all desire,” he said. Sir Derek would have liked the Government to have commissioned the review, but it showed no enthusiasm for doing so. The King’s Fund stepped in, enabling him to produce this report.

He states that more money will be needed over the next two decades unless steps are taken to deal with pressing concerns. That could undermine the current widespread political support for the NHS “and raise questions about its long-term future”, he says.

Of the more than 43 billion extra that has been spent, pay and price inflation have accounted for 18.9 billion, he concludes. New contracts for consultants, GPs and other staff have been introduced, but “there is very little robust evidence so far to demonstrate significant benefits arising from the new pay deals”. Staff numbers have risen far above the targets set in the NHS Plan of 2000, with targets for consultants exceeded by 16 per cent, for GPs by 166 per cent, for nurses by 272 per cent, and for therapists by 102 per cent. The biggest increase in NHS activity has been in accident and emergency departments, where attendances have grown by more than a third since 2002-03. This is hard to explain, but is probably caused by changes in behaviour, shorter waiting times and changes in GPs’ out-of-hours arrangements, the report says.

Public health budgets, aimed at tackling issues such as obesity and smoking, had been raided to bridge financial problems in the NHS, he said. It was impossible to track trends in public health spending or health promotion in the past five years because no official figures were kept. Sir Derek said: “It is also indicative of the relatively low priority given to public health that, while nonpublic health medical staff numbers have increased by nearly 60 per cent since 1997, the number of public health consultants and registrars has gone down overall.”

Sir Derek said at the publication of the report that there were “lots of positives” in his study. These included reduced waiting times, the use of less expensive statins and extra staff. He said that the framework introduced by the Government should remain in place for the next few years to minimise further disruption. He said in his report, however, that the restructuring had been expensive and had taken managers’ eyes off the priority of running the service.

Alan Johnson, the Health Secretary, will call today for direct intervention to encourage healthier lifestyles after the report’s warning of spiralling obesity levels. The future of the NHS depends on encouraging people to take care of themselves, he will tell members of the New Health Network. “Government simply cannot afford to be the passive observers of unhealthy lifestyles, only intervening when chronic diseases such as diabetes, heart disease or lung cancer are already well established,” he will argue. “Public health issues must be elevated to the top of the national agenda by a Department for Health which takes an even more active role in encouraging healthy lifestyles.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This report is a damning critique of the Government’s failure to get value for money out of all the extra investment in the NHS. Ministers cannot ignore these recommendations as they did with last year’s report by Sir Derek into social care.”

Andrew Lansley, the Shadow Health Secretary, said: “Even Gordon Brown’s own adviser thinks he has mismanaged the NHS. Labour have invested lots and achieved too little. Gordon Brown is obsessed with pursuing top-down reorganisation instead of delivering genuine reform, which gives power to professionals and better healthcare to patients.” He added: “Public health budgets have been robbed to pay off huge deficits despite warnings about the strain that spiralling obesity levels will have on the NHS. Labour’s ignorance belies their arrogance.”

A spokeswoman for the Department of Health said: “We welcome this report and its recognition that the Government’s investment and reform have improved patient care. We agree that more has to be done to improve NHS productivity and to tackle some lifestyle issues like obesity. We also agree that spending on healthcare will need to continue to grow above inflation if we are to meet patients’ growing expectations. “These issues will be central to decisions made in the next few weeks as part of the Government’s Comprehensive Spending Review and the long-term review of the health service being conducted by Lord Darzi.”

Source




Australia: The depersonalization of government medicine continues apace

HOSPITAL patients in Queensland are to be stamped with barcodes in a move to prevent operations being performed on the wrong body parts. Last financial year 31 mistaken procedures were performed, including three cases of the wrong tooth extracted and two operations on the incorrect part of patients' spines. In another instance, a person's left tonsil was removed in error and a separate patient had botox injected into the wrong body part.

Queensland Health's Patient Safety Centre senior director John Wakefield presented the figures to a Royal Australasian College of Surgeons state meeting near Cairns. They represented a huge increase on 2005-06 numbers, when six such cases were recorded, but Dr Wakefield said the centre had been actively encouraging public hospital staff to report incidents. "You might think: 'Oh gosh, how do these things happen?' " he said. "But as medicine has become more complex and we get people through the system quicker, there's more opportunities for mistakes to be made. "It usually happens in very busy hospitals. A major Brisbane hospital when I was working there three years ago had 22 operating theatres. That's a surgical factory."

Dr Wakefield said although the mistakes were rare, with more than 800,000 patients admitted to Queensland public hospitals in 2006-07, they were all preventable. "For the vast majority, there was very little harm but we regard all these errors potentially as leading to serious harm," Dr Wakefield said outside the meeting. "We're unearthing a problem, a risk in our system, which we've got to fix."

An analysis of the cases found patient misidentification was a significant cause of the problem. Dr Wakefield said Queensland Health planned pilot projects to eliminate the problem, including a study into the benefits of barcoding patients. "In the US veterans' health system, basically every patient has a barcode on the normal hospital wristband as well as their name and date of birth," he said. "It's a big technical investment but we'd like to explore that. "It doesn't just protect against patient misidentification, it protects against the wrong drug being administered as well."

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12 September, 2007

Fix health care by making Americans care about costs

As it does every August, the Census Bureau has announced its latest estimate of how many people in the USA lack health insurance. The 47 million figure is higher than last year's estimate of 44.8 million. But as also happens every August, health care reformers will soon misinterpret that estimate to push counterproductive reforms.

The truth is, there are not 47 million U.S. residents who can't get health insurance. According to the Department of Health and Human Services, that Census estimate "appears to overstate the uninsured substantially compared to other surveys." Those other recent surveys put the number between 19 million and 36 million. And all those estimates include people who could obtain coverage. As many as 20% of the "uninsured" are eligible for government health programs, so in effect they are insured. On top of that, economists Kate Bundorf of Stanford University and Mark Pauly estimate that as many as 75% of the uninsured can afford to buy insurance.

Make no mistake, America has an uninsured problem. As journalist Jonathan Cohn documents in his book Sick, the high cost of coverage produces far too many avoidable tragedies. Nonetheless, most reformers, including Cohn, focus obsessively on expanding coverage, despite the fact that many economists can find no evidence that it is a cost-effective way to improve health. Simply expanding coverage would have little effect on the quality of care, health disparities, or how long we live, nor would it stop free-riders from shifting costs to others. In fact, expanding coverage through government regulation or tax-and-transfer programs would make our problem worse.

Consider how we purchase health coverage. Every year, the average family of four spends thousands of dollars in taxes to fund care for others, and according to data from the Kaiser Family Foundation, that family spends $11,000 for its own employer-controlled coverage.

More than 200 million Americans have public or employer-controlled coverage, and all are essentially purchasing it with someone else's money. And that's the problem: Americans demand more coverage than they would if they were spending their own money. In fact, we demand as much coverage as Canadians, for whom health care is supposed to be free. Both American and Canadian patients pay only about 14 cents for every dollar of medical care they consume.

It should come as no surprise that health insurance premiums have risen 87% since 2000. Doctors and insurance companies can get away with charging high prices because their customers don't bear the costs directly. This isn't some inevitable result of market forces, but of government programs and tax preferences for employer-controlled insurance. By rewarding employer-controlled coverage — and penalizing plans that stay with you from job to job — the government strips people of their health insurance when they need it most.

President Bush and GOP presidential candidate Rudy Giuliani have endorsed reforms that would extend the tax break applying to employer-controlled coverage to individually purchased coverage as well. Those reforms would let families control the $11,000 that purchases their own coverage. The Congressional Budget Office estimates the Bush proposal would expand coverage to 7 million people. If we want to increase access to health care, our first priority must be to contain costs. Nothing would help more than 200 million cost-conscious consumers. Letting Americans own their health care dollars is the right thing to do. And as it happens, it would also cover a lot of the uninsured.

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11 September, 2007

Health care issues are better addressed at the state rather than the federal level

"America should adopt a single-payer health system like Canada's."

"Sweden has social benefits x, y, and z, while the U.S. is still in the dark ages."

"Even Cuba, CUBA, is better at providing x for their people than America is."

These opinions are very common. For the sake of argument, I'll concede that Canada, Sweden, and Cuba may be better at providing some social services than is the United States. But this leaves out some interesting information. Canada has fewer people than California, and a smaller gross domestic product. Sweden has the same number of people as Georgia. Cuba's population is about the same size as Ohio's.

Indeed, the state with the lowest GDP, Vermont, is wealthier than some 60 countries, most of whom have far greater populations. Indeed, the poorest state, Mississippi has the same per capita GDP as Greece and New Zealand, and is well ahead of dozens of countries with a more comprehensive health care system than the United States.

Surely, if poorer countries can afford universal health care, the United States should, right?

But that's asking the wrong question. Consider that while all nations of Europe have some form of government-run health care, the systems vary in the different countries; there is no one-size-fits, European Union program.

We shouldn't be asking, "Why doesn't the federal government provide universal health care?" but rather, "Why doesn't California? Or Georgia? Or Ohio, Mississippi, Vermont, Nebraska, or Wisconsin? If the people in those states, or any state, really wanted such a system, they could certainly afford it, because other countries of similar size and less wealth provide it.

And isn't 50 different solutions to our heath care problems better than a one-size-fits-all, nationwide plan that may not work? I'm not advocating socialized medicine, but I believe the debate over free markets vs. government intervention should take place at the state, not the federal level. One state may increase income taxes to pay for "universal" health care coverage. Another may greatly increases sales taxes, and another property taxes. Some states will only cover the poor but require others to purchase insurance. Some would provide basic care, while others might offer more advanced care. And some may take a laissez-faire approach and not do anything at all. In any case, the people would be better represented at the state level than in Congress, because of the much smaller state legislative districts. It would be far more difficult for lobbyists of the insurance industry or Big Pharma to bribe 50 state legislatures than just one Congress. The states would serve as "laboratories of democracy," and would learn from each other what works best and what doesn't work at all.

Such is how government under the United States Constitution is supposed to operate. Under the Constitution, Congress isn't authorized to run, regulate, or subsidize our health care. Because the Tenth Amendment prohibits the federal government from doing anything the Constitution doesn't expressly authorize it to do, federal intervention in health care is unconstitutional.

This is not an anachronistic interpretation of the Constitution, unless undertanding basic English is also anachronistic. Yes, the Supreme Court hasn't struck down unconstitutional programs such as Medicaid and the prescription drug benefit , but that's neither here nor there. For decades, the Supreme Court held that segregation was constitutional, and then, one day, poof! it wasn't. The Supreme Court does as the Supreme Court wants, not what the Constitution says.

The truth is, once we ignore or "reinterpret" one provision of the Constitution, the others - even the ones we like - will also fall. The President and Congress started attacking the Tenth Amendment in earnest during the 1930's New Deal era. Next to go was the clause authorizing only Congress to declare war. That went out with Korea and the U.S. has been at war somewhere most of the time since then - with disastrous results. The War on Drugs has led to federal violations of just about every provision of the Bill of Rights, and there are thousands of gun laws on the books that flout the Second Amendment. Should we then be shocked that a President would now "reinterpret" the clauses about habeas corpus and warrantless searches?

Any federal solution to our health care problems would be unconstitutional. This would only encourage even more unconstitutional legislation and is thus a grave threat to our liberty. Instead of increasing the federal role in health, the federal government should end its health programs, laws, and regulations, and return the money back to states or the people, leaving it up to them to solve their health care problems.

Many countries that have government-run health care are smaller and far less wealthy than many of our states. This shows that the states could have the same thing if the people wanted it, and if the federal government didn't interfere. I don't think socialized medicine is a good idea. But if you want to agitate for socialized medicine, do it at the state level. It's the Constitutional and democratic thing to do.

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10 September, 2007

Australia: Don't have an accident on the weekend

MATTHEW Lawson was a code one patient who died at the scene of his accident near the Gold Coast. Despite his urgent need for medical treatment, it took ambulance officers 25 minutes to reach the father of two young daughters. Records obtained under Freedom of Information laws also reveal ambulance officers pressed the "on-scene button" more than five minutes before they actually arrived, a practice the Queensland Ambulance Service Commissioner has vehemently denied is used to falsify response-time records.

As concern continues to build about the state of our ambulance service, Mr Lawson's family desperately wants to know whether he could have been saved if medical treatment had been delivered sooner. Mr Lawson, 35, of Ormeau Hills, died about an hour after his motorbike collided with a car on August 26 last year at Ormeau, just a few minutes away from the closest ambulance station.

An ambulance spokeswoman said that station was closed on the weekends and the nearest operating station was about 10km away at Beenleigh. "At the time of the call, ambulance teams in the area were responding to a number of life-threatening cases, including two patients with chest pain and a patient with breathing problems," she said. Mr Lawson's family said they were told by a Queensland Health official that he might have been saved if medical help had arrived sooner because he most probably bled to death from his multiple fractures.

A coroner is investigating his death. An autopsy found he died of "multiple injuries due to a motorcycle accident". Mr Lawson's sister, Michelle Lawson, said the QAS was endangering lives with its lengthy response times. "It's just not fair. Matthew bled to death on the side of the road and I feel that the ambulance service and the Government as a whole are responsible for his death.," she said. "I think if the ambulance did get there within a certain time frame he probably could have survived."

Ambulance records show the first officers reached the scene at 6.19pm but treatment did not begin until 6.26pm after a second crew arrived. A statement from QAS said the time recording of 6.19pm was a mistake. "The Woodridge unit pressed the on-scene button at 6.19pm when adjacent to the incident but the crew then realised that they were unable to cross the Pacific Motorway at that location and had to proceed down the motorway to an exit and return along the service road to the incident," the statement said. The service also lost an electrocardiogram strip the family had requested.

Source




Don't have an accident in Britain

A teenage climber dialled 999 [Britain's emergency no.] when he was left clinging for his life to the side of a cliff - and was put on hold.

Terry Price, 16, was stuck more than an hour after seeing his mate Roy Williams, 18, plunge 40ft to the ground. He called 999 from the cliff in Uphill, Somerset but was connected to police in South Wales and Nottinghamshire before finally being put through to local cops.

Terry, of Weston-super-Mare, said: "I was hanging on for my life and they put me on hold when I rang 999. "It was half-an-hour before I was put through to the right person and another hour until they arrived. I couldn't believe it. It felt like I was clinging on for ages - it was my worst nightmare."

Roy suffered a fractured thumb, broken tooth and facial injuries and was badly shaken up.

BT spokesman Jason Mann said: "We are very sorry that this happened. "When we get a 999 call from a mobile, the operator can see which mast the call came through and identify which area's emergency department they should put the caller through to. "It appears the young man's signal was picked up by a mast in South Wales instead of one in Somerset. That can happen if a mast in the specific area is down."

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9 September, 2007

Another bad hair day for the NHS

One task this blog has undertaken is to challenge the illusions and myths of nationalized health care. Which is not to argue that the US system is the ideal alternative. That is a different issue. The main myth we try to address is the idea that there is universal health coverage under socialized medicine. Much like we know that socialism doesn’t feed everyone—witness the politically induced famines in the Ukraine in the Thirties and in China in the 50s — we know it doesn’t give medical care to all either.

Socialism has always relied upon the political allocation of scarce goods, meaning that some groups or classes of people are intentionally denied access. And since socialism has proven itself very poor at the creation of those goods and services, its allocations are, by necessity, made from a smaller pool. There is no “universal” coverage under “universal health insurance”.

It may be that everyone can get an aspirin if they want it, or a doctor’s appointment if they can wait long enough. But the serious medical requirements, the ones most people worry about, are not available to everyone by any stretch of the imagination. They are often denied in a calculated manner to bolster the second main claim of socialized health care -- that it is cheaper. Obviously if you refuse to give people care that is costly, you can have cheaper care. Deny all care and the cost is zero. “Cheaper” can be obtained in any system if you limit consumption intentionally. That is not necessarily a good thing.

To illustrate this point we take a snapshot look at the much praised (by the nationalizers) National Health Service in the United Kingdom. This service is often held up as a model for the world to emulate. The argument given by some is that it provides more service, better service and cheaper service. Nationalized care gives more of one kind of service, over small things, and lots less of other services for serious illnesses. Add it all together and there is a lot less health care. The service is better if you are worried about small issues but worse if you are concerned about serious ones. So “better” is determined by whether there is a minor problem with your health or something major. Cheaper it is, but the lower cost is induced by the denial of care on a routine basis for more costly problems.

What is wrong with a snapshot, using British news reports on the NHS over a few days, is that perhaps the NHS was having “a bad hair day”. There are just some days when even the super models look pretty awful. So regular snapshots are needed. In fact, a portfolio of photos is usually required to make a decent judgment.

Here are a few other snapshots taken from British news sources for the last few days. We are not accumulating random incidents over a long period of time, but numerous incidents over a very short period of time. These are in no particular order to this issues.

The National Health Service says that they will have a 983 million pound surplus (almost 2 billion dollars) this year. That is after a 547 million deficit last year. Twenty-two of the local trusts, which provide the actual care, are in debt and for 13 of them the debt is growing rapidly. This is not as bad as last year but still serious. Sounds good. Of course one way to get rid of a deficit, or lower it, is to spend less which in this case means to cut health care.

The general secretary of the Royal College of Nursing, Dr. Peter Carter, raised that issue. “We have to ask at what cost this has been achieved.” Carter says one way this was done was to increase workloads of doctors and nurses even more. The Telegraph for August 30 reports:

... Hamish Meldrum, chairman of the BMA GPs' committee, said the cuts were "thinly disguised forms of rationing" patient care. "At the end of last year we saw services to patients being cut, with operations delayed, outpatient clinics cancelled, and referral management schemes," he said. "There are still hospitals that are threatening to lay off hundreds of staff in order to break even." Only last week, plans to downgrade A & E services and maternity services in Greater Manchester sparked protests from the Tories. Maternity services will shut at four hospitals, the A & E at one hospital will be downgraded and intensive care for premature babies will move from another.

Liberal Democrat health spokesman, Norman Lamb, said “this year’s surplus” was created by “dreadful cuts in key services” last year. One such cost savings has been in the way junior doctors have been treated. Many are simply left unemployed as the NHS trusts try to cut costs by reducing the number of physicians they have to pay.

For instance, Dr. Kapil Lad was working at one hospital which blocks access to personal email during work hours. When he got home that evening he found an email which said he had a few hours to respond as to whether he wanted to take a one month job. Non-response during that time was considered a rejection. Yet the time limit had passed because he was actually in the hospital caring for patients. Now he finds himself unemployed as a physician. He is now considering employment options outside the UK and says that he feels that if takes a foreign job it is unlikely he’ll return to the UK.

Trainee doctors are easy for the NHS to dismiss or ignore so they have. The country has 33,000 of them but is offering only 22,000 training posts. The rest are left out in the cold. With about a third of all junior doctors getting screwed over it is no surprise that many of them took to the streets to protest as the accompanying photo shows.

Hip replacements under the NHS are notoriously slow. But 79-year-old Thembi Nobadula finally received the replacement she needed and then was sent home without the follow up care required. She ends up sleeping sitting up in a chair and has been unable to take a bath for months. All she needed was one piece of equipment that would allow her to get in and out of the tub but NHS wasn’t listening. Her condition was considered bad enough that the NHS sent her to hospital appointments by ambulance but no one would listen to her needs. Only after the local Islington newspaper got involved did they suddenly listen and promise she would get the equipment she needed in about a week’s time.

Thelma Nixon has a serious eye condition that will lead to blindness unless treated -- wet macular degeneration. Injections of Lucentis into the eye are needed. But the NHS told her she can’t have them. They were more expensive than guidelines allowed. Thelma remortgaged her home to cover the cost of injections herself through private care. The York Press campaigned on her behalf and so did the Royal National Institute for the Blind -- without the publicity it is unlikely she would have received the NHS treatment.

A local businessman funded some of her injections and two other readers of the original newspaper article also were donating funds toward further injections. But with the bad publicity in this case the local NHS trust relented. But Thelma was warned that if she sought any further private treatment it would jeopardize the funding she would received.

William Foreman, 66, of Suffolk, needed a hip replacement. The NHS told him he would have to wait. And when it comes to hip replacements the elderly wait, and wait, and wait. Foreman didn’t wait. He took 6,400 of his savings and flew to Poland. That covered his flight, the hip replacement, and three weeks or rehabilitation. From the time he was told he needed the hip replacement to the surgery itself was a total of two weeks. For this price he got a private room and twice daily sessions with a physiotherapist.

Foreman is just one of thousands of people from the UK who become “medical tourists”. Medical tourism is a booming business that helps individuals who can’t get timely treatment, or treatment at all, from the NHS obtain the same treatment overseas. One study indicates that 50,000 people leave the UK every year for medical treatment elsewhere. If they didn't the waiting lists would be even longer. And the money these people spend to get the care they aren't receiving from the NHS is not counted toward health care costs for the NHS.

Russ Jones needs the drug Sutent because he has a gastrointestinal stromal tumor. The NHS has refused to supply it because it is too costly and they question whether it is effective. Jones is now depleting his savings to pay for the drugs himself. The problem Jones has is very rare which is why there is little research on the drug which would prove whether it is effective or not. But in some parts of the UK Sutent is available while in others it is routinely denied. This has lead to what some are calling a “postcode lottery”. People who live in certain favored areas receive treatment that is routinely denied to everyone else.

Cancer patients in Northern Ireland, part of the UK and under the NHS, are unhappy. Those suffering from asbestos cancer have been told they will have to wait until 2009 at the earliest before they can receive the drug Alimta. This form of lung cancer is incurable and Belfast is one of the UK hotspots for the disease. While Alimta does not cure the disease it relieves symptoms and increases life expectancy. Waiting two years for treatment is a death sentence since most patients with the disease die within one year. The drug is available in other parts of the UK by the NHS just not to people in the “hotspot” of Northern Ireland.

Brigitte Stankovic has worked her entire life as a hair dresser. Now 42 she runs a busy hair salon. She has kidney problems and high blood pressure and needs regular medical attention. But to seek that treatment means taking hours off of work at a loss of personal income -- and lost income is not counted in health care costs. Brigitte explained her problem:

With the NHS I just couldn’t get an appointment to suit me or the phone was constantly engaged and when I did get an appointment you would be sitting for ages in cramped conditions and then rarely see the same doctor. I have worked all my life, since I was 15-years-old and running a hairdressing salon is a job where time is money and I couldn’t afford to go on like that.

She said that with the NHS it was impossible to get treatment without losing work time and income. Brigitte now uses the first private GP practice to open in Wales. Dr. Jo Longstaffe sent up Independent General Practice three years ago and now has three offices with a fourth opening shortly. She has six doctors working for her and three more on the way.

Our final snapshot of the NHS for the last few days covers the phenomenon of “hidden” waiting lists. It is widely known that socialized health care often results in very long waiting lists. These lists prove a constant embarrassment to the advocates of the system. One way of addressing the problem is to cut the lists. This doesn’t mean that people receive treatment. It just means they are removed from the official waiting list and put on a waiting list for the waiting list. This means they no longer have “guaranteed” treatment within a specific period of time.

The Scotsman reports that “5000 Lothian patients have been switched from main waiting lists on to the ‘availability status code’ list” instead. And while these secondary waiting lists had seen some reductions in recent years they are growing once again. The reason for the growth is that fewer surgeries than needed are provided.

Separately, NHS Lothian was also unable to secure all the surgery time it wanted for patients with coronary heart disease - one of the biggest killers in the region. Local health chiefs asked the Golden Jubilee for four weekly sessions, but were only granted two, later increased to three. Another issue in tackling the level of ASC codes in the Lothians is the need to provide more orthopaedic surgery, such as hip and knee operations. More than 300 plastic surgery and orthopaedic patients have now been sent to the private Murrayfield Hospital instead.

In Scotland alone the “hidden” waiting list has 25,000 people on it who are merely waiting to be moved to the official waiting list. Public Health Minister Shona Robison promises that no one will wait “more than 16 weeks for treatment” and that they will get “rid of hidden waiting lists” -- next year. Apparently it’s another bad hair day for the NHS.

Source



Wealthy could get health benefits under Democrat plan

Thousands of families who earn enough to pay a tax designed for wealthy Americans also would be eligible for government-subsidized health care for low-income children if proposals in the Democrat-controlled Congress become law. In New York, almost 15,000 families who pay the alternative minimum tax would be covered under the healthcare program if the state's plan to increase eligibility to those earning four times the poverty level - $83,000 for a family of four - is approved, according to an analysis by the Heritage Foundation, a conservative think tank. "Only in Washington would you consider a family both rich and poor at the same time," said Greg D'Angelo, a research assistant with the Heritage Foundation. "It's the only place where one could be that creative."

If every state raised its eligibility cap for the program to New York's standard, then about 70,000 families nationwide who pay the tax - which applies to millions of households that make heavy use of certain tax breaks such as tax-exempt bonds and child credits - would be eligible. The House and Senate last month passed bills to expand the State Children's Health Insurance Plan, or SCHIP, to families earning several times the national poverty level. A conference to hammer out differences in the two versions is expected to begin this week.

The White House has threatened to veto both bills because of their hefty costs. The Senate bill would expand eligibility in the program to families earning up to three times the national poverty level - about $62,000 annually for a family of four. About 1.7 million children and a handful of adults enrolled in private health insurance plans would receive SCHIP coverage by 2012 under the bill, according to analysis of the program by the Congressional Budget Office. "This bill essentially extends a welfare benefit to middle-class households," stated a policy paper issued by the White House Office of Management and Budget.

The House bill would give SCHIP coverage to 1.5 million Americans who currently have insurance, the Congressional Budget Office says. Both bills would allow states to seek waivers to exceed the eligibility caps in the legislation, provided that the states meet certain benchmarks ensuring that their poorest children are covered by the program. Many states are expected to seek waivers for families earning three times or more above the national poverty level, thus extending SCHIP coverage to millions of middle-class Americans. "If we just want to go to a government-run, socialized medicine, fine - this is it," said Senate Minority Whip Trent Lott, Mississippi Republican, on the Senate floor last month. "I'll be back in years to come and say: 'I warned ya.' This thing is going to continue to grow."

The Bush administration last month announced new rules that will make it more difficult for states to seek waivers. The policy includes a requirement that 95 percent of all children from families earning less than twice poverty level must first be enrolled in SCHIP or Medicaid before a waiver is granted.

Democrats have accused the president of obstructing the program, saying that locating and enrolling 95 percent of a state's poorest families is almost a logistic impossibility. State health officials in high-tax states such as New Jersey, which currently has the nation's highest SCHIP income eligibility cap at 350 percent, or $72,275 for a family of four, say waivers are needed to keep pace with their state's high cost of living.

More than 75 percent of the 122,525 New Jersey children receiving SCHIP assistance live in families earning no more than twice the federal poverty level - $41,300 for a family of four. The median family income in New Jersey for a family of four is $90,261 - about $30,000 higher than the national median, according to the U.S. Census Bureau. "Living in New Jersey, it's a huge expenditure for a low-income family to have medical stability," said Suzanne Esterman, a spokeswoman with the New Jersey Department of Human Resources. "This is a vital program in New Jersey."

And SCHIP coverage isn't free for everyone. In New Jersey, only families at the lowest income levels escape paying monthly premiums and co-payments for doctor visits. Families earning 350 percent about the poverty level pay a $125 monthly premium, while families at the 300 percent level pay $74.50.

The House bill proposes a $50 billion spending increase for the program over five years, for a total of about $75 billion. The plan would add an estimated 5 million children to the 6 million already enrolled in the program, which expires Sept. 30. The Senate version would spend an additional $35 billion over five years and would cover about 3 million children not currently enrolled. To pay for the plans, House Democrats proposed a 45-cent-per-pack increase in the cigarette tax and cuts to the Medicare Advantage program. The Senate version calls for a 61-cent-per-pack increase in the cigarette tax but no cuts to Medicare Advantage.

Source





8 September, 2007

Don't get prostate cancer in Canada

A shortage of urologists has become so pronounced that patients' lives are at risk, managers of a St. John's-based health authority have been warned. In a powerfully worded letter to the Eastern Health regional authority, urologist Dr. Douglas Drover said an "excessive volume of work" in the specialty has meant waiting times of almost a year for patients seeking treatment.

Drover, who was attending a medical conference last week, was not available for an interview with CBC News. However, his letter lays out a litany of problems. For instance, about 300 patients are waiting for operating room time so that surgery can be performed. Drover is one of just seven urologists practising in Newfoundland and Labrador. He urged Eastern Health to hire more specialists, warning that not to do so would be "tantamount to medical negligence."

Andy Grant, a member of a prostate cancer support group in St. John's, said he is afraid that people will die - or already have - while waiting for surgery. "First of all, [patients deal with] the shock you might have prostate cancer, then the shock of being confirmed with prostate cancer," he said. "Now you have the shock of saying, 'I have to wait until next year?' "

New Democratic Party Leader Lorraine Michael said she was disturbed to learn of the problems that Drover outlined. "I think the word I would use is 'horrified.' I could not believe what was in his letter," she said. "We're sounding like we're in a developing country and not in a province that has the resources that we have."

Health Minister Ross Wiseman said the government is working on a solution to staffing shortages in urology and other areas. "We're in the process now of developing a physician human resource plan, and we hope to be able to, either in the early fall or late winter, roll out that strategy," Wiseman said. [WTF! They need to hire more doctors, not "roll out a strategy"!] "[This] will identify the kinds of specialties and family practice doctors we have - where we need them [and] how many we need - and that will give us then a blueprint for the future."

Drover's letter said Nova Scotia, with less than double the population of Newfoundland, has more than four times the number of urologists, with 29.

Source




When healthcare becomes a privilege rather than something that you buy

'NHS should not treat those with unhealthy lifestyles' say Tories

David Cameron is considering NHS Health Miles Cards to reward clean living. Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. Patients would be handed "NHS Health Miles Cards" allowing them to earn reward points for losing weight, giving up smoking, receiving immunisations or attending regular health screenings. Like a supermarket loyalty card, the points could be redeemed as discounts on gym membership and fresh fruit and vegetables, or even give priority for other public services - such as jumping the queue for council housing.

But heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act. Those who abused the system - by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries - could also be penalised. The report calls for a greater emphasis on the "citizen's responsibility" to be healthy and says no one should expect taxpayers to fund their unhealthy lifestyles.

Yet while the Health Miles Card would award points for giving up smoking and losing weight, it could penalise those who are already fit and well because they would receive no benefits under the scheme. Also, the NHS already demands that obese patients lose weight before receiving hip replacements. And any moves to impose compulsory cards on patients would provoke a backlash from civil liberties groups.

The Dorrell report also calls for a consultation on raising the smoking age to 18 and for shops to be stripped of their licences if they sell tobacco and alcohol to minors. It proposes a fully-trained nurse to be made available to every school to offer advice on sexual health - but Tory officials stressed they would not be offering children contraceptives. Ministers should divert more attention and funding to public health epidemics which are costing the NHS billions a year, the report says.

Source





7 September, 2007

Britain launches global healthcare plan for poor countries

Talk about the blind leading the blind!

British Prime Minister Gordon Brown launched an international initiative, which aims to improve healthcare and sweep away killer diseases in some of the world's poorest countries. The International Health Partnership (IHP) is bidding to help developing countries make better use of foreign aid by cutting bureaucracy and building stronger national healthcare systems. "We could be the generation that is able to say that we conquered these diseases and that, I think, places a moral duty on us to work together," Mr Brown told a press conference at his Downing Street office. "There is no greater cause than that every child in the world should be given the benefit of healthcare - that a life free from the scourge of preventable disease, a gift that was perhaps unimaginable even 10 years ago, is a gift that today can be achieved and would enrich us all."

Mr Brown said that his ultimate goal was to wipe out diseases such as HIV/AIDS, malaria, polio, tuberculosis and measles. The IHP brings together bodies including the World Health Organisation (WHO), the World Bank and the Bill and Melinda Gates Foundation with the governments of Britain, Canada, France, Germany, Italy, the Netherlands, Norway and Portugal. It is being launched to give new impetus to efforts to meet United Nations Millennium Development Goals on issues like child mortality and the number of mothers dying in childhood.

In July, UN Secretary-General Ban Ki-moon warned that the international community was "seriously off-track" on some of the goals, which were set in 2000 and are due to be met in 2015. The first wave of developing countries which will hook up with the IHP includes Burundi, Ethiopia, Kenya, Mozambique, Zambia, Cambodia and Nepal. But Mr Brown said he expected other nations, both donors and developing countries, will get involved as the IHP evolves.

Officials say that over the next couple of years, the first seven countries will identify particular problems in their national health care systems before working with international partners to address them. The developing countries have committed to prioritising healthcare issues, while the donor countries have pledged to work together more - freeing up resources to fight diseases by slashing red tape - as well as providing more long-term and predictable funding.

Norwegian Prime Minister Jens Stoltenburg, who worked with Mr Brown on the plan, illustrated the need for more coordination between donor countries. "There are so many different countries, so many different donors, so many different UN agencies, so many different NGOs working in the same countries with the same issues but without any coordination," he said. "So it is a big problem that in many developing countries, they have to do a lot of bureaucratic work."

The project does not involve new funding, but the British Government disputes claims that this could limit its impact, saying that global aid for health has doubled since 2000. "This is about making what we do more effective, adding up to greater than the sum of its parts... It's about getting a bigger bang for your buck," a senior British Government source said, speaking on condition of anonymity.

Oxfam director Barbara Stocking welcomed the launch of the IHP, but said it needed extra cash to achieve its goals. "This initiative will only succeed if enough countries get behind it and if it mobilises additional aid to provide coordinated and expanded state health provision," she said. Major economies including the United States and Japan have not signed up for the IHP.

Source




Negligent cancer screening in the NHS

A patient who found out that she had breast cancer after she was allegedly given the all-clear by a consultant told a medical disciplinary hearing that she did not want other women to suffer the same fate. Jane Andrews, from Winchester, was giving evidence at a General Medical Council hearing in Manchester yesterday into allegations that Lan Keng Lun failed to carry out breast screening assessments to the required standards at the Epping NHS Breast Screening Service at St Margaret’s Hospital.

It is alleged that eight other patients were affected by below-standard screenings at the service run by The Princess Alexandra NHS Trust. Dr Lan had been the consultant radiologist at the service since April 1998 and director of breast screening since March 2003. The hearing was told that Ms Andrews was recalled to the service after a mammogram on March 10, 2003, revealed issues, such as an abnormal lymph node, that needed further assessment. She was seen by Dr Lan on March 26, when he examined her breasts clinically and by ultrasound scan, but is alleged to have failed to take an ultrasound image of the abnormal lymph node. Ms Andrews told the hearing that Dr Lan said she had three cysts that had all yielded aspirate. However, in a letter to Ms Andrews’s GP, Dr Lan said that only two of three cysts yielded aspirate and there was a definite lump felt in the outer part of the left breast, which he claims he told her to keep an eye on.

Ms Andrews, who is in her late 50s, said Dr Lan suggested that she return after three years but advised her to continue to check her breasts in that time. She said: “As far as I was concerned the clinical outcome was satisfactory for both of us, I didn’t have any doubts I had healthy breasts.” But months later Ms Andrews felt an ache under her arm when moving furniture and discovered the lump a short time afterwards, which was diagnosed as cancer. She claims that an earlier diagnosis could have increased her chances of survival.

Source





6 September, 2007

Mandatory mental health checks in an Edwards Fascist state!

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care. "It requires that everybody be covered. It requires that everybody get preventive care," he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. "If you are going to be in the system, you can't choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK."

He noted, for example, that women would be required to have regular mammograms in an effort to find and treat "the first trace of problem." Edwards and his wife, Elizabeth, announced earlier this year that her breast cancer had returned and spread.

Edwards said his mandatory health care plan would cover preventive, chronic and long-term health care. The plan would include mental health care as well as dental and vision coverage for all Americans. "The whole idea is a continuum of care, basically from birth to death," he said.

The former North Carolina senator said all presidential candidates talking about health care "ought to be asked one question: Does your plan cover every single American?" "Because if it doesn't they should be made to explain what child, what woman, what man in America is not worthy of health care," he said. "Because in my view, everybody is worth health care."

Edwards said his plan would cost up to $120 billion a year, a cost he proposes covering by ending President Bush's tax cuts to people who make more than $200,000 per year.

Source Some good comments from Charlie Foxtrot




Some satire from "The People's Cube"

"The People's Cube" is clearly a satire on Communism and its still-numerous American friends but I suspect that the "cube" referred to is not just Rubik's. The central and holiest building in Mecca is the Kaaba -- which is Arabic for "cube"



Presidential hopeful John Edwards yesterday stated that his state run health care system would be mandatory. "It requires that everybody be covered. It requires that everybody get preventive care," he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. "If you are going to be in the system, you can't choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK."

This prompted an immediate response from the Hillary Clinton campaign. In a statement issued today Hillary mocked the North Carolina Senator. "Ha...Twenty years? My health care plan calls for five minutes in the middle of the night. A simple house call by state doctors and a knock on the door at 3AM when you're given five minutes to pack one suitcase before you are taken by health care professionals to the nearest hospital if the state deems you unhealthy and not fit."

"Mammograms? Hell no, euthanasia. Leave it to the professionals to decide whether you are healthy or not. Simple diagnostic tests like if you're able to hold a shovel will determine your general heath."

Source





5 September, 2007

NHS fiddles the books

The health service is set to record a surplus of nearly 1 billion pounds this year after desperate measures turned its finances around. David Nicholson, the chief executive of the NHS, has predicted a surplus of 983 million in 2007-08, up from 510 million in 2006-07. It is a rapid turnaround from the 54 million deficit recorded in 2005-06 that blighted Patricia Hewitt’s term as Health Secretary.

The number of NHS organisations in deficit has fallen sharply, with only 22 of 341 expecting not to show a surplus by the end of the year. However, some of these 22 organisations have seen their deficits grow. Leicestershire County and Rutland Primary Care Trust, for example, is expecting a 22.7 million deficit at the end of 2007-08, up from 17.8 million the previous year. A few organisations, including the University Hospitals Coventry and Warwickshire NHS Trust and the East of England Strategic Health Authority, are expected to slip into the red for the first time.

The forecast 983 million surplus would be ploughed back into patient care, Mr Nicholson said. The NHS gross deficit - the total deficit of individual organisations - is expected to be £204 million this financial year, down from 911 million in 2006-07. The Prime Minister said that the turnaround meant that the Government could now put money into other areas of the NHS. Gordon Brown said: “We are talking about more access, more money to tackle hospital infections and measures to ensure people get the best personal care. “People know that the health service has 80,000 more nurses and 20,000 more doctors and we are building more hospitals. Some have already been completed. People do understand the health service is getting better but it is going to get even better.” Alan Johnson, the Health Secretary, said: “We have to stay within budgets. This means we have got a surplus of 1.3 per cent of the total budget, which is just about where it should be. We can spend that money on additional services. That money belongs to the NHS.”

But critics said that the Government should also count the cost of getting back into balance. Peter Carter, general secretary of the Royal College of Nursing, said: “In our view, freezing and deleting health workers’ posts, cutting services to patients and raiding training budgets is not the right way to balance the books. “We now have a curious situation where the NHS is forecasting a surplus of nearly 1 billion but is unable to find jobs for thousands of newly qualified nurses desperate to put their skills and commitment to work. “At the same time, nurses already working on hospital wards and in the community have seen their workloads increase as they are expected to do ever more with even fewer resources. “If there is taxpayers’ money lying idle in NHS banks accounts, let us put it to good use by investing it in front-line staff and getting thousands of newly qualified nurses into work.”

Stephen O’Brien, the Shadow Health Minister, said: “How can it be right for strategic health authorities to hold back money from local hospitals when they are fighting to keep services open?” Hamish Meldrum, chairman of the British Medical Association, said: “The question now is, what is going to be done with the surplus? We would like crucial budgets to be restored, and longer-term, cost-effective policies to be adopted. In future, it’s important that we don’t go through a further turmoil of boom and bust.”

Source





4 September, 2007

NHS too busy treating foreigners to treat Brits promptly

British maternity services are notoriously deficient -- with far too few staff for the demand. Is it any wonder when so many foreigners come to Britain to give birth at no charge?

A confidential internal report on health tourism estimates that the bill for treating foreign patients amounts to at least 62 million pounds a year, The Times has learnt. The figure is “bound to be an underestimate” since new rules intended to prevent the abuse of the NHS by foreign patients are being ignored, according to the report. A survey has found that NHS managers are failing to ensure patients are asked to prove their eligibility and are chasing only around half of the debts owed. The findings suggest that taxpayers are picking up hospital bills for foreign patients that come to more than 30 million a year. Some of the 62 million is paid back by the patients.

The Government promised a crack-down three years ago. Hospitals were told to charge patients who were found not to be resident in Britain or from countries with reciprocal arrangements. John Hutton, when he was a health minister, said in April 2004: “I expect trusts to make enforcement of the regulations part of their core business.” Ministers have repeatedly refused to answer questions on how much health tourism costs the NHS, claiming that statistics are not collected on the number of patients treated who are not entitled to free care.

The scale of abuse was estimated internally following the introduction of the new regulations. The Department of Health last week lost an 18-month battle to suppress findings of an internal report when they were released to the Conservative MP Ben Wallace under the Freedom of Information Act. In addition to the first official estimates the documentbears out previously anecdotal suggestions that maternity and HIV services are being targeted. “Maternity . . . was frequently mentioned as an issue,” the report states. The problem uncovered by the survey, carried out in late 2004 to early 2005, was so acute that officials suggested that the Government contacted air-lines to ask them to prevent heavily pregnant women from flying to the UK from Nigeria, India or Pakistan.

Treatment for HIV was “widely recognised to be a problem area” with clinicians “hostile” to the idea of charging foreign patients. Department of Health officials found that the manager responsible for checking eligibility “was not welcome” in one hospital’s HIV ward. “We are currently being criticised by the the Terrence Higgins Trust without actually charging many people or collecting the money,” the official notes.

Last night a spokeswoman for the Department of Health said that it refused to accept the findings of its own report, insisting that it was based on a sample of only 12 trusts. She claimed that the “situation is much better than it was three years ago” but conceded that the department could not produce figures to prove it. She added: “We are in the middle of a review with the Home Office, which is looking at tightening up enforcement of the regulations.”

Mr Wallace, who uncovered the report, said: “This Government is conniving at a ‘Don’t ask, don’t charge and don’t chase’ policy that is leaving the NHS wide open to abuse.”

Source





3 September, 2007

Fraud and deception about SCHIP

The battle should be over by now, but it’s not. Congress has still not passed the bill that revises and reconstitutes the State Children’s Health Insurance Program (SCHIP), since it recessed for summer vacation – umm, excuse us, constituent services travel – before reconciling the House and Senate versions of the legislation. However, as a final step in at least attempting to insulate this impending legislation from simply becoming another clandestine step to nationalized health insurance, the Bush administration has added what Reuters called “new standards” to limit the applicability of that healthcare subsidy to truly low-income recipients.

If a state wants to offer subsidies to families with incomes above 250 percent of the poverty-level, they must first prove that they have already extended the offer to at least 95 percent of those families earning below the 200 percent amount, providing for those children through either Medicare or the child health program. (There are other conditions, but this is the one raising the most unwarranted controversy.) Since none of the 50 states have thus far come anywhere near that level of coverage for the truly indigent, the expectation is that efforts to raise the bar will now be considered to be in violation of both spirit and letter of the SCHIP authorization.

Why this is exactly wrong somehow … well, that remains to be seen. If the intended beneficiaries of a “hand-up” program (aiding the children of poor families) are not being served adequately, it’s hard to argue that funds aimed at that target population should somehow be diverted to helping those who are somewhat less hamstrung by their economic status. The charge that advocates of such a “middle-class handout” are merely using the SCHIP reauthorization to promote their intended socialization of healthcare seems pretty valid. But immediately following the news of the Bush regime’s rule-change, the barrage began.

A Boston Globe account, entitled “Children may lose out on insurance,” starts right in with its lead paragraph, declaring that, “Thousands of Massachusetts children from low-income families could be denied health insurance under new rules imposed by the Bush administration late last week. The rules could cut federal matching funds for a state-run program that is a key component of the state’s health insurance initiative.”

Let’s examine those phrases: Apparently there are “thousands of children” in the Bay State alone, who come from “low-income families” (defined how? They make more than twice the poverty-level, but less than 2-1/2 times it) and would be denied “health insurance” (it says nothing about access to healthcare, only “insurance”) because the Bush program would “cut federal matching funds” that supplement an existing state program.

Translation: Families with children exist in Massachusetts (and by implication in many other states) who cannot provide healthcare for their children on their own, and do not qualify for public assistance from the state … because they make too much money! And the reason the state can’t assist them anyway is because it will be denied “federal matching funds” to pay for such subsidies – unless it can show it has ALREADY taken care of all the even POORER families in the state, the ones who REALLY need the help! Forgive us for looking askance, but this is just socialist claptrap, disguising a not-so-covert attempt to expand the scope of public healthcare subsidization!

And as the article continues, the state’s senior Senator, Edward M. Kennedy, who has never seen a federal subsidy program he couldn’t wish were more widespread, is leading the fight to challenge the new restrictions, described as “the latest volley in the national battle over the future of … SCHIP.” The piece notes that the program already insures “some 6.6 million children nationally and 90,500 in Massachusetts” among low-income families. During its recent (Mitt) Romneyfication, the state had raised that 200 percent ceiling, to families at 300 percent of the poverty-level income ($61,950 for a family of four). This added “about 14,000” children to the coverage

Excuse us for wondering, but is there really a need to pay for the healthcare of families making that kind of money? And even if we grant that there is, is there really a burden being placed, merely by requiring that BEFORE those (rather affluent, by most standards) folks are serviced, you make sure you are caring for and covering all the folks down at the $40K family income and lower ranges?

The outrage seems entirely misdirected. Instead of railing against restrictions of federal subsidy of yet another government program, these voices should be raised in favor of efforts to promote lower access costs to healthcare, for EVERY family, regardless of income. Such measures as tax credits for individuals, rather than corporations, for providing for their own wellness … now there’s a step in the right direction.

The Globe article (still posing as “news” mind you) goes on to state that “In Massachusetts, the program is the main means of insuring children in families above the poverty level who do not qualify for Medicaid and who frequently cannot afford private insurance.” It adds, somewhat indignantly, that “The state’s health insurance initiative did not include any other effort to cover children,” while stating that the new guidelines “could block enrollment of more children above 250 percent of the poverty level and could make it tougher for the state to continue covering about 4,500 already enrolled.” Meanwhile, it concedes, “State officials said they do not yet have a count of the number who are eligible but not enrolled.”

Massachusetts is not the only place where this tightening will affect “the children”: citing the lobbying group Families USA, the story notes that “at least 17 other states” have already expanded their coverage up the income ladder, and five more have been considering raising the ceilings. The overall effect was to strike fear in the Bush administration, which (understandably?) viewed this as a stealth campaign to create a de facto universal healthcare program.

Dennis Smith, director of the federal Centers for Medicare & Medicaid Services, who sent out the policy letter, is quoted as saying that, “SCHIP was created for children in low-income families, We want to make sure those kids are covered before we go to the higher-income kids.” This is hardly a radical statement by any standards. His intention in sending the letter, he says, was to enforce rules “designed to ensure that the program is not substituting for private insurance.”

As if this were not enough evidence, the so-called “progressive” ranks have also weighed in with outrage at Smith’s proclamation. One notable example comes from Harold Meyerson posting at The American Prospect site, with “A Dickens of a President [http://www.prospect.org/cs/articles?article=a_dickens_of_a_president]. Meyerson cleverly compares the actions of the Bushites, and Smith in particular, to the fictional antics of the orphanage overseers in “Oliver Twist,” quoting rather extensively from the Charles Dickens classic, and comparing the Bushies to the likes of “Limbkins, Bumble and kindred Dickensian grotesques …”

Regardless of the literary eloquence (as was noted in the editor’s note to this blurb a few days ago), this whole argument is a crock. The claims that these restrictions would harm the truly poor are nonsense; what would hurt them far more (granting for the sake of argument the validity and effectiveness of the existing program, which is the one thing both sides of the aisle, both houses of Congress and the President seem to concur on) is the death of the program as it now stands, simply because of the self-serving agendas of both sides.

Meanwhile, in both of those houses, efforts to raise the limits continue, with Bush still threatening to veto the program’s extension if these additional measures are not stricken from the bill placed on his desk for signature. To these eyes, it would appear that the new rules, if they were to stick, might actually make such a veto academic, while allowing the program for the truly indigent to proceed. That would hardly seem to be a bad thing, for those who really care about helping poor kids.

Source





2 September, 2007

The myth of health insurance

Forty million Americans are said to have no health insurance. Those who do have health insurance are frustrated by having to pay ever-increasing premiums for steadily diminishing medical services. Conventional wisdom tells us that we are facing a "health insurance crisis."

It is important to recognize that what we call "health insurance" has little to do with health and nothing to do with insurance. We do not face a "health insurance crisis." We face the consequences of a set of economic and social problems rooted in a futile effort to make the distribution of health care -unlike the distribution of virtually every other good and service in our society- egalitarian.

The typical contractor of homeowner's insurance is the homeowner. He buys insurance to protect himself from costly loss caused by events outside his control, such as fire, not to defray the recurring expense of maintaining it. The ideal outcome for both the buyer and the seller of home and automobile insurance is for the policyholder to never make use of his policy.

The typical contractor of health insurance is not the insured person but his employer. Neither party is free to negotiate the terms of the policy. The employee cannot bargain for a lower premium in exchange for a high deductible or for choosing to be not covered for alcoholism or schizophrenia. The employer is not free to decline coverage for state-mandated medical services. In New York State, for example, the Women's Wellness Act mandates group health-insurance plans to cover contraceptives including abortifacients, and the Infertility Coverage Act mandates that they cover infertility treatments, including selective fetal reduction (abortion of multiple fetuses conceived by artificial means).

The economic survival of an insurance company depends in large part on collecting more in premiums than it pays out in claims. To bring about that outcome the insurer employs certain methods, some complicated, some very simple. Although embarrassingly obvious, some of these simple measures need to be mentioned because they are absent from what we mislabel "health insurance." For example, a person cannot buy a policy to protect himself from a loss caused by his own actions, such as burning down his own home. But so-called health insurance protects the individual from the medical consequences of his own actions, for example, injuring himself by smashing his car while drunk. Not surprisingly, all the participants in the complex scheme we call "health insurance" are unhappy with the result.

In the case of genuine insurance, there is a direct relationship between the dollar value of the protection purchased and its cost to the insured. The premium for a life-insurance policy with a face value of $100,000 is less than for a policy for a multiple of that amount. In health insurance no such relationship exists between premium paid and compensation received. Moreover, the health-insurance company, acting on its own behalf, can write a contract with a "cap" on claims, that is, for the maximum amount it will pay the insured, regardless of the health-care cost he incurs. The insured person, who typically does not act on his own behalf but is "provided" insurance as an important part of his job benefit, has no reciprocal options.

The sole rational purpose of true insurance is to protect the insured from an unanticipated economic loss so large as to jeopardize his economic well-being. No one sells or buys insurance to cover the cost of maintaining his property. Home insurance does not pay for plumbing repairs; automobile insurance does not pay for replacing worn-out windshield wipers. Yet people demand precisely this kind of reimbursement from so-called health insurance.

"Health Insurance": The Illusion of Equality

If health insurance is not insurance, what is it? It is a modern version of the illusion that all men are equal -or, when ill, ought to be treated as if they were equal. When religion was the dominant ideology, death was (supposed to be) the great equalizer: once they departed the living, prince and pauper were equal. Today, when medicine is the dominant ideology, health care is (supposed to be) the great equalizer: everyone's life is "infinitely precious" and hence deserves the same protection from disease. Of course, prince and pauper did not receive the same burial services, and rich and poor do not receive the same medical services. But people prefer the illusion of equality to the recognition of inequality.

Actually, the ruled have always longed for "universal health care," and the rulers have always supplied them with a policy that the masses accepted as such a service. In the Middle Ages, universal health care was called Catholicism. In the twentieth century, it was called Communism. In the 21st century, it is called Universal Health Insurance. What we choose to call "health insurance" is, in fact, a system of cost-shifting masquerading as a system of insurance. We treat a public, statist political system of health care as if it were a system of private health insurance purchased for the purpose of obtaining private medical care.

Everyone knows but no one admits that health insurance is not really insurance. In fact, Americans now view their health insurance as an open-ended entitlement for reimbursement for virtually any expense that may be categorized as "health care," such as the cost of birth-control pills or Viagra. The cost of these services is covered on the same basis as the cost of medical catastrophes, such as treatment for the consequences of a brain tumor. Such distorted incentives produce the perverted outcomes with which we are all too familiar.

From a public-health point of view, the state of our health is partly, and often largely, in our own hands and is our own responsibility, even if we have a chronic illness, such as arthritis or diabetes. It is an immoral and impractical endeavor to try to reject that responsibility and place the burden for the consequences on others.

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1 September, 2007

Cancer survival rates in Britain versus the USA

Sure, I know that just one mention of why I dislike nationalized health care sends some of my left-of-center readers into a frenzy. It seems that the cause d'jour on the Left is the implementation of a state run system of health care in America. It is the public policy version of the Holy Grail.

Questioning nationalized health care is, to them, a similar sort of heresy as questioning the necessity of baptism by immersion at a Baptist tent revival. Alas, I'm used to the role of village atheist so I don't mind.

Of the various state systems of health care the National Health Service in England holds a special place in the pantheon of state system -- mainly because it one of the first and one of the most pervasive. It has gone through a process of beatification in some circles. And I think it qualifies. And like anyone who is beatified that means it is declared holy on insufficient grounds and it is dead. Maybe it's not clinically dead but it certainly is on life support with the struggle more and more difficult each year.

Ask any member of the nationalize health sects where they would rather be sick, America or the U.K., and they will dutifully tell you how the British system is more fair and gives more health care to more people. That is the argument I generally hear. Giving out lots of care is easy and can be done cheaply. But the real issue is not what you give out but what are the results of the actual care given?

So ask yourself what you want to do if you had cancer. Would you prefer to get "equal" care or more effective care? Would you rather have a system that equalizes the treatment rate or one that maximizes survival rates?

A research team for The Lancet Oncology has looked at the survival rates for individuals diagnosed with cancer. This rate is determined by the number of patients who are still alive five years after being diagnosed with cancer. They ranked the various nations of Europe and then compared the survival rate to that of cancer patients in the United States -- the Great Satan of Health Care.

National Health Care covers England, Scotland and Northern Ireland and Wales.

If you are a female in Scotland, your chances of surviving five years after a cancer diagnosis is 48%. In Northern Ireland it is slightly better at 51% and even better in England at 52.7%. Wales comes out tops there with 54.1%. The percentage of American women who survive more than five years after a cancer diagnosis was 62.9%. This, by the way, is a higher survival rate than any of the European countries that were surveyed. And the survey included all the major European health system except France, where the statistics were not made available.

Male cancer survival rates show that 40.2% of Scottish men live five or more years after diagnosis. In Northern Ireland it is 42%, England is 44.8% and and Wales is 47.9%. The United States has a male survival rate of 66.3%.

If 100 English women are diagnosed this month with cancer, then 47 will, on average, die in the next five years. In the United States, with all the problems the health systems does have, an extra 16 women per 100, will live. Sure, its just statistics, unless you happen to be one of those 16 women. And for every 100 English men diagnosed this month 55 will die in the next five years. If the same 100 men lived in the United States an extra 21 of them would live.

One of the researchers from Scotland, Prof. Ian Kunkler saays that one reason for the low survival rate in the U.K is partially due to the long waiting periods before treatment. He says that there is "good evidence that survival for lung cancer has been compromised by long waiting lists for radiotherapy treatment."

Oddly the BBC managed to report this story without once mentioning the higher survival rate in the United States. But they do publish the European mean survival rate for men and women. They have a graph showing the survival rates but it is not calibrated too finely. My best estimate from the chart is that mean average survival rate for women appears to be around 51% about 11 points behind the U.S. And for men it appears to be 47% or about 19 points behind the U.S.

Lung cancer survival rates in England and Wales are very depressing. Only 6% of either sex survive. The U.S. survival rate is between two to three times higher, or up to about 16%. However, one relatively new regimen of care developed in the U.S. has shown survival rates of up to 29%.

Perhaps there are arguments as to why one might prefer to live in England versus the US (I spend more time in the UK than I do the US myself) but certainly if survival rates count for something -- and they do to those who are trying to survive -- I know which I would pick.

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