GOVERNMENT MAKES WAR ON DOCTORS

The current Congress has a few lame ducks, but they're still mighty busy birds - trying to push through lots of big legislation such as 1000 pages of a $338 billion omnibus spending bill. They're also hoping that little bills zip right through, below the public's radar, such as H.R. 3015 which targets physicians and pharmacists in the take-no-prisoners war on pain drugs and patients suffering chronic pain. H.R. 3015, the National All Schedules Prescription Electronic Reporting Act, the US House of Representatives in October. It's now before the Senate where it's slated for a voice vote before the current session of Congress expires on January 2, 2005. A voice vote is a way to pass a bill quickly without a record of which way each senator voted.

This bill would encourage states to establish programs requiring physicians and other providers such as pharmacists to report any and every prescription for a wide range of commonly prescribed drugs, including pain medications and anti-depressants. In addition to the medicine and dose, the doctor would have to give the government the patient's name, address and telephone number. This private prescription information would then become part of a national computer database, available to the police and also possibly to employers, newspapers, blackmailers, or anybody else curious about such information.

The patient would not even know about the release of this prescription information, much less consent to its release or review. Police would have access to personal prescription information without having probable cause to believe a crime had been committed and without convincing a judge to issue a search warrant.

Drug Enforcement Administration (DEA) agents and state licensure boards already have great powers. They currently can get information on prescriptions written for controlled substances and have sweeping authority to investigate anybody they choose and to prosecute doctors for prescribing more pain killers than agents think appropriate. HR 3015 would dramatically enhance the reach of police and DEA agents into the privacy of doctors and patients.

Some government officials liken doctors to terrorists, and want equal judicial vigor in pursuing doctors. For example, Assistant U.S. Attorney Gene Rossi declared to a reporter that "our office will try our best to root out [certain doctors] like the Taliban. Stay tuned." according to a September press release from the Association of American Physicians and Surgeons.

In opposition to the bill, Rep. Ron Paul, MD, of Texas said HR 3015 "is yet another unjustifiable attempt by the federal government to use the war on drugs as an excuse for invading the privacy and liberties of the American people and for expanding the federal government's disastrous micromanagement of medical care." He pointed out that the government is embarking on a "war on pain patients and their doctors" which "has already resulted in the harassment and prosecution of many doctors... whose only 'crime' is prescribing legal medication... to relieve their patients' pain. These prosecutions, in turn, have scared other doctors so that they are unwilling to prescribe an adequate amount of pain medication, or even any pain medication, for their suffering patients."

Could it be that government agents are going after innocent and hard-working doctors because the doctors are easy targets? Are real criminals going free because these same government agents find it too much work to break through the complicated logistic and legal defenses that real criminals sometimes build and hide behind?

Rather than giving non-medical officials more authority, power and money, congress and the president should restrain the DEA from essentially telling doctors how to practice medicine. Rather than using resources to send trained actors feigning pain to entrap doctors, the DEA and other agencies should communicate and cooperate with doctors.

To further this goal, the Association of American Physicians and Surgeons (AAPS) recently developed a 3-point "Communicate and Cooperate" proposal to encourage physicians and law enforcement to work together to prevent prescription drug abuse. The proposal includes several ways law enforcement agents can work with doctors, such as:

1. Working together to track suspected drug abusers. To balance current laws requiring doctors to provide information about suspected abusers to the government, government agencies would notify doctors about suspicious patient behavior such as contact with know drug dealers or abusers.

2. Reviewing possible cases with professional medical boards before filing charges in court. Doctors would review a physician's practice with police before non-medical prosecutors would file criminal charges. This would help prevent embarrassing errors by government agents and would prevent worsening the current shortage of doctors willing to adequately treat patients with chronic and painful medical conditions.

3. Mutual training of law enforcement and medical personnel. Law enforcement people would educate doctors about recognizing patterns of illegal activity and criminal intent; doctors would educate police about modern pain treatment.

And why is the US Senate vote scheduled for only a "Yea" or "Nay" voice vote, without recording which senator voted which way? One reason is often so that senators can't be held to account for their votes. As Rep. Paul says, "Instead of further eroding our medical privacy, Congress should take steps to protect it."

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RATIONING MEDICAL CARE COVERTLY

The US healthcare system doesn't need the burgeoning medical costs of baby boomers to make it unsustainable. It already is. With costs every year rising two percentage points faster than personal income, it's universally acknowledged that the system is broken, but no one can agree on how to fix it. The nub of the problem is that Americans refuse to accept any form of rationing in a system that accounts for 14.1per cent of GDP, the highest in the world, yet which still leaves 45 million people without insurance and the rest paying premiums averaging 8.2 per cent of gross pay.

All of this so patients can have the expensive tests they demand - but may not need - given to them by doctors who are forced, by threat of lawsuits, to practice defensive medicine. But the reality is that rationing goes on every day, mostly behind closed doors with patients left out of the loop. "You can eat up all of your profits if one or two patients linger in the intensive care unit of a hospital," says Lorraine Micheletti, head nurse at Philadelphia's Northeastern Hospital. Under management orders to cut stays to keep the hospital open, Micheletti told the Wall Street Journal she encouraged families of older patients with not much in the way of quality years left to not keep them alive.

Under a form of rationing proposed by Washington-based analyst Robert Hungate, health insurance subscribers would pay little to visit their family doctor, half of specialists' fees and then a substantial part - though it will be capped - for hospital stays and expensive procedures. "What I argue is that we have to achieve rationing by choice," he says. "That's what markets do, and markets ration better than bureaucracies."

Critics, though, say healthcare is a fundamental right and should not be determined by factors such as costs. The American Medical Association's declaration of professional responsibility says a physician's duty is to treat the sick and injured with competence and compassion, and without prejudice, says private physician David Rogers. "Without prejudice means to avoid any bias that could possibly interfere with or reduce the quality of care," he says. "In my opinion, this would include using costs when making treatment decisions."

But Annie Liebowitz, former chief medical officer of Aetna, one of the biggest health insurers in the US, asks whether it is good to burden a patient with expenses that could have been avoided, or prescribe a brand name drug when a generic drug at half the cost is equally effective. "When given the choice of two equally effective diagnostic tests, or treatment approaches or medication options, physicians must consider which is likely to cost less," Dr Liebowitz says. "Our patients' needs are our first priority, but the healthcare system we all depend on is also our patient."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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Father left to suffer in agony

Fortunately, private compassion took over from uncaring public medicine bureaucrats

A 37-year-old father of three could lose one of his legs because the Health Department took more than three months to organise treatment for him in a NSW hospital. Mark Mathews, who is in agony from a circulation disease that has caused gaping ulcers on his legs, eventually accepted a lifeline thrown to him by a Queensland hospital that agreed to treat him first and chase payment later. Mr Mathews, of Yamba, said he waited in vain to hear back from NSW Health after his doctors sought treatment for his condition in a hyperbaric chamber at Sydney's Prince of Wales Hospital. "But I heard nothing despite ringing several times. Now I'm afraid the delay in treatment may cost me my leg," he said.

Mr Mathews' plight was eased when he rang the Centre for Hyperbaric Medicine at Brisbane's Wesley Hospital. "They were shocked and said, 'Just get up here as quickly as possible.' ... "After all I'd been through, I couldn't believe it. They've been fantastic." Centre manager David King said he had decided to treat Mr Mathews first and "ask questions later".

Liberal MP for Clarence Steve Cansdell said he was appalled at the treatment of Mr Mathews. "It's a bureaucratic bungle. They've treated him like he was applying for a licence," Mr Cansdell said. "This is one of the worst cases that I've come across."

Mr Mathews suffers from Buerger's disease, a severe and painful form of thrombosis that affects the hands and legs. When at home, he cannot sleep lying down and struggles to walk. He spends his days and nights sitting and sleeping upright in a chair.

The Northern Rivers Area Health Service said there had been a communication breakdown when Mr Mathews switched doctors. A spokesman said the cost of his treatment in Queensland would be met by Northern Rivers Area Health.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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ANOTHER EXAMPLE OF THE NEED FOR TORT REFORM

Last week, my wife and I took two of our three sons to see the film The Incredibles. If you have no young children begging you to see it and think it has no message applicable to adults, allow me to correct you. It is a powerful movie in its storyline, animation, and moral lessons. Mr. Incredible is one of a number of superheroes who fight crime and, as you would imagine, do good deeds. During one incident, Mr. Incredible saves a man jumping from a building. It turns out that the man did not want to be saved and responds to the good deed by filing a lawsuit. Eventually, legal action causes all the superheroes to retire and go undercover in a government protection program. The plot of the movie revolves around living in a litigious society and overcoming those who insist that anyone with a special gift or talent be forced into mediocrity.

The message is striking, although the idea of superheroes saving the day is obviously farfetched. As I thought about the movie, though, I realized that litigiousness and mediocrity are some of the biggest obstacles in our culture. The propensity to settle every dispute by legal action undermines values, such as trust and forgiveness, that are essential to the maintenance of genuine community. Fear of rewarding or achieving excellence discourages human persons from fulfilling God-given potential.

The story of Mr. Incredible is actually more common than most of us would like to admit. I asked a friend of mine to relate his father's story to illustrate my point. He wrote:

"My father is a retired Obstetrician-Gynecologist. He attended Notre Dame for undergrad then Loyola Medical School. After his residency in Chicago he was offered a terrific position with a hospital in Chicago which would have put him on the cutting edge of Obstetrics and Gynecology at a time (the late '60s) when that field was on the edge of extraordinary change."

"My Dad turned down that job. He decided to return to his small hometown of Escanaba, Michigan. Escanaba is a town of 12,000 people located in the Upper Peninsula. There he could give back to the community that raised him and gave him so much. He would be the first OB-GYN specialist that small community ever saw. During the late '60s, the '70s and early '80s, my Dad was the only Ob-Gyn specialist within a 45-mile radius of Escanaba. He enjoyed long hours, long nights, phone calls at all hours, and the ineffable joy of ushering in new human life to the small town he loved. His commitment to that community was heroic and tireless. And his connection with the community was intimate. He delivered hundreds of babies each year and he passionately and humanely cared for women in and around Escanaba during some very traumatic moments in their lives."

"In the mid to late '80s, his malpractice premiums become so onerous (roughly $150,000 per year) that he was forced to consider retirement. The premium problem along with the new awful reality of having to look at each new patient or case as a potential lawsuit started sucking the joy and satisfaction right out of the practice for him."

"In the early '90s, he was sued twice as a tangential defendant in two lawsuits where he had been called into difficult deliveries at the last minute because he was a specialist. In these two lawsuits he was deposed by a plaintiff's attorney from lower Michigan who treated my father so uncivilly and disrespectfully that my Dad finally had the joy of his practice completely taken away. The premiums were outrageous, the trial lawyers were everywhere, and the demand was for perfect babies, or else."

"Alas, in 1995, my Dad retired for good at age 59. The medical practice he loved became a potential exposure he could not afford; and it became an adversarial environment he would never understand. Escanaba, Michigan, sadly lost one of the finest physicians it has ever, or will ever, have the honor of calling "Doctor Bill." It was tragic and it was wholly preventable."

Dr. Bill's vocation, his calling, has been taken away from him. No one gains, but the entire population of Escanaba loses.

The fictional tale of Mr. Incredible comes to life in this doctor's story. With thousands of other similar stories, it is testimony to the profound need for tort reform in our nation. Pastors are afraid to counsel people. Nurses are nervous about giving needed care. Teachers fear to address the issues they know are troubling the lives of their students. Manufacturers raise the cost of their product because of the constant threat of lawsuits. Restaurants warn people that their coffee is hot and shouldn't be carried in their laps. At some point, it becomes simply ridiculous and any sense of biblical fairness is lost.

Of course we need to maintain avenues of justice for those who have been injured by the actions of another. But without some limitation, without the exercise of some prudence, without some appreciation for what we are doing to ourselves and our culture, we are in danger of suing ourselves into oblivion.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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LEGAL MADNESS: DOCTORS HAVE LESS RIGHTS THAN OTHER WORKERS?

Do doctors have to form a union to get the same rights to strike etc as everyone else? It seems so. It's all hot air, of course. Anybody who thought that prosecuting the doctors is a solution to anything would soon get the boot one way or another

Maryland doctors who take part in group boycotts or work slowdowns to protest the state's high medical-malpractice insurance rates run the risk of violating antitrust law, state officials say. "Doctors can lobby and they can also make independent, unilateral decisions on how they want to handle their own business. But what they can't do is get together and agree not to see patients," said Ellen S. Cooper, an assistant attorney general in Maryland. Ms. Cooper would not specifically comment on recent actions by physicians in Prince George's and Washington counties.

Last week, doctors at Prince George's Hospital Center and in Washington County in Western Maryland said they would cancel nonemergency procedures to draw public attention to the rising cost of medical-malpractice insurance. At issue is whether independent doctors in Maryland decided as a group to withhold services to change their economic circumstances. If so, they might be crossing a line from political protest to price fixing and collusion, antitrust lawyers warned.

"It sounds pretty dangerous to me," said Herb Hovenkamp, a professor at the University of Iowa who specializes in antitrust law. "There is a labor exemption that permits employees to do this, but independent doctors don't qualify for labor immunity." Mr. Hovenkamp said doctors could be penalized for participating in work slowdowns or group boycotts. They could be forced to reimburse monetary losses that result from the slowdown. "If the hospital takes a big hit in revenue, the damages could get quite large," he said.

Bob Howell, a spokesman for the Prince George's Hospital Center, said it hasn't suffered in the slowdown. "From our perspective, we haven't seen that much of a difference," Mr. Howell said. "There haven't been any doctors unavailable to do certain procedures."

"Professionals are not exempted from the antitrust laws, and they're not allowed to ... boycott or fix prices," said Bert Foer, president of the D.C.-based American Antitrust Institute. "They're at a risk when they do this sort of thing."

The doctors who participated in the recent slowdowns say they want state lawmakers to call a special session to reduce malpractice insurance premiums. The doctors say the rising rates are forcing many physicians to retire, leave the state or change specialities. Last week, Gov. Robert L. Ehrlich Jr., a Republican, said he planned to deliver a revised medical-malpractice insurance reform bill to Democratic legislative leaders this week. Mr. Ehrlich has been working with House Speaker Michael E. Busch and Senate President Thomas V. Mike Miller Jr., both Democrats, on a malpractice reform measure for a special General Assembly session before a 33 percent increase in insurance premiums takes effect Dec. 31. The doctors' first payments of the higher premiums are due Dec. 1.

Dr. Willie C. Blair, president of the medical staff at Prince George's Hospital Center, said the slowdown was a last resort for doctors because lawmakers have been slow to call a special session. He said the slowdown, in which more than 100 physicians participated, will not continue this week. About 40 physicians from Prince George's County and more than 60 from Washington County participated in last week's slowdown, which included halting elective procedures such as biopsies and hernia operations. Dr. Blair said he wasn't worried about facing sanctions as a result of the slowdown. "Lock me up and send me to jail," he said. "I can't pay my workers, I can't pay my malpractice insurance. ... The lawyers said we couldn't do it, and they've been keeping us in line all along. We followed the rules and followed the rules, and look where it got us. We're down and out." ... Dr. Blair said physicians will not rule out another slowdown. But he doesn't expect that to happen anytime soon. "We just wanted to be heard," he said. "We're trying to get some results."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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ROMNEYCARE: SOUNDS INTERESTING

"Governor Mitt Romney today proposed a sweeping expansion of private health coverage for the state's 460,000 uninsured people, and extended a hand to Democrats in the Legislature to pass a healthcare program next year.

In an article published in the Globe's opinion pages, Romney said he wants to change insurance laws to encourage insurers to offer stripped down health plans to small businesses and individuals. He would also provide "aggressively managed treatment" to send the working poor to clinics and hospitals for healthcare, redouble efforts to steer eligible people into Medicaid, and target Medicaid fraud.

Romney argued that his "Commonwealth Care" plan can "lead to every citizen in Massachusetts having health coverage." The governor insisted his proposal would not require a tax increase, or force employers to provide coverage to their workers, or make the state responsible for insuring everyone.

"Next year I am committed to working with the Legislature to pass a comprehensive, market-based reform program for healthcare," Romney wrote. "It will not require new taxes. What it will do is restrain the growth in healthcare costs and change how we provide healthcare for those who receive it at taxpayer expense."

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BUT MAYBE NOT

Making it more expensive to hire people is really dumb -- unless you WANT to create high unemployment

Massachusetts: Healthcare plan targets businesses: "Governor Mitt Romney said yesterday that he envisions a range of penalties for businesses that fail to provide health insurance, such as forcing them to pay a higher minimum wage, banning them from doing business with state agencies, or slapping a decal on their window to publicize their refusal. The Republican governor, disclosing details of his new healthcare proposal for the first time, said a system of 'carrots and sticks' would persuade businesses that don't provide health insurance to their workers to do so. Most of the employers he is targeting are small businesses with fewer than 50 workers. 'It could actually be a lot cheaper for businesses to provide insurance than to have to conform to the higher minimum wage for those that don't provide insurance,' Romney told reporters in a briefing in his State House office."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Operating theatres shut to save cash as thousands of Australians wait for surgery

Hospitals are closing operating theatres to doctors wanting to perform planned surgery for up to a third of the year to save money, despite there being almost 70,000 people on NSW waiting lists. Nepean Hospital surgeon Richard Hanney said the hospital suspended planned surgery for around 12 weeks each year, including breaks over Christmas, Easter and other school holidays. Also, surgeons were expected to give up a day's worth of operating every two months to make room for more emergency surgery. As a result, some doctors who were available to do one list a week for 52 weeks were getting into the theatres for only 35 weeks a year.

The most recently available figures show that last September there were 2524 people waiting for planned surgery at Nepean, including 762 who had waited for more than a year. Dr Hanney, a member of the board of the NSW branch of the Royal Australasian College of Surgeons, said it was hard to work out just how long the state's teaching hospitals were closed to planned surgery, because each hospital restricted it in different ways. For example, aside from holiday shutdowns, the Royal North Shore Hospital ceases to perform elective surgery after 3pm each day.

The president of the NSW branch of the Australian Medical Association, John Gullotta, said an AMA phone survey showed some of Sydney's teaching hospitals had increased their holiday shutdowns since 2002. It revealed the Prince of Wales Hospital ceased performing elective surgery for four weeks over the 2002 holiday season. The hospital will do likewise this year but for six weeks from December 19. Dr Gullotta said he did not believe there was any reason to stop performing planned surgery except on the major public holidays.

The Opposition health spokesman, Barry O'Farrell, yesterday attacked the State Government for allowing elective surgery operating times to be cut while waiting lists were so high. "There are currently 65,348 people waiting for elective surgery in NSW. More than 9000 have been waiting over a year," he said. "There is no doubt that waiting lists would be reduced if the Carr Government showed a greater commitment to funding surgery times."

Representatives of three area health services contacted by the Herald yesterday said that the holiday suspension of elective surgery was to give staff and surgeons time off. As well, they said, patients preferred not to have surgery during peak holiday periods. Nurses upset over staffing shortages at Maitland Hospital have closed 26 beds. The nurses carried out their threat of industrial action after representatives of the NSW Nurses Association met the Hunter Area Health Service's Reasonable Workloads Committee to ask for extra staff. It is believed to be the first time such action has been taken by nurses in NSW. Four of the paediatrics ward's 14 beds, four of the medical ward's 34 beds and eight of the surgical ward's 34 beds have been closed. The general secretary of the association, Brett Holmes, said nurses were furious that Hunter Health had not provided sufficient funds to employ enough nurses to run the hospital safely. A Hunter Health spokeswoman said additional nurses were being recruited.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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GETTING POLITICAL BIASES MADE PART OF PROFESSIONAL ETHICS IS TOO CLEVER BY HALF

If such rules are enforced that will just lead to the discrediting and ditching of the professional ethics concerned

When Gov. Ernie Fletcher signed a death warrant for a convicted killer this month, he may have done more than start the clock ticking on an execution. Some say Fletcher, a doctor, may have put his medical license at risk. American Medical Association guidelines bar doctors from taking part, directly or indirectly, in executions. And Kentucky requires doctors to follow AMA ethical guidelines. "I think it's a clear violation," said Dr. Arthur Zitrin, an 86-year-old retired psychiatrist in New York and an outspoken death-penalty opponent. Zitrin is also challenging the license of a Georgia doctor accused of helping nurses find a vein in a condemned man for a lethal injection.

A group of doctors is seeking an opinion from the Kentucky Board of Medical Licensure on whether Fletcher can sign death warrants without running the risk of having his medical license revoked. The board is not scheduled to take up the matter until at least January, and would not comment in the meantime.

On Nov. 8, Fletcher signed a death warrant for 51-year-old Thomas Clyde Bowling, convicted of shooting to death the husband-and-wife owners of a dry cleaning business outside their store in 1990. Bowling is set to die by lethal injection Nov. 30. Fletcher's executive counsel, John Roach, said the Republican governor did not violate AMA guidelines or other ethical standards. "By signing a death warrant, in no way is Gov. Ernie Fletcher participating in the conduct of an execution," Roach said. "Gov. Fletcher's role under the law is consistent with the roles of judges fulfilling their legal duty and jurors fulfilling their legal obligations regardless of their professions."

The AMA guidelines forbid doctors to actively take part in an execution or to take any "action which would directly cause the death of the condemned" or "which would assist, supervise or contribute" to the death of the inmate.....

Fletcher, 52, earned his medical degree at the University of Kentucky and was a family practitioner until he was elected to Congress in 1998. He was elected governor last year and is still licensed as a physician in Kentucky.

The Federation of State Medical Boards said it has no information on any doctors who may have been disciplined for taking part in an execution. Not all states incorporate AMA guidelines into state law. For example, it would not be illegal in California for a physician to participate in an execution, according to Candis Cohen, spokeswoman for the Medical Board of California.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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THE REALITY OF CANADIAN SOCIALIZED MEDICINE

The Barbarian Invasions, recently released on DVD by Buena Vista Home Video, offers a disturbing vision of state-run medicine. The Canadian film won two awards at the 2003 Cannes Film Festival (best screenplay and best actress) and took home this year's Oscar for best foreign-language film. It is the story of a man with a terminal disease who renews his relationships with his friends and family, especially his adult son. Much of the action takes place in a hospital in Montreal, Quebec, where director and screenwriter Denys Arcand dissects the Canadian health care system.

The film opens with a nun struggling down the corridor of a crowded ward to administer Holy Communion. Patients, health professionals, even electricians, are tripping over each other, packed into an environment of general confusion. And yet there is another floor of the hospital that is completely closed, thanks to a government directive.

The dying man's son is a successful investment banker in London. He's the kind of guy who can wriggle around anything. First he wrangles his way into the hospital's management offices without a pass and corners the manager, who is completely isolated from the chaos outside. He offers her a bribe to get his father moved out of the zoo and into a private space on the empty floor. She quietly takes the bribe but points out that she can do nothing without the hospital employees' union. The son pays off the union boss to prepare a private room on the empty floor. Painters, carpenters, and other workers quickly make it up.

Then, because there is virtually no access to PET (positron emission tomography) scans in Canada, the banker takes his father to Vermont to get one. One of the son's friends in Baltimore -- one of many Canadian doctors who have emigrated to the U.S. -- examines the scan and informs him his father will have a much better chance in Baltimore than in Montreal. Remarkably, the father will have none of it: "I voted for socialized health care," he proclaims, "and I'm prepared to suffer the consequences!"

With this line, the father speaks for too many Canadians, who often wrap their national identity in nationalized health care. This is why Canadian politicians have not had the courage to give Canadians more health freedom. But the pain and inhumanity caused by the Canadian system are starting to make even the most nationalistic of us reconsider the amount of control over health services that we've ceded to our government.

The Barbarian Invasions tells us a lot about the consequences of government monopoly health care. The hospitals are poorly managed, the doctors and nurses confused, the unions who really run the show thuggish, the patients all but ignored. The film has sparked a debate in Canada about the role of the state in health care. Any American who thinks health care in the United States would be improved by implementing a single-payer system would learn much from it too.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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CANADIAN COURT REFUSES TO LEGISLATE

SCOTUS should take note

The Supreme Court of Canada refused to elevate health funding to a constitutional right in a ruling that was a stunning setback for families of autistic children asking the state to pay for expensive treatment. The unanimous and unequivocal decision overturned two British Columbia court rulings that found the provincial government violated the Charter of Rights equality guarantees for the disabled. Yesterday's decision will have an impact across Canada, hindering lawsuits in which parents in several provinces are seeking court orders forcing governments to pay for early intervention therapy that costs up to $60,000 per year per child.

The case was considered one of the most significant social policy issues to reach the high court in years. All 10 provinces and Ottawa intervened to warn the judges that governments would need unlimited budgets if health care were to become all things to all people. Constitutional expert Jamie Cameron said that it would have been difficult for the court to carve out an exception for autistic children without exposing the stretched health system to a flood of lawsuits on behalf of people seeking coverage for other disabilities. "The court has shown appropriate institutional caution here in resisting the invitation to constitutionalize the health-care system," said Mr. Cameron, a law professor at York University in Toronto. "Once the precedent is created, it would encourage other claims."

Parents of autistic children are devastated and outraged. At the Supreme Court, Ottawa mother Debbie Barbesin, her eyes filled with tears, wondered how she will continue to pay therapy bills for her eight-year-old son, Dylan. David Sherriff-Scott, an Ottawa lawyer whose autistic son turned 11 yesterday, said the absence of state funding "dooms these children to a life of being marginalized." In Langley, B.C., Sabrina Freeman, mother of 16-year-old Miki, denounced the ruling as "total unadulterated garbage" and chastised the judges for caving in to political pressure. "If my child is not entitled to be part of the health care system, then the government is not entitled to my taxes," she said.

The 7-0 ruling was the culmination of a six-year legal battle begun by four B.C. families after the government refused to fund what is known as Lovaas autism treatment, saying it was "novel, controversial, experimental and not a medically necessary service." The treatment, which has shown dramatic results in some cases, was pioneered in the United States by psychologist Ivar Lovaas in the late 1980s. Autistic children undergo 20 to 40 hours a week of intensive one-on-one therapy that is most effective when a child is young.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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THE LATEST ON TENNCARE

A decade after Tennessee inaugurated a health care plan for the state's most vulnerable residents that was hailed as a model for the nation, the program is once more being held up as a model - of failure in an era of soaring medical costs and voters' aversion to higher taxes. Today the plan, TennCare, which sought to improve health care for Medicaid recipients while covering those who fall through the federal program's cracks, is on the ropes. Gov. Phil Bredesen, a conservative Democrat and former health maintenance organization entrepreneur, has threatened the program with extinction, saying that rising costs and generous benefits - TennCare consumes nearly a third of the state's $25 billion budget - make it unaffordable unless it can be radically restructured to save money and limit benefits.

In the coming year alone, the program faces a potential deficit of $650 million. After more than a week of tense negotiations between the governor and advocates for TennCare's 1.3 million users - nearly a quarter of the state's population, including an estimated 430,000 who would not be covered by Medicaid if TennCare disappeared - the two sides decided to "step back from the brink," as Mr. Bredesen put it. "Before I go down the road of taking 430,000 people off the rolls - more specifically, before I can face even one of them, individually, and tell them that it is over, that I can no longer help - I need to be clear in my own heart that I've done everything that I know how to do to solve this," the governor said. Rather than immediately kill TennCare, as he was poised to do, the governor agreed on Wednesday to one more round of talks after Thanksgiving, though he said saving the program was still a long shot.....

The fate of TennCare has profound national as well as personal implications. Other governors, also under pressure to stem rising health insurance costs, are watching to see whether Tennessee will provide a model for how to trim their own programs.... Created by former Gov. Ned McWherter, TennCare replaced Medicaid for those Tennessee residents not covered by other health insurance on Jan. 1, 1994. As costs for health care and prescription drugs rose steadily in subsequent years, TennCare became a larger and larger portion of the state's budget and a frequent political flashpoint.....

By the time Mr. Bredesen, a former Nashville mayor, ran for governor in 2002, TennCare had become the state's sharpest political thorn, and he won partly by promising to overhaul it. In 2003, the state began phasing in a preferred drug list to cut the cost of prescriptions. On Feb. 17, citing a recent report that TennCare would be $650 million in the hole in 2005, Mr. Bredesen offered what he called a "last chance" to save the program. "We need to face the facts," he said. "We have too many people with too many benefits for the money we have." He said he could come up with a new, permanent TennCare fix that was affordable and fraud-free without cutting benefits for children, pregnant women and the disabled. In May, the Legislature approved the broad outlines of his plan, including a limit of 10 doctor visits per year (later raised to 12) and six prescriptions per month (recently, the governor said that might have to be lowered to four). "What began as a grand vision had become a political scramble to cut the program as fast as possible," said Gordon Bonnyman, head of the Tennessee Justice Center and the leading legal advocate for TennCare recipients.

The program's advocates fought back. In June, Mr. Bonnyman went to federal court to argue that the changes violated four consent decrees he had won over the years that forced TennCare to abide by federal standards in certain crucial areas, like eligibility, home health visits and medical screening for children..... The lines were firmly drawn. On one side was the governor, the Legislature and representatives for doctors, hospitals and drug companies. On the other side were Mr. Bonnyman and other advocates for TennCare's users, like AARP, the Children's Defense Fund and dozens of charities and associations like the Alzheimer's Foundation and the National Mental Health Foundation.

In September, Mr. Bredesen officially requested federal approval of some of the changes he had sought, providing fresh specifics that further troubled the program's advocates. Meanwhile, the governor has grown increasingly vocal about what he calls the advocates' intransigence, and ratcheted up his rhetoric, comparing the health care program favored by Mr. Bonnyman to "a dictator in a glass coffin" and declaring the program he was proposing as "more American." The advocates have also shown a willingness to appeal to emotions. "Certainly, some people will die who would not otherwise have died," if the program is killed, Mr. Bonnyman said. On Nov. 10, attacking the advocacy groups for their persistent lawsuits, Mr. Bredesen said he was ready to give up his overhaul efforts and pull the plug on TennCare.

Mr. Bonnyman asked for more time and the governor said he would continue talking. On Wednesday, just when it appeared that negotiations were stalled for good, Mr. Bredesen invited Mr. Bonnyman to his office for their first one-on-one meeting and, that evening, made his unexpected announcement. "These talks have not gone well, and we are at an impasse," the governor said. "By any reasonable measure, I should say, 'it's over,' and move on." Instead, the governor promised to give it one more try after a vacation and a Thanksgiving holiday.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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AUSTRALIAN STATE FAILS TO COPE WITH HEALTH NEEDS: BLAMES AGING

And aging is the one problem that was totally predictable -- a problem that should therefore have been easily planned for by our bureaucratic geniuses

"When doctors at St George Hospital switched off Isaac Messiha's life support last Thursday night, it highlighted a much larger issue than the end of one man's life. Welcome to the medical dilemma of the future: in an age of technological breakthrough but seriously limited resources, who will receive help? And who won't? Messiha, 75, suffered a heart attack on October 17 and his family claimed the hospital flicked the switch to free up a bed in intensive care. The hospital denies this. But, hard-hearted or hard-headed, sadly it is a pointer to the future.

Few would argue that the health system is buckling under the strain of coping. Most experts say the onset of the ageing population is to blame. NSW Nurses Association general secretary Brett Holmes told The Sun-Herald: "We are running our health system at 100 per cent occupancy. We have an insufficient bed capacity to deal with the increasing demand." It is no secret that people are living longer and, consequently, requiring more medical care. Everyone predicted the greying population would create a demographic time bomb. What went wrong was that no one correctly estimated when it would explode.

NSW Health Minister Morris lemma admitted to The Sun-Herald that the Government, like many others around the world, had fallen behind the eight ball. And although he plans to "ramp up" the nursing workforce in the next year, the results from his initiatives will not be seen for another two or three years. He hopes to double the number of TAFE places available for enrolled nurses next year and attract more overseas-trained nurses from the US, Canada, Britain, Ireland, the Philippines, Singapore, Hong Kong, Scandinavia and possibly India. He is also trying to tempt nurses who have left the profession back into the workforce. Since 2002,1140 have returned but many are only casual or part-time.

NSW hospitals need about 12,000 extra nurses by 2014 but lemma's main problem is luring workers into a system which appears to be cracking underthe pressure. The workload for nurses has never been greater and it seems each week hospital emergency departments are placed on code red because they are unable to take any more patients. To ensure more beds are available in emergency wards, major public hospitals such as the Prince of Wales, in Sydney's eastern suburbs, are developing programs to "fast track" elderly patients.

When these patients present themselves, they will bypass the normal route and be cared for by a specialist team. About 33 per cent of patients treated in emergency departments are aged over 70. They represent a very special case: often, their first appearance will be the precursor to many more. Sometimes, because of their home circumstances, there is nowhere else for them to go. It is yet to be seen whether the minister's initiatives will alleviate some of the stress. He gets full marks for trying. But is it too little too late?"


The above is an excerpt from an editorial that appeared in the Sydney (Australia) "Sun-Herald" on November 14, 2004

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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THAT'S BUREAUCRATIC MEDICINE FOR YOU

Australian hospitals are "underprepared" for an infectious disease outbreak, compromised by limited resources, inadequate training and a lack of co-operation between the states and the commonwealth. According to a highly critical report prepared by the federal Parliamentary Library, there are "major deficiencies" in the emergency health response to the outbreak of infectious disease in the Australia.

While health authorities appear prepared for a single infectious disease outbreak, there are serious questions about how well the "messy" system would work when it came under pressure, particularly against several disease fronts. Experts said that hospitals were not able to deal with a sudden influx of multiple casualties, because of insufficient intensive care facilities. Based on interviews with experts in public health policy and practice between March and May this year, the paper says there is a potentially damaging "tug-of-war" between the commonwealth and states over disease management.....

The respondents also argued that policy-makers with limited public health knowledge were making decisions on critical public health matters with little or no consultation with experts or practitioners in the field.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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PRIVATE MEDICINE DELIVERS IN INDIA

What a piece of work is India! I have just returned from Mumbai, reeling from the collision of first with third worlds. I had rushed to Santa Cruz, a smart suburb of Mumbai, to be by my father's bedside at a hospital with the worryingly old-fashioned name of the Dr Dadubhai Saraswati Hospital. My father had suffered a heart attack and was undergoing tests to establish what needed to be done.

In times past, we would have flown him to some private hospital in London, where he would have had the latest technology at his disposal and we could confidently expect a moonlighting and highly qualified NHS cardiologist to carry out the operation. No more. India is awash with cardiologists and surgeons. The country that has stuffed every global corporation with IT experts and accountants is also producing medical specialists by the thousands. Mumbai has hospitals full of world-class surgeons, scalpels at the ready.

So, Dr Dadubhai Saraswati Hospital it is. Mongrel dogs and their puppies are in the hospital compound. The monsoon has ensured that everywhere is splattered with mud and dirt. And dozens and dozens of people crowd the entrance. I am shown the way to the intensive-care unit. Nothing could be more different from the scene I've left behind. The hum of air-conditioning heralds a spanking-clean waiting room. No mosquitoes, no flies, just quiet efficiency. There is a video screen in the corner that responds to touch commands. I type in my father's name. Up comes all sorts of information - the name of the doctor in charge, his room number, and not just the day and date of my father's admission but the precise time: 10.44.50. The people at the reception are courteous. They tell me that visiting hours are from 10 to 11 in the morning. As it is 9.45am, we should be able to see him shortly. All this, and no money has exchanged hands. Modern, secular, corruption-free India is here at last!

The next few days pass with a surprising orderliness. Guards closely manage the waiting room, ensuring that no more than two people are allowed in at any one time. Bags are checked - not for suspect terrorist equipment but to remove any food and drink from visitors. Indians, given half a chance, will bring out their home-made chapattis and tiffin boxes anywhere and at any time. But Dr Saraswati was wise to this and has banned such behaviour.

We meet many times with the surgeon. It would be hard to come across a more urbane, sophisticated man. He answers our questions with practised ease. More than that: he fills us with confidence. He is one of India's top surgeons and charges a pretty packet, but he is right up-to-date with the latest in surgical techniques. And he is planning to perform the operation using a new technique called "beating heart" surgery. It turns out (as we discover later that night surfing the internet) that this method does what it says on the tin: namely, keeps the heart beating while the operation is under way. It replaces the more conventional method in which the heart is stopped and blood diverted through a heart-and-lung bypass machine, then artificially pumped back around the body. Just two years ago, the BBC was reporting the trials of this technique at the Bristol Royal Infirmary. Now our man in Mumbai is going to use it on my father.

The surgeon's account of what he will do is so assured and stated with such conviction that we consent. The date for the operation is set. We all meet again three days prior to the operation. One of the surgeon's assistants informs us that he will need five pints of blood. Jolly interesting information, I think to myself. But I am missing the point. We are to provide the blood. I'm sorry? Yes. Apparently it's our job to provide fresh blood for the operation. Hospitals do have their own supplies but they are limited and could be stale. Suddenly, we are back to third-world reality. India does not have an effective blood donor system. The whole business takes me aback - but my sister immediately starts sending text messages to all her friends to find out (a) who is B+ and (b) whether they are ready to give a pint for her father. All sorts of people reply. The good news is that everyone seems to know his or her blood type. But some are recovering from an illness; others are away. One text simply says "me, me, me, me - please let it be me". By that night, three have agreed. In the morning, two more come forward. The blood is given and tea and biscuits handed out. Even better news comes the next day - all the blood is "good".

Come the day of the operation, we all head for the hospital. It's going to be a six-hour operation starting at 10am. We arrive by 9am with no thought other than to be around as the surgery progresses. We rest content in the knowledge that, here in the stiflingly damp heat of the monsoon, my father is in the hands of a surgeon as good as anyone in the world, carrying out an operation at the cutting edge of cardiac surgery. Within minutes of our arrival, a very typical Indian commotion disturbs the calm of the intensive-care unit waiting room. The word "platelet" is bandied about a lot. Apparently, the surgeon wants six platelets to be ready by 11.30. I do not have a clue what a platelet is. (Dictionary definition: "Platelets are one of the three types of blood cells, along with red and white blood cells. Platelets are small and sticky and their job is to prevent bruising and stop bleeding after an injury.")

The trouble turns out to be that Dr Dadubhai Saraswati Hospital doesn't have any platelets of its own. It might have the latest high-tech equipment in the operating theatre but its blood banks do not have "platelets". A nearby hospital - 30 minutes in Mumbai traffic - apparently does. Whose job, though, is it to collect them from the other hospital? No one seems to know the answer. But now somebody has to go. Once again, members of my family come to the rescue. Of course, we cannot just go and collect them. We need a form, signed in triplicate by an official of the hospital. It is now 9.45am. The operation is about to start. In the cubicle where the official sits, we are told to sit down and wait. The official is deep in discussion with someone else. My sister translates the conversation for me. They are talking about the merits of particular taxi services and making arrangements for the transportation of some patient in about two weeks' time. Any attempt at pushing this along is met with a stony glare and an implication that the taxi conversation could go on for a good deal longer if we don't do as we were told. The official merely shrugs when told that the surgeon has requested the platelets by 11.30am.

My brother goes back to the intensive-care unit to persuade someone to call the platelet official. The call is made and the official finally looks up at us, scribbles something down and instructs us to go to the next office. It takes her precisely 30 seconds. In the next room, two girls are painting their nails. Some slightly hysterical conversations later, we receive the forms. We need to copy them but, it transpires, Dr Dadubhai Saraswati Hospital does not possess a photocopying machine. One of my cousins, wise in the ways of Mumbai street traders, rushes out into the main road, finds a kiosk that makes photocopies and returns within minutes.

A frantic journey ensues through traffic-laden Mumbai streets. Mercifully, the hospital with the platelets delivers the precious blood cells with speed and efficiency. The car races back to deliver the platelets to the operating theatre. By the evening, the operation is over. It turns out my father needed a triple heart bypass. A little later, the surgeon comes to see us in a scene familiar to viewers of all medical soap operas. But it is good news. He is very happy with the way the operation has gone. Now, it's up to my father. The next 72 hours are critical. He is in the post-operative intensive-care unit. A video screen is set up for us and a camera placed in front of my father's bed. We can see him: knocked out and full of tubes coming out of every part of his body. But there he is. And within days he is able to speak to us through the video screen.

Today, my father is back at home, just ten days after his operation. I am back in England. Oh, one last thing. When it came to paying our suave and sophisticated surgeon his fee, how did he wish to be paid? Cash, of course. Some things will never change.

This article by Samir Shah first appeared in the "New Statesman" of November 15, 2004 under the title "A Bollywood hospital saga"




Florida: Judge blocks "bad doctor" amendment: "A judge Monday temporarily halted a new state constitutional amendment that would yank the licenses of doctors who commit three acts of medical malpractice, saying that some specifics need to be spelled out before it takes effect. Circuit Judge Janet E. Ferris agreed in part with hospitals that sued seeking to block the amendment from taking effect until some aspects of it can be clarified, most likely by the Legislature when it meets in the spring, or by the courts."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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Dispelling Malpractice Myths

"News reports of recent efforts to reduce malpractice insurance costs have missed what is needed: genuine reform of the medical justice system. A good way to start is by jettisoning some commonly held misperceptions about the current malpractice system. Call them the "Myths of Malpractice." Here's what is really going on:

Myth No. 1: The medical malpractice crisis is someone else's problem, not mine. Premiums paid for malpractice insurance directly affect everyone's access to needed care and the cost of this care. Some excellent doctors are leaving practice in the face of unaffordable insurance premiums. Others are cutting back on the services they offer. To the limited extent allowed, doctors and hospitals pass increased malpractice insurance expenses on to patients and their health insurers. If we don't fix the problems with the malpractice system, you may lose your doctor. You certainly will pay more for your care.

Myth No. 2: We need to preserve the current legal system to guarantee a fair hearing and provide compensation for patients harmed by the health care system. The medical justice system today is mostly random; it has become essentially a lottery. Hardly anyone seems to know this, although the facts are on the public record. A 1991 New England Journal of Medicine study found that nine out of 10 victims of disability-causing malpractice go uncompensated. That's right -- overwhelmingly, people harmed through medical mishaps are not compensated.

And a recent study by Harvard University researchers found that 80 percent of malpractice claims were filed against doctors who had made no error whatever. For instance, recent articles in scientific journals have documented that many, if not most, cases of birth-related cerebral palsy -- cases in which juries tend to be highly sympathetic to plaintiffs -- are not the result of malpractice by obstetricians. Juries often deliver sizable awards against providers who commit no errors for what are unfavorable, but random, outcomes of nature.

Myth No. 3: The malpractice system is necessary to punish and remove incompetent health care providers. Unfortunately, the system that rarely provides just compensation for patients also perversely protects doctors who need to be removed from practice, by enabling them to sue other physicians who might step forward to question their competence. This undoubtedly has a chilling effect on whistle-blowing, and those who regulate doctors are often reluctant to suspend or revoke licenses without expert medical testimony.

Nor does the current liability system provide a way to make health care safer. Physicians, nurses and other professionals want to provide quality care, but they are human and make mistakes. What we need is a system that allows health care providers to work together to study errors and put practical improvements in place to prevent recur- rences. The current system discourages doctors from talking about system failures for fear of being sued.

Myth No. 4: Malpractice costs are not a big deal -- they amount to less than 2 percent of total health care costs. The number sounds insignificant until you stop to consider that U.S. health care spending was a staggering $1.66 trillion in 2003 -- so we are talking of costs on the order of $16 billion to $32 billion. In the case of Johns Hopkins Medicine, malpractice premiums as a percentage of physicians' total income have risen threefold over the past four years. In 2001 malpractice premiums were about 3 percent of total physician income at Johns Hopkins. They are nearly 10 percent today -- and growing.

The irrationality of our current medical justice system leads to the practice of "defensive medicine," in which doctors try to stave off lawsuits by ordering more tests than are medically necessary. Got a headache? You are as likely to get a CAT scan as a couple of aspirin. The added costs of defensive medicine are estimated at $50 billion to $100 billion per year.

Myth No. 5: The current malpractice insurance system is in crisis because insurance companies are trying to cover losses from unwise financial investments made during the dot-com boom.

Malpractice insurance rates are skyrocketing in large part because of the increasing size of malpractice awards. Nationally, median jury awards for medical malpractice doubled from 1995 to 2000, increasing from $500,000 to $1 million. Median out-of-court settlements also were up significantly during that time, rising 40 percent from $350,000 to $500,000.

Hospitals and doctors often settle cases out of court, even when they know they have done nothing wrong, because they fear putting their fate at the whim of unpredictable juries. Higher jury awards and settlements invariably mean higher malpractice insurance premiums and medical costs.

Our system of medical justice is fair to no one but malpractice lawyers. Nationally, attorneys and the legal system gobble up about 60 percent of the costs involved with malpractice cases and awards. They are the true winners in this system -- and patients, hospitals and the general public are paying higher prices to subsidize the purchase of tickets for our medical lottery.

A few new caps on liability costs aren't going to solve the problem. It's time we begin a comprehensive reform of the medical justice system".

The writer, William R. Brody, is president of Johns Hopkins University.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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MAKING DRUG APPROVALS ENORMOUSLY EXPENSIVE REDUCES THE SUPPLY OF NEW DRUGS: HOW SURPRISING!

But it is very alarming when antibiotics that we all could need are put on hold

Pharmaceutical companies have all but stopped developing new antibiotics, placing Australians at greater risk of infections from drug-resistant strains of bacteria. "In the 1980s there were three to five new antibiotics a year coming on to the market, whereas now we'd be lucky to get a new one every two years," said Professor Lindsay Grayson, director of the department of infectious diseases at Melbourne's Austin Hospital. "And there's definitely a greater array of different germs now resistant to every single antibiotic that there is."

Professor Grayson told The Australian that drug companies were, instead, focusing on drugs that were used for long periods and provided greater profit such as drugs to treat cholesterol, obesity or anxiety. "You treat someone who is sick with antibiotics for only a week or two. They make more money with, say, an anti-obesity drug that someone takes for 40 years," he said. Writing in The Medical Journal of Australia, Professor Grayson and infectious diseases physician Patrick Charles said it cost more than $US500 million ($650 million) to research and develop any new drug. "So not only are they developing fewer new antibiotics, the ones they are launching are ones that treat many germs, to reduce costs and maximise profits," he said. "But to do that, these multi-purpose drugs need to be able to kill lots of different types of germs. As a physician, that's not what I want to use. "If I'm treating someone for a sore throat, that same antibiotic is killing a lot of physically harmless, and needed, bacteria in your bowel, for example, and the collateral damage is too great. We want to use an antibiotic that is very clearly targeted to the germ that we want to kill, whereas they want a drug that they can market to treat lots of different germs."

A recent study that appeared in the journal Clinical Infectious Diseases stated that Food and Drug Administration approvals for new antibiotics in the US declined 56 per cent during the past 20 years. The researchers showed only five of the 506 drugs currently under development were antibiotics. About 7000 Australians a year die from hospital superbugs, but Professor Grayson warned the problems will become more critical with the development of multi-drug resistant germs that spread in the general public. "MRSA, a form of golden staph, was once only in the hospitals, but now it's developed a new strain that's out in the community," he said. "In San Francisco, they've had a 20-fold increase in patients presenting with multi-resistant golden staph that they got in the community, not in hospitals. It's a very scary scenario."

"If the discovery and development of innovative medicines, including new antibiotics, is to be encouraged then intellectual property will need to be strengthened and the reward for innovation increased, not decreased, as is the current trend," Medicines Australia spokesman Steve Haynes said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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A WELCOME DEATH

Gov. Phil Bredesen announced yesterday that the state plans to dissolve TennCare. Up to 430,000 people will be cut from the financially troubled supplemental Medicaid program barring a reprieve.

The governor held out some hope for saving the program and announced that he will try for seven more days to work out an agreement with legal advocates who have won several court decisions about the level of health care the state must provide to TennCare enrollees. But he said it was unlikely an agreement could be reached with the advocates in the next seven days. An attorney for TennCare recipients, who accused the Democrat first-term governor of making advocates into "scapegoats," also was pessimistic about a last-minute deal.

Bredesen ran for governor two years ago with a promise to fix TennCare, whose $7.8 billion price tag would mushroom in coming years, or to end it. TennCare provides health-care coverage for the poor, uninsured and disabled and covers 1.3 million Tennesseans, or about 22 percent of the state population.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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UK GOVERNMENT ATTEMPT TO MIMIC THE PRIVATE SECTOR FAILS

A pioneering treatment centre hailed by Tony Blair as the "embodiment of the new NHS" faces closure after failing to attract patients and losing more than œ3 million. The clinic at Central Middlesex Hospital, North London, the first in Britain to offer elective treatments not requiring an overnight stay, could close by the end of the year. The fast-track "ambulatory care and diagnostic centre" (ACAD) was described by Mr Blair as "a brand-new type of hospital" when it opened in 1999. He said it would "work longer hours, including at weekends, and will involve much more day surgery".

Five years on, the centre is running at less than half capacity and has stopped working at weekends because of lack of demand. Paediatric wards have been described as "virtually empty" and more than 20 nursing staff have been relocated. When it opened, it was hailed by ministers as the start of a revolution in healthcare and a model for best practice. A further 25 clinics, offering popular elective work such as orthopaedics and general day-care surgery, and designed to cater for 200,000 patients a year, have since opened at a cost of more than œ350 million. But other centres, such as one attached to Hammersmith Hospital, have been hit by lack of use and falling revenues.

Nicky Bloom, the Middlesex centre's general manager, told the Health Service Journal that North West London Hospitals Trust was likely to close its unit, which has lost more than œ3.4 million in potential revenue. She said the centre, part of NHS Elect, a consortium of four NHS treatment centres, had performed 6,439 operations since April, against a capacity of 23,000. Ms Bloom said that favour-able treatment by the Government of the independent sector under its "choice" agenda meant that it was "not a level playing field".

However, this week the consortium said that it would expand to include nine more NHS treatment centres. According to the NHS Modernisation Agency, a target of 80 treatment centres to be completed by 2005 is likely to be achieved. Caroline Dove, director of NHS Elect, said the new centres hoped that being part of the consortium would help them to find ways to fill spare capacity and build up links with overseas providers. Robert Naylor, chief executive of University College London Hospitals Foundation Trust, which also has two treatment centres, said he remained concerned that the NHS centres were destined to fail because they could not compete with private providers. He said that the Government was assisting the independent treatment centres with inducements such as long-term guaranteed contracts at enhanced tariff rates, which the NHS centres had not been given.

Andrew Lansley, the Shadow Health Secretary, said that the problems faced by treatment centres were caused by bureaucracy and a lack of forethought by the Government. "Mr Blair said that the new NHS needed more capacity before it could offer choice. That's all talk. Here's an example of where capacity is available but Labour bureaucracy stops choice," he said.

A spokeswoman for the Department of Health said that competition from the independent sector was not to blame, and it had been the trust's decision to develop the capacity for 23,000 patients. "There is no advantage given to the independent sector under the choice process," she said.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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THE BANNED FLU VACCINE WAS PERFECTLY OK

Bureaucracy caused the problem

Headlines about shortages of influenza vaccine are becoming as much a part of autumn as the World Series. In 2000, manufacturing delays and plant shutdowns sent many people scrambling for the hard-to-get vaccine. In 2001, fears of anthrax poisoning drew unexpectedly high demand, as did a particularly nasty flu bug in 2003. But 2004's scenario was undoubtedly the worst. This year the trouble began after British health officials on October 5 suspended the license of Chiron Corporation's Liverpool, England, flu-vaccine plant for "failure to comply with the requirements of Good Manufacturing Practice [regulations] leading to concerns of possible microbial contamination of product." Just that quickly nearly half-around 48 million doses-of the anticipated U.S. flu-vaccine supply disappeared.

Not surprisingly, public-health officials, politicians, and editorialists are now calling for government to "do something" to prevent this from happening again. There are not enough makers of flu vaccine for the U.S. market, they argue. Government must take steps to bring more companies into the business. Health and Human Services Secretary Tommy Thompson wants Congress to promise to buy 100 million doses of vaccine annually, guaranteeing manufacturers a healthy market. Thompson has also wants government to purchase any surplus vaccine at the end of each season to ensure enough is made.

As with previous flu-and other-vaccine shortages, the common assumption is that the free market doesn't work. Or, in the words of a former New York city health commissioner: "This has taught us that the consequence of leaving it to market forces leaves the country as a whole without any rational distribution plan." But all this overlooks one very important fact: government itself caused the flu-vaccine troubles.

In 1999 there were four makers of injectable influenza vaccine serving the United States. That same year the U.S. Food and Drug Administration (FDA) began a new system of vaccine-plant inspections that resulted in numerous fines, plant shutdowns, and mandatory (and expensive) new investments. FDA suspensions and citations drove one vaccine maker, Parkedale Pharmaceuticals, out of the business in 2000 on the eve of flu-shot season. (See my "Weakened Immunity: How the Food and Drug Administration Caused Recent Vaccine Supply Problems," Independent Review, Summer 2004.) Another company that struggled with numerous expensive FDA mandates and a $30 million fine, Wyeth Pharmaceuticals, left the business in 2002. Makers of childhood vaccines were equally hurt. Between 2000 and 2003, shortages occurred for eight of 11 childhood vaccines-nearly all directly linked to FDA mandates....

British, not FDA, officials brought about this year's shortage, but they used the same regulatory weapon the FDA had used years earlier-so-called "good manufacturing practice" violations. Under these standards, inspectors examine a plant's entire manufacturing process, not just the end product. FDA officials went to England and suggested additional vaccine contamination was found, but they were unclear about who found it or whether it was in vaccine set for public use. (Sabin Russell, "All of Chiron's flu vaccine deemed unsafe, FDA checks firms plant, says no doses can be salvaged," San Francisco Chronicle, October 16, 2004.) In the end, FDA officials clearly stated only one thing: "The problems that we found in the plant in the UK were what we call good manufacturing practice violations."

In light of all this, it seems quite likely there was no evidence of any flaw in the vaccines Chiron was prepared for release to the U.S. market-just official objections to "manufacturing practices." Indeed, Chiron officials stated clearly after their license suspension that all vaccine slotted for release had been tested and found "safe." In the words of the company chairman: "I think this [license suspension] reflects a regulatory philosophy that "focuses more on `system and process' and less on `the end product.'" (Denise Gellene and Melissa Healy, "Anticipated Supply of Flu Vaccine for U.S. Is Abruptly Cut in Half," Los Angeles Times, October 6, 2004.)

Unfortunately, as it stands today, U.S. "regulatory hurdles" (not to mention the ever-present threat of protectionism) make it difficult for drugs and vaccines to enter the U.S. from abroad. ("Flu, that was close," The Economist, October 21, 2004.) Even in the midst of this year's crisis, when vaccine makers in Canada and Germany offered to help supply the strapped U.S. market, American health officials were "doubtful" any newly offered vaccine could get FDA approval in time. This despite the fact the CDC believes that for every one million elderly people vaccinated against flu, 900 deaths and 1,300 hospitalizations are prevented.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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SHEER IDIOCY FINALLY COMING UNDER ATTACK

Truck drivers can spend only 11 consecutive hours on the road legally, with a 60-hour-per-week maximum. Airline pilots can fly only eight hours in a 24-hour period, and no more than 30 hours per week. It's no wonder those rules exist. Exhaustion in either group invites mistakes that kill. So why is it that medical interns and residents, who hold sick people's lives in their hands, can regularly work 100-hour weeks, including 30-hour shifts?

Two new studies reported in The New England Journal of Medicine now confirm that sleep-deprived interns make substantially more serious medical mistakes when they work shifts of 24 hours or more than when they work shorter shifts. The details are eye-opening. Interns in the coronary and intensive care units of Boston's Brigham and Women's Hospital who worked 80 hours per week, including 24-hour shifts, made almost six times as many diagnostic errors and 36% more medical errors as colleagues who were limited to 16-hour shifts and 63 hours per week. The errors included sticking a tube in the wrong vein and ordering 10 times the correct dosage of a medication. Other staffers often found and corrected the mistakes before serious harm was caused, researchers said. Interns working the longer hours also were more likely to nod off on their shifts. The same results presumably would be found for residents, who work the same hours. Both are doctors in training, with residents having a year or more of experience.

Just 17 months ago, the Accrediting Committee for Graduate Medical Education (ACGME) tightened rules governing interns' and residents' hours. They are now limited to an average of 80 hours a week in any four-week period and can't work more than 24 hours straight, though six hours can be added for paperwork and classes. That results in some 100-hour-plus weeks. Simple logic - not to mention the new research - says those rules are too loose. But two powerful forces work against reason.

The first is medical tradition. Many physicians believe an onerous residency is a necessary rite of passage to expose young doctors to the real world. The attitude is, "We went through it. So should they." Very tough. Not very smart.

The second factor is cost. After seeing the studies' findings, Brigham and Women's Hospital cut interns' hours substantially. Changes so far have cost $500,000, on top of nearly $1.9 million for complying with the new ACGME rules. Expensive, but better than killing people. Medicine will never be a 9-to-5 job. But the goal is to deliver quality care, not to run a tough-man competition or cut costs so severely that patients are endangered.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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GREAT RESULT IN FLORIDA

"Lawyers and doctors carried their bitter fight over medical malpractice into the Florida Constitution. Both sides lost, and maybe the public as well. Doctors put Amendment 3 on the ballot, which limits the contingency fees that lawyers can collect on malpractice awards. Lawyers countered with two amendments of their own. Amendment 7 makes hospital and doctors' records about medical errors public. Amendment 8 requires the state to deny doctors licenses to practice if they have three medical malpractice judgments against them.

Voters on Tuesday said yes to all three -- odd choices if you listen to the rhetoric coming from both sides. According to the lawyers, Amendment 3 will discourage them from taking malpractice cases, offering no recourse to many victims of medical error. And according to doctors, Amendments 7 and 8 will accelerate what they say is an exodus of doctors from the state and from high-risk specialties.

We're not sure what message voters were trying to send, if any. It could be that they believe that both lawyers and doctors are part of the complex malpractice problem. Or it could simply be that voters -- who approved all eight amendments on the ballot -- were in an agreeable mood.

We're also not sure who will lose the most from passage of these amendments. Lawyers will be hit in the pocketbook, hard. Amendment 3 will cost a lawyer $250,000 in a million-dollar malpractice verdict.

But Amendment 8, with its Draconian professional death penalty, will encourage doctors to settle lawsuits rather than risk losing their ability to practice in the state. In fact, a part of the problem with the amendment, other than its inflexibility, is that it only counts trial verdicts, administrative rulings and decisions of binding arbitration. The most egregious cases of malpractice are often settled privately."

The only one I am a bit dubious about is "three strikes and you're out" against doctors. It's a good law in theory but litigation madness could make it bad in fact. On the other hand, it may make courts a lot more cautious about approving frivolous lawsuits if it means the State will be losing lots of its doctors

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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DEREGULATION THE ANSWER TO SPIRALLING HEALTH CARE COSTS

"The soaring cost of health care has become one of this nation's most pressing public issues. Politicians and pundits regularly talk of new programs and changes in law that could address this problem, and some have even discussed the implementation of a socialized health care system. Unfortunately, there is little discussion of one policy response that would significantly lower health care costs: doing away with outmoded and questionable health care regulations that raise prices but produce little if any benefit. As one health economics textbook puts it, "the U.S. health care system, while among the most `market oriented' in the industrialized world, remains the most intensively regulated sector of the U.S. economy." Regulation is taxation by another name. Instead of taxing private resources to fund government spending, regulation directs how private individuals use those resources. The costs of regulation are the benefits we would derive from alternative uses of those resources.

To determine the costs of health care regulation and ascertain whether those costs are offset by benefits, my colleagues at Duke University and I have spent several years evaluating the economic literature to estimate the net burden that health care regulations place on the U.S. economy. Our preliminary results are published today (10/4) by the Cato Institute. We examined five areas of government regulation that apply solely to the health care sector: regulation of health facilities (hospitals, nursing homes, etc.), health professionals (doctors, nurses and many other providers), health insurance (pricing restrictions, benefit mandates, portability requirements, etc.), pharmaceuticals and medical devices, as well as the medical liability system.

Our review of the literature on 47 different types of health care regulation suggests their total cost was roughly $339.1 billion in 2002. After subtracting the $170.1 billion in benefits that we calculate those regulations provide, we find that health care regulation places a net burden on society of $169.1 billion annually. Broken down by component, the medical liability system appears to impose the greatest net cost, at $80.6 billion per year. We arrive at that estimate after accounting for the medical liability system's benefits: averted mortality and disability, plus the compensation paid to injured patients.

We estimate that Food and Drug Administration regulation of pharmaceuticals and medical devices imposes a net annual cost of $41.8 billion. The lion's share of that cost represents the value society places on the net number of lives that are lost while waiting for better pharmaceuticals to be approved, after subtracting the number of lives saved by FDA regulation.

In 2002, regulation of hospitals and other health facilities cost an estimated $25.1 billion. The two greatest costs in this category are hospital accreditation and licensure requirements (net cost $8.6 billion), and laws that tax hospitals and redistribute the revenues to those providing above-average amounts of uncompensated care (net cost $5.2 billion). Health insurance regulations cost Americans $14.4 billion annually, while regulation of doctors and other health professionals cost $7.1 billion annually.

This leads to some troubling realizations. Over the next 10 years, the net cost of health care regulations will be some three times more than the $534 billion cost of the new Medicare prescription drug benefit. By increasing the cost of medical care, regulation increases the cost of health insurance. We estimate health care regulation makes coverage unaffordable for approximately 7.5 million Americans.

Though one might suppose this added burden ensures better medical care, it is likely that it costs lives instead. Several studies have established a tradeoff between income and mortality: As income rises, mortality falls because people are able to purchase more health and safety. We estimate that by making Americans $169.1 billion poorer each year, health care regulations induce approximately 22,205 deaths annually. That is over 4,000 more deaths than the Institutes of Medicine attribute to uninsurance.

If we are to get the most out of our health care sector, policymakers must address the high cost of health care regulation. In terms of priorities, it would appear that medical liability reform offers the most promising target for regulatory cost savings, followed by deregulation of the FDA, health insurance (e.g., mandated health benefits) and health facilities (e.g., accreditation and licensure). What should be clear from even this rough picture of the health care regulatory landscape is that the potential savings from deregulation are far too large to be ignored.



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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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Superbug now puts Aussie public hospitals on alert


A deadly hospital superbug, responsible for shutting down wards and operating theatres throughout Britain, has alarmed Australian health authorities. NSW hospitals are testing different strategies to combat MRSA (methicillin-resistant staphylococcus aureus), a virulent form of golden staph. However, a NSW Health spokeswoman said that the strategies had not had long-term success. "Globally, health-care-associated MRSA continues to be a problem," she said. "MRSA places a significant microbiological, financial and human burden on health systems and recipients of health care." The spokeswoman said the health department's most recent figures showed that, between January and June last year, 399 cases of MRSA were reported in NSW. "These cases demonstrate that people who receive in-patient care in a hospital have some risk," she said.

About 7000 Australians die from hospital bugs, including MRSA, each year and 160,000 Australians are struck down with infections. The rate of antibiotic-resistant infections is also increasing. The first case of MRSA in Australia was recorded in 1977. In Britain, it is estimated 5000 people die from MRSA-related problems each year, while the number of MRSA cases has increased by 600 per cent in the past decade. Britain's new chief nursing officer has identified the superbug as a top priority as infection rates continue to climb.

The NSW Health spokeswoman said: "Information such as that from the UK provides a unique opportunity for Australian health professionals to re-examine their current MRSA prevention strategies. "Global hospital-associated infection trends are often early indicators of situations that may subsequently arise in NSW."...

MRSA can also cause serious problems when people have weakened immune systems. Also, patients who undergo surgery are three times more likely to pick up MRSA along with people who have been admitted to hospital many times and received care from many different health-care workers. MRSA victims may suffer from boils, abscesses, septic wounds, heart-valve problems, toxic shock syndrome and death.

The strategies adopted by NSW Health to fight MRSA include educating staff about the importance of washing their hands and designing hospital rooms to reduce the chance of the superbug being transmitted. ["DUH"!]

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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