WHAT APPALLING NONSENSE: A NEW LAYER OF BUREAUCRACY
And fitting it through the privacy regulations will impose a huge bureaucratic load
President Bush returned to the state that helped seal his re-election victory to pitch his second-term health agenda, urging greater use of computerized medical records and electronic prescriptions. "It can save money and save lives," Bush said Thursday at a forum at the Cleveland Clinic. He said medical record-keeping, where most prescriptions and many medical documents are still handwritten, lags that of other industries.
In Washington, the Department of Health and Human Services announced steps to incorporate electronic prescribing into the new Medicare prescription drug program that begins in January 2006. The regulations will require that e-prescribing is made available to participating seniors, White House spokesman Trent Duffy said....
"Most industries in America have used information technology to make their businesses more cost effective, more efficient and more productive - and the truth of the matter is health care hasn't," Bush said.
In the budget he will send Congress next month, Bush will propose spending $125 million to test computerization of health records, more than twice what is being spent in the budget year that ends Sept. 30. Bush also said ways must be found to safeguard medical records to protect against "people prying into them."
Bush's pledge to do more to encourage wider use of electronic medical record-keeping - and allow pharmacies, hospitals, doctors' officers and insurers to share information - was praised as a good starting point by the health care industry. "There has been a huge amount of pressure from across the health care field to have the federal government take an active role in the development of electronic health care records," said Scott Wallace, head of the National Alliance for Health Information Technology.
The Cleveland Clinic has been helping the government develop standards for medical computerization and Bush heard from doctors who showed him some of the technology and then joined him on the stage. "Very impressive," Bush said.
More here
***************************
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.
***************************
Monday, January 31, 2005
Sunday, January 30, 2005
THE UNINSURED ARE A SMALLER PROBLEM THAN IT SEEMS
Forty million people uninsured. Or is it fifty? Both numbers have the virtues of being both memorable and round. However, when lying with statistics, precision also matters. The currently fashionable number of people without medical insurance, beloved of politicians, talking heads, social critics, whining journalists, state medicine advocates, and everybody else with an agenda, is currently 45 million in 2003, a rise of 1.4 million over 2002, and precisely 15.6 percent of the population. And, so they tell us, this number can only increase as escalating premiums (now rising faster than at any time since 1991) drive more employers out of the market entirely.
And everybody's wondering, "Why can't a country that presumes to take care of the world, take care of itself?" The answer is, "We can." But understanding the answer requires a basic understanding of the obvious. And that, neither the chattering classes nor the government nor the insurance companies wants you to do. To get at the problem, it's necessary first to "disaggregate" the pool of the uninsured, figure out who and what they really are and whether or not they're really quite so uninsured.
First of all, everybody is "insured" in the sense that you cannot be legally turned away from an emergency room (assuming you can find one) in life-threatening situations. Also, Medicaid insures 13.3 million poor Americans; various state programs provide some sort of coverage for millions more. So, by and large, if people aren't insured, there must be other factors at work.....
The result is that, today, the health care market is not for health care, or between doctors and patients, at all. It's between large employers and large insurers, negotiating large blocks of employee policies. But even this wouldn't be so bad, were the system not a bizarre caricature of capitalism, hard-wired to keep costing more. Today's health insurance isn't really insurance by definition, the pooling of risk against unlikely but predictable events at all. It's the payment of a flat fee for potentially limitless services. Obviously, beyond a certain point, the only way insurance companies and HMOs can make money is to raise premiums, reduce care, or both. That point was crossed long ago.
So what to do? First, recognize that the problem of the uninsured is much smaller and more manageable than the inflated numbers suggest. You don't wreck the health care system for tens of millions in order to help a small minority. You bring them into the system. This you do by breaking the link between health care and employment(and government!), permitting groups to form for the sole purpose of buying insurance. And you regain the distinction between insurance, in this case "major medical," and purchase of service.
So what we have — de facto — is less of a crisis and more a problem that can be solved. The first step is to admit that the widely advocated 50 million uninsured is a medical myth.
More here
***************************
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.
***************************
Forty million people uninsured. Or is it fifty? Both numbers have the virtues of being both memorable and round. However, when lying with statistics, precision also matters. The currently fashionable number of people without medical insurance, beloved of politicians, talking heads, social critics, whining journalists, state medicine advocates, and everybody else with an agenda, is currently 45 million in 2003, a rise of 1.4 million over 2002, and precisely 15.6 percent of the population. And, so they tell us, this number can only increase as escalating premiums (now rising faster than at any time since 1991) drive more employers out of the market entirely.
And everybody's wondering, "Why can't a country that presumes to take care of the world, take care of itself?" The answer is, "We can." But understanding the answer requires a basic understanding of the obvious. And that, neither the chattering classes nor the government nor the insurance companies wants you to do. To get at the problem, it's necessary first to "disaggregate" the pool of the uninsured, figure out who and what they really are and whether or not they're really quite so uninsured.
First of all, everybody is "insured" in the sense that you cannot be legally turned away from an emergency room (assuming you can find one) in life-threatening situations. Also, Medicaid insures 13.3 million poor Americans; various state programs provide some sort of coverage for millions more. So, by and large, if people aren't insured, there must be other factors at work.....
The result is that, today, the health care market is not for health care, or between doctors and patients, at all. It's between large employers and large insurers, negotiating large blocks of employee policies. But even this wouldn't be so bad, were the system not a bizarre caricature of capitalism, hard-wired to keep costing more. Today's health insurance isn't really insurance by definition, the pooling of risk against unlikely but predictable events at all. It's the payment of a flat fee for potentially limitless services. Obviously, beyond a certain point, the only way insurance companies and HMOs can make money is to raise premiums, reduce care, or both. That point was crossed long ago.
So what to do? First, recognize that the problem of the uninsured is much smaller and more manageable than the inflated numbers suggest. You don't wreck the health care system for tens of millions in order to help a small minority. You bring them into the system. This you do by breaking the link between health care and employment(and government!), permitting groups to form for the sole purpose of buying insurance. And you regain the distinction between insurance, in this case "major medical," and purchase of service.
So what we have — de facto — is less of a crisis and more a problem that can be solved. The first step is to admit that the widely advocated 50 million uninsured is a medical myth.
More here
***************************
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.
***************************
Saturday, January 29, 2005
Medical lawsuit diagnosis : "When a friend told me recently he was to undergo a painful medical procedure to see if he has cancer, it reminded me of a time years ago when I faced a similar prospect. ... The first part was uncomfortable but not painful or with any great infection risk. After a young doctor had put me through this first part, an older specialist took over and examined the results -- and decided against the second part of the test. My wife asked me if that meant I did not have cancer. My answer was, 'No! What it means is that the doctor weighed the alternatives and decided that the chance that I had cancer was sufficiently small, and the danger of infection from the test itself was sufficiently large, that the best choice was not to go any further.' ... Since this was many years ago, apparently the doctor chose correctly. But how many doctors feel free to make such choices in today's legal climate?"
***************************
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.
***************************
***************************
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.
***************************
Friday, January 28, 2005
DOCTORS OPTING OUT
'It was slow water torture," says Paul Ryack. That's how the 63-year-old board-certified internist describes his working life just a few years ago. With a few thousand patients, many of them elderly, he could barely find time to listen to halting explanations of their immediate complaints--let alone talk about the importance of lowering blood pressure or losing weight--in the 15 or so minutes he could allot to each. "I was unable to make the time to sit with patients, to get to know them, to help with preventive activities that we need and want," says Ryack, who practices in Santa Barbara, Calif. His costs were so high, and payment per patient so low, that taking even another dozen minutes wasn't possible. "You'd go broke," he says. The end result: a creeping sense of burnout.
Many doctors around the country are similarly frustrated. A 2001 California survey of physicians found that 75 percent of respondents grew less satisfied with practicing medicine over the previous five years. A nationwide survey by the Henry J. Kaiser Family Foundation found that 87 percent of doctors say the overall morale of the profession has gone down in the past few years, and nearly 60 percent said their own morale had declined.
Chat with your own doctor--on the off chance she has time for a conversation--and she is likely to echo those sentiments. "The practice of medicine does not offer the kinds of rewards for what you have to put into it," says Carl Getto, associate dean for hospital affairs at the University of Wisconsin Medical School, who oversees a staff of more than 1,000 physicians.
The hassle factors. Those rewards--including satisfying relationships with patients, autonomy, high status, and comparatively high pay--are increasingly outweighed by the reality of a 21st-century U.S. medical practice. In their place: reams of time-consuming paperwork that is out of proportion to time spent caring for patients, declining reimbursements from insurers, a loss of autonomy from managed care, and fear of malpractice lawsuits.
For patients, the implications of these changes are huge. Some doctors are retiring or cutting back their hours. That means fewer doctors are available. Others are opting for specialties, such as radiology, with less demanding schedules. Many are cutting out certain insurers, and thus cutting out patients who use those insurers. A handful are deliberately restructuring their practices to see fewer--and richer--patients. "It's like a casino," says Doug Farrago, a family medicine physician in Auburn, Maine, and publisher of Placebo Journal , a publication filled with the dark ironies of current medicine. "Older docs can cash in their chips, and younger ones are looking for a different game," he says. In a country that will demand more and more from its healthcare system as the population ages, this is only going to get worse--and your doctor's problems may become yours.
It's not surprising that the doctors who are most upset about how things are now are the 50- and 60-year-olds who remember how it used to be: You made medicine your top priority and reaped emotional and financial rewards. "It was the golden age of medicine when they came in--it was fee for service, and you did what you thought was the best thing for the patient," says Phil Miller with Merritt, Hawkins & Associates, an Irving, Texas-based physician search firm. But the rise of managed care and large insurers, for better or for worse, has changed things. Insurance companies may not cover the drug a doctor prefers to prescribe for a given condition. Mountains of paperwork are required to gain approval for consults or outside services. Then there is the threat of malpractice suits. Doctors in so-called crisis states have stopped delivering babies or staged walkouts in the face of climbing insurance rates; even where insurance is more affordable, doctors fear being sued. That takes a toll.
More here
***************************
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.
***************************
'It was slow water torture," says Paul Ryack. That's how the 63-year-old board-certified internist describes his working life just a few years ago. With a few thousand patients, many of them elderly, he could barely find time to listen to halting explanations of their immediate complaints--let alone talk about the importance of lowering blood pressure or losing weight--in the 15 or so minutes he could allot to each. "I was unable to make the time to sit with patients, to get to know them, to help with preventive activities that we need and want," says Ryack, who practices in Santa Barbara, Calif. His costs were so high, and payment per patient so low, that taking even another dozen minutes wasn't possible. "You'd go broke," he says. The end result: a creeping sense of burnout.
Many doctors around the country are similarly frustrated. A 2001 California survey of physicians found that 75 percent of respondents grew less satisfied with practicing medicine over the previous five years. A nationwide survey by the Henry J. Kaiser Family Foundation found that 87 percent of doctors say the overall morale of the profession has gone down in the past few years, and nearly 60 percent said their own morale had declined.
Chat with your own doctor--on the off chance she has time for a conversation--and she is likely to echo those sentiments. "The practice of medicine does not offer the kinds of rewards for what you have to put into it," says Carl Getto, associate dean for hospital affairs at the University of Wisconsin Medical School, who oversees a staff of more than 1,000 physicians.
The hassle factors. Those rewards--including satisfying relationships with patients, autonomy, high status, and comparatively high pay--are increasingly outweighed by the reality of a 21st-century U.S. medical practice. In their place: reams of time-consuming paperwork that is out of proportion to time spent caring for patients, declining reimbursements from insurers, a loss of autonomy from managed care, and fear of malpractice lawsuits.
For patients, the implications of these changes are huge. Some doctors are retiring or cutting back their hours. That means fewer doctors are available. Others are opting for specialties, such as radiology, with less demanding schedules. Many are cutting out certain insurers, and thus cutting out patients who use those insurers. A handful are deliberately restructuring their practices to see fewer--and richer--patients. "It's like a casino," says Doug Farrago, a family medicine physician in Auburn, Maine, and publisher of Placebo Journal , a publication filled with the dark ironies of current medicine. "Older docs can cash in their chips, and younger ones are looking for a different game," he says. In a country that will demand more and more from its healthcare system as the population ages, this is only going to get worse--and your doctor's problems may become yours.
It's not surprising that the doctors who are most upset about how things are now are the 50- and 60-year-olds who remember how it used to be: You made medicine your top priority and reaped emotional and financial rewards. "It was the golden age of medicine when they came in--it was fee for service, and you did what you thought was the best thing for the patient," says Phil Miller with Merritt, Hawkins & Associates, an Irving, Texas-based physician search firm. But the rise of managed care and large insurers, for better or for worse, has changed things. Insurance companies may not cover the drug a doctor prefers to prescribe for a given condition. Mountains of paperwork are required to gain approval for consults or outside services. Then there is the threat of malpractice suits. Doctors in so-called crisis states have stopped delivering babies or staged walkouts in the face of climbing insurance rates; even where insurance is more affordable, doctors fear being sued. That takes a toll.
More here
***************************
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.
***************************
Thursday, January 27, 2005
THE CALIFORNIA MESS
Democrat damage plain to see
"Will California ever escape the pall created by the misdeeds and miscalculations of our former governor? As if it wasn't enough that Gray Davis left us with the highest electricity bills in the nation, spiraling workers' compensation and health insurance costs, and budget deficits as far as the eye can see, a protest lodged by California's nurses at the state Capitol building last week is a reminder that our former governor did his best to destroy this state's hospitals as well.
To refresh everyone's memory, on Oct. 10, 1999, with the signing of AB 394, California became the first state in the union with minimum requirements for nurse-to-patient ratios in its hospitals. Though initially meant to go into effect Jan. 1, 2001, the bill's author, Assemblywoman Sheila Kuehl, D-Santa Monica, agreed to have the phase-in start Jan. 1, 2002, with full compliance mandated by Jan. 1 of this year. Surveying the wreckage that has already been wrought by this bill, and foreseeing further damage to California's hospitals if full implementation was allowed to proceed, Gov. Arnold Schwarzenegger in November issued an executive decree delaying these new standards until 2008, much to the chagrin of the California Nurses Association.
Why did our governor intercede? Well, because California leads the nation in hospital closures, and survey after survey suggests that the No. 1 reason is their inability to be profitable. Hospital administrators say any further requirement to increase payrolls at this time would add to their burgeoning red ink. And they note that given the circumstances in the nursing profession, even if hospitals had the money to add to their staffs, there just aren't enough employable nurses out there to meet the edicts of Kuehl's statute. "In the past two years, our cost of providing quality services increased 23 percent, but payments for those services increased only 4 percent," reported Jan Emerson of the California Healthcare Association. "Hospitals in California have reached a tipping point." As for the nursing shortage, she said, "Conceptually, you'd think more nurses means better patient care, but if you do not have enough nurses in the work force, you run into the exact opposite of what you intended. There are not enough nurses in California we have the worst nursing shortage in the country."
Given this backdrop, it's baffling that any state leader would push for a staffing-ratio law that would cost hospitals an estimated $1 billion per year in salaries and benefits. This is money that our cash- strapped hospitals just don't have. They weren't much better off in 1999 when Davis signed the bill. In fact, an article that appeared in Nurse Week in May of that year - "Closing Time: California leads nation in hospital closures" - chronicled the problems. And even if it is somehow possible that Davis wasn't aware of the financial problems facing the hospital industry when he signed this legislation, it's all but impossible to assume that he was still in the dark by the time the law went into effect.
That's because in May 2001 - 19 months after the bill was signed and seven months before it kicked in - CaliforniaAttorney General Bill Lockyer issued a policy briefing titled, "Financial Problems Most Common Reason Cited for Recent Hospital Closings." How could Gray Davis embrace this bill? How could he do this to us? It's hard to fathom the scope of his mismanagement.
More here
***************************
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.
***************************
Democrat damage plain to see
"Will California ever escape the pall created by the misdeeds and miscalculations of our former governor? As if it wasn't enough that Gray Davis left us with the highest electricity bills in the nation, spiraling workers' compensation and health insurance costs, and budget deficits as far as the eye can see, a protest lodged by California's nurses at the state Capitol building last week is a reminder that our former governor did his best to destroy this state's hospitals as well.
To refresh everyone's memory, on Oct. 10, 1999, with the signing of AB 394, California became the first state in the union with minimum requirements for nurse-to-patient ratios in its hospitals. Though initially meant to go into effect Jan. 1, 2001, the bill's author, Assemblywoman Sheila Kuehl, D-Santa Monica, agreed to have the phase-in start Jan. 1, 2002, with full compliance mandated by Jan. 1 of this year. Surveying the wreckage that has already been wrought by this bill, and foreseeing further damage to California's hospitals if full implementation was allowed to proceed, Gov. Arnold Schwarzenegger in November issued an executive decree delaying these new standards until 2008, much to the chagrin of the California Nurses Association.
Why did our governor intercede? Well, because California leads the nation in hospital closures, and survey after survey suggests that the No. 1 reason is their inability to be profitable. Hospital administrators say any further requirement to increase payrolls at this time would add to their burgeoning red ink. And they note that given the circumstances in the nursing profession, even if hospitals had the money to add to their staffs, there just aren't enough employable nurses out there to meet the edicts of Kuehl's statute. "In the past two years, our cost of providing quality services increased 23 percent, but payments for those services increased only 4 percent," reported Jan Emerson of the California Healthcare Association. "Hospitals in California have reached a tipping point." As for the nursing shortage, she said, "Conceptually, you'd think more nurses means better patient care, but if you do not have enough nurses in the work force, you run into the exact opposite of what you intended. There are not enough nurses in California we have the worst nursing shortage in the country."
Given this backdrop, it's baffling that any state leader would push for a staffing-ratio law that would cost hospitals an estimated $1 billion per year in salaries and benefits. This is money that our cash- strapped hospitals just don't have. They weren't much better off in 1999 when Davis signed the bill. In fact, an article that appeared in Nurse Week in May of that year - "Closing Time: California leads nation in hospital closures" - chronicled the problems. And even if it is somehow possible that Davis wasn't aware of the financial problems facing the hospital industry when he signed this legislation, it's all but impossible to assume that he was still in the dark by the time the law went into effect.
That's because in May 2001 - 19 months after the bill was signed and seven months before it kicked in - CaliforniaAttorney General Bill Lockyer issued a policy briefing titled, "Financial Problems Most Common Reason Cited for Recent Hospital Closings." How could Gray Davis embrace this bill? How could he do this to us? It's hard to fathom the scope of his mismanagement.
More here
***************************
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.
***************************
Wednesday, January 26, 2005
STUPID HATRED OF DRUG COMPANIES
The fact that volume matters more than price means the emphasis of the prescription-drug debate is all wrong. We've been focused on the drug manufacturers. But decisions about prevalence, therapeutic mix, and intensity aren't made by the producers of drugs. They're made by the consumers of drugs. This is why increasing numbers of employers have in recent years made use of what are known as Pharmacy Benefit Managers, or PBMs. The PBMs draw up drug formularies--lists of preferred medications. They analyze clinical trials data to find out which drugs are the most cost-effective. In a category in which there are many equivalent options, they bargain with drug firms, offering to deliver all their business to one company in exchange for a discount. They build incentives into prescription drug plans to encourage intelligent patient behavior.
There is no mention of these successes in The Truth About the Drug Companies, [a new book by Dr. Marcia Angell, a physician and former editor of The New England Journal of Medicine]. Though much of the book is concerned with the problem of such costs, PBMs, the principal tool that private health care plans use to control rising drug costs, are dismissed in a few paragraphs.
Angell's focus, instead, is on the behavior of the pharmaceutical industry. An entire chapter, for instance, centers on the fact that the majority of drugs produced by the pharmaceutical industry are either minor variations or duplicates of drugs already on the market. Merck pioneered the statin category with Mevacor. Now we have Pfizer's Lipitor, Bristol-Myers Squibb's Pravachol, Novartis's Lescol, AstraZeneca's Crestor, and Merck's second entrant, Zocor--all of which do pretty much the same thing.
Angell thinks these "me-too" drugs are a waste of time and money, and that the industry should devote its resources to the development of truly innovative drugs instead. In one sense, she's right: We need a cure for Alzheimer's much more than we need a fourth or fifth statin. Yet me-too drugs are what drive prices down. The presence of more than one drug in a given category gives PBMs their leverage when it comes time to bargain with pharmaceutical companies.
Angell appears to understand none of this. "Medicare will have to pay whatever drug companies charge," she writes, bafflingly, "and it will have to cover expensive me-too drugs as well as more cost-effective ones."
The core problem in bringing drug spending under control, in other words, is persuading the users and buyers and prescribers of drugs to behave rationally, and the reason we're in the mess we're in is that, so far, we simply haven't done a very good job of that. "The sensitivity on the part of employers is turned up pretty high on this," Robert Nease, who heads applied decision analysis for one of the nation's largest PBMs, the St. Louis-based Express Scripts, says. "This is not an issue about how to cut costs without affecting quality. We know how to do that. We know that generics work as well as brands. We know that there are proven step therapies. The problem is that we haven't communicated to members that we aren't cheating them."
Among the costliest drug categories, for instance, is the new class of anti-inflammatory drugs known as cox-2 inhibitors. The leading brand, Celebrex, has been heavily advertised, and many patients suffering from arthritis or similar conditions ask for Celebrex when they see their physician, believing that a cox-2 inhibitor is a superior alternative to the previous generation of nonsteroidal anti-inflammatories (known as NSAIDs), such as ibuprofen. (The second leading cox-2 inhibitor, Merck's Vioxx, has just been taken off the market because of links to an elevated risk of heart attacks and strokes.) The clinical evidence, however, suggests that the cox-2s aren't any better at relieving pain than the NSAIDs. It's just that in a very select group of patients they have a lower risk of side effects like ulcers or bleeding. "There are patients at high risk--people who have or have had an ulcer in the past, who are on blood-thinning medication, or who are of an advanced age," Nease says. "That specific group you would likely start immediately on a cox-2." Anyone else, he says, should really be started on a generic NSAID first.
"The savings here are enormous," he went on. "The cox-2s are between a hundred and two hundred dollars a month, and the generic NSAIDs are pennies a day--and these are drugs that people take day in, day out, for years and years." But that kind of change can't be implemented unilaterally: The health plan and the employer have to explain to employees that in their case a brand-new, hundred-dollar drug may not be any better than an old, one-dollar drug.
There is a second book out this fall on the prescription drug crisis, titled Overdosed America (HarperCollins; $24.95), by John Abramson, who teaches at Harvard Medical School. At one point, Abramson discusses a study he found in a medical journal, concluding that the statin Pravachol lowered the risk of stroke in patients with coronary heart disease by 19 percent. That sounds like a significant finding, but, as Abramson shows, it isn't. In the six years of the study, 4.5 percent of those taking a placebo had a stroke versus 3.7 percent of those on Pravachol. In the real world, that means that for every thousand people you put on Pravachol you prevent one stroke which, given how much the drug costs, comes to at least $1.2 million per stroke prevented.
Here is a classic case of the kind of thing that bedevils the American health system: dubious findings that, without careful evaluation, have the potential to drive up costs. But whose fault is it? It's hard to blame Pravachol's manufacturer, Bristol-Myers Squibb. The study's principal objective was to look at Pravachol's effectiveness in fighting heart attacks; the company was simply using that patient population to make a secondary observation about strokes. In any case, Bristol-Myers didn't write up the results. A group of cardiologists from New Zealand and Australia did, and they hardly tried to hide Pravachol's shortcomings in women and older people. All those data are presented in a large chart on the study's third page.
In the end, the fight to keep drug spending under control is principally a matter of information, of proper communication among everyone who prescribes and pays for and ultimately uses drugs about what works and what doesn't, and what makes economic sense and what doesn't, and medical journals play a critical role in this process. As Abramson writes: "When I finished analyzing the article and understood that the title didn't tell the whole story, that the findings were not statistically significant, and that Pravachol appeared to cause more strokes in the population at greater risk, it felt like a violation of the trust that doctors (including me) place in the research published in respected medical journals."
The journal in which the Pravachol article appeared, incidentally, was The New England Journal of Medicine. And its editor at the time the paper was accepted for publication? Dr. Marcia Angell. Physician, heal thyself.
More here
***************************
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.
***************************
The fact that volume matters more than price means the emphasis of the prescription-drug debate is all wrong. We've been focused on the drug manufacturers. But decisions about prevalence, therapeutic mix, and intensity aren't made by the producers of drugs. They're made by the consumers of drugs. This is why increasing numbers of employers have in recent years made use of what are known as Pharmacy Benefit Managers, or PBMs. The PBMs draw up drug formularies--lists of preferred medications. They analyze clinical trials data to find out which drugs are the most cost-effective. In a category in which there are many equivalent options, they bargain with drug firms, offering to deliver all their business to one company in exchange for a discount. They build incentives into prescription drug plans to encourage intelligent patient behavior.
There is no mention of these successes in The Truth About the Drug Companies, [a new book by Dr. Marcia Angell, a physician and former editor of The New England Journal of Medicine]. Though much of the book is concerned with the problem of such costs, PBMs, the principal tool that private health care plans use to control rising drug costs, are dismissed in a few paragraphs.
Angell's focus, instead, is on the behavior of the pharmaceutical industry. An entire chapter, for instance, centers on the fact that the majority of drugs produced by the pharmaceutical industry are either minor variations or duplicates of drugs already on the market. Merck pioneered the statin category with Mevacor. Now we have Pfizer's Lipitor, Bristol-Myers Squibb's Pravachol, Novartis's Lescol, AstraZeneca's Crestor, and Merck's second entrant, Zocor--all of which do pretty much the same thing.
Angell thinks these "me-too" drugs are a waste of time and money, and that the industry should devote its resources to the development of truly innovative drugs instead. In one sense, she's right: We need a cure for Alzheimer's much more than we need a fourth or fifth statin. Yet me-too drugs are what drive prices down. The presence of more than one drug in a given category gives PBMs their leverage when it comes time to bargain with pharmaceutical companies.
Angell appears to understand none of this. "Medicare will have to pay whatever drug companies charge," she writes, bafflingly, "and it will have to cover expensive me-too drugs as well as more cost-effective ones."
The core problem in bringing drug spending under control, in other words, is persuading the users and buyers and prescribers of drugs to behave rationally, and the reason we're in the mess we're in is that, so far, we simply haven't done a very good job of that. "The sensitivity on the part of employers is turned up pretty high on this," Robert Nease, who heads applied decision analysis for one of the nation's largest PBMs, the St. Louis-based Express Scripts, says. "This is not an issue about how to cut costs without affecting quality. We know how to do that. We know that generics work as well as brands. We know that there are proven step therapies. The problem is that we haven't communicated to members that we aren't cheating them."
Among the costliest drug categories, for instance, is the new class of anti-inflammatory drugs known as cox-2 inhibitors. The leading brand, Celebrex, has been heavily advertised, and many patients suffering from arthritis or similar conditions ask for Celebrex when they see their physician, believing that a cox-2 inhibitor is a superior alternative to the previous generation of nonsteroidal anti-inflammatories (known as NSAIDs), such as ibuprofen. (The second leading cox-2 inhibitor, Merck's Vioxx, has just been taken off the market because of links to an elevated risk of heart attacks and strokes.) The clinical evidence, however, suggests that the cox-2s aren't any better at relieving pain than the NSAIDs. It's just that in a very select group of patients they have a lower risk of side effects like ulcers or bleeding. "There are patients at high risk--people who have or have had an ulcer in the past, who are on blood-thinning medication, or who are of an advanced age," Nease says. "That specific group you would likely start immediately on a cox-2." Anyone else, he says, should really be started on a generic NSAID first.
"The savings here are enormous," he went on. "The cox-2s are between a hundred and two hundred dollars a month, and the generic NSAIDs are pennies a day--and these are drugs that people take day in, day out, for years and years." But that kind of change can't be implemented unilaterally: The health plan and the employer have to explain to employees that in their case a brand-new, hundred-dollar drug may not be any better than an old, one-dollar drug.
There is a second book out this fall on the prescription drug crisis, titled Overdosed America (HarperCollins; $24.95), by John Abramson, who teaches at Harvard Medical School. At one point, Abramson discusses a study he found in a medical journal, concluding that the statin Pravachol lowered the risk of stroke in patients with coronary heart disease by 19 percent. That sounds like a significant finding, but, as Abramson shows, it isn't. In the six years of the study, 4.5 percent of those taking a placebo had a stroke versus 3.7 percent of those on Pravachol. In the real world, that means that for every thousand people you put on Pravachol you prevent one stroke which, given how much the drug costs, comes to at least $1.2 million per stroke prevented.
Here is a classic case of the kind of thing that bedevils the American health system: dubious findings that, without careful evaluation, have the potential to drive up costs. But whose fault is it? It's hard to blame Pravachol's manufacturer, Bristol-Myers Squibb. The study's principal objective was to look at Pravachol's effectiveness in fighting heart attacks; the company was simply using that patient population to make a secondary observation about strokes. In any case, Bristol-Myers didn't write up the results. A group of cardiologists from New Zealand and Australia did, and they hardly tried to hide Pravachol's shortcomings in women and older people. All those data are presented in a large chart on the study's third page.
In the end, the fight to keep drug spending under control is principally a matter of information, of proper communication among everyone who prescribes and pays for and ultimately uses drugs about what works and what doesn't, and what makes economic sense and what doesn't, and medical journals play a critical role in this process. As Abramson writes: "When I finished analyzing the article and understood that the title didn't tell the whole story, that the findings were not statistically significant, and that Pravachol appeared to cause more strokes in the population at greater risk, it felt like a violation of the trust that doctors (including me) place in the research published in respected medical journals."
The journal in which the Pravachol article appeared, incidentally, was The New England Journal of Medicine. And its editor at the time the paper was accepted for publication? Dr. Marcia Angell. Physician, heal thyself.
More here
***************************
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.
***************************
Tuesday, January 25, 2005
FDA PLEASES NO-ONE
The FDA, considered the gold standard in drug safety review, lost its luster in 2004 after a string of high-profile drug controversies. The growing crisis ofconfidence could lead to reforms at the FDA and stricter rules on pharmaceutical firms in 2005. The year began with a firestorm, and then things got hotter. In its worst period in recent memory, the Food and Drug Administration spent 2004 reeling from charges that it allows companies to keep dangerous drugs on the market, lets them hide bad data, relies on a firm's word alone to fix manufacturing flaws, and stifles safety alerts by its own scientists. After a series of high-profile drug controversies, government investigations and the stunning withdrawal of the blockbuster drug Vioxx, critics are charging that the agency is dangerously compromised by industry influence.
True or not, the FDA's alleged weaknesses are becoming the industry's woes. The crisis of confidence over the agency's performance is so deep that consumers are hearing experts openly debate: Is the U.S. drug supply safe? The doubts have tarnished some of the biggest pharmaceutical firms and the most widely sold drugs on the market: household names like Paxil, Zoloft and Crestor. Nearly half the nation's flu vaccine supply, from Chiron's Fluvirin, was found to be contaminated. The profitable arthritis drug Vioxx was suddenly withdrawn as a heart-attack risk, amid charges that the FDA should have yanked it years ago. Now its chemical cousin, Pfizer's arthritis pain drug Celebrex, has also been linked to heart failure at high doses. And just last week, the FDA warned users of the painkiller naproxen, sold over the counter under the brand name Aleve, that the drug might increase a person's risk of having a heart attack or stroke.
The FDA's troubles began with an uproar in February over the agency's refusal to air a staff scientist's conclusion that certain anti-depressants, like Paxil, could increase the risk of suicide in children. It culminated in November, when one of the FDA's top safety staffers, Dr. David Graham, baldly declared at a U.S. Senate hearing that the agency is incapable of protecting the public. A government survey of FDA scientists showed that such doubts are pervasive, with nearly a fifth saying they had faced pressure to support a drug approval despite safety concerns.
In the perceived regulatory vacuum, a host of other players has stepped in to dog the industry: federal and state prosecutors, Congress, the Securities and Exchange Commission, eminent scientific journal editors, drug salespeople-turned whistle-blower, as well as patients, shareholders and their lawyers. For some firms, the impact has been severe:
-- Vioxx manufacturer Merck faces an international deluge of personal injury suits that could cost billions. Since Vioxx's withdrawal, Merck has lost $28.1 billion in market capitalization and is cutting 5,100 jobs.
-- Pfizer forked over $430 million to settle prosecutors' charges of marketing violations that the FDA is supposed to police. Since Celebrex was linked to heart attacks, Pfizer dropped about $21.9 billion in market capitalization.
-- Chiron of Emeryville may lose its solid share of the U.S. flu vaccine market due to lapses in the sterility of its manufacturing processes that the FDA is suspected of failing to correct in time. Chiron's market cap is down about $2.48 billion.
In the year ahead, Congress will consider proposals to revamp the FDA and toughen the rules for pharmaceutical firms. One fierce industry critic says that would not only be good for patients, it could also be good for business. Larry Sasich of the watchdog group Public Citizen said companies stand to lose the worldwide commercial advantage conferred by FDA approval if the agency loses its image as the gold standard of safety review. "We're getting to a point right now where we might start to see consumers losing confidence in the FDA,'' Sasich said. "It would be in the companies' best interests to see the standards raised.''
In the coming year, Congress may consider proposals to split the FDA's safety surveillance unit into a fully independent division. Critics charge that the concerns of safety experts like Graham are suppressed by the better- staffed drug approval units that benefit most from industry fees. The FDA denies those claims but has recently taken steps to give dissenters a greater voice.
Dr. Eric Topol, a prominent cardiologist who raised early alarms about Vioxx, said Congress hasn't given the FDA new powers to keep up with changing times. "The FDA doesn't have any authority to disseminate data that (it has)," he said, because information submitted in the drug approval process is considered proprietary. On the other hand, Topol said, the industry now has free rein to tout its drugs in direct-to-consumer ads. Patients then clamor for the new drugs, but doctors don't have complete information about them, he said.
Arthur Levin, director of the Center for Medical Consumers, said patients can help fix the system if they stop expecting drugs to be silver bullets that cure ailments without causing side effects.... Rosen said the industry group has yet to take a position on proposals to change the FDA. But he agreed with Levin that expectations should be more realistic. "All medicines have risks, and the job of the FDA is to balance the benefits versus the risks," he said. "If the FDA can be made stronger, we're certainly interested in sitting down and talking to folks about that.''
More here
***************************
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.
***************************
The FDA, considered the gold standard in drug safety review, lost its luster in 2004 after a string of high-profile drug controversies. The growing crisis ofconfidence could lead to reforms at the FDA and stricter rules on pharmaceutical firms in 2005. The year began with a firestorm, and then things got hotter. In its worst period in recent memory, the Food and Drug Administration spent 2004 reeling from charges that it allows companies to keep dangerous drugs on the market, lets them hide bad data, relies on a firm's word alone to fix manufacturing flaws, and stifles safety alerts by its own scientists. After a series of high-profile drug controversies, government investigations and the stunning withdrawal of the blockbuster drug Vioxx, critics are charging that the agency is dangerously compromised by industry influence.
True or not, the FDA's alleged weaknesses are becoming the industry's woes. The crisis of confidence over the agency's performance is so deep that consumers are hearing experts openly debate: Is the U.S. drug supply safe? The doubts have tarnished some of the biggest pharmaceutical firms and the most widely sold drugs on the market: household names like Paxil, Zoloft and Crestor. Nearly half the nation's flu vaccine supply, from Chiron's Fluvirin, was found to be contaminated. The profitable arthritis drug Vioxx was suddenly withdrawn as a heart-attack risk, amid charges that the FDA should have yanked it years ago. Now its chemical cousin, Pfizer's arthritis pain drug Celebrex, has also been linked to heart failure at high doses. And just last week, the FDA warned users of the painkiller naproxen, sold over the counter under the brand name Aleve, that the drug might increase a person's risk of having a heart attack or stroke.
The FDA's troubles began with an uproar in February over the agency's refusal to air a staff scientist's conclusion that certain anti-depressants, like Paxil, could increase the risk of suicide in children. It culminated in November, when one of the FDA's top safety staffers, Dr. David Graham, baldly declared at a U.S. Senate hearing that the agency is incapable of protecting the public. A government survey of FDA scientists showed that such doubts are pervasive, with nearly a fifth saying they had faced pressure to support a drug approval despite safety concerns.
In the perceived regulatory vacuum, a host of other players has stepped in to dog the industry: federal and state prosecutors, Congress, the Securities and Exchange Commission, eminent scientific journal editors, drug salespeople-turned whistle-blower, as well as patients, shareholders and their lawyers. For some firms, the impact has been severe:
-- Vioxx manufacturer Merck faces an international deluge of personal injury suits that could cost billions. Since Vioxx's withdrawal, Merck has lost $28.1 billion in market capitalization and is cutting 5,100 jobs.
-- Pfizer forked over $430 million to settle prosecutors' charges of marketing violations that the FDA is supposed to police. Since Celebrex was linked to heart attacks, Pfizer dropped about $21.9 billion in market capitalization.
-- Chiron of Emeryville may lose its solid share of the U.S. flu vaccine market due to lapses in the sterility of its manufacturing processes that the FDA is suspected of failing to correct in time. Chiron's market cap is down about $2.48 billion.
In the year ahead, Congress will consider proposals to revamp the FDA and toughen the rules for pharmaceutical firms. One fierce industry critic says that would not only be good for patients, it could also be good for business. Larry Sasich of the watchdog group Public Citizen said companies stand to lose the worldwide commercial advantage conferred by FDA approval if the agency loses its image as the gold standard of safety review. "We're getting to a point right now where we might start to see consumers losing confidence in the FDA,'' Sasich said. "It would be in the companies' best interests to see the standards raised.''
In the coming year, Congress may consider proposals to split the FDA's safety surveillance unit into a fully independent division. Critics charge that the concerns of safety experts like Graham are suppressed by the better- staffed drug approval units that benefit most from industry fees. The FDA denies those claims but has recently taken steps to give dissenters a greater voice.
Dr. Eric Topol, a prominent cardiologist who raised early alarms about Vioxx, said Congress hasn't given the FDA new powers to keep up with changing times. "The FDA doesn't have any authority to disseminate data that (it has)," he said, because information submitted in the drug approval process is considered proprietary. On the other hand, Topol said, the industry now has free rein to tout its drugs in direct-to-consumer ads. Patients then clamor for the new drugs, but doctors don't have complete information about them, he said.
Arthur Levin, director of the Center for Medical Consumers, said patients can help fix the system if they stop expecting drugs to be silver bullets that cure ailments without causing side effects.... Rosen said the industry group has yet to take a position on proposals to change the FDA. But he agreed with Levin that expectations should be more realistic. "All medicines have risks, and the job of the FDA is to balance the benefits versus the risks," he said. "If the FDA can be made stronger, we're certainly interested in sitting down and talking to folks about that.''
More here
***************************
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.
***************************
Monday, January 24, 2005
Health Care Tax Credits for the Uninsured
Support is growing for a proposed solution to the rising number of uninsured Americans: a health insurance tax credit. If properly designed and implemented, a tax credit would allow uninsured, low income individuals and families to purchase affordable, quality health insurance. To be effective, a health care tax credit must meet some specific criteria: (1) It must be refundable for lowwage workers (that is, they get the subsidy even if they have no tax liability); (2) The credit must be advanceable, so that it can be used to pay monthly premiums as they come due, rather than a lump-sum payment received when tax returns are filed on April 15; (3) It must not come with costly mandates that raise the cost of insurance and price healthy people out of the market; (4) It must be widely available, so that the market is large enough to attract many buyers and sellers; (5) It must be limited in dollar amount so that it does not encourage wasteful spending; and (6) It should be compatible with Health Savings Accounts (HSAs).
The Tax Credit Under Current Law: One Step Forward. In 2002, Congress created a health care tax credit for individuals who have lost their manufacturing jobs to foreign competition. Also eligible are individuals whose pensions are endangered because their former employer went belly up. The goal was to help this vulnerable population afford health insurance by giving them a credit worth 65 percent of the cost of their premiums. Yet, only six percent of those who may be eligible have taken advantage of the credit. Why? Unfortunately, in designing the credit, under the Trade Adjustment Assistance (TAA) program, Congress took one step forward and three steps back. The forward step is that the credit is advanceable and refundable, allowing individuals with modest incomes who owe little or no income tax to receive the federal subsidy as their premiums come due.
Guaranteed Issue Regulations: One Step Back. But Congress took a step back by mandating that any insurance company offering policies to the eligible population must provide coverage to all individuals who qualify for the credit, regardless of their medical condition. This restriction, known as guaranteed issue, may sound like a way to protect consumers, but it actually harms those who need coverage by driving up prices. When insurance companies are forced to accept all applicants, they raise premiums to guard against loss. Subsequently, business dwindles because neither sick nor healthy people can afford the policies, so carriers leave the market, and rates go up as competition decreases.
These outcomes have been borne out repeatedly in all eight states that have imposed guaranteed issue on insurance carriers in the market for individually purchased insurance. For example, when New Jersey imposed guaranteed issue on all health insurers, state premiums skyrocketed to more than double the national average. As recently as September 2004, New Jersey’s average individual insurance premium was $4,080, compared with the median average of $1,656. The state of Kentucky has now done an about-face, repealing guaranteed issue after 45 insurers left the state and consumers had no access to affordable coverage. Likewise, when Congress mandated guaranteed issue on carriers participating in the TAA credit program, they received very few takers. According to the U.S. Treasury Department, of the 39 states participating in the program, 20 have no private carriers offering a policy and 14 states have only one private insurer offering a plan. The resulting lack of competition drives up prices, limits choice, and, ultimately, limits consumer participation and coverage.
Limiting the Market: A Second Step Back. Congress took another step back when it chose to limit the TAA tax credit mostly to individuals near retirement age and living on meager unemployment benefits — a population with more limited means and significantly higher health needs than most other uninsured. A recent Government Accountability Office report found that to use the tax credit, those eligible had to spend 13 percent to 25 percent of their monthly income on premiums. Testing a tax credit on this population, combined with inflated prices due to guaranteed issue, was a recipe for failure.
Encouraging Wasteful Insurance: A Third Step Back. Another flaw in TAA health credit design is that it provides an unlimited, partial subsidy, rather than a dollar-for-dollar credit up to a maximum limit. Individuals must pay 35 percent of the cost of their health insurance, with taxpayers picking up 65 percent. This encourages waste by subsidizing the last dollar of insurance spending as much as the first dollar. By contrast, a 100 percent tax credit for the lowest income purchasers could reduce the cost of a modest — but still comprehensive — policy to zero. Limiting the credit to a fixed amount requires individuals to pick up 100 percent of the additional cost for policies with more expensive coverage. The Bush administration’s proposed tax credit avoids this problem by offering a flat dollar-for-dollar credit to low income individuals ($1,000) and families (up to $3,000). The credit phases out gradually for those with higher incomes (more than 200 percent of the poverty level), but the fact that it is limited avoids the incentive to spend wastefully."
Prospects for a Workable Tax Credit. The good news is that tax credits can work if they are well designed and target the right buyers. The majority of today’s uninsured are working individuals and families with very modest incomes. They earn too much to qualify for Medicaid, but not enough to afford coverage without assistance. They may be in jobs where health insurance is not offered or cannot afford their share of their company’s coverage. In fact, more than 80 percent of uninsured individuals have full or part-time jobs and more than 30 percent have incomes that are 100 to 200 percent of the federal poverty level. This should be the target group for a health tax credit.
This uninsured population is relatively young and eminently insurable at reasonable rates. In most states, the limited credit proposed by President Bush would pay for between half and two-thirds of the average cost of health insurance (based on a full $1,000 tax credit and eHealthInsurance’s estimated median average individual premium of $1,656 annually). For uninsured individuals with chronic health conditions, coverage should come through state high-risk pools, programs that already exist in 33 states. These pools allow the small percentage of the uninsured with serious health conditions to obtain health insurance coverage that is capped at 150 to 200 percent of the average premium cost in that state. This cost could be offset with tax credits, thus providing a safety net for a vulnerable population, while keeping premiums more affordable to others.
Tax Credits for Health Savings Accounts. Congress should also consider using tax credits to help people afford the newly created Health Savings Accounts. HSAs are attractive to those with modest incomes because premiums are much lower with high deductible policies coupled with HSAs. A portion of the tax credit ($700 for individuals, $2,000 for families) could be used to purchase insurance and the remainder ($300 for individuals, $1,000 for families) could be deposited directly into a tax-free HSA to use for deductible expenses under a Bush administration tax proposal. HSAs, which are portable from job to job and into retirement, provide an excellent way for individuals and families to accumulate savings for health expenses.
Source
***************************
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.
***************************
Support is growing for a proposed solution to the rising number of uninsured Americans: a health insurance tax credit. If properly designed and implemented, a tax credit would allow uninsured, low income individuals and families to purchase affordable, quality health insurance. To be effective, a health care tax credit must meet some specific criteria: (1) It must be refundable for lowwage workers (that is, they get the subsidy even if they have no tax liability); (2) The credit must be advanceable, so that it can be used to pay monthly premiums as they come due, rather than a lump-sum payment received when tax returns are filed on April 15; (3) It must not come with costly mandates that raise the cost of insurance and price healthy people out of the market; (4) It must be widely available, so that the market is large enough to attract many buyers and sellers; (5) It must be limited in dollar amount so that it does not encourage wasteful spending; and (6) It should be compatible with Health Savings Accounts (HSAs).
The Tax Credit Under Current Law: One Step Forward. In 2002, Congress created a health care tax credit for individuals who have lost their manufacturing jobs to foreign competition. Also eligible are individuals whose pensions are endangered because their former employer went belly up. The goal was to help this vulnerable population afford health insurance by giving them a credit worth 65 percent of the cost of their premiums. Yet, only six percent of those who may be eligible have taken advantage of the credit. Why? Unfortunately, in designing the credit, under the Trade Adjustment Assistance (TAA) program, Congress took one step forward and three steps back. The forward step is that the credit is advanceable and refundable, allowing individuals with modest incomes who owe little or no income tax to receive the federal subsidy as their premiums come due.
Guaranteed Issue Regulations: One Step Back. But Congress took a step back by mandating that any insurance company offering policies to the eligible population must provide coverage to all individuals who qualify for the credit, regardless of their medical condition. This restriction, known as guaranteed issue, may sound like a way to protect consumers, but it actually harms those who need coverage by driving up prices. When insurance companies are forced to accept all applicants, they raise premiums to guard against loss. Subsequently, business dwindles because neither sick nor healthy people can afford the policies, so carriers leave the market, and rates go up as competition decreases.
These outcomes have been borne out repeatedly in all eight states that have imposed guaranteed issue on insurance carriers in the market for individually purchased insurance. For example, when New Jersey imposed guaranteed issue on all health insurers, state premiums skyrocketed to more than double the national average. As recently as September 2004, New Jersey’s average individual insurance premium was $4,080, compared with the median average of $1,656. The state of Kentucky has now done an about-face, repealing guaranteed issue after 45 insurers left the state and consumers had no access to affordable coverage. Likewise, when Congress mandated guaranteed issue on carriers participating in the TAA credit program, they received very few takers. According to the U.S. Treasury Department, of the 39 states participating in the program, 20 have no private carriers offering a policy and 14 states have only one private insurer offering a plan. The resulting lack of competition drives up prices, limits choice, and, ultimately, limits consumer participation and coverage.
Limiting the Market: A Second Step Back. Congress took another step back when it chose to limit the TAA tax credit mostly to individuals near retirement age and living on meager unemployment benefits — a population with more limited means and significantly higher health needs than most other uninsured. A recent Government Accountability Office report found that to use the tax credit, those eligible had to spend 13 percent to 25 percent of their monthly income on premiums. Testing a tax credit on this population, combined with inflated prices due to guaranteed issue, was a recipe for failure.
Encouraging Wasteful Insurance: A Third Step Back. Another flaw in TAA health credit design is that it provides an unlimited, partial subsidy, rather than a dollar-for-dollar credit up to a maximum limit. Individuals must pay 35 percent of the cost of their health insurance, with taxpayers picking up 65 percent. This encourages waste by subsidizing the last dollar of insurance spending as much as the first dollar. By contrast, a 100 percent tax credit for the lowest income purchasers could reduce the cost of a modest — but still comprehensive — policy to zero. Limiting the credit to a fixed amount requires individuals to pick up 100 percent of the additional cost for policies with more expensive coverage. The Bush administration’s proposed tax credit avoids this problem by offering a flat dollar-for-dollar credit to low income individuals ($1,000) and families (up to $3,000). The credit phases out gradually for those with higher incomes (more than 200 percent of the poverty level), but the fact that it is limited avoids the incentive to spend wastefully."
Prospects for a Workable Tax Credit. The good news is that tax credits can work if they are well designed and target the right buyers. The majority of today’s uninsured are working individuals and families with very modest incomes. They earn too much to qualify for Medicaid, but not enough to afford coverage without assistance. They may be in jobs where health insurance is not offered or cannot afford their share of their company’s coverage. In fact, more than 80 percent of uninsured individuals have full or part-time jobs and more than 30 percent have incomes that are 100 to 200 percent of the federal poverty level. This should be the target group for a health tax credit.
This uninsured population is relatively young and eminently insurable at reasonable rates. In most states, the limited credit proposed by President Bush would pay for between half and two-thirds of the average cost of health insurance (based on a full $1,000 tax credit and eHealthInsurance’s estimated median average individual premium of $1,656 annually). For uninsured individuals with chronic health conditions, coverage should come through state high-risk pools, programs that already exist in 33 states. These pools allow the small percentage of the uninsured with serious health conditions to obtain health insurance coverage that is capped at 150 to 200 percent of the average premium cost in that state. This cost could be offset with tax credits, thus providing a safety net for a vulnerable population, while keeping premiums more affordable to others.
Tax Credits for Health Savings Accounts. Congress should also consider using tax credits to help people afford the newly created Health Savings Accounts. HSAs are attractive to those with modest incomes because premiums are much lower with high deductible policies coupled with HSAs. A portion of the tax credit ($700 for individuals, $2,000 for families) could be used to purchase insurance and the remainder ($300 for individuals, $1,000 for families) could be deposited directly into a tax-free HSA to use for deductible expenses under a Bush administration tax proposal. HSAs, which are portable from job to job and into retirement, provide an excellent way for individuals and families to accumulate savings for health expenses.
Source
***************************
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.
***************************
Sunday, January 23, 2005
IN HEAVILY REGULATED HOSPITALS, PRICING IS ANYTHING THEY THINK THEY CAN GET AWAY WITH
So much for all the regulation. Competition anyone?
Patient advocate [translation: legal parasite] Tony Garr became a patient recently and found out how nice it is to have insurance. The X-ray alone in connection with his prostate biopsy was priced at $880. His insurance paid $167.58 for that. He was charged $18.62. Discount applied to his insurance company: about 79%. In contrast, the uninsured have long been billed the full list price, well above the amount insurance companies negotiate with individual hospitals and medical professionals. Now, Nashville-area hospitals are beginning to change their policies toward the uninsured, starting new discounts for those without insurance and, in some cases, making existing discounts for poor people more generous.
In Tennessee, an estimated 323,000 people will be removed from the state's insurance program for the poor, TennCare, starting this spring if a proposal by Gov. Phil Bredesen goes through. Some of them will find insurance elsewhere; others will join the estimated 45 million Americans who don't have private or government insurance.
Hospitals nationwide have been accused for years of charging exorbitant prices to the uninsured. Hospitals have maintained that they couldn't offer discounts because they might be punished by Medicare rules. However, the federal government recently clarified its position, saying hospitals could offer discounts to the uninsured.
Vanderbilt University Medical Center has one of the most straightforward polices toward the uninsured among the large local hospitals: Those at the federal poverty level pay nothing, and those at up to 200% of the poverty level pay no more than 7% of their income. The hospital is considering raising its discount eligibility to 275% of the poverty level.
HCA Inc., which owns several area hospitals, announced earlier this month that it is scrapping its sliding-scale discounts for the low-income uninsured and offering discounts for everyone that are similar to those insurance companies get. Company spokespeople said the discounts vary by procedure and hospital, and they were unable to provide specific examples or quantify the average discounts.
Saint Thomas Health Services, which already had a sliding-scale discount for different low-income groups, has a new program of discounts for uninsured people who don't meet its low-income guidelines. The hospital system declined to provide specifics.
The three major hospital systems in Nashville declined to give list prices for procedures, which would give an idea of the discounts' value. Patient advocates complain that the health-care system is too secretive and that patients have no way of knowing whether they're getting a raw deal. ''If you go to the hospital and say you need an appendectomy, 'How much will it cost?' They won't tell you,'' said Garr, the executive director of the Tennessee Health Care Campaign, a nonprofit organization that works on behalf of patients. ''It's pretty hard to trust these prices.''
Patient advocates have been pressuring hospitals to disclose price information. California last summer began requiring hospitals to make their list prices public, compiled in a compendium at each hospital called the chargemaster. Tennessee hospitals aren't required to publish their chargemasters, arguing that for competitive reasons they don't want other hospitals to know their prices.
But the hospitals say they do try to make people aware that they could get breaks on price. HCA plans to put signs up letting people know about the availability of discounts. Hospital staff will first try to qualify patients for Medicaid or its free charity care, but if patients don't meet its low-income guidelines, the new discounts will be applied, the company said. Vanderbilt said it would let people know about its discounts through financial counselors who get involved anytime there is an uninsured patient. ''We're actually in the process of developing brochures and signage in all areas to let patients know we have these programs,'' said the hospital's finance officer, Warren Beck.
More here
***************************
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.
***************************
So much for all the regulation. Competition anyone?
Patient advocate [translation: legal parasite] Tony Garr became a patient recently and found out how nice it is to have insurance. The X-ray alone in connection with his prostate biopsy was priced at $880. His insurance paid $167.58 for that. He was charged $18.62. Discount applied to his insurance company: about 79%. In contrast, the uninsured have long been billed the full list price, well above the amount insurance companies negotiate with individual hospitals and medical professionals. Now, Nashville-area hospitals are beginning to change their policies toward the uninsured, starting new discounts for those without insurance and, in some cases, making existing discounts for poor people more generous.
In Tennessee, an estimated 323,000 people will be removed from the state's insurance program for the poor, TennCare, starting this spring if a proposal by Gov. Phil Bredesen goes through. Some of them will find insurance elsewhere; others will join the estimated 45 million Americans who don't have private or government insurance.
Hospitals nationwide have been accused for years of charging exorbitant prices to the uninsured. Hospitals have maintained that they couldn't offer discounts because they might be punished by Medicare rules. However, the federal government recently clarified its position, saying hospitals could offer discounts to the uninsured.
Vanderbilt University Medical Center has one of the most straightforward polices toward the uninsured among the large local hospitals: Those at the federal poverty level pay nothing, and those at up to 200% of the poverty level pay no more than 7% of their income. The hospital is considering raising its discount eligibility to 275% of the poverty level.
HCA Inc., which owns several area hospitals, announced earlier this month that it is scrapping its sliding-scale discounts for the low-income uninsured and offering discounts for everyone that are similar to those insurance companies get. Company spokespeople said the discounts vary by procedure and hospital, and they were unable to provide specific examples or quantify the average discounts.
Saint Thomas Health Services, which already had a sliding-scale discount for different low-income groups, has a new program of discounts for uninsured people who don't meet its low-income guidelines. The hospital system declined to provide specifics.
The three major hospital systems in Nashville declined to give list prices for procedures, which would give an idea of the discounts' value. Patient advocates complain that the health-care system is too secretive and that patients have no way of knowing whether they're getting a raw deal. ''If you go to the hospital and say you need an appendectomy, 'How much will it cost?' They won't tell you,'' said Garr, the executive director of the Tennessee Health Care Campaign, a nonprofit organization that works on behalf of patients. ''It's pretty hard to trust these prices.''
Patient advocates have been pressuring hospitals to disclose price information. California last summer began requiring hospitals to make their list prices public, compiled in a compendium at each hospital called the chargemaster. Tennessee hospitals aren't required to publish their chargemasters, arguing that for competitive reasons they don't want other hospitals to know their prices.
But the hospitals say they do try to make people aware that they could get breaks on price. HCA plans to put signs up letting people know about the availability of discounts. Hospital staff will first try to qualify patients for Medicaid or its free charity care, but if patients don't meet its low-income guidelines, the new discounts will be applied, the company said. Vanderbilt said it would let people know about its discounts through financial counselors who get involved anytime there is an uninsured patient. ''We're actually in the process of developing brochures and signage in all areas to let patients know we have these programs,'' said the hospital's finance officer, Warren Beck.
More here
***************************
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.
***************************
Saturday, January 22, 2005
HEALTH-CARE: THE NEW BATTLEFIELD AGAINST SOCIALISM
Karl Marx may have suffered a second death at the end of the last century, but look for a spirited comeback in this one. The next great battle between socialism and capitalism will be waged over human health and life expectancy. As rich countries grow richer, and as healthcare technology continues to improve, people will spend ever growing shares of their income on living longer and healthier lives. U.S. healthcare costs have already reached 15 percent of annual national income and could exceed 30 percent by the middle of this century—and other industrialized nations are not far behind. Certainly, an aging population is part of the story. But if economic productivity keeps growing at its current extraordinary pace, Europeans, Japanese, and Americans could triple their current income per person by 2050. Inevitably, we will spend a lot of that income on improving and maintaining our health.
Which brings us to Marx. When the price of medical care takes up just a small percentage of national income, it is hard to argue with the notion that everyone should enjoy similar medical treatment. Sure, critics may gripe that the higher taxes needed to pay for universal health coverage may cut into economic growth a bit, but so what? A little redistribution won’t suddenly transform the United States into a failed, Soviet-style “workers’ paradise.” But as health costs creep up to, say, 25 percent of national income, things get more complicated. Americans would see their tax bills more than double, while total taxes could reach 75 percent of many Europeans’ income. With oppressive tax burdens and heavy state intervention in health—already the largest sector of the economy—socialism would have crept in through the back door.
Of course, smug Europeans, Canadians, or Japanese may think that exploding healthcare costs are a purely U.S. problem. Certainly, the British and Canadian governments successfully wield their monopolies over healthcare to hold down both doctors’ incomes and prescription drug prices. And part of the rise in U.S. healthcare costs stems from the breakdown of the checks and balances that more centralized systems provide. (For example, Americans are several times more likely to receive heart bypass surgery than Canadians, where the procedure is reserved for extreme cases. Yet several studies suggest that patients are no worse off in Canada than in the United States). And even the most fanatical free marketers recognize that healthcare is different from other markets, and that the standard supply-and-demand principles don’t necessarily apply. Consumers have poor information, and there is an obvious case for greater government involvement than in other markets.
But if all countries squeezed profits in the health sector the way Europe and Canada do, there would be much less global innovation in medical technology. Today, the whole world benefits freely from advances in health technology that are driven largely by the allure of the profitable U.S. market. If the United States joins other nations in having more socialized medicine, the current pace of technology improvements might well grind to a halt. Even as the status quo persists, I wonder how content Europeans and Canadians will remain as their healthcare needs become more expensive and diverse. There are already signs of growing dissatisfaction with the quality of all but the most basic services. In Canada, the horrific delays for elective surgery remind one of waiting for a car in the old Soviet bloc. And despite British Chancellor Gordon Brown’s determined efforts to rebuild the country’s scandalously dilapidated public hospital system, anyone who can afford to go elsewhere usually does. With public healthcare systems fraying at the edges, many countries outside the United States increasingly face the need to allow a greater play of market forces.
During the next few decades, modern societies will wrestle with very tough questions and tradeoffs: What, exactly, are people’s basic health needs in an era where medical technology relentlessly advances the frontiers of the possible? How do we help people while still giving them the incentive to economize on their use of scarce healthcare resources? And who plays God—the bureaucrats, the doctors, or the forces of the market?
Ultimately, the case for some government intervention and regulation in health care is compelling on the grounds of efficiency (because costs are out of control) and moral justice (because our societies rightly take a more egalitarian view of health than of material possessions). The issue is precisely how much redistribution of income and government intervention is warranted. With the health sector on track to make up almost a third of economic activity later this century, the next great battle between capitalism and socialism is already underway.
Source
***************************
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.
***************************
Karl Marx may have suffered a second death at the end of the last century, but look for a spirited comeback in this one. The next great battle between socialism and capitalism will be waged over human health and life expectancy. As rich countries grow richer, and as healthcare technology continues to improve, people will spend ever growing shares of their income on living longer and healthier lives. U.S. healthcare costs have already reached 15 percent of annual national income and could exceed 30 percent by the middle of this century—and other industrialized nations are not far behind. Certainly, an aging population is part of the story. But if economic productivity keeps growing at its current extraordinary pace, Europeans, Japanese, and Americans could triple their current income per person by 2050. Inevitably, we will spend a lot of that income on improving and maintaining our health.
Which brings us to Marx. When the price of medical care takes up just a small percentage of national income, it is hard to argue with the notion that everyone should enjoy similar medical treatment. Sure, critics may gripe that the higher taxes needed to pay for universal health coverage may cut into economic growth a bit, but so what? A little redistribution won’t suddenly transform the United States into a failed, Soviet-style “workers’ paradise.” But as health costs creep up to, say, 25 percent of national income, things get more complicated. Americans would see their tax bills more than double, while total taxes could reach 75 percent of many Europeans’ income. With oppressive tax burdens and heavy state intervention in health—already the largest sector of the economy—socialism would have crept in through the back door.
Of course, smug Europeans, Canadians, or Japanese may think that exploding healthcare costs are a purely U.S. problem. Certainly, the British and Canadian governments successfully wield their monopolies over healthcare to hold down both doctors’ incomes and prescription drug prices. And part of the rise in U.S. healthcare costs stems from the breakdown of the checks and balances that more centralized systems provide. (For example, Americans are several times more likely to receive heart bypass surgery than Canadians, where the procedure is reserved for extreme cases. Yet several studies suggest that patients are no worse off in Canada than in the United States). And even the most fanatical free marketers recognize that healthcare is different from other markets, and that the standard supply-and-demand principles don’t necessarily apply. Consumers have poor information, and there is an obvious case for greater government involvement than in other markets.
But if all countries squeezed profits in the health sector the way Europe and Canada do, there would be much less global innovation in medical technology. Today, the whole world benefits freely from advances in health technology that are driven largely by the allure of the profitable U.S. market. If the United States joins other nations in having more socialized medicine, the current pace of technology improvements might well grind to a halt. Even as the status quo persists, I wonder how content Europeans and Canadians will remain as their healthcare needs become more expensive and diverse. There are already signs of growing dissatisfaction with the quality of all but the most basic services. In Canada, the horrific delays for elective surgery remind one of waiting for a car in the old Soviet bloc. And despite British Chancellor Gordon Brown’s determined efforts to rebuild the country’s scandalously dilapidated public hospital system, anyone who can afford to go elsewhere usually does. With public healthcare systems fraying at the edges, many countries outside the United States increasingly face the need to allow a greater play of market forces.
During the next few decades, modern societies will wrestle with very tough questions and tradeoffs: What, exactly, are people’s basic health needs in an era where medical technology relentlessly advances the frontiers of the possible? How do we help people while still giving them the incentive to economize on their use of scarce healthcare resources? And who plays God—the bureaucrats, the doctors, or the forces of the market?
Ultimately, the case for some government intervention and regulation in health care is compelling on the grounds of efficiency (because costs are out of control) and moral justice (because our societies rightly take a more egalitarian view of health than of material possessions). The issue is precisely how much redistribution of income and government intervention is warranted. With the health sector on track to make up almost a third of economic activity later this century, the next great battle between capitalism and socialism is already underway.
Source
***************************
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.
***************************
Friday, January 21, 2005
A PRIVATE MEDICAL SCHOOL: THE SOCIALISTS WILL HATE THIS!
A Harley Street doctor is setting up Britain's first independent medical school since the start of the NHS to cater for the increasingly urgent need to train more doctors. The Hunter School of Medicine will open in September next year on Brunel University's Uxbridge campus and is aimed primarily at training senior NHS nurses and paramedics to become doctors. The school, which is named after John and William Hunter, 18th-century surgeons and physicians from Glasgow, hopes to pioneer new ideas in the selection and training of doctors.
It is the brainchild of Paul MacLoughlin, former physician to Sir Angus Ogilvy, the late husband of Princess Alexandra. "We're really just going back to a tried and tested formula," Dr MacLoughlin told The Times, adding that all the London medical schools started privately. "We just want to give senior nurses and paramedics who've done well a chance to go further. At the moment, these people don't have much opportunity to do so."
Britain currently has fewer doctors per head of population than any other country in Europe, and with the reduction in hospital hours, early retirement and the rise in women entering the profession, Dr MacLoughlin believes that state medical schools will be unable to meet the shortage.
All medical schools approved by the General Medical Council must be allied to a university. By linking with Brunel University, which specialises in the sciences, the first intake of 30 to 40 students will be able to make use of the university's spare capacity in pre-clinical subjects at little extra cost. The students will make use of facilities at private practices and at full capacity should number 250 a year. Instead of requiring several million pounds to set up the school, Dr MacLoughlin estimates that he needs to raise just œ1 million to appoint a professor of anatomy and establish an anatomy department.
With a firm grounding in medicine, most students will be expected to take a fast-track course of four years and will be charged about 20,000 pounds each year or the same rate as overseas students going to a state-funded medical school.
Bursaries, grants and scholarships are expected to be available. The course will be more expensive but two years shorter than most undergraduate degrees, and will follow the GMC's guidelines in Tomorrow's Doctors and Good Medical Practice.
The board of trustees includes Sir Barry Jackson, President of the Royal Society of Medicine, Professor Bo Drasar, a former Dean of the London School of Hygiene and Tropical Medicine, and several senior professors and experts, including Galal Yousef, a consultant in clinical virology who is a Sudanese government minister. Professor Steven Schwartz, the vice-chancellor, said yesterday that he welcomed the opportunity to establish a medical school and that by making use of private facilities, including the London Clinic, it was the next step in public private partnerships and delivering better healthcare in Britain. "There is a large network of excellent private hospitals, laboratories and clinics in this country. At present they are not involved in teaching. Yet they can make a valuable contribution to medical education and help to meet the demand for new doctors and other health professionals," he said.
There are 29 medical schools in Britain and 7,350 students of medicine. All the courses for school-leavers and graduates are oversubscribed.
Two years ago Derek Wanless, a former chief executive of NatWest, produced a government-backed report forecasting that Britain could be short of 25,000 doctors in 20 years' time, despite the extra medical school places already provided. As a result Terence Kealey, the Vice-Chancellor of Buckingham University and a trained doctor, is also hoping to establish an independent medical school. Dr Kealey has already appointed Karol Sikora, Professor of Cancer Medicine at Imperial College London's School of Medicine, dean-elect. But the school will cost some 20 million pounds to establish and take four years to build. Students will be charged about 20,000 pounds and are expected to come mainly from overseas.
Dr Kealey's aim is to recruit academics who put patients at the heart of their teaching
Source
***************************
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.
***************************
A Harley Street doctor is setting up Britain's first independent medical school since the start of the NHS to cater for the increasingly urgent need to train more doctors. The Hunter School of Medicine will open in September next year on Brunel University's Uxbridge campus and is aimed primarily at training senior NHS nurses and paramedics to become doctors. The school, which is named after John and William Hunter, 18th-century surgeons and physicians from Glasgow, hopes to pioneer new ideas in the selection and training of doctors.
It is the brainchild of Paul MacLoughlin, former physician to Sir Angus Ogilvy, the late husband of Princess Alexandra. "We're really just going back to a tried and tested formula," Dr MacLoughlin told The Times, adding that all the London medical schools started privately. "We just want to give senior nurses and paramedics who've done well a chance to go further. At the moment, these people don't have much opportunity to do so."
Britain currently has fewer doctors per head of population than any other country in Europe, and with the reduction in hospital hours, early retirement and the rise in women entering the profession, Dr MacLoughlin believes that state medical schools will be unable to meet the shortage.
All medical schools approved by the General Medical Council must be allied to a university. By linking with Brunel University, which specialises in the sciences, the first intake of 30 to 40 students will be able to make use of the university's spare capacity in pre-clinical subjects at little extra cost. The students will make use of facilities at private practices and at full capacity should number 250 a year. Instead of requiring several million pounds to set up the school, Dr MacLoughlin estimates that he needs to raise just œ1 million to appoint a professor of anatomy and establish an anatomy department.
With a firm grounding in medicine, most students will be expected to take a fast-track course of four years and will be charged about 20,000 pounds each year or the same rate as overseas students going to a state-funded medical school.
Bursaries, grants and scholarships are expected to be available. The course will be more expensive but two years shorter than most undergraduate degrees, and will follow the GMC's guidelines in Tomorrow's Doctors and Good Medical Practice.
The board of trustees includes Sir Barry Jackson, President of the Royal Society of Medicine, Professor Bo Drasar, a former Dean of the London School of Hygiene and Tropical Medicine, and several senior professors and experts, including Galal Yousef, a consultant in clinical virology who is a Sudanese government minister. Professor Steven Schwartz, the vice-chancellor, said yesterday that he welcomed the opportunity to establish a medical school and that by making use of private facilities, including the London Clinic, it was the next step in public private partnerships and delivering better healthcare in Britain. "There is a large network of excellent private hospitals, laboratories and clinics in this country. At present they are not involved in teaching. Yet they can make a valuable contribution to medical education and help to meet the demand for new doctors and other health professionals," he said.
There are 29 medical schools in Britain and 7,350 students of medicine. All the courses for school-leavers and graduates are oversubscribed.
Two years ago Derek Wanless, a former chief executive of NatWest, produced a government-backed report forecasting that Britain could be short of 25,000 doctors in 20 years' time, despite the extra medical school places already provided. As a result Terence Kealey, the Vice-Chancellor of Buckingham University and a trained doctor, is also hoping to establish an independent medical school. Dr Kealey has already appointed Karol Sikora, Professor of Cancer Medicine at Imperial College London's School of Medicine, dean-elect. But the school will cost some 20 million pounds to establish and take four years to build. Students will be charged about 20,000 pounds and are expected to come mainly from overseas.
Dr Kealey's aim is to recruit academics who put patients at the heart of their teaching
Source
***************************
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.
***************************
Thursday, January 20, 2005
PUBLIC HOSPITALS KILL
A dehydrated child who waited four hours for treatment in a country emergency department was among 21 people who died through errors in Victoria's public hospitals last financial year. According to a report obtained by The Age, inexperienced staff failed to accurately monitor the deteriorating condition of the child, whose age and gender is not known. The report said that the busy emergency department of the unnamed hospital had no clear plans for the monitoring of young patients.
The case is one of 85 significant medical errors reported to the Department of Human Services in 2003-04 that are contained in the Sentinel Event Program report, obtained under freedom of information laws. The report details medical procedures on the wrong patient, procedures on the wrong body part, medication errors, infection control breaches and cases in which instruments or materials were left in patients after surgery. The other deaths involved 10 mostly elderly people who died after falls (three in hospital-run residential aged-care facilities), four people given the wrong drug or an incorrect drug dosage, two due to a catheter fatally damaging an artery in the heart during routine surgery, and two women dying during childbirth. Two patients - one had absconded - committed suicide.
The number of sentinel events - rare, clear-cut incidents that can have a catastrophic outcome for patients - was up slightly on the previous year, but it is regarded by experts as being only a fraction of the serious or deadly mistakes made by hospital medical staff. The figures do not include errors in private hospitals.
Department of Human Services chief clinical adviser Jenny Bartlett said the reporting of serious medical errors varied between public hospitals. "There are hospitals that have endorsed this program actively and supportively, and there are some hospitals that haven't grasped the benefit of contributing to system-wide improvement," she said.
The report said two non-English-speaking patients not given access to an interpreter had surgery on the wrong parts of their bodies. One had a cataract operation on the wrong eye, the other had an operation to remove a skin cancer on the wrong leg. Dr Bartlett said most of the 14 cases in which the wrong patient or wrong body part was operated on were for minor procedures. "We haven't had the wrong leg amputated," she said.
Four people died due to drug errors, including two patients who were given too much anticoagulant after heart surgery. Ten complications due to surgical errors included a case in which a patient's bowel was reconnected in the wrong place. Six complications due to anaesthetic management included a patient whose lungs collapsed after equipment broke down before a brain operation.
Instruments or gauze packs were left behind after eight operations. In one case, surgeons sewed up a woman after an emergency caesarean section despite a count that revealed one gauze pack was missing.
Two people hurt in car accidents were further injured when staff at country hospitals who were inexperienced in trauma cases failed to detect spinal injury in the neck. Dr Bartlett said significant inconsistencies in treatment of spinal injuries led to written guidelines being sent to each hospital.
The aim of reporting is to identify reasons for mistakes so that they are not repeated. Most errors were attributed to poor staff communication, problems with procedures and guidelines, or inadequate training.
Source
***************************
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.
***************************
A dehydrated child who waited four hours for treatment in a country emergency department was among 21 people who died through errors in Victoria's public hospitals last financial year. According to a report obtained by The Age, inexperienced staff failed to accurately monitor the deteriorating condition of the child, whose age and gender is not known. The report said that the busy emergency department of the unnamed hospital had no clear plans for the monitoring of young patients.
The case is one of 85 significant medical errors reported to the Department of Human Services in 2003-04 that are contained in the Sentinel Event Program report, obtained under freedom of information laws. The report details medical procedures on the wrong patient, procedures on the wrong body part, medication errors, infection control breaches and cases in which instruments or materials were left in patients after surgery. The other deaths involved 10 mostly elderly people who died after falls (three in hospital-run residential aged-care facilities), four people given the wrong drug or an incorrect drug dosage, two due to a catheter fatally damaging an artery in the heart during routine surgery, and two women dying during childbirth. Two patients - one had absconded - committed suicide.
The number of sentinel events - rare, clear-cut incidents that can have a catastrophic outcome for patients - was up slightly on the previous year, but it is regarded by experts as being only a fraction of the serious or deadly mistakes made by hospital medical staff. The figures do not include errors in private hospitals.
Department of Human Services chief clinical adviser Jenny Bartlett said the reporting of serious medical errors varied between public hospitals. "There are hospitals that have endorsed this program actively and supportively, and there are some hospitals that haven't grasped the benefit of contributing to system-wide improvement," she said.
The report said two non-English-speaking patients not given access to an interpreter had surgery on the wrong parts of their bodies. One had a cataract operation on the wrong eye, the other had an operation to remove a skin cancer on the wrong leg. Dr Bartlett said most of the 14 cases in which the wrong patient or wrong body part was operated on were for minor procedures. "We haven't had the wrong leg amputated," she said.
Four people died due to drug errors, including two patients who were given too much anticoagulant after heart surgery. Ten complications due to surgical errors included a case in which a patient's bowel was reconnected in the wrong place. Six complications due to anaesthetic management included a patient whose lungs collapsed after equipment broke down before a brain operation.
Instruments or gauze packs were left behind after eight operations. In one case, surgeons sewed up a woman after an emergency caesarean section despite a count that revealed one gauze pack was missing.
Two people hurt in car accidents were further injured when staff at country hospitals who were inexperienced in trauma cases failed to detect spinal injury in the neck. Dr Bartlett said significant inconsistencies in treatment of spinal injuries led to written guidelines being sent to each hospital.
The aim of reporting is to identify reasons for mistakes so that they are not repeated. Most errors were attributed to poor staff communication, problems with procedures and guidelines, or inadequate training.
Source
***************************
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.
***************************
Wednesday, January 19, 2005
BONE-HEADED HEALTH INSURANCE
Because health insurance is so heavily regulated it is more like a government bureaucracy than a business -- and it shows. Tom Barrett reports below what happened when he needed a CPAP machine to treat his sleep apnea
Health insurance companies are remarkably short-sighted. By and large they refuse to pay for preventative measures that prevent serious, more costly conditions from occurring. (Not all insurance companies are like this, but most are.) Their bureaucratic systems often delay necessary treatments until they become life-threatening. A case in point is my tailor, Mr. Glickstien. He mentioned to me one day many years ago that he had seen blood in his urine. I was a paramedic at that time, and immediately thought of a half-dozen terrible things that could indicate. I advised him to see a doctor right away. He said that his insurance company told him he had to see a general practitioner first, then wait four to six weeks to see a specialist. I told him to go to the emergency room. He did, and was told that if he had waited another day he probably would have died.
Out of the quarter of a million people who read Conservative Truth each week, there are probably thousands of you with similar stories. Mine began when the medical supply company told me that Blue Cross (my insurance company) now required a sleep study before supplying a CPAP machine. Not only that, but Blue Cross only pays for rentals now, and the medical supply company (the only one that is authorized by Blue Cross) does not rent, but only sells CPAP machines! Talk about a catch-22!
Assuming (falsely) that I was dealing with reasonable people, I said that I had already had a sleep study. They countered that it had to be within the last twelve months. I told them I was already suffering from lack of sleep, that I needed the machine now, and that it would take four to six weeks to get a sleep study. They said, "Sorry."
Assuming (falsely) that if I could get past the clerks I might be able to speak with someone more intelligent, I asked for a supervisor. It turned out that she, too, was incapable of any action beyond reading from a prepared script. I had to 1) Get a prescription for a sleep study; 2) Wait a month or more for the study; and 3) Wait for Blue Cross to decide whether they would supply the machine. Never mind the fact that being without the machine could cause serious medical problems that would cost them far more than the machine, and never mind the fact that waiting a month could be life-threatening. That's what the rule book says.
Assuming (falsely) that they would listen to a Medical Doctor, I asked my very busy physician to call Blue Cross, and he was kind enough to do so (thank you, Dr. Liporace, and your wonderful office manager, Jackie). Surely these pencil-necked clerks would not ignore the advice of a trained physician! Wrong again. He told them that sleep apnea is not a condition that reverses itself. If I had it six years ago when they did the first study, I still have it today. He also confirmed that his clinical findings were that I currently have sleep apnea, and that it was imperative that I continue to receive CPAP treatment. He sent them a prescription for the machine, and a Letter of Medical Necessity, confirming that the device was necessary for my health. Their response? "Sorry."
Still believing (falsely) that these people would not be so stupid as to ignore the relative costs, I pointed out that CPAP machines cost between $600 and $800, and that the sleep study would cost between $2500 and $3000. "Why would you want to spend thousands for a sleep study instead of hundreds for a CPAP, just to find out what a Medical Doctor has already told you?" Well, it turns out that they ARE that stupid.
I bring these things up for two reasons. First, America needs to realize that idiotic decisions by insurance companies such as delaying treatment for my tailor friend, or denying less expensive preventative treatments, are causing medical insurance costs to sky-rocket, and in many cases are costing people their lives.
Second, not everyone has the options I have. I will purchase my own CPAP machine, and then spend whatever time it takes to force Blue Cross to reimburse me, because I cannot afford to go any longer without therapy. But there are hundreds of thousands of people in this country who don't have that option. They pay the unconscionable rates these companies charge, and can't afford to pay extra for necessary treatments when they are arbitrarily denied by their insurance companies.
Enough about insurance companies. You can expect to see more in this column about the abuses of these companies who advertise about how much they care about us, but who treat us like we are beggars when we expect the treatment we pay for. Let me end by encouraging you to be aware of the problem of sleep apnea.
More here
***************************
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.
***************************
Because health insurance is so heavily regulated it is more like a government bureaucracy than a business -- and it shows. Tom Barrett reports below what happened when he needed a CPAP machine to treat his sleep apnea
Health insurance companies are remarkably short-sighted. By and large they refuse to pay for preventative measures that prevent serious, more costly conditions from occurring. (Not all insurance companies are like this, but most are.) Their bureaucratic systems often delay necessary treatments until they become life-threatening. A case in point is my tailor, Mr. Glickstien. He mentioned to me one day many years ago that he had seen blood in his urine. I was a paramedic at that time, and immediately thought of a half-dozen terrible things that could indicate. I advised him to see a doctor right away. He said that his insurance company told him he had to see a general practitioner first, then wait four to six weeks to see a specialist. I told him to go to the emergency room. He did, and was told that if he had waited another day he probably would have died.
Out of the quarter of a million people who read Conservative Truth each week, there are probably thousands of you with similar stories. Mine began when the medical supply company told me that Blue Cross (my insurance company) now required a sleep study before supplying a CPAP machine. Not only that, but Blue Cross only pays for rentals now, and the medical supply company (the only one that is authorized by Blue Cross) does not rent, but only sells CPAP machines! Talk about a catch-22!
Assuming (falsely) that I was dealing with reasonable people, I said that I had already had a sleep study. They countered that it had to be within the last twelve months. I told them I was already suffering from lack of sleep, that I needed the machine now, and that it would take four to six weeks to get a sleep study. They said, "Sorry."
Assuming (falsely) that if I could get past the clerks I might be able to speak with someone more intelligent, I asked for a supervisor. It turned out that she, too, was incapable of any action beyond reading from a prepared script. I had to 1) Get a prescription for a sleep study; 2) Wait a month or more for the study; and 3) Wait for Blue Cross to decide whether they would supply the machine. Never mind the fact that being without the machine could cause serious medical problems that would cost them far more than the machine, and never mind the fact that waiting a month could be life-threatening. That's what the rule book says.
Assuming (falsely) that they would listen to a Medical Doctor, I asked my very busy physician to call Blue Cross, and he was kind enough to do so (thank you, Dr. Liporace, and your wonderful office manager, Jackie). Surely these pencil-necked clerks would not ignore the advice of a trained physician! Wrong again. He told them that sleep apnea is not a condition that reverses itself. If I had it six years ago when they did the first study, I still have it today. He also confirmed that his clinical findings were that I currently have sleep apnea, and that it was imperative that I continue to receive CPAP treatment. He sent them a prescription for the machine, and a Letter of Medical Necessity, confirming that the device was necessary for my health. Their response? "Sorry."
Still believing (falsely) that these people would not be so stupid as to ignore the relative costs, I pointed out that CPAP machines cost between $600 and $800, and that the sleep study would cost between $2500 and $3000. "Why would you want to spend thousands for a sleep study instead of hundreds for a CPAP, just to find out what a Medical Doctor has already told you?" Well, it turns out that they ARE that stupid.
I bring these things up for two reasons. First, America needs to realize that idiotic decisions by insurance companies such as delaying treatment for my tailor friend, or denying less expensive preventative treatments, are causing medical insurance costs to sky-rocket, and in many cases are costing people their lives.
Second, not everyone has the options I have. I will purchase my own CPAP machine, and then spend whatever time it takes to force Blue Cross to reimburse me, because I cannot afford to go any longer without therapy. But there are hundreds of thousands of people in this country who don't have that option. They pay the unconscionable rates these companies charge, and can't afford to pay extra for necessary treatments when they are arbitrarily denied by their insurance companies.
Enough about insurance companies. You can expect to see more in this column about the abuses of these companies who advertise about how much they care about us, but who treat us like we are beggars when we expect the treatment we pay for. Let me end by encouraging you to be aware of the problem of sleep apnea.
More here
***************************
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.
***************************
Tuesday, January 18, 2005
THE ATTACK ON PRIVATE HOSPITALS
By now it is common knowledge that the retiring Baby Boom generation will impose tremendous pressure on Social Security and private pension plans as the number of workers per retiree shrinks. Less widely known is the impact this demographic trend will have on the availability of health care, and particularly hospital care. The capacity of America’s hospitals can be increased in two ways: by making existing hospitals more efficient, or by building new hospitals. Both ways will have to be utilized to meet the rising demand for hospital care by an aging population. Unfortunately, public policies at the national and state levels stand in the way.
The Medicare Modernization Act of 2003 was mostly about adding a prescription drug benefit for senior citizens, but it also included an 18-month moratorium on the development of new specialty hospitals. These hospitals typically focus on a few areas of surgical practice such as heart surgery or orthopedic surgery. The general hospitals responded to this competition by asking Congress to protect them from their more efficient and less costly rivals. Congress delivered, but only temporarily.
Competition between specialty hospitals and general hospitals helps to prevent either from charging excessive prices. It also spurs innovation, as competitors look for ways to be more efficient and provide either better service for the same price, or the same service for a lower price. Innovations such as redesigned hospital layouts lead to lower costs and help explain why specialty hospitals report spending approximately 30 percent of their operating costs on labor, while general hospitals spend between 40 and 60 percent. Also, by adding new capacity to the health care system, particularly in such areas as cardiac surgery and orthopedics, specialty hospitals could play a major role in ensuring there is enough capacity to treat the growing number of elderly who require more health services.
The American Hospital Association (AHA) is seeking a permanent ban on new specialty hospitals. For health care consumers today and in the future, that is a bad idea. A permanent ban would force us all to pay higher costs for health care, would reduce the number of choices we have for health care services, and would slow down the progress in making hospitals more efficient and increasing their capacity.
The American Medical Association (AMA), the nation’s largest association of physicians, is opposed to making the ban permanent. Physicians understand that specialty hospitals encourage competition and provide high-quality, cost-effective health care.
More here
***************************
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.
***************************
By now it is common knowledge that the retiring Baby Boom generation will impose tremendous pressure on Social Security and private pension plans as the number of workers per retiree shrinks. Less widely known is the impact this demographic trend will have on the availability of health care, and particularly hospital care. The capacity of America’s hospitals can be increased in two ways: by making existing hospitals more efficient, or by building new hospitals. Both ways will have to be utilized to meet the rising demand for hospital care by an aging population. Unfortunately, public policies at the national and state levels stand in the way.
The Medicare Modernization Act of 2003 was mostly about adding a prescription drug benefit for senior citizens, but it also included an 18-month moratorium on the development of new specialty hospitals. These hospitals typically focus on a few areas of surgical practice such as heart surgery or orthopedic surgery. The general hospitals responded to this competition by asking Congress to protect them from their more efficient and less costly rivals. Congress delivered, but only temporarily.
Competition between specialty hospitals and general hospitals helps to prevent either from charging excessive prices. It also spurs innovation, as competitors look for ways to be more efficient and provide either better service for the same price, or the same service for a lower price. Innovations such as redesigned hospital layouts lead to lower costs and help explain why specialty hospitals report spending approximately 30 percent of their operating costs on labor, while general hospitals spend between 40 and 60 percent. Also, by adding new capacity to the health care system, particularly in such areas as cardiac surgery and orthopedics, specialty hospitals could play a major role in ensuring there is enough capacity to treat the growing number of elderly who require more health services.
The American Hospital Association (AHA) is seeking a permanent ban on new specialty hospitals. For health care consumers today and in the future, that is a bad idea. A permanent ban would force us all to pay higher costs for health care, would reduce the number of choices we have for health care services, and would slow down the progress in making hospitals more efficient and increasing their capacity.
The American Medical Association (AMA), the nation’s largest association of physicians, is opposed to making the ban permanent. Physicians understand that specialty hospitals encourage competition and provide high-quality, cost-effective health care.
More here
***************************
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.
***************************
Monday, January 17, 2005
SWISS HEALTH CARE
In many countries, common sense is not so common in the health-care finance. We should therefore look at the system used in a country where pragmatism means everything, and ideology means little: Switzerland. No health care system is perfect, but the Swiss one makes very few people complain. It is able to provide services to heads of state as well as the poorest, including immigrants from different countries, who make up about a fifth of the population. What lesson should we take? Swiss common sense tells us that the market is the best solution for almost all areas of human activity, including the provision of health-care services. Public funding comes only when the private sector fails. What a difference when compared to the statist approach prevailing in Scandinavia, United Kingdom, Canada, Czech Republic and many other countries. Also, "public" does not inevitably mean "state". Swiss health care is extremely decentralized. Switzerland does not have any Ministry of Health. Every canton and every self-governing administration unit is in charge of its own regulation, hospital accreditation, and funding. Thus, there are 26 slightly different systems in a country with a population of 7 million. A statist bureaucrat will immediately think of the chaos that must reign there. But an economist sees a different phenomenon: competition.
Yes, even though the country lacks a health ministry, it does have the Federal Office of Public Health. Yes, it does regulate health care standards, but financing is mostly left to the market. Yes, health insurance is mandatory in Switzerland, which applies even to foreigners staying longer than three months. However, the system is primarily market-based. There are about 90 competing health-insurance companies. Patients are completely free to choose their insurance company, general practitioner, and specialist. The funding from public resources accounts for some 15 percent of the total cost. About 10 percent is covered from old-age or disability insurance. Health-insurance firms cover almost a half of the expense. About a quarter is financed by the patients in direct payments. The remaining share of the cost is divided between cantons, cities, and the federal government.
There are no officials who would decide how much money should flow into the system. No bureaucrat decides, for instance, that an insurance company pays a hospital about 5 euros per hour for the use of an operating theatre. Everything is a matter of market relations between the patients, insurance companies, and health-care facilities. The law only lays down that the basic insurance must be provided on a non-profit basis. The insurers make profit on above-standard programs. It's worth noting that even the basic programs would be deemed highly above-standard in most other countries.
In a system based on supply and demand, the patient is not a supplicant left at the mercy of gods in white gowns, but a respected client. Switzerland naturally also remembers its needy citizens. Cantonal hospitals are intended just for them. Switzerland, unlike many other developed countries (the US, France, Germany), has never connected health care to employers, an arrangement that hinders competition in many other countries. In the United States in particular, it is the poor who are most penalized by this system.
Swiss health care is obviously costly. However, any service of good quality, based on top-skilled labor in a developed country will always be expensive. But do we want doctors and other medical staff to take vows of poverty? Should patients be treated by paupers worrying about their basic necessaries of life? With equal costs, a system based on market prices will always be more efficient than a state-governed one with administrative prices. The money will be used more effectively. Taxpayers will not subsidize poor management of hospitals. A facility or a doctor that provides bad services will go bankrupt. Public subsidies are directed to poor patients, not to poor hospitals, as it routinely happens under the Czech health care system. Even poor patients have lots of power to choose.
It is impossible to set out all the details in a brief article. The Swiss system is not absolutely faultless - it lacks proper disclosure of quality of health care facilities, for instance. Also, according to some critics, role of the government has been slowly but surely increasing. Yet we can conclude one important message: health care should be managed not by a physician, nor by an economist, but by the market. And this is why Swiss health care is so good.
Source
***************************
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.
***************************
In many countries, common sense is not so common in the health-care finance. We should therefore look at the system used in a country where pragmatism means everything, and ideology means little: Switzerland. No health care system is perfect, but the Swiss one makes very few people complain. It is able to provide services to heads of state as well as the poorest, including immigrants from different countries, who make up about a fifth of the population. What lesson should we take? Swiss common sense tells us that the market is the best solution for almost all areas of human activity, including the provision of health-care services. Public funding comes only when the private sector fails. What a difference when compared to the statist approach prevailing in Scandinavia, United Kingdom, Canada, Czech Republic and many other countries. Also, "public" does not inevitably mean "state". Swiss health care is extremely decentralized. Switzerland does not have any Ministry of Health. Every canton and every self-governing administration unit is in charge of its own regulation, hospital accreditation, and funding. Thus, there are 26 slightly different systems in a country with a population of 7 million. A statist bureaucrat will immediately think of the chaos that must reign there. But an economist sees a different phenomenon: competition.
Yes, even though the country lacks a health ministry, it does have the Federal Office of Public Health. Yes, it does regulate health care standards, but financing is mostly left to the market. Yes, health insurance is mandatory in Switzerland, which applies even to foreigners staying longer than three months. However, the system is primarily market-based. There are about 90 competing health-insurance companies. Patients are completely free to choose their insurance company, general practitioner, and specialist. The funding from public resources accounts for some 15 percent of the total cost. About 10 percent is covered from old-age or disability insurance. Health-insurance firms cover almost a half of the expense. About a quarter is financed by the patients in direct payments. The remaining share of the cost is divided between cantons, cities, and the federal government.
There are no officials who would decide how much money should flow into the system. No bureaucrat decides, for instance, that an insurance company pays a hospital about 5 euros per hour for the use of an operating theatre. Everything is a matter of market relations between the patients, insurance companies, and health-care facilities. The law only lays down that the basic insurance must be provided on a non-profit basis. The insurers make profit on above-standard programs. It's worth noting that even the basic programs would be deemed highly above-standard in most other countries.
In a system based on supply and demand, the patient is not a supplicant left at the mercy of gods in white gowns, but a respected client. Switzerland naturally also remembers its needy citizens. Cantonal hospitals are intended just for them. Switzerland, unlike many other developed countries (the US, France, Germany), has never connected health care to employers, an arrangement that hinders competition in many other countries. In the United States in particular, it is the poor who are most penalized by this system.
Swiss health care is obviously costly. However, any service of good quality, based on top-skilled labor in a developed country will always be expensive. But do we want doctors and other medical staff to take vows of poverty? Should patients be treated by paupers worrying about their basic necessaries of life? With equal costs, a system based on market prices will always be more efficient than a state-governed one with administrative prices. The money will be used more effectively. Taxpayers will not subsidize poor management of hospitals. A facility or a doctor that provides bad services will go bankrupt. Public subsidies are directed to poor patients, not to poor hospitals, as it routinely happens under the Czech health care system. Even poor patients have lots of power to choose.
It is impossible to set out all the details in a brief article. The Swiss system is not absolutely faultless - it lacks proper disclosure of quality of health care facilities, for instance. Also, according to some critics, role of the government has been slowly but surely increasing. Yet we can conclude one important message: health care should be managed not by a physician, nor by an economist, but by the market. And this is why Swiss health care is so good.
Source
***************************
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.
***************************
Sunday, January 16, 2005
MEDICAL MYTHS
"The recently published "Miracle Cure," by Sally Pipes, president of the San Francisco-based Pacific Research Institute, exposes health-care myths while explaining why the sometimes-touted Canadian style health care isn't the answer. Myth: Uninsured individuals have no access to medical care. Fact: It turns out that in 2004 uninsured Americans received $125 billion of health care, of which $41 billion was provided totally free of charge.
Myth: Skyrocketing prescription drugs are driving health-care spending up. Fact: According to the Bureau of Labor Statistics, as a whole, Americans spend about 1 percent of their income on drugs. Seniors spend about 3 percent on drugs, less than the amount they spend on entertainment. Spending on drugs, as a percent of total health-care spending, was 10 percent in 1960. It's roughly the same today.
The fact of business is, pharmaceutical spending actually lowers total health-care spending. It often replaces expensive and invasive surgical procedures and the time spent in the hospital. For example, in a yearlong disease-management program, Humana Hospitals studied 1,100 congestive heart failure patients. While pharmaceutical costs increased by 60 percent, the medications reduced hospital costs by 78 percent -- a net savings of $9 million.
Among other myths exposed in "Miracle Cure" is the myth that our health-care problems derive from the fact that we have a free-market health-care system. Little can be further from the truth. The government has been the largest participant in our health-care system since the 1960s. Today, the government directly pays for 45 percent of health-care spending. Government intervenes in the form of tax subsidies and costly regulations on private insurers. Regulations imposed on medical practitioners are oppressive. According to a study by PricewaterhouseCoopers, for every four hours that a physician devotes to caring for a Medicare patient, hospital administrators spend 30 minutes on Medicare paperwork. For emergency room care, it's one hour spent on paperwork per one hour spent caring for a patient.
Is Canada better? In her book, Sally Pipes reports the case of 58-year-old Canadian Don Cerniz, who noticed blood in his urine. It took three weeks to get his first test and another month for an MRI, and treatment for his cancer didn't begin until six months later. According to the Vancouver, British Columbia-based Fraser Institute's yearly survey of medical waiting times, Cerniz was lucky: "The median wait for an MRI across Canada was 12.6 weeks. Patients in Prince Edward Island experienced the shortest wait for an MRI (six weeks), while Newfoundland residents waited longest (33.5 weeks)." Overall, Canada's total waiting time between referral from a general practitioner to treatment averaged about 18 weeks in 2004".
More here.
***************************
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.
***************************
"The recently published "Miracle Cure," by Sally Pipes, president of the San Francisco-based Pacific Research Institute, exposes health-care myths while explaining why the sometimes-touted Canadian style health care isn't the answer. Myth: Uninsured individuals have no access to medical care. Fact: It turns out that in 2004 uninsured Americans received $125 billion of health care, of which $41 billion was provided totally free of charge.
Myth: Skyrocketing prescription drugs are driving health-care spending up. Fact: According to the Bureau of Labor Statistics, as a whole, Americans spend about 1 percent of their income on drugs. Seniors spend about 3 percent on drugs, less than the amount they spend on entertainment. Spending on drugs, as a percent of total health-care spending, was 10 percent in 1960. It's roughly the same today.
The fact of business is, pharmaceutical spending actually lowers total health-care spending. It often replaces expensive and invasive surgical procedures and the time spent in the hospital. For example, in a yearlong disease-management program, Humana Hospitals studied 1,100 congestive heart failure patients. While pharmaceutical costs increased by 60 percent, the medications reduced hospital costs by 78 percent -- a net savings of $9 million.
Among other myths exposed in "Miracle Cure" is the myth that our health-care problems derive from the fact that we have a free-market health-care system. Little can be further from the truth. The government has been the largest participant in our health-care system since the 1960s. Today, the government directly pays for 45 percent of health-care spending. Government intervenes in the form of tax subsidies and costly regulations on private insurers. Regulations imposed on medical practitioners are oppressive. According to a study by PricewaterhouseCoopers, for every four hours that a physician devotes to caring for a Medicare patient, hospital administrators spend 30 minutes on Medicare paperwork. For emergency room care, it's one hour spent on paperwork per one hour spent caring for a patient.
Is Canada better? In her book, Sally Pipes reports the case of 58-year-old Canadian Don Cerniz, who noticed blood in his urine. It took three weeks to get his first test and another month for an MRI, and treatment for his cancer didn't begin until six months later. According to the Vancouver, British Columbia-based Fraser Institute's yearly survey of medical waiting times, Cerniz was lucky: "The median wait for an MRI across Canada was 12.6 weeks. Patients in Prince Edward Island experienced the shortest wait for an MRI (six weeks), while Newfoundland residents waited longest (33.5 weeks)." Overall, Canada's total waiting time between referral from a general practitioner to treatment averaged about 18 weeks in 2004".
More here.
***************************
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.
***************************
Saturday, January 15, 2005
BRITISH PUBLIC HOSPITALS CAN'T AFFORD CLEANERS
The scale of the reduction of cleaning staff gives firm backing to the widespread belief that wards have become dirtier and less safe. The figures, compiled by Unison, the public service union, showed that there were 55,000 hospital cleaners, either NHS employees or working in the hospitals for private cleaning contractors, last year. In 1984, there were more than 100,000. Unison demanded last night that the Health Secretary, John Reid, urgently review the number of cleaners needed. The union's general secretary, Dave Prentis, who has spoken to The Observer about his own brush with death after contracting MRSA, said: 'It is wrong that people have to recover from operations in these conditions, that visitors have to come into them and staff have to work in them. You wouldn't tolerate these levels of dirt at home, so why do we allow them in hospitals?' He said that since the introduction of market testing for cleaning services in 1983, controlling infections had become more difficult.
The figures were greeted with alarm last night by doctors and patients' groups. Claire Rayner, president of the Patients' Association, who herself contracted MRSA following a knee operation, said: 'These figures are terrifying. Cleaners have left because they are often blamed when it's not their fault; they feel demoralised and still they are paid a very low wage.' Dr Paul Grime, the British Medical Association's representative on hospital hygiene, said: 'A 50 per cent drop in the number of cleaners seems quite high to us. There are lots of factors behind MRSA but cleaning is a very important one.'
There is growing concern about how a drop in hygiene standards has contributed to the rise of MRSA - or methicillin-resistant staphylococcus aureus - which was contracted by 100,000 people last year in hospitals and is the cause of about 5,000 deaths a year. Rates of the bug are thought to have trebled over the past 10 years.
A spokesman for Reid said the drop in numbers of cleaners was not disputed, but that Department of Health figures showed that in 1986 there were 88,000 cleaners. He also said the size of the NHS estate had reduced by 20 per cent in the past two decades - therefore there was less space to clean.
MRSA Support, a patient group, said its own tests showed that the superbug was surviving cleaning regimes. Tony Field, its founder, said: 'We went to two Midlands hospitals and did swabs and found high rates of MRSA there.'
Official figures released last month showed that fewer than half of hospitals had good levels of cleanliness. Only half of the 1,184 hospitals in England had 'acceptable levels', while 27 were considered poor or unacceptable.
More here
***************************
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.
***************************
The scale of the reduction of cleaning staff gives firm backing to the widespread belief that wards have become dirtier and less safe. The figures, compiled by Unison, the public service union, showed that there were 55,000 hospital cleaners, either NHS employees or working in the hospitals for private cleaning contractors, last year. In 1984, there were more than 100,000. Unison demanded last night that the Health Secretary, John Reid, urgently review the number of cleaners needed. The union's general secretary, Dave Prentis, who has spoken to The Observer about his own brush with death after contracting MRSA, said: 'It is wrong that people have to recover from operations in these conditions, that visitors have to come into them and staff have to work in them. You wouldn't tolerate these levels of dirt at home, so why do we allow them in hospitals?' He said that since the introduction of market testing for cleaning services in 1983, controlling infections had become more difficult.
The figures were greeted with alarm last night by doctors and patients' groups. Claire Rayner, president of the Patients' Association, who herself contracted MRSA following a knee operation, said: 'These figures are terrifying. Cleaners have left because they are often blamed when it's not their fault; they feel demoralised and still they are paid a very low wage.' Dr Paul Grime, the British Medical Association's representative on hospital hygiene, said: 'A 50 per cent drop in the number of cleaners seems quite high to us. There are lots of factors behind MRSA but cleaning is a very important one.'
There is growing concern about how a drop in hygiene standards has contributed to the rise of MRSA - or methicillin-resistant staphylococcus aureus - which was contracted by 100,000 people last year in hospitals and is the cause of about 5,000 deaths a year. Rates of the bug are thought to have trebled over the past 10 years.
A spokesman for Reid said the drop in numbers of cleaners was not disputed, but that Department of Health figures showed that in 1986 there were 88,000 cleaners. He also said the size of the NHS estate had reduced by 20 per cent in the past two decades - therefore there was less space to clean.
MRSA Support, a patient group, said its own tests showed that the superbug was surviving cleaning regimes. Tony Field, its founder, said: 'We went to two Midlands hospitals and did swabs and found high rates of MRSA there.'
Official figures released last month showed that fewer than half of hospitals had good levels of cleanliness. Only half of the 1,184 hospitals in England had 'acceptable levels', while 27 were considered poor or unacceptable.
More here
***************************
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.
***************************
Friday, January 14, 2005
The Myth of Universal Health Care
The Left likes to speak of a "right to health care" and they promise that socialised medicine is the only way to protect that right. But in fact that is a myth. Not one socialised health care system in the world fulfils a right to universal health care.
My first real experience with the promises of socialised health care was in South Africa when Nelson Mandela promised free health care to all children under two years of age. That promise was quickly broken. First the emergency ward was inundated with mothers and their children. They showed up by the thousands. In fact the only ones who got any health care were the ones who could afford to sit and wait for hours at a time. The "free" care was paid for by diverting medical care from other, sometimes more serious, cases to these people. And for the most part the cases that now got attention were issues like sniffles, ear aches and sneezing.
Some would point out that in spite of that the serious cases got attention. Also not true. Early on the government started making exceptions. Premature infants under a specified weight limit did not qualify for this universal, free health care. In one prominent case the parents pleaded with the hospital for care for their new born. The bureaucrats said a rule is a rule and refused. Because the media covered the story private donations poured in for the family. With the money they received they transferred to a private hospital and paid for the care needed by their baby. The child survived but only because private alternatives existed. Many advocates of "universal" health care would ban such private alternatives. In those systems, unless you can get a bureaucrat to approve your treatment, you are out of luck.
Of course that happens all the time. Various illnesses are simply ignored under socialised health care. Others are political favourites. If you happen to become ill with a problem favoured by the elite they you may receive treatment. Otherwise you are just out of luck. So much for universal health care under socialism. In some places patients over a particular age are forbidden to receive dialysis treatment or heart surgery. Under socialism the sooner the old die off the better it is for the system. The Soviets stopped people from emigrating right up until retirement at which point, instead of labouring to keep the system going, they became a burden. The Soviets didn't want burdens so people previously banned from leaving were now encouraged to do so. Many socialist health care systems restrict immigration for the same reason.
Take New Zealand as an example. To immigrate to New Zealand each applicant must go through a long, tedious process of health examinations with "approved" physicians only. There are also strict age requirements in order to assure the government that the person will pay more into the system than they will ever collect. Now of course there are elderly people who would love to retire in New Zealand and who have the money to care for themselves and pay for private health insurance. They can forget it unless they are very wealthy indeed.
The government wants to keep the illusion of universal health care alive here. And if they allowed people into the country who were not part of that system it would call the system itself into question. Now these retired folks would be better off here even without access to socialised health care. And the economy would benefit from the wealth they would bring into the country. Even the government would collect increased tax revenues from their presence. But they can't come in because protecting the illusion of socialised health care is more important. Instead of everyone winning the government prefers increasing the number of losers just to protect the illusion of universal health care. And that means obvious cases of exclusion have to be avoided for the less obvious cases of exclusion that are rampant under universal health care.
It is not just certain classes of illnesses and certain classes of people that are excluded under the "universal" health care system. Certain types of treatments are also excluded no matter how well they may work. Specific types of surgical procedures are excluded because they are too costly. Specific drugs are excluded while cheaper varieties, which many not work as well, are embraced instead. The reason for all of this is scarcity. All medical care is a scarce good and thus has a price or cost. Prices are a means of rationing scarce goods including health care. You can abolish the price system-which socialists have long dreamed of-but you can't abolish scarcity. The prices do not cause the scarcity. The scarcity causes the prices. Without the use of price rationing you must substitute other forms of rationing instead.
So under socialised health care scarce health care is rationed out by political edict or by queuing. There is nothing "universal" about socialised health care at all. It is still rationed out similar to health care under market oriented systems. But there is a difference. The monopoly provision under socialist systems means that private alternatives are either difficult or impossible to find. Health care will always cost something but in the socialist system the bureaucrats get to decide which "treatments" are worth it and which are not. They get to decide who is worthy of treatment and who is not. They get to decide which illnesses receive attention and which are ignored.
While it is built on the promise of empowering the people socialised health care disempowers them and instead empowers bureaucrats and politicians. While it promises "universal" care it in fact restricts that care just as much, in fact more so, than does market oriented medical care.....
It is tragic that some people will never receive the medical care they need. Socialised health care did not solve that problem at all they just politicised it. At least in the market I could try to raise the funds for the care I might need. But in a true socialist system the monopoly health provider can exclude me and I'm stuck. I can't turn to the private alternative because under socialism there is no private alternative. Capitalist health care may ration care just like the socialist system does but it provides more and more options as time goes by. And each individual has the option of seeking alternative financing of that care....
Source
***************************
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.
***************************
The Left likes to speak of a "right to health care" and they promise that socialised medicine is the only way to protect that right. But in fact that is a myth. Not one socialised health care system in the world fulfils a right to universal health care.
My first real experience with the promises of socialised health care was in South Africa when Nelson Mandela promised free health care to all children under two years of age. That promise was quickly broken. First the emergency ward was inundated with mothers and their children. They showed up by the thousands. In fact the only ones who got any health care were the ones who could afford to sit and wait for hours at a time. The "free" care was paid for by diverting medical care from other, sometimes more serious, cases to these people. And for the most part the cases that now got attention were issues like sniffles, ear aches and sneezing.
Some would point out that in spite of that the serious cases got attention. Also not true. Early on the government started making exceptions. Premature infants under a specified weight limit did not qualify for this universal, free health care. In one prominent case the parents pleaded with the hospital for care for their new born. The bureaucrats said a rule is a rule and refused. Because the media covered the story private donations poured in for the family. With the money they received they transferred to a private hospital and paid for the care needed by their baby. The child survived but only because private alternatives existed. Many advocates of "universal" health care would ban such private alternatives. In those systems, unless you can get a bureaucrat to approve your treatment, you are out of luck.
Of course that happens all the time. Various illnesses are simply ignored under socialised health care. Others are political favourites. If you happen to become ill with a problem favoured by the elite they you may receive treatment. Otherwise you are just out of luck. So much for universal health care under socialism. In some places patients over a particular age are forbidden to receive dialysis treatment or heart surgery. Under socialism the sooner the old die off the better it is for the system. The Soviets stopped people from emigrating right up until retirement at which point, instead of labouring to keep the system going, they became a burden. The Soviets didn't want burdens so people previously banned from leaving were now encouraged to do so. Many socialist health care systems restrict immigration for the same reason.
Take New Zealand as an example. To immigrate to New Zealand each applicant must go through a long, tedious process of health examinations with "approved" physicians only. There are also strict age requirements in order to assure the government that the person will pay more into the system than they will ever collect. Now of course there are elderly people who would love to retire in New Zealand and who have the money to care for themselves and pay for private health insurance. They can forget it unless they are very wealthy indeed.
The government wants to keep the illusion of universal health care alive here. And if they allowed people into the country who were not part of that system it would call the system itself into question. Now these retired folks would be better off here even without access to socialised health care. And the economy would benefit from the wealth they would bring into the country. Even the government would collect increased tax revenues from their presence. But they can't come in because protecting the illusion of socialised health care is more important. Instead of everyone winning the government prefers increasing the number of losers just to protect the illusion of universal health care. And that means obvious cases of exclusion have to be avoided for the less obvious cases of exclusion that are rampant under universal health care.
It is not just certain classes of illnesses and certain classes of people that are excluded under the "universal" health care system. Certain types of treatments are also excluded no matter how well they may work. Specific types of surgical procedures are excluded because they are too costly. Specific drugs are excluded while cheaper varieties, which many not work as well, are embraced instead. The reason for all of this is scarcity. All medical care is a scarce good and thus has a price or cost. Prices are a means of rationing scarce goods including health care. You can abolish the price system-which socialists have long dreamed of-but you can't abolish scarcity. The prices do not cause the scarcity. The scarcity causes the prices. Without the use of price rationing you must substitute other forms of rationing instead.
So under socialised health care scarce health care is rationed out by political edict or by queuing. There is nothing "universal" about socialised health care at all. It is still rationed out similar to health care under market oriented systems. But there is a difference. The monopoly provision under socialist systems means that private alternatives are either difficult or impossible to find. Health care will always cost something but in the socialist system the bureaucrats get to decide which "treatments" are worth it and which are not. They get to decide who is worthy of treatment and who is not. They get to decide which illnesses receive attention and which are ignored.
While it is built on the promise of empowering the people socialised health care disempowers them and instead empowers bureaucrats and politicians. While it promises "universal" care it in fact restricts that care just as much, in fact more so, than does market oriented medical care.....
It is tragic that some people will never receive the medical care they need. Socialised health care did not solve that problem at all they just politicised it. At least in the market I could try to raise the funds for the care I might need. But in a true socialist system the monopoly health provider can exclude me and I'm stuck. I can't turn to the private alternative because under socialism there is no private alternative. Capitalist health care may ration care just like the socialist system does but it provides more and more options as time goes by. And each individual has the option of seeking alternative financing of that care....
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.
***************************
Thursday, January 13, 2005
JUNK SCIENCE KEEPING MEDICINES AWAY FROM PEOPLE WHO NEED THEM
If a drug has no side-effects, it has no main effects either
Depending on which of two recent studies you may have read about, you might suppose the pain reliever Alleve (naproxen) will either reduce or increase the risk of heart attacks. On Dec. 13, the Financial Times reported, "Widely used anti-inflammatory drugs such as ibuprofen and naproxen could help reduce the risk of heart attacks, while abruptly halting the usage increases the risks, according to a large U.K. study." On Dec. 21, The Washington Post dished out the opposite advice, noting, "Federal officials announced that naproxen, a painkiller sold by prescription and also over the counter as Aleve, might increase people's risk of having a heart attack."
Between those dates, my periodontist prescribed naproxen. What the press described as a "quick review of the data" in the United States may have suggested to equally hasty readers I should stop using naproxen or risk a heart attack. But the larger British study said stopping naproxen would risk a heart attack. So, I decided to take a closer look at the U.S. version.
It turns out that in a study of about 2,400 older people, 70 of those using naproxen had some "cardiovascular event," such as a stroke or heart attack, but only two or three died. The 70 was said to be twice the rate among those taking a placebo. Press reports promptly ascribed that minor difference (1« percent) to the added risk of taking a large daily dose of naproxen for three years. For all we know, the difference might be because those taking naproxen ate fatter foods than most other participants, exercised less, were older, had worse family histories or smoked more cigarettes. Nobody said these other risk factors were properly taken into account, so the quick review lacks statistical credibility.
Even in the case of Vioxx, nobody claims it is dangerous if the normal 25 mg dose is taken only a couple of weeks, as I would still like to do for an arthritic big toe on vacations (because I'm allergic to Celebrex). I am now denied the opportunity to use Vioxx responsibly, not to eliminate even the slightest health risk (impossible), but in hopes of reducing litigation risk. Typing "Vioxx" into Google generates about 14 million hits, mostly ads inviting people to share in the fabulous riches from class-action suits. One says, "Vioxx lawsuit is the easiest way to make you a millionaire."
Mass tort lawyers must love David Graham, an associate director in the Food and Drug Administration's Office of Drug Safety. Mr. Graham became an instant media darling when he testified against the FDA at a November hearing of the Senate Finance Committee. Yet Mr. Graham's testimony was not so much about blowing whistles as it was about tooting horns. "During my career, I believe I have made a real difference for the cause of patient safety. ... I have recommended the market withdrawal of 12 drugs. Only two of these remain on the market today - Accutane and Arava." He then recommended banning several other FDA-approved medications.
Mr. Graham's urge to banish risk reflects the mindset of aspiring regulatory czars. The fewer drug choices left to doctors and patients, the better job Mr. Graham imagines he has done. Yet if zero risk from new drugs was really ideal, then it would be best to simply ban all new drugs.
The FDA does not go quite that far, but the agency has certainly slowed introduction of many drugs that could have saved or improved many lives if available sooner. A classic example was beta-blockers, which an American Heart Association study says "lengthen the lives of people at risk of sudden death due to irregular heart beats." Beta-blockers were available in Europe in 1967; the FDA banned them until 1976.....
The hullabaloo about questionable risks from chronic overuse of such beneficent drugs as Celebrex and Alleve may yet cause truly serious health risks if it contributes to the terrifying FDA urge to deny doctors and patients timely access to vital drugs.
More here
***************************
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.
***************************
If a drug has no side-effects, it has no main effects either
Depending on which of two recent studies you may have read about, you might suppose the pain reliever Alleve (naproxen) will either reduce or increase the risk of heart attacks. On Dec. 13, the Financial Times reported, "Widely used anti-inflammatory drugs such as ibuprofen and naproxen could help reduce the risk of heart attacks, while abruptly halting the usage increases the risks, according to a large U.K. study." On Dec. 21, The Washington Post dished out the opposite advice, noting, "Federal officials announced that naproxen, a painkiller sold by prescription and also over the counter as Aleve, might increase people's risk of having a heart attack."
Between those dates, my periodontist prescribed naproxen. What the press described as a "quick review of the data" in the United States may have suggested to equally hasty readers I should stop using naproxen or risk a heart attack. But the larger British study said stopping naproxen would risk a heart attack. So, I decided to take a closer look at the U.S. version.
It turns out that in a study of about 2,400 older people, 70 of those using naproxen had some "cardiovascular event," such as a stroke or heart attack, but only two or three died. The 70 was said to be twice the rate among those taking a placebo. Press reports promptly ascribed that minor difference (1« percent) to the added risk of taking a large daily dose of naproxen for three years. For all we know, the difference might be because those taking naproxen ate fatter foods than most other participants, exercised less, were older, had worse family histories or smoked more cigarettes. Nobody said these other risk factors were properly taken into account, so the quick review lacks statistical credibility.
Even in the case of Vioxx, nobody claims it is dangerous if the normal 25 mg dose is taken only a couple of weeks, as I would still like to do for an arthritic big toe on vacations (because I'm allergic to Celebrex). I am now denied the opportunity to use Vioxx responsibly, not to eliminate even the slightest health risk (impossible), but in hopes of reducing litigation risk. Typing "Vioxx" into Google generates about 14 million hits, mostly ads inviting people to share in the fabulous riches from class-action suits. One says, "Vioxx lawsuit is the easiest way to make you a millionaire."
Mass tort lawyers must love David Graham, an associate director in the Food and Drug Administration's Office of Drug Safety. Mr. Graham became an instant media darling when he testified against the FDA at a November hearing of the Senate Finance Committee. Yet Mr. Graham's testimony was not so much about blowing whistles as it was about tooting horns. "During my career, I believe I have made a real difference for the cause of patient safety. ... I have recommended the market withdrawal of 12 drugs. Only two of these remain on the market today - Accutane and Arava." He then recommended banning several other FDA-approved medications.
Mr. Graham's urge to banish risk reflects the mindset of aspiring regulatory czars. The fewer drug choices left to doctors and patients, the better job Mr. Graham imagines he has done. Yet if zero risk from new drugs was really ideal, then it would be best to simply ban all new drugs.
The FDA does not go quite that far, but the agency has certainly slowed introduction of many drugs that could have saved or improved many lives if available sooner. A classic example was beta-blockers, which an American Heart Association study says "lengthen the lives of people at risk of sudden death due to irregular heart beats." Beta-blockers were available in Europe in 1967; the FDA banned them until 1976.....
The hullabaloo about questionable risks from chronic overuse of such beneficent drugs as Celebrex and Alleve may yet cause truly serious health risks if it contributes to the terrifying FDA urge to deny doctors and patients timely access to vital drugs.
More here
***************************
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.
***************************
Wednesday, January 12, 2005
REALITY BITES IN TENNESSEE
And legal vultures led by the vastly misnamed Bonnyman helped push the system over
Gov. Phil Bredesen announced Monday that he will drop 323,000 adults from the state's expanded Medicaid program to save about $1.7 billion a year, but will preserve health coverage for children. The announcement capped weeks of negotiations between Bredesen and health care advocates in an effort to save a Tennessee program that offers coverage to the working poor who make too much money to qualify for regular Medicaid. Advocates said the cuts would be devastating and pleaded with the governor to reconsider the move.
The governor's plan ends coverage for adults who make more than the Medicaid cutoff, but retains it for more than 100,000 children whose families fall in that range. "I say to you with a clear heart that I've tried everything," the Democratic governor said. "There is no big lump of federal money that will make the problem go away. It is just not there." The governor has said court settlements that forced Tennessee to raise the level of coverage it provided meant it could not afford to continue with the expanded program.
Bredesen had announced in November that he intended to return to basic Medicaid, ending coverage for all 430,000 adults and children, because of mushrooming costs. He agreed to negotiations with lawyers for the working poor, but said Monday that the advocates were "living in a fairyland" and would not work to find realistic solutions. "I feel like I can hold my head up as we move through the unpleasant changes we have to make," he said.
Gordon Bonnyman, the chief legal advocate in the case against the state, hoped the governor would change his mind. "Cuts of that size are unprecedented and unthinkable," he said.
Source
***************************
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.
***************************
And legal vultures led by the vastly misnamed Bonnyman helped push the system over
Gov. Phil Bredesen announced Monday that he will drop 323,000 adults from the state's expanded Medicaid program to save about $1.7 billion a year, but will preserve health coverage for children. The announcement capped weeks of negotiations between Bredesen and health care advocates in an effort to save a Tennessee program that offers coverage to the working poor who make too much money to qualify for regular Medicaid. Advocates said the cuts would be devastating and pleaded with the governor to reconsider the move.
The governor's plan ends coverage for adults who make more than the Medicaid cutoff, but retains it for more than 100,000 children whose families fall in that range. "I say to you with a clear heart that I've tried everything," the Democratic governor said. "There is no big lump of federal money that will make the problem go away. It is just not there." The governor has said court settlements that forced Tennessee to raise the level of coverage it provided meant it could not afford to continue with the expanded program.
Bredesen had announced in November that he intended to return to basic Medicaid, ending coverage for all 430,000 adults and children, because of mushrooming costs. He agreed to negotiations with lawyers for the working poor, but said Monday that the advocates were "living in a fairyland" and would not work to find realistic solutions. "I feel like I can hold my head up as we move through the unpleasant changes we have to make," he said.
Gordon Bonnyman, the chief legal advocate in the case against the state, hoped the governor would change his mind. "Cuts of that size are unprecedented and unthinkable," he said.
Source
***************************
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.
***************************
Tuesday, January 11, 2005
GOVERNMENT SETTING US UP FOR A FLU DISASTER
During the winter of 1918-19, only months after the end of World War I, much of the world was ravaged again, this time by the "Spanish flu" that killed an estimated 40 to 50 million people. Normal societal functions, including commerce, education, and government services, were virtually shut down in many places....
Vaccination to prevent viral and bacterial diseases is modern medicine's most cost-effective intervention. Although their social value is high, vaccines' economic value to pharmaceutical companies is low because of their minimal return on investment and the manufacturers' exposure to legal liability. The underlying problem is government policies that discourage companies from investing aggressively in new vaccines, and that have failed to stockpile antiviral drugs.
The major purchaser of most vaccines, the Centers for Disease Control and Prevention, extracts huge discounts from manufacturers. Arbitrary and excessive regulation also blocks progress. As a result, innovation has suffered and vaccine producers have abandoned the field in droves, leaving only four major manufacturers and a few dozen products. There are only two producers of injectable flu vaccine for the U.S. market.
To correct these broad deficiencies, and to stop an evolving flu pandemic in its tracks, the government must take a number of steps: increase funding for basic research on subunit vaccines (which are safer and cheaper and should have shorter development times than conventional ones) and other novel approaches; and stockpile anti-flu medicines. The CDC must stop demanding discounts that discourage manufacturers, and regulators should pursue "reciprocity" agreements on approvals so vaccines and antiviral drugs licensed in certain foreign countries can be marketed in the United States.
In the longer term, Congress could take other measures to improve the climate for vaccine-makers, such as offering tax breaks to offset research and development costs; requiring that health-insurance providers cover immunizations without deductibles; and stipulating that once the Food and Drug Administration approves a vaccine, the government will compensate victims of side effects. These measures collectively constitute a health insurance policy we can't do without.
More here
***************************
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.
***************************
During the winter of 1918-19, only months after the end of World War I, much of the world was ravaged again, this time by the "Spanish flu" that killed an estimated 40 to 50 million people. Normal societal functions, including commerce, education, and government services, were virtually shut down in many places....
Vaccination to prevent viral and bacterial diseases is modern medicine's most cost-effective intervention. Although their social value is high, vaccines' economic value to pharmaceutical companies is low because of their minimal return on investment and the manufacturers' exposure to legal liability. The underlying problem is government policies that discourage companies from investing aggressively in new vaccines, and that have failed to stockpile antiviral drugs.
The major purchaser of most vaccines, the Centers for Disease Control and Prevention, extracts huge discounts from manufacturers. Arbitrary and excessive regulation also blocks progress. As a result, innovation has suffered and vaccine producers have abandoned the field in droves, leaving only four major manufacturers and a few dozen products. There are only two producers of injectable flu vaccine for the U.S. market.
To correct these broad deficiencies, and to stop an evolving flu pandemic in its tracks, the government must take a number of steps: increase funding for basic research on subunit vaccines (which are safer and cheaper and should have shorter development times than conventional ones) and other novel approaches; and stockpile anti-flu medicines. The CDC must stop demanding discounts that discourage manufacturers, and regulators should pursue "reciprocity" agreements on approvals so vaccines and antiviral drugs licensed in certain foreign countries can be marketed in the United States.
In the longer term, Congress could take other measures to improve the climate for vaccine-makers, such as offering tax breaks to offset research and development costs; requiring that health-insurance providers cover immunizations without deductibles; and stipulating that once the Food and Drug Administration approves a vaccine, the government will compensate victims of side effects. These measures collectively constitute a health insurance policy we can't do without.
More here
***************************
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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