WOULD YOU LIKE TO HAVE BUREAUCRATIC RULES DETERMINING WHETHER YOU LIVE OR DIE?

It's been happening informally in Britain for years but now it is being officially acknowledged

Elderly patients could be denied some treatments because of their age under new proposals set out by the Government’s national health advisory body. The National Institute for Health and Clinical Excellence (NICE), which provides guidance on health issues for England, confirmed yesterday that it had set out the controversial ideas in a consultation paper. Members of the institute’s Citizen’s Council said that in cases in which age could affect the benefits or risks of treatment, medical staff would be justified in discriminating.

Charities have raised concern that the views, which will be taken into account by the institute when it makes recommendations about policy or drugs, could lead to the elderly being refused some services. Gordon Lishman, director- general of Age Concern, said that the consultation document indicated that elderly people could suffer further discrimination from the NHS. He said that policies against the elderly already existed in cases such as breast cancer screening, which was denied to women over 70 as a routine procedure. Rates of breast cancer in this age group remain highest, at close to 350 per 100,000 people. Some mental health initiatives also revealed age discrimination, the charity said, including situations where pensioners were moved from consultations with a psychiatrist to dementia schemes simply on the grounds of age. “These draft guidelines are muddled and if applied could be a real step backwards,” Mr Lishman said. “We have a long way to go to scrap unfair practice suffered by older people in the NHS . . . Everyone should have the right to treatment according to what they need as individuals, never on the sole basis of their date of birth.” Age Concern said that around 80 per cent of GPs already believed that there was discrimination against older people in the system. Campaigners argue that as the over-70s are the most intensive users of the NHS, and given the country’s ageing population, the age group should be at the forefront of health policy thinking.

The Citizen’s Council, a panel of 30 members of the public which considers ethical and moral judgments on behalf of the institution, had been asked to discuss issues of age last year. It followed discussion of whether health services should discriminate against the obese or those who smoke.

The institute’s report recommended that all patients should be treated equally regardless of age, gender, race, or socio- economic status. But it said that there should be exceptions if a patient’s condition was self-inflicted and the “self-inflicted causes of the condition influences the likely outcome of the use of the intervention”. The second exception should apply “where age is an indicator of benefit or risk”. In these cases “age discrimination is appropriate”, the report recommended. The institute said that the issue of treatment for different age groups was a common one and that any discrimination would have to be based on justifiable clinical evidence. Andrew Dillon, its chief executive, said: “The institute has to make difficult decisions about how well treatments work and which treatments offer the NHS best value for money. We know that factors such as age and lifestyle can influence how clinically or cost-effective a treatment is. We are asking people whether NICE is getting it right when we take this type of factor into account.”

Jonathan Ellis, a policy manager at Help the Aged, said that any possible discrimination contravened the Government’s stated aim of tackling the prejudice against older people that exists in health care services. “To suggest that anyone should receive less care and attention simply because they happen to be older is blatant discrimination,” he said.


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MEDICAID TO BE CUT

Governors and state legislators have devised proposals for sweeping changes in Medicaid to curb its rapid growth and save billions of dollars. Under the proposals, some beneficiaries would have to pay more for care, and states would have more latitude to limit the scope of services. The proposals, drafted by separate working groups of governors and state legislators, provide guidance to Congress, which 10 days ago endorsed a budget blueprint that would cut projected Medicaid spending by $10 billion over the next five years. Many of the proposals resemble ideas advanced by President Bush as part of his 2006 budget. In some cases, the governors embrace Mr. Bush's proposals but go further. At the same time, they also reject some of the president's recommendations that they believe would shift costs to the states.

John Adams Hurson, a member of the Maryland House of Delegates who is president of the National Conference of State Legislatures, said: "I am a Democrat, a liberal Democrat, but we can't sustain the current Medicaid program. It's fiscal madness. It doesn't guarantee good care, and it's a budget buster. We need to instill a greater sense of personal responsibility so people understand that this care is not free."

A coalition of beneficiary advocates, labor unions and health care providers is already gearing up to fight any significant cutbacks in Medicaid. The coalition includes AARP, Families USA, pediatricians, hospitals and nursing homes.

State officials say their goal is not just to save money, but also to avoid wholesale cuts in coverage like those in Tennessee, which is dropping more than 300,000 people from its Medicaid rolls, and in Missouri, which is dropping 90,000. Medicaid, the nation's largest health insurance program, covers more than 50 million low-income people. Though originally intended for the poor, it now covers people with incomes well above the poverty level in some states.

The National Governors Association and the National Conference of State Legislatures are still refining their proposals, with the aim of getting their recommendations to Congress for action this year. States, they say, should be allowed to impose higher co-payments and deductibles on Medicaid recipients with higher incomes. Moreover, they say, states should not have to offer the same comprehensive set of benefits to all Medicaid recipients, but should be allowed to provide some people with more limited benefits, like those offered by commercial insurers and the Children's Health Insurance Program. States should be able to establish "different benefit packages for different populations, or in different parts of the state," the governors say in a draft of their new policy.

The proposals developed over the last month by governors and state legislators have a substantial chance of becoming law. Congressional leaders have expressed a desire to rein in Medicaid costs, appear ready to act and are just waiting for advice from state officials. "We want to invite the governors to the table," said Representative Jim Nussle, Republican of Iowa, who is chairman of the House Budget Committee and a potential candidate for governor next year. With Medicaid, as with welfare, states have an influential voice because they help finance the program.

Federal and state spending on Medicaid has grown an average of 10 percent a year over the last five years - much faster than federal or state revenues - and now totals more than $300 billion annually. Drug prices and hospital costs have risen at a brisk pace, but the increase in enrollment is a more important factor. From 2000 to 2004, according to the Congressional Budget Office, the number of Medicaid recipients grew by one-third. This growth coincides with the erosion of employer-sponsored health benefits. As employers have cut back coverage and raised premiums, private insurance has become less available and less affordable to low-wage workers.

In recent months, the governors have drafted at least three versions of a paper titled "Medicaid Reform: A Comprehensive Approach." The documents, obtained by The New York Times, offer a vision of "Medicaid plus health care reform," including "incentives and penalties for individuals to take more responsibility for their health care."

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U.S. GOVERNMENT ACCEPTS ITS RESPONSIBILITY FOR ILLEGALS

Pity the taxpayer has to pay but it is better than stiffing the doctors and hospitals

The Bush administration announced on Monday that it would start paying hospitals and doctors for providing emergency care to illegal immigrants. The money, totaling $1 billion, will be available for services provided from Tuesday through September 2008. Congress provided the money as part of the 2003 law that expanded Medicare to cover prescription drugs, but the new payments have nothing to do with the Medicare program.

Members of Congress from border states, like Senator Jon Kyl, Republican of Arizona, had sought the money. They said the treatment of illegal immigrants imposed a huge financial burden on many hospitals, which are required to provide emergency care to patients who need it, regardless of their immigration status or ability to pay.

Under the new program, hospitals are supposed to ask patients for certain documents to substantiate claims for payment. But Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said a hospital should not directly ask a patient "if he or she is an undocumented alien." Instead, Dr. McClellan said, hospitals can try to establish a patient's status by analyzing the answers to "indirect questions": Is the person eligible for Medicaid? (If so, payment is generally not available under the new program.) Has the person reported a foreign place of birth? Does the person have a border-crossing card like those issued to Mexican citizens? Does the person have a foreign passport, a foreign driver's license or a foreign identification card? The Bush administration abandoned a proposal that would have required many hospitals to ask patients if they were United States citizens or legal immigrants. "In no circumstances are hospitals required to ask people about their citizenship status," Dr. McClellan said on Monday. Hospital executives and immigrant rights groups had said such questions would deter illegal immigrants from seeking hospital care and could lead to serious public health problems by increasing the spread of communicable diseases.

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

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