POPULARITY OF DRUG PLAN CREEPING UP
Who cares if Medicare's new drug plan is a bit confusing, Dixie and Frank Gulyas of Citrus Heights concluded. For the first time in their retirement, they'll have coverage to help pay for prescription drugs. "It's going to save us a lot of money," said Dixie Gulyas. "I feel good about it." Overshadowed by the troubles that have plagued the Medicare Part D drug plan since its Jan. 1 start is the fact that many Medicare beneficiaries who have been paying out of pocket for expensive prescription drugs can get help. Even consumer advocates who complain that the implementation has been disastrous don't want seniors and disabled persons who can benefit to be deterred from signing up.
New enrollment figures released Wednesday by Mike Leavitt, the U.S. Health and Human Services secretary, show 1.3 million more people have enrolled since Jan. 13, bringing the number of Medicare beneficiaries with some type of drug coverage now to 25 million nationally. Among the 4.3 million Californians on Medicare, the number who signed up for stand-alone drug plans increased from about 155,000 to 235,000. The number in managed-care plans with drug benefits remained about the same. "Enrollment is up, the price is down, the system is working better every day," said Leavitt at a press conference in Pensacola, Fla., to encourage Medicare beneficiaries to sign up.
About 1 million Californians were required to switch from Medi-Cal to Medicare for their prescriptions on Jan. 1. Declaring the problems that ensued an emergency, California said Medi-Cal will continue to pay for drugs until problems can be worked out with Medicare. From now until May 15, all other Medicare beneficiaries will have to decide if they want to buy the coverage. Some may choose to remain with other drug coverage if they have a similar plan through their former employer.
Sacramento's Health Insurance Counseling and Advocacy Program, HICAP, is still busy trying to help those making the switch from Medi-Cal who ran into lots of trouble getting their prescriptions filled, said assistant director Margaret Reilly. But those problems don't mean that all Medicare beneficiaries should stay away from the new benefit, she said. "If you have a limited income and limited assets, you could benefit," she said. "If you don't have prescription drug coverage now and haven't had it in the past, you could benefit."
For example, she recently enrolled an 84-year-old woman who uses only two prescriptions whose income wasn't low enough to qualify her for free or reduced-cost coverage. Reilly explained her reason for signing up. "You look at it as a traditional health or insurance plan," she said. While the woman doesn't need much help in paying for her prescriptions or use many drugs now, she probably will in the future. "You're looking at the future, not so much what your needs are today," said Reilly, who pointed out that beneficiaries who sign up late will face lifelong penalties for their delay in enrolling. "That's going to become important."
That's exactly why Leslie Farrell of Sacramento signed up her 85-year-old mother on Medicare's Web site even though the older woman is in good health and uses few prescriptions. Her mother, who had no drug coverage, will save about $200 a year on her current prescriptions through her drug plan, she said. But Farrell was more concerned about making sure the drugs her mother might need as she ages are covered.
Leavitt said seniors need to consider their future drug needs and remember that like any insurance plan, it will cost more if they wait until after the May 15 deadline to enroll. He also urged those wanting to change plans not to wait until the last of the month to avoid delays in getting their coverage.
While Medicare's 24-hour telephone help line now has a wait time of one minute or less, the new drug plans need to make more improvements in their customer service.
The Gulyases decided to sign up for the Secure Horizons Medicare Advantage plan, which will provide both managed-care health coverage for their medical care and prescription drug coverage. Instead of paying $300 a month for health insurance alone with no drug coverage, they'll now pay $37 per person per month for medical care that also provides drug coverage. Dixie Gulyas, 73, is healthy and still works part time, but she said her 69-year-old husband takes eight prescriptions and suffers from circulatory problems, high blood pressure and other chronic problems. The drug coverage has relieved her worries about how to pay for future prescription drug costs. "It's one less thing I have to worry about. With my husband's condition, you never know," she said. "Something is going to get all of us one of these days."
Source
Australian health insurance price rises not as bad this year: "Private health fund premiums will climb an average of 5.7 per cent from April 1, adding $3 a week on a typical family policy. But the increases - which will fall to an average weekly slug of $2 after the federal Government's 30 per cent rebate - are the lowest annual price hikes for five years. Health funds say increased payouts to members, which rose 8.1 per cent to almost $5.9billion for hospital benefits alone in 2004-05, are one factor behind the rises. Other drivers were said to be a 20 per cent rise in payouts for prostheses and the popularity and spread of "gap cover" products that in some cases paid the doctor's entire fee. Private health fund membership is increasing. There are now about 8.8 million Australians with hospital cover - 43.1 per cent of the population - and 8.6 million with ancillary cover. Almost all the increase is among people aged more than 60, who place the greatest pressure on health funds."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 28, 2006
Monday, February 27, 2006
THE ELDERLY ARE JUST A NUISANCE IN BRITAIN'S NHS
Best if they get a bug and die
Barbara Yeo died in March last year, and time has not yet been able to diminish for Harriet the distressing, haunting images of her mother as she lay breathless and in pain in her hospital bed. An 83-year-old former hospital matron who, in her working life, specialised in care of the elderly, Barbara had not been in the peak of health, but nor was she terminally ill. And yet her own admission to hospital for routine treatment of leg ulcers was to prove fatal. Barbara died of viral gastroenteritis - a stomach bug that she contracted from a highly infectious patient who was placed next to her on the ward. As her condition rapidly deteriorated, the acronym DNR - for Do Not Resuscitate - was placed on her notes.
'I told the doctor that that would be going against her wishes. Because she was a nurse, it was a conversation we had had many times. But they did it anyway. They treated the age, not the patient, and it cost my mother her life,' says Harriet.
The story of Barbara's demise is one that will resonate with many. We are living longer and, consequently, more likely to become frail and vulnerable through age. Two thirds of patients in hospital wards are over 65. Most of those who have had to care for an elderly and sick relative understand that resources are limited. But care, sympathy and dignity shouldn't be, and yet you do not have to canvass hard to find those who, in some way, feel let down by the system.
The problem is that, too often, frustration is swiftly overwhelmed by grief. Rather than kick up a fuss, families find themselves slinking away in bitter resignation. Harriet Yeo, however, is not a slinker. A strident woman who stands six feet tall, she is used to making her presence felt as a councillor in her home town of Ashford, Kent, as a former trades union official, and also as someone who has served on three National Health Trust bodies.
Shortly after her mother died, she was appointed a member of the Labour Party's National Executive Committee - a position that brings her into direct contact with Government ministers. And shortly after that, she found herself launching 'Forgetmenot' - a campaign that will very possibly clash with Party policy but will also, she hopes, give a strong voice to those who feel alone and powerless. 'I'm not saying that all hospital care for the elderly is bad, but a lot of it is,' she says. 'The more I talked to people about what happened to my mother, the more I realised that older people are being discriminated against, not just in my hospital, but all over the country. 'It is too big a problem for any one individual, but by creating a national force, we can be heard. And I am not going to be cowed, because speaking out is the only way I can feel some good might come of my mother's death.' ......
In November 2004, Barbara's GP arranged for her to be admitted to the William Harvey Hospital in Ashford with suspected constipation. In fact, tests revealed that there was nothing wrong with her bowels, but doctors did then advise that she undergo intensive treatment on her leg ulcers - painful sores that are usually caused by circulation problems and are common in the elderly.
Barbara was given morphine for pain relief, and from that point, according to Harriet, her condition rapidly deteriorated. She became dehydrated and delusional and remained in pain because, says Harriet 'it was the wrong sort of pain relief for the arthritic pain she had'. Following complaints from Harriet, Barbara was taken off the morphine, and within 48 hours, the delusions had stopped. But her weight appeared to have dropped drastically - although how drastically Harriet cannot be sure because Barbara was not weighed. 'With hindsight, I would have insisted she was weighed on admission, as all elderly patients should be.'
Barbara came home for Christmas, during which time she ate enough to go up two dress sizes, and was re-admitted in January to continue the leg ulcer treatment. As the weeks passed, the ulcers improved, but Harriet was less than impressed with the more general care her mother received. 'She was catheterised as soon as she was admitted, despite being fully continent. Why? Because it is easier, of course, if a nurse doesn't have to attend when she needs to go to the bathroom. But by keeping her still, they were depleting her mobility. 'During two months in hospital, she had her hair washed just once, and that was because we insisted and paid a hairdresser to do it. My mother was a woman who went to the hairdressers every week. Not enabling her to maintain her appearance was an affront to her dignity.'
Barbara died four days after contracting what staff in the hospital were referring to as the 'winter vomiting bug'. When Harriet questioned why an infected patient had been put next to her mother, she says she was told that the consultant and the infection control nurse had deemed it 'an acceptable risk'. The matter is now the subject of a police complaint, and also a complaint that Harriet has lodged with the General Medical Council. Both cases are unlikely to be resolved for many months.
More here
Playing politics puts mothers' and their babies' lives at risk
Comment from Miranda Devine in Sydney, Australia
The tragic case of baby Natalia Lalic, who died five days after being born at Camden Hospital in 2003, should serve as a warning of the potential consequences of political and ideological meddling in childbirth. The increasing demands by feminist ideologues for "women-centred" birth centres with midwives providing exclusive care neatly dovetail with the desire by the State Government to cut health costs while appearing to deliver new facilities in marginal seats.
Natalia was born five days after the 2003 state election in Camden Hospital's new $3.5 million maternity unit, which had been opened with great fanfare six weeks earlier. Camden was a marginal seat, and the only seat the ALP won from the Liberals. At the time, then health minister Craig Knowles, member for the neighbouring seat of Macquarie Fields, was under siege from whistleblower nurses. Though Camden was just a 20-minute drive from Campbelltown Hospital's fully staffed maternity unit, which could have done with the extra money, the Government opened the new ward against the advice of the South Western Sydney Area Health Service board, which was concerned about duplicating resources and a shortage of specialists. When no anaesthetists could be found for Camden, a bureaucrat was flown to South Africa to recruit. No expense was spared.
But, as the NSW Medical Tribunal has heard, there was no pediatrician on hand to resuscitate Natalia when she was born without a heartbeat after a difficult labour in which the umbilical cord was wrapped around her neck. Some anaesthetists on roster lived 40 minutes away and pediatricians 30 minutes away. Crucially, the hospital required 69 minutes to set up an emergency caesarean section. So even when it was clear the baby was in distress, the obstetrician on duty made the decision that it would be faster for her to be born by assisted vaginal delivery. She died five days later.
The doctor has since endured three debilitating years of blame for the judgement calls he made that terrible morning. The Health Care Complaints Commission alleged he should have organised a caesarean and called a pediatrician earlier. Last week the obstetrician, whose name has been suppressed, was cleared of any wrongdoing by the tribunal. There was no guarantee the baby would have lived if a caesarean had been ordered.
But an anaesthetist who works in northern Sydney says Natalia might have had a better chance in a bigger hospital. When an emergency caesarean is needed, the ideal time from "decision to incision" is less than 20 minutes, not 69 minutes, he says. At a hospital such as Royal North Shore a woman can be on the operating table in 10 minutes.
And yet, a recent review of maternity services in the Northern Sydney Central Coast Health service area has recommended fewer births at RNS (down 15 births a month to 200) and more at smaller, less-resourced units, such as Mona Vale and Ryde. The anaesthetist says health bureaucrats want to reduce the 2400 annual births at RNS by 600 or 700, for budgetary reasons. The amalgamation of northern Sydney with the Central Coast in January, he says, has led to a transfer of resources from northern Sydney's budget to the Central Coast, where, he cynically points out, Gosford is a marginal Liberal seat that Labor is targeting. "Politicians use obstetric services as a vote-winner," he says.
The review has not addressed specialist concerns about safety at small units and makes only politically palatable recommendations, he says. While it states that duplication of obstetric services between Manly and Mona Vale is "not sustainable", it advocates the "development of shared positions across the two sites". Specialist doctors also feel the review report was released stealthily, on January 2, "when everyone is on holidays", with comments due by January 16. The report states that "volumes of births across the seven sites are not sufficient to support seven traditional maternity units" with full services of obstetricians, anaesthetists and midwives. But it does not recommend closing Ryde and Wyong obstetric units, as many specialists think should happen.
If the safety of mother and child were paramount, common sense would dictate that you would make most use of hospitals such as Royal North Shore, instead of using every means to reduce births there. And just because there is an anaesthetist across the corridor ready for an emergency caesarean or to provide pain relief, doesn't mean a mother can't have a drug-free natural birth. It just means she has a choice.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
Best if they get a bug and die
Barbara Yeo died in March last year, and time has not yet been able to diminish for Harriet the distressing, haunting images of her mother as she lay breathless and in pain in her hospital bed. An 83-year-old former hospital matron who, in her working life, specialised in care of the elderly, Barbara had not been in the peak of health, but nor was she terminally ill. And yet her own admission to hospital for routine treatment of leg ulcers was to prove fatal. Barbara died of viral gastroenteritis - a stomach bug that she contracted from a highly infectious patient who was placed next to her on the ward. As her condition rapidly deteriorated, the acronym DNR - for Do Not Resuscitate - was placed on her notes.
'I told the doctor that that would be going against her wishes. Because she was a nurse, it was a conversation we had had many times. But they did it anyway. They treated the age, not the patient, and it cost my mother her life,' says Harriet.
The story of Barbara's demise is one that will resonate with many. We are living longer and, consequently, more likely to become frail and vulnerable through age. Two thirds of patients in hospital wards are over 65. Most of those who have had to care for an elderly and sick relative understand that resources are limited. But care, sympathy and dignity shouldn't be, and yet you do not have to canvass hard to find those who, in some way, feel let down by the system.
The problem is that, too often, frustration is swiftly overwhelmed by grief. Rather than kick up a fuss, families find themselves slinking away in bitter resignation. Harriet Yeo, however, is not a slinker. A strident woman who stands six feet tall, she is used to making her presence felt as a councillor in her home town of Ashford, Kent, as a former trades union official, and also as someone who has served on three National Health Trust bodies.
Shortly after her mother died, she was appointed a member of the Labour Party's National Executive Committee - a position that brings her into direct contact with Government ministers. And shortly after that, she found herself launching 'Forgetmenot' - a campaign that will very possibly clash with Party policy but will also, she hopes, give a strong voice to those who feel alone and powerless. 'I'm not saying that all hospital care for the elderly is bad, but a lot of it is,' she says. 'The more I talked to people about what happened to my mother, the more I realised that older people are being discriminated against, not just in my hospital, but all over the country. 'It is too big a problem for any one individual, but by creating a national force, we can be heard. And I am not going to be cowed, because speaking out is the only way I can feel some good might come of my mother's death.' ......
In November 2004, Barbara's GP arranged for her to be admitted to the William Harvey Hospital in Ashford with suspected constipation. In fact, tests revealed that there was nothing wrong with her bowels, but doctors did then advise that she undergo intensive treatment on her leg ulcers - painful sores that are usually caused by circulation problems and are common in the elderly.
Barbara was given morphine for pain relief, and from that point, according to Harriet, her condition rapidly deteriorated. She became dehydrated and delusional and remained in pain because, says Harriet 'it was the wrong sort of pain relief for the arthritic pain she had'. Following complaints from Harriet, Barbara was taken off the morphine, and within 48 hours, the delusions had stopped. But her weight appeared to have dropped drastically - although how drastically Harriet cannot be sure because Barbara was not weighed. 'With hindsight, I would have insisted she was weighed on admission, as all elderly patients should be.'
Barbara came home for Christmas, during which time she ate enough to go up two dress sizes, and was re-admitted in January to continue the leg ulcer treatment. As the weeks passed, the ulcers improved, but Harriet was less than impressed with the more general care her mother received. 'She was catheterised as soon as she was admitted, despite being fully continent. Why? Because it is easier, of course, if a nurse doesn't have to attend when she needs to go to the bathroom. But by keeping her still, they were depleting her mobility. 'During two months in hospital, she had her hair washed just once, and that was because we insisted and paid a hairdresser to do it. My mother was a woman who went to the hairdressers every week. Not enabling her to maintain her appearance was an affront to her dignity.'
Barbara died four days after contracting what staff in the hospital were referring to as the 'winter vomiting bug'. When Harriet questioned why an infected patient had been put next to her mother, she says she was told that the consultant and the infection control nurse had deemed it 'an acceptable risk'. The matter is now the subject of a police complaint, and also a complaint that Harriet has lodged with the General Medical Council. Both cases are unlikely to be resolved for many months.
More here
Playing politics puts mothers' and their babies' lives at risk
Comment from Miranda Devine in Sydney, Australia
The tragic case of baby Natalia Lalic, who died five days after being born at Camden Hospital in 2003, should serve as a warning of the potential consequences of political and ideological meddling in childbirth. The increasing demands by feminist ideologues for "women-centred" birth centres with midwives providing exclusive care neatly dovetail with the desire by the State Government to cut health costs while appearing to deliver new facilities in marginal seats.
Natalia was born five days after the 2003 state election in Camden Hospital's new $3.5 million maternity unit, which had been opened with great fanfare six weeks earlier. Camden was a marginal seat, and the only seat the ALP won from the Liberals. At the time, then health minister Craig Knowles, member for the neighbouring seat of Macquarie Fields, was under siege from whistleblower nurses. Though Camden was just a 20-minute drive from Campbelltown Hospital's fully staffed maternity unit, which could have done with the extra money, the Government opened the new ward against the advice of the South Western Sydney Area Health Service board, which was concerned about duplicating resources and a shortage of specialists. When no anaesthetists could be found for Camden, a bureaucrat was flown to South Africa to recruit. No expense was spared.
But, as the NSW Medical Tribunal has heard, there was no pediatrician on hand to resuscitate Natalia when she was born without a heartbeat after a difficult labour in which the umbilical cord was wrapped around her neck. Some anaesthetists on roster lived 40 minutes away and pediatricians 30 minutes away. Crucially, the hospital required 69 minutes to set up an emergency caesarean section. So even when it was clear the baby was in distress, the obstetrician on duty made the decision that it would be faster for her to be born by assisted vaginal delivery. She died five days later.
The doctor has since endured three debilitating years of blame for the judgement calls he made that terrible morning. The Health Care Complaints Commission alleged he should have organised a caesarean and called a pediatrician earlier. Last week the obstetrician, whose name has been suppressed, was cleared of any wrongdoing by the tribunal. There was no guarantee the baby would have lived if a caesarean had been ordered.
But an anaesthetist who works in northern Sydney says Natalia might have had a better chance in a bigger hospital. When an emergency caesarean is needed, the ideal time from "decision to incision" is less than 20 minutes, not 69 minutes, he says. At a hospital such as Royal North Shore a woman can be on the operating table in 10 minutes.
And yet, a recent review of maternity services in the Northern Sydney Central Coast Health service area has recommended fewer births at RNS (down 15 births a month to 200) and more at smaller, less-resourced units, such as Mona Vale and Ryde. The anaesthetist says health bureaucrats want to reduce the 2400 annual births at RNS by 600 or 700, for budgetary reasons. The amalgamation of northern Sydney with the Central Coast in January, he says, has led to a transfer of resources from northern Sydney's budget to the Central Coast, where, he cynically points out, Gosford is a marginal Liberal seat that Labor is targeting. "Politicians use obstetric services as a vote-winner," he says.
The review has not addressed specialist concerns about safety at small units and makes only politically palatable recommendations, he says. While it states that duplication of obstetric services between Manly and Mona Vale is "not sustainable", it advocates the "development of shared positions across the two sites". Specialist doctors also feel the review report was released stealthily, on January 2, "when everyone is on holidays", with comments due by January 16. The report states that "volumes of births across the seven sites are not sufficient to support seven traditional maternity units" with full services of obstetricians, anaesthetists and midwives. But it does not recommend closing Ryde and Wyong obstetric units, as many specialists think should happen.
If the safety of mother and child were paramount, common sense would dictate that you would make most use of hospitals such as Royal North Shore, instead of using every means to reduce births there. And just because there is an anaesthetist across the corridor ready for an emergency caesarean or to provide pain relief, doesn't mean a mother can't have a drug-free natural birth. It just means she has a choice.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 26, 2006
SOUTH AFRICA: NEW DESTINATION FOR SURGICAL TOURISM
The market can work in medicine too if it is allowed
The number of foreigners having plastic surgery in South Africa has shot up dramatically in the past year. "In December 2004 we had six patients and last month we had 25," said Peter Rodway, managing director of Mediscapes, which sells cosmetic surgery packages, mostly to foreigners on holiday in Cape Town. The packages include the procedure, accommodation, tourist excursions and the assistance of therapists and nurses during recovery. While foreigners wanted a wide range of procedures, Mr Rodway said: "Without question the most popular is breast augmentation." The next most popular procedures are tummy tucks, rhinoplasty, liposuction and facelifts. And even though the rand has strengthened, Mr Rodway said the cost of plastic surgery in South Africa remained 60-65 per cent cheaper than in Britain or the US.
Johannesburg company Surgeon and Safari has also noted a marked rise in demand. "We were booked up completely in January," chief executive Lorraine Melvill said. "On average last year we had 30 clients a month and in 2004 we had about 15 a month." The number of bookings made through a competitor, Surgical Attractions of Johannesburg, has also grown significantly. "Foreigners are encouraged by the exchange rate, medical expertise and the anonymity," chief executive Ingrid Lomas said. All three companies reported that most of their clients were from England.
Cosmetic surgery had been demystified by extreme makeovers on television and in the press, said plastic surgeon Stuart Meintjes, of the Rose Clinic. The plastic-surgery craze has annoyed some surgeons in Britain and the US, from where many citizens also travel to Croatia, Belgium, Poland, Thailand or Argentina for cheaper prices. Mr Rodway said that after a successful trip to a plastic-surgery convention in London last year, he was asked not to return because companies like his were siphoning off British clientele.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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 market can work in medicine too if it is allowed
The number of foreigners having plastic surgery in South Africa has shot up dramatically in the past year. "In December 2004 we had six patients and last month we had 25," said Peter Rodway, managing director of Mediscapes, which sells cosmetic surgery packages, mostly to foreigners on holiday in Cape Town. The packages include the procedure, accommodation, tourist excursions and the assistance of therapists and nurses during recovery. While foreigners wanted a wide range of procedures, Mr Rodway said: "Without question the most popular is breast augmentation." The next most popular procedures are tummy tucks, rhinoplasty, liposuction and facelifts. And even though the rand has strengthened, Mr Rodway said the cost of plastic surgery in South Africa remained 60-65 per cent cheaper than in Britain or the US.
Johannesburg company Surgeon and Safari has also noted a marked rise in demand. "We were booked up completely in January," chief executive Lorraine Melvill said. "On average last year we had 30 clients a month and in 2004 we had about 15 a month." The number of bookings made through a competitor, Surgical Attractions of Johannesburg, has also grown significantly. "Foreigners are encouraged by the exchange rate, medical expertise and the anonymity," chief executive Ingrid Lomas said. All three companies reported that most of their clients were from England.
Cosmetic surgery had been demystified by extreme makeovers on television and in the press, said plastic surgeon Stuart Meintjes, of the Rose Clinic. The plastic-surgery craze has annoyed some surgeons in Britain and the US, from where many citizens also travel to Croatia, Belgium, Poland, Thailand or Argentina for cheaper prices. Mr Rodway said that after a successful trip to a plastic-surgery convention in London last year, he was asked not to return because companies like his were siphoning off British clientele.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 25, 2006
U.S. HEALTH INSURANCE CHANGE HAS TO COME
Cutting the tax deductibility tie to jobs and cutting the maze of bureaucratic rules that tie up health care providers would be big forward steps -- among others
In today's world economy, health care costs are a drain on many businesses as they struggle to compete with overseas companies that pay workers far less and provide few benefits. Even unions that have fought to maintain generous health insurance for workers are beginning to make concessions. Last fall, the United Auto Workers agreed to health insurance cuts at General Motors in hopes that the $1 billion in annual savings would help revive the company. Workers and retirees will pay more in the deal, which will reduce the health care liability that GM has said adds $1,500 to the price of every car it sells. Ford recently struck a similar deal and Chrysler also wants concessions from the union. Given that GM and the UAW were pioneers in establishing job-based insurance, the agreement was a strong signal of just how troubled America's system is.....
Health care costs have made it attractive for employers to hire workers not eligible for typical employee benefits, including those who work through outside agencies or who are self-employed independent contractors. A recent report by the Iowa Policy Project, a nonpartisan research organization, found that one in four workers, or 34 million Americans in 2001, worked in temporary, part-time and contract positions. The report noted that our economy's shift to these kinds of jobs is "threatening to unravel the employment-based health insurance system in the United States and swell the ranks of the uninsured and underinsured."
In the face of rising costs, some business leaders are openly calling for an end to the job-based health insurance system. One is Robert S. Miller, chairman of Delphi, an auto-parts supplier and former GM subsidiary that recently went into bankruptcy. "Back in the days, when you worked for one employer till age 65 and then died at age 70, and when health care was unsophisticated and inexpensive, the social contract inherent in defined-benefit programs perhaps made some economic sense," he told the Wall Street Journal in October about his efforts to turn Delphi around. "Today, defined-benefit programs are an anachronism" ...
While some discuss how to replace the job-based insurance system, others are trying different ways to shore it up. There are proposals in Washington to make it easier for people to buy insurance on their own. Congress has appointed a citizens task force to hold town meetings around the country on the future of America's health care system. National initiatives are pushing the health care industry to expand its use of information technology, such as computerized medical records, in hopes of reducing costs.
Employers are offering wellness programs, discouraging unhealthful behavior like smoking and banding together to rate the quality of health care providers in hopes competition will ultimately lower their insurance rates.
There are also new "consumer driven" health plans that pair high-deductible health insurance with tax-free medical-savings accounts. Many economists predict that these plans, only beginning to be offered by employers, are the wave of the future. Supporters say such plans will save employers money, allow more people to obtain coverage, turn Americans into more prudent consumers of health care and improve the overall health care system by giving patients greater flexibility to shop for their own care. But critics say the higher deductibles and out-of-pocket expenses will cause some people to skimp on care and drain people with chronic conditions. "I am convinced that consumer-driven health plans will save money," Dr. A. Mark Fendrick, a professor of internal medicine and health management and policy at the University of Michigan, told employers gathered in Scottsdale in November at a National Business Coalition on Health conference. "But as you cost-shift, people will get sick and die."
Still, even the most optimistic experts say that these and other ideas will not be able to avert the crisis in health coverage that many predict in the next decade. America's aging population combined with the expense of new medical technology and treatments are likely to continue to drive care costs up. And, as costs rise, the job-based insurance system will continue to unravel, overwhelming hospitals and public-assistance programs.
Tommy Thompson, secretary of the U.S. Department of Health and Human Services from 2001 until January 2005, supports many of the new cost-cutting initiatives. But he believes they will not be enough to avert a crisis. He said more drastic measures are necessary, including major reforms of Medicaid and Medicare, government assistance to help employers provide insurance and programs to cover the nation's 46 million uninsured. "We have eight years to make some dramatic shifts in the transformation of health care," Thompson predicted. Without significant changes, spending on health care in the United States is projected to climb from $1.9 trillion this year to $3.4 trillion in 2013. "I don't think the system can afford 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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
Cutting the tax deductibility tie to jobs and cutting the maze of bureaucratic rules that tie up health care providers would be big forward steps -- among others
In today's world economy, health care costs are a drain on many businesses as they struggle to compete with overseas companies that pay workers far less and provide few benefits. Even unions that have fought to maintain generous health insurance for workers are beginning to make concessions. Last fall, the United Auto Workers agreed to health insurance cuts at General Motors in hopes that the $1 billion in annual savings would help revive the company. Workers and retirees will pay more in the deal, which will reduce the health care liability that GM has said adds $1,500 to the price of every car it sells. Ford recently struck a similar deal and Chrysler also wants concessions from the union. Given that GM and the UAW were pioneers in establishing job-based insurance, the agreement was a strong signal of just how troubled America's system is.....
Health care costs have made it attractive for employers to hire workers not eligible for typical employee benefits, including those who work through outside agencies or who are self-employed independent contractors. A recent report by the Iowa Policy Project, a nonpartisan research organization, found that one in four workers, or 34 million Americans in 2001, worked in temporary, part-time and contract positions. The report noted that our economy's shift to these kinds of jobs is "threatening to unravel the employment-based health insurance system in the United States and swell the ranks of the uninsured and underinsured."
In the face of rising costs, some business leaders are openly calling for an end to the job-based health insurance system. One is Robert S. Miller, chairman of Delphi, an auto-parts supplier and former GM subsidiary that recently went into bankruptcy. "Back in the days, when you worked for one employer till age 65 and then died at age 70, and when health care was unsophisticated and inexpensive, the social contract inherent in defined-benefit programs perhaps made some economic sense," he told the Wall Street Journal in October about his efforts to turn Delphi around. "Today, defined-benefit programs are an anachronism" ...
While some discuss how to replace the job-based insurance system, others are trying different ways to shore it up. There are proposals in Washington to make it easier for people to buy insurance on their own. Congress has appointed a citizens task force to hold town meetings around the country on the future of America's health care system. National initiatives are pushing the health care industry to expand its use of information technology, such as computerized medical records, in hopes of reducing costs.
Employers are offering wellness programs, discouraging unhealthful behavior like smoking and banding together to rate the quality of health care providers in hopes competition will ultimately lower their insurance rates.
There are also new "consumer driven" health plans that pair high-deductible health insurance with tax-free medical-savings accounts. Many economists predict that these plans, only beginning to be offered by employers, are the wave of the future. Supporters say such plans will save employers money, allow more people to obtain coverage, turn Americans into more prudent consumers of health care and improve the overall health care system by giving patients greater flexibility to shop for their own care. But critics say the higher deductibles and out-of-pocket expenses will cause some people to skimp on care and drain people with chronic conditions. "I am convinced that consumer-driven health plans will save money," Dr. A. Mark Fendrick, a professor of internal medicine and health management and policy at the University of Michigan, told employers gathered in Scottsdale in November at a National Business Coalition on Health conference. "But as you cost-shift, people will get sick and die."
Still, even the most optimistic experts say that these and other ideas will not be able to avert the crisis in health coverage that many predict in the next decade. America's aging population combined with the expense of new medical technology and treatments are likely to continue to drive care costs up. And, as costs rise, the job-based insurance system will continue to unravel, overwhelming hospitals and public-assistance programs.
Tommy Thompson, secretary of the U.S. Department of Health and Human Services from 2001 until January 2005, supports many of the new cost-cutting initiatives. But he believes they will not be enough to avert a crisis. He said more drastic measures are necessary, including major reforms of Medicaid and Medicare, government assistance to help employers provide insurance and programs to cover the nation's 46 million uninsured. "We have eight years to make some dramatic shifts in the transformation of health care," Thompson predicted. Without significant changes, spending on health care in the United States is projected to climb from $1.9 trillion this year to $3.4 trillion in 2013. "I don't think the system can afford that."
More here
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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 24, 2006
Can you put a price on compassion?
I have witnessed the very poor and the very well off get terminally sick and get lousy heath care from a hospital or a doctor, and rich or poor, in so many cases they die in horrible conditions. Money isn't going to make people care more and do the right thing. Compassion should not come with a price.
My mom had a sister (my aunt) who woke up on her 17th birthday with some dreadful crippling disease. This beautiful young woman, Eva, at the prime of her life, was ready to graduate and go on to nursing school, but instead she was struck down with a devastating illness. She could no longer get out of bed to stand up and walk, nor do anything for herself any more.
It was 1929, in Scalplevel, Pennsylvania. Her father (my granddad) worked as a caretaker in a hospital in Pittsburgh, a job many would have killed to have in those days, when jobs were scarce. For tests, whatever tests they did in 1929, they took her to the hospital where her father worked, where a score of doctors saw her.
They thought she had a form of polio, but they were not sure. At first they kept Eva at home, because in those days that's what people did. They had a special bed delivered from the hospital, and put her in the front room where it was sunny and there was a big window to see out. There was really no therapy then, for someone who was bedridden from a crippling illness like that, so they did what doctors told then to. They wanted her home as long as possible.
Eva's now-diabetic mom and very strong-willed father did the best they could for their ailing daughter, with help from my mom and her four sisters. Family was always there, to help take care of her. And when Eva was 36 -- yes, 18 years later -- she went to the care facility at the Pittsburgh hospital. She lived there until she passed away at the ripe old age of 78.
From what my mom told me, Eva was a saint. She never complained, and she insisted on having sick children come into her room to see her and talk with her. She loved visitors, and family members always had time for her. Never a day would go by when one or more would not make the 30 mile trek to see her and make sure she was being treated right.
And as far as I know, the hospital staff loved Eva, too. They had their yearly group pictures taking with her, and she never had a complaint. She was a giving soul. For some reason her hands and wrist and arms were not afflicted; she loved to crochet and that she did! Her colorful afghans (blankets) were all over the hospital's beds, everyone had one. All the family members had them. At one time she would turn out one afghan a week, and they sold some too.
Eva was an amazing human being. I got the chance to meet her while growing up, but since my mom and dad moved to New Jersey when they married it was only on vacations twice a year that we'd go back home to Pennsylvania. Always, the first thing we would do was see Eva, and I always felt truly blessed to be in this woman's company. She was always smiling. I hold back the tears as I recall the memories of our visits. I only regret that there were not enough of them.
My grandfather Henry passed away in 1951, before I was born. He was fortunate to have a steady job and keep his large house during the depression, when most people were out of work. Don't get me wrong, it was back-breaking work what he did at the hospital! He burned medical waste and took care of the grounds around the hospital, and from what my mom has told me sometimes he was there 14 hours a day! He'd lost his left leg when he was 18, when a barn door fell on him, but it certainly didn't slow the man down for long. He never liked the prosthetic leg they gave him, so he made his own leg out of wood and whatever else he contrived. I've seen photos of him, and he looked pretty damn hearty and feisty, I wouldn't want to mess with him.
Did my aunt Eva get the care she needed? I think she did! Did it cost her family lots of money? I don't think so -- they did not have much money in the first place! People just pulled together and did the right thing, and people who were in the position to serve the sick and needy enjoyed their chosen professions. They were good compassionate human beings, and you can't put a price on that.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
I have witnessed the very poor and the very well off get terminally sick and get lousy heath care from a hospital or a doctor, and rich or poor, in so many cases they die in horrible conditions. Money isn't going to make people care more and do the right thing. Compassion should not come with a price.
My mom had a sister (my aunt) who woke up on her 17th birthday with some dreadful crippling disease. This beautiful young woman, Eva, at the prime of her life, was ready to graduate and go on to nursing school, but instead she was struck down with a devastating illness. She could no longer get out of bed to stand up and walk, nor do anything for herself any more.
It was 1929, in Scalplevel, Pennsylvania. Her father (my granddad) worked as a caretaker in a hospital in Pittsburgh, a job many would have killed to have in those days, when jobs were scarce. For tests, whatever tests they did in 1929, they took her to the hospital where her father worked, where a score of doctors saw her.
They thought she had a form of polio, but they were not sure. At first they kept Eva at home, because in those days that's what people did. They had a special bed delivered from the hospital, and put her in the front room where it was sunny and there was a big window to see out. There was really no therapy then, for someone who was bedridden from a crippling illness like that, so they did what doctors told then to. They wanted her home as long as possible.
Eva's now-diabetic mom and very strong-willed father did the best they could for their ailing daughter, with help from my mom and her four sisters. Family was always there, to help take care of her. And when Eva was 36 -- yes, 18 years later -- she went to the care facility at the Pittsburgh hospital. She lived there until she passed away at the ripe old age of 78.
From what my mom told me, Eva was a saint. She never complained, and she insisted on having sick children come into her room to see her and talk with her. She loved visitors, and family members always had time for her. Never a day would go by when one or more would not make the 30 mile trek to see her and make sure she was being treated right.
And as far as I know, the hospital staff loved Eva, too. They had their yearly group pictures taking with her, and she never had a complaint. She was a giving soul. For some reason her hands and wrist and arms were not afflicted; she loved to crochet and that she did! Her colorful afghans (blankets) were all over the hospital's beds, everyone had one. All the family members had them. At one time she would turn out one afghan a week, and they sold some too.
Eva was an amazing human being. I got the chance to meet her while growing up, but since my mom and dad moved to New Jersey when they married it was only on vacations twice a year that we'd go back home to Pennsylvania. Always, the first thing we would do was see Eva, and I always felt truly blessed to be in this woman's company. She was always smiling. I hold back the tears as I recall the memories of our visits. I only regret that there were not enough of them.
My grandfather Henry passed away in 1951, before I was born. He was fortunate to have a steady job and keep his large house during the depression, when most people were out of work. Don't get me wrong, it was back-breaking work what he did at the hospital! He burned medical waste and took care of the grounds around the hospital, and from what my mom has told me sometimes he was there 14 hours a day! He'd lost his left leg when he was 18, when a barn door fell on him, but it certainly didn't slow the man down for long. He never liked the prosthetic leg they gave him, so he made his own leg out of wood and whatever else he contrived. I've seen photos of him, and he looked pretty damn hearty and feisty, I wouldn't want to mess with him.
Did my aunt Eva get the care she needed? I think she did! Did it cost her family lots of money? I don't think so -- they did not have much money in the first place! People just pulled together and did the right thing, and people who were in the position to serve the sick and needy enjoyed their chosen professions. They were good compassionate human beings, and you can't put a price on that.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 23, 2006
Self-Deception about Medical Care
Sloppy thinking can make intelligent people say stupid things. Take Christine Cassel. She has been a physician specializing in geriatric medicine for 30 years and recently published Medicare Matters, a brief against privatization of the huge, brittle government program. Interviewed recently on National Public Radio, she made this argument for public support of Medicare: It is not simply a program for the elderly, she said. “It is a family program. If Medicare didn’t exist, we’d be paying those bills.”
I don’t know who Dr. Cassel thinks is paying the bills now, but I have a pretty good idea it’s you and I and anyone else who pays taxes. I truly can’t imagine what Dr. Cassel thought she was saying. It’s possible she was engaging in sophistry, but she might really believe what she said. For many people, government’s distribution of money is completely unrelated to its collection of money. On days they are thinking about distribution, the furthest thing from their minds is collection. It’s self-deception, but it’s effective.
This may be why such people can’t see government for what it is: a massive transfer machine. In the end, all government can do is move money from one person to another. Whether you think that’s right or wrong, let’s at least agree on what it does. Government takes from A to give to B, and it uses the threat of physical force (such as incarceration) to ensure that A will surrender whatever is demanded of him. Government looks a lot less attractive when described in those terms — which may be one reason why people such as Dr. Cassel don’t want to think of it that way. It’s too unpleasant.
Once we see the nature of government clearly, her fallacy becomes glaring. Not everyone has sick elderly parents. Obviously, they would not be paying additional medical bills if Medicare did not exist. Many people have sick elderly parents who would have had medical insurance had Medicare not existed. Those people also would not have had additional medical bills. True, some people have sick elderly parents who would not have had medical insurance. Does that justify Medicare? How so? Ordinarily, we think that being unable to afford something does not justify taking it from someone else. Why is this principle suspended when it comes to medical care?
A large part of Dr. Cassel’s erroneous thinking lies in her failing to realize that if you change one thing, you will necessarily change others. She looks at all the elderly people on Medicare and imagines that if government is subtracted from the picture, all medical care is subtracted with it. Not so. Most people, knowing the government was not going to pay for their care, would have bought private insurance. But that’s only the most obvious answer. Long before there was Medicare and Medicaid, many people of modest and low income received decent medical care through fraternal organizations. Lodges would sign contracts with doctors, in effect buying services in bulk that, throughout the year, would be distributed to members and their families at affordable prices. The system made medical care accessible while maintaining self-responsibility and cost-consciousness.
It was so successful that other doctors, fearing that competition would reduce their incomes, got their government-backed medical societies to crack down on “lodge practice.” Who would argue that today’s precarious method of providing medical care and insurance — through government and bosses — is superior?
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
Sloppy thinking can make intelligent people say stupid things. Take Christine Cassel. She has been a physician specializing in geriatric medicine for 30 years and recently published Medicare Matters, a brief against privatization of the huge, brittle government program. Interviewed recently on National Public Radio, she made this argument for public support of Medicare: It is not simply a program for the elderly, she said. “It is a family program. If Medicare didn’t exist, we’d be paying those bills.”
I don’t know who Dr. Cassel thinks is paying the bills now, but I have a pretty good idea it’s you and I and anyone else who pays taxes. I truly can’t imagine what Dr. Cassel thought she was saying. It’s possible she was engaging in sophistry, but she might really believe what she said. For many people, government’s distribution of money is completely unrelated to its collection of money. On days they are thinking about distribution, the furthest thing from their minds is collection. It’s self-deception, but it’s effective.
This may be why such people can’t see government for what it is: a massive transfer machine. In the end, all government can do is move money from one person to another. Whether you think that’s right or wrong, let’s at least agree on what it does. Government takes from A to give to B, and it uses the threat of physical force (such as incarceration) to ensure that A will surrender whatever is demanded of him. Government looks a lot less attractive when described in those terms — which may be one reason why people such as Dr. Cassel don’t want to think of it that way. It’s too unpleasant.
Once we see the nature of government clearly, her fallacy becomes glaring. Not everyone has sick elderly parents. Obviously, they would not be paying additional medical bills if Medicare did not exist. Many people have sick elderly parents who would have had medical insurance had Medicare not existed. Those people also would not have had additional medical bills. True, some people have sick elderly parents who would not have had medical insurance. Does that justify Medicare? How so? Ordinarily, we think that being unable to afford something does not justify taking it from someone else. Why is this principle suspended when it comes to medical care?
A large part of Dr. Cassel’s erroneous thinking lies in her failing to realize that if you change one thing, you will necessarily change others. She looks at all the elderly people on Medicare and imagines that if government is subtracted from the picture, all medical care is subtracted with it. Not so. Most people, knowing the government was not going to pay for their care, would have bought private insurance. But that’s only the most obvious answer. Long before there was Medicare and Medicaid, many people of modest and low income received decent medical care through fraternal organizations. Lodges would sign contracts with doctors, in effect buying services in bulk that, throughout the year, would be distributed to members and their families at affordable prices. The system made medical care accessible while maintaining self-responsibility and cost-consciousness.
It was so successful that other doctors, fearing that competition would reduce their incomes, got their government-backed medical societies to crack down on “lodge practice.” Who would argue that today’s precarious method of providing medical care and insurance — through government and bosses — is superior?
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 22, 2006
New Study Finds Medicare’s Administrative Costs Are Underestimated
(The appearance of this post was delayed by a blogger.com malfunction)
It is frequently asserted that Medicare’s administrative costs are only 2 percent, compared with more than 20 percent for the private sector—and concluded that a “single payer” system would produce enough cost savings to cover all the uninsured. A study just released by the Council for Affordable Health Insurance (CAHI) shows that Medicare’s costs are underestimated, and private costs overestimated. Moreover, the additional private costs do return some value. If hidden administrative costs are added in, Medicare’s costs are seen to be about 5.2 percent. Private sector costs, calculated in a comparable way, are 8.9 percent, or 16.7 percent if commissions, premium tax, and profit are included.
Because the percentage is calculated as administrative costs divided by total claims, Medicare is favored because it covers older and sicker people with average claims of $6,600 per year, compared to $2,700 for privately insured persons. Correcting for this factor, Medicare’s administrative burden would be in the range of 6 to 8 percent for a population similar to that covered by private insurance.
Private companies spend more in scrutinizing claims before payment. Medicare relies more on post-payment investigation, and such costs are allocated to law enforcement rather than administration. While private insurers pay commissions to bring in premiums, the government forces employers to collect and process Medicare “premiums.” Additional costs of raising money for Medicare (such as interest on government debt and the cost of collecting the general revenues that subsidize Part B) are large but not estimated in the study.
CAHI concludes that the real issue is not which sector has the lower administrative costs, but which does the better job of providing good coverage for the best price. Even with the price controls imposed by the government, CAHI believes that the private sector provides much better value for money.
The study does not consider the administrative costs imposed on physicians and hospitals, the costs of fraud by carriers and providers, the economic consequences of the taxes required to support Medicare, or the other effects of Medicare on the medical market.
Source
One of my medical correspondents adds:
No doubt,. if they were all considered, costs would far exceed private costs and profits as well:
1. Cost for "Joint Comission" and all the White Coat nurses on the "Compliance" payroll are not included.
2. Costs for employer to collect Medicare tax are not included.
3. Costs for "Medicare Fraud" investigations are included in Law Enforcement budget - not included.
4. Costs for "Private Insurance" to make up for below-cost Medicare reimbursement are not included.
5. My hospital had a "Corporate Integrity Agreement" because of "Medicare Fraud" - included a whole office of "compliance" -attorneys, high priced admninstrators; Lectures on "Compliance" etc.. Cost at least as much as alleged fraud. Not included.
6. Quite a number of Medicare claims are "denied" for no apparent reason at all - then paid following re-submission. Much extra work for billing companies. Costs not included.
7. Career Health Care Financing beurocrats and legislators who make new rules are already on the Government payroll. Costs not included.
This is just the "tip of the iceberg" .
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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 appearance of this post was delayed by a blogger.com malfunction)
It is frequently asserted that Medicare’s administrative costs are only 2 percent, compared with more than 20 percent for the private sector—and concluded that a “single payer” system would produce enough cost savings to cover all the uninsured. A study just released by the Council for Affordable Health Insurance (CAHI) shows that Medicare’s costs are underestimated, and private costs overestimated. Moreover, the additional private costs do return some value. If hidden administrative costs are added in, Medicare’s costs are seen to be about 5.2 percent. Private sector costs, calculated in a comparable way, are 8.9 percent, or 16.7 percent if commissions, premium tax, and profit are included.
Because the percentage is calculated as administrative costs divided by total claims, Medicare is favored because it covers older and sicker people with average claims of $6,600 per year, compared to $2,700 for privately insured persons. Correcting for this factor, Medicare’s administrative burden would be in the range of 6 to 8 percent for a population similar to that covered by private insurance.
Private companies spend more in scrutinizing claims before payment. Medicare relies more on post-payment investigation, and such costs are allocated to law enforcement rather than administration. While private insurers pay commissions to bring in premiums, the government forces employers to collect and process Medicare “premiums.” Additional costs of raising money for Medicare (such as interest on government debt and the cost of collecting the general revenues that subsidize Part B) are large but not estimated in the study.
CAHI concludes that the real issue is not which sector has the lower administrative costs, but which does the better job of providing good coverage for the best price. Even with the price controls imposed by the government, CAHI believes that the private sector provides much better value for money.
The study does not consider the administrative costs imposed on physicians and hospitals, the costs of fraud by carriers and providers, the economic consequences of the taxes required to support Medicare, or the other effects of Medicare on the medical market.
Source
One of my medical correspondents adds:
No doubt,. if they were all considered, costs would far exceed private costs and profits as well:
1. Cost for "Joint Comission" and all the White Coat nurses on the "Compliance" payroll are not included.
2. Costs for employer to collect Medicare tax are not included.
3. Costs for "Medicare Fraud" investigations are included in Law Enforcement budget - not included.
4. Costs for "Private Insurance" to make up for below-cost Medicare reimbursement are not included.
5. My hospital had a "Corporate Integrity Agreement" because of "Medicare Fraud" - included a whole office of "compliance" -attorneys, high priced admninstrators; Lectures on "Compliance" etc.. Cost at least as much as alleged fraud. Not included.
6. Quite a number of Medicare claims are "denied" for no apparent reason at all - then paid following re-submission. Much extra work for billing companies. Costs not included.
7. Career Health Care Financing beurocrats and legislators who make new rules are already on the Government payroll. Costs not included.
This is just the "tip of the iceberg" .
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 21, 2006
Five-year wait for dentist
Even with very limited eligibility
Waiting times for basic check-ups in Queensland's public dental services can be as long as up to five years, according to the Australian Dental Association. This is despite the State Government spending more on public dental services than any other state, allocating about $132 million compared with NSW, which spends about $100 million. Yet Queenslanders still have the worst teeth in the nation, while the government and councils are engaged in an argument over the provision of fluoride in drinking water.
Figures provided by Queensland Health and Health Minister Stephen Robertson confirm the length of time people were waiting for public dental services. He said that it should be noted that the majority of dental services in Queensland are provided by the private sector. "Queensland has the most generous eligibility criteria for public oral health services of any state or territory," he said. "Around 1.8 million Queenslanders, adults and children, are eligible for free oral health care."
Mr Robertson said consultant Peter Forster's Health Systems Review acknowledged the high demand for oral health services and the difficulties experienced in meeting that demand. "Workforce shortages [Translation: Measly wages for dentists] are a significant issue in meeting demand. The shortage of dentists is a national issue. Queensland Health currently has about 300 full-time dentist positions. In January 2006, 20 per cent of these positions were vacant," he said.
"Patients with dental emergencies are generally seen within 24 hours. Those with non-emergency conditions will wait longer. "It is unlikely that waiting times for non-urgent care will improve greatly in 2006."
Opposition health spokesman Dr Bruce Flegg said public dental services were effectively being rationed. "There is a means test and only people with pension or health care cards can access the service," Dr Flegg said. "It would be a pretence for the state government to say we have a universal free dental service because we do not."
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
Even with very limited eligibility
Waiting times for basic check-ups in Queensland's public dental services can be as long as up to five years, according to the Australian Dental Association. This is despite the State Government spending more on public dental services than any other state, allocating about $132 million compared with NSW, which spends about $100 million. Yet Queenslanders still have the worst teeth in the nation, while the government and councils are engaged in an argument over the provision of fluoride in drinking water.
Figures provided by Queensland Health and Health Minister Stephen Robertson confirm the length of time people were waiting for public dental services. He said that it should be noted that the majority of dental services in Queensland are provided by the private sector. "Queensland has the most generous eligibility criteria for public oral health services of any state or territory," he said. "Around 1.8 million Queenslanders, adults and children, are eligible for free oral health care."
Mr Robertson said consultant Peter Forster's Health Systems Review acknowledged the high demand for oral health services and the difficulties experienced in meeting that demand. "Workforce shortages [Translation: Measly wages for dentists] are a significant issue in meeting demand. The shortage of dentists is a national issue. Queensland Health currently has about 300 full-time dentist positions. In January 2006, 20 per cent of these positions were vacant," he said.
"Patients with dental emergencies are generally seen within 24 hours. Those with non-emergency conditions will wait longer. "It is unlikely that waiting times for non-urgent care will improve greatly in 2006."
Opposition health spokesman Dr Bruce Flegg said public dental services were effectively being rationed. "There is a means test and only people with pension or health care cards can access the service," Dr Flegg said. "It would be a pretence for the state government to say we have a universal free dental service because we do not."
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 20, 2006
A GOOD COMMENT ON YESTERDAY'S POST:
From a reader with a memory
The interesting thing about all the reductions in beds in Qld Health now seems to be a flawed "modelling." If you believe that then I have parking spaces to sell on Sydney Harbour Bridge and Ocean Front Land at the base of Uluru. Two things intrigue me. Why can't the Australian Public have the names of these "modelers?" If we had them we might not be so confident that the same people can get it right this time. If they are not the same people who are they? Are they clinicians -- almost certainly not. The unfortunate truth of Medical Administrators are that they are failed clinicians (at least it keeps them away from the patients) or non-clinicians whose backgrounds are quite suspect.
Queensland two decades ago had an enviable health system [Under a long-term conservative State government]. Now it runs close to a third world country standard. Bundaberg, Caboolture and Patel are merely symptoms of a very sick system created by a "model" (for model read delusion) that we can budget-drive hospitals rather than needs-drive them. Awful language but there you are. Of course we need to have a good eye on budgets but they should be the driving force. With an increasing population in Queensland there should be more beds not fewer. Not really rocket science is it? And if you think that Bundaberg and Caboolture hospitals are bad, just wait for the exposures to come. Unfortunately many of those who could expose the problems are either dead or in the "shut yo mouth" group. Fradulent waiting lists, surgery lists not allowed to proceed even when the surgeons were willing to work on (they were sent to libraries and paid to do nothing), outspoken critics muzzled and threatened, (even the Forster report was flawed as the people "assisting the inquiry" were in some cases the worst bullies in the system), a rise of manager numbers coinciding with a fall in real clinicians (remember a lot of so called clinicians are not hands on clinicians -- which has never come out), the increasing scourge of excessive documentation and reduction in care/ treatment giving, and so on. The bus is moving but without drivers. In all good remedies it is important to realize that the incumbents were and are part of the problem. They will merely change the decor and documentation. They have no real will to work or practice medicine.
Now to medical graduate numbers. Even with the figures looking bad you must remember that now medical school intakes have 50% plus female graduates. There is nothing wrong with female medicos IF they practice full time. Many don't - quite apart from maternity leave many choose now to work 2-3 days a week and even restricted hours at that. Of course they have that right BUT medical graduates are expensive for the community to train, unlike lawyers and other courses who simply need a barn, a few talking heads, and access to the internet (why we don't even need a good Law Library these days - just access to the internet). As to the problem of country needs and medicos, it could be solved simply by giving a 3x factor to medicare rebates for remote areas and defined areas of need and reducing the benefits to urban medicos. I can hear the howls of "unfair and conscription" already.
Universal Insurance Mandate Leads to Political Interference in Private Health-Care Decisions
Republican Governor Mitt Romney is proposing that all citizens of Massachusetts be required to purchase health insurance, join a government-subsidized program, or face a financial penalty. His plan is being touted as a free-market alternative to proposals being pushed by advocates of single-payer health care. Its compulsory feature is similar, in some ways, to the mandate proposed by congressional Republicans after the Clinton administration called for universal coverage in the fall of 1993. What's wrong with the government mandating individuals to purchase health insurance?
The Cato Institute analyzed the Republican's 1993 plan and pointed out why a mandate is dangerous to liberty. Following are excerpts from that Cato Policy Analysis:
* "Once we presume that government is ultimately responsible for guaranteeing that every American has health insurance, we also guarantee a permanent role for politicians in determining an accompanying set of issues. Once government mandates insurance coverage, it must define what constitutes `adequate' insurance coverage for each citizen."
* "By endorsing the concept of compulsory universal insurance coverage, [the bill] undermines the traditional principles of personal liberty and individual responsibility that provide essential bulwarks against all-intrusive governmental control of health care."
* ".[The bill] makes the fatal mistake of endorsing compulsory, government-defined, universal insurance coverage. That fundamental feature...opens the door wide to extensive political interference in private health care decisions."
* "Sweeping every American into a mandatory health insurance dragnet is not only offensive on philosophical grounds; it is also impossible to achieve.... Even under Canada's system of national health insurance, an estimated 2 to 5 percent of the population in the province of British Columbia is uninsured. Despite 41 state laws that require motorists to purchase automobile liability insurance, one in seven automobile drivers remains uninsured."
* "It is also rather difficult to enforce mandates on people who fall between the cracks of government databases. Not even heavy reliance on tax penalties can overcome the Internal Revenue Service's inability to track down millions of Americans who refuse, or fail, to file tax returns. And every 10 years the Census Bureau demonstrates that it cannot locate several million citizens."
* "Thus, one can expect that any...enforcement offensive to coerce the voluntarily uninsured into signing up for a mandatory coverage scheme will become both prohibitively onerous and politically pointless at the margin."
* "When those costs are added to the havoc that further political control of the entire health care market would wreak, even subsidizing the full amount of uncompensated care with public funds looks like a better buy for American society."
Of course, this is not to say that a single-payer system for the uninsured would be better than mandated insurance. As noted in an article titled "Universal Health Care Won't Work-Witness Medicare," (written by Sue Blevins and published by Cato in 2003):
* "At first glance, many Americans might find the idea of single-payer health insurance appealing, given current economic conditions and high health insurance costs. However, before we accept such a drastic shift in national health policy, we should examine how single-payer health insurance could affect all individuals' health care costs, choices and privacy."
* "If history is any indication, any single-payer initiative will end up costing much more than advocates claim. That, in turn, will lead to higher taxes and/or rationing under which the government will determine which medical treatments will and will not be covered. How do we know this will happen? Because single-payer health care has already been empirically tested on seniors in the United States."
Medicare is the largest single payer of health care in the United States and the world. Thus, for Americans to understand how a compulsory program would affect them, they need only look to Medicare to see its impact on individual freedom. They can see clearly how a universal mandate for health insurance leads to political interference in private health-care decisions for all.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
From a reader with a memory
The interesting thing about all the reductions in beds in Qld Health now seems to be a flawed "modelling." If you believe that then I have parking spaces to sell on Sydney Harbour Bridge and Ocean Front Land at the base of Uluru. Two things intrigue me. Why can't the Australian Public have the names of these "modelers?" If we had them we might not be so confident that the same people can get it right this time. If they are not the same people who are they? Are they clinicians -- almost certainly not. The unfortunate truth of Medical Administrators are that they are failed clinicians (at least it keeps them away from the patients) or non-clinicians whose backgrounds are quite suspect.
Queensland two decades ago had an enviable health system [Under a long-term conservative State government]. Now it runs close to a third world country standard. Bundaberg, Caboolture and Patel are merely symptoms of a very sick system created by a "model" (for model read delusion) that we can budget-drive hospitals rather than needs-drive them. Awful language but there you are. Of course we need to have a good eye on budgets but they should be the driving force. With an increasing population in Queensland there should be more beds not fewer. Not really rocket science is it? And if you think that Bundaberg and Caboolture hospitals are bad, just wait for the exposures to come. Unfortunately many of those who could expose the problems are either dead or in the "shut yo mouth" group. Fradulent waiting lists, surgery lists not allowed to proceed even when the surgeons were willing to work on (they were sent to libraries and paid to do nothing), outspoken critics muzzled and threatened, (even the Forster report was flawed as the people "assisting the inquiry" were in some cases the worst bullies in the system), a rise of manager numbers coinciding with a fall in real clinicians (remember a lot of so called clinicians are not hands on clinicians -- which has never come out), the increasing scourge of excessive documentation and reduction in care/ treatment giving, and so on. The bus is moving but without drivers. In all good remedies it is important to realize that the incumbents were and are part of the problem. They will merely change the decor and documentation. They have no real will to work or practice medicine.
Now to medical graduate numbers. Even with the figures looking bad you must remember that now medical school intakes have 50% plus female graduates. There is nothing wrong with female medicos IF they practice full time. Many don't - quite apart from maternity leave many choose now to work 2-3 days a week and even restricted hours at that. Of course they have that right BUT medical graduates are expensive for the community to train, unlike lawyers and other courses who simply need a barn, a few talking heads, and access to the internet (why we don't even need a good Law Library these days - just access to the internet). As to the problem of country needs and medicos, it could be solved simply by giving a 3x factor to medicare rebates for remote areas and defined areas of need and reducing the benefits to urban medicos. I can hear the howls of "unfair and conscription" already.
Universal Insurance Mandate Leads to Political Interference in Private Health-Care Decisions
Republican Governor Mitt Romney is proposing that all citizens of Massachusetts be required to purchase health insurance, join a government-subsidized program, or face a financial penalty. His plan is being touted as a free-market alternative to proposals being pushed by advocates of single-payer health care. Its compulsory feature is similar, in some ways, to the mandate proposed by congressional Republicans after the Clinton administration called for universal coverage in the fall of 1993. What's wrong with the government mandating individuals to purchase health insurance?
The Cato Institute analyzed the Republican's 1993 plan and pointed out why a mandate is dangerous to liberty. Following are excerpts from that Cato Policy Analysis:
* "Once we presume that government is ultimately responsible for guaranteeing that every American has health insurance, we also guarantee a permanent role for politicians in determining an accompanying set of issues. Once government mandates insurance coverage, it must define what constitutes `adequate' insurance coverage for each citizen."
* "By endorsing the concept of compulsory universal insurance coverage, [the bill] undermines the traditional principles of personal liberty and individual responsibility that provide essential bulwarks against all-intrusive governmental control of health care."
* ".[The bill] makes the fatal mistake of endorsing compulsory, government-defined, universal insurance coverage. That fundamental feature...opens the door wide to extensive political interference in private health care decisions."
* "Sweeping every American into a mandatory health insurance dragnet is not only offensive on philosophical grounds; it is also impossible to achieve.... Even under Canada's system of national health insurance, an estimated 2 to 5 percent of the population in the province of British Columbia is uninsured. Despite 41 state laws that require motorists to purchase automobile liability insurance, one in seven automobile drivers remains uninsured."
* "It is also rather difficult to enforce mandates on people who fall between the cracks of government databases. Not even heavy reliance on tax penalties can overcome the Internal Revenue Service's inability to track down millions of Americans who refuse, or fail, to file tax returns. And every 10 years the Census Bureau demonstrates that it cannot locate several million citizens."
* "Thus, one can expect that any...enforcement offensive to coerce the voluntarily uninsured into signing up for a mandatory coverage scheme will become both prohibitively onerous and politically pointless at the margin."
* "When those costs are added to the havoc that further political control of the entire health care market would wreak, even subsidizing the full amount of uncompensated care with public funds looks like a better buy for American society."
Of course, this is not to say that a single-payer system for the uninsured would be better than mandated insurance. As noted in an article titled "Universal Health Care Won't Work-Witness Medicare," (written by Sue Blevins and published by Cato in 2003):
* "At first glance, many Americans might find the idea of single-payer health insurance appealing, given current economic conditions and high health insurance costs. However, before we accept such a drastic shift in national health policy, we should examine how single-payer health insurance could affect all individuals' health care costs, choices and privacy."
* "If history is any indication, any single-payer initiative will end up costing much more than advocates claim. That, in turn, will lead to higher taxes and/or rationing under which the government will determine which medical treatments will and will not be covered. How do we know this will happen? Because single-payer health care has already been empirically tested on seniors in the United States."
Medicare is the largest single payer of health care in the United States and the world. Thus, for Americans to understand how a compulsory program would affect them, they need only look to Medicare to see its impact on individual freedom. They can see clearly how a universal mandate for health insurance leads to political interference in private health-care decisions for all.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 19, 2006
Growing population but shrinking hospitals? -- that's government!
Australian public hospitals show the way
Queensland has almost 500 fewer hospital beds than when the Beattie Government took office in 1998, figures released late yesterday show. Health Minister Stephen Robertson provided the data following questions this week and admitted he had given incorrect information to Parliament on the subject. He said the information supplied to him by his department about bed numbers at the end of last financial year had inadvertently included neonatal cots in the count. So rather than 9994 available beds as Mr Robertson told Parliament, the figure was actually 7017. The number compares with 7515 when Labor took office.
Mr Robertson said bed numbers had been reduced because of health care models that predicted a reduced reliance on overnight hospital stays. "Advice from hospital experts at the time was that less beds would be needed in future because many people requiring simple surgery would be in hospital for a matter of hours instead of occupying beds for several days." Premier Peter Beattie acknowledged last month that the modelling had been flawed.
The Opposition this week attacked the Government for promising to open an extra 66 beds to address problems in emergency departments, when it had shut down hundreds since coming to office. Liberal leader Bob Quinn last night said the figures highlighted why patients struggled to get their surgery on time in Queensland hospitals. "Under this Government, there's been a loss of 500 beds and at one stage they were actually 800 beds down," Mr Quinn said. "When you combine the closure of beds with the exodus of doctors out of the system, you see why people can't get their operation on time, while the waiting lists have blown out and why emergency departments have been closed. "All of this points to how badly the hospitals have been managed by Labor in the past seven years. "This loss of 500 beds has occurred at the same time that Queensland's population has increased by 500,000."
Mr Robertson said the number of available beds had also declined under the Coalition government, falling by 149 in 2« years. But he said bed numbers was "a very poor measure of hospital system performance, because it is subject to significant estimation error". "There is also no way of verifying data from earlier years to determine whether current definitions were rigorously followed.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
Australian public hospitals show the way
Queensland has almost 500 fewer hospital beds than when the Beattie Government took office in 1998, figures released late yesterday show. Health Minister Stephen Robertson provided the data following questions this week and admitted he had given incorrect information to Parliament on the subject. He said the information supplied to him by his department about bed numbers at the end of last financial year had inadvertently included neonatal cots in the count. So rather than 9994 available beds as Mr Robertson told Parliament, the figure was actually 7017. The number compares with 7515 when Labor took office.
Mr Robertson said bed numbers had been reduced because of health care models that predicted a reduced reliance on overnight hospital stays. "Advice from hospital experts at the time was that less beds would be needed in future because many people requiring simple surgery would be in hospital for a matter of hours instead of occupying beds for several days." Premier Peter Beattie acknowledged last month that the modelling had been flawed.
The Opposition this week attacked the Government for promising to open an extra 66 beds to address problems in emergency departments, when it had shut down hundreds since coming to office. Liberal leader Bob Quinn last night said the figures highlighted why patients struggled to get their surgery on time in Queensland hospitals. "Under this Government, there's been a loss of 500 beds and at one stage they were actually 800 beds down," Mr Quinn said. "When you combine the closure of beds with the exodus of doctors out of the system, you see why people can't get their operation on time, while the waiting lists have blown out and why emergency departments have been closed. "All of this points to how badly the hospitals have been managed by Labor in the past seven years. "This loss of 500 beds has occurred at the same time that Queensland's population has increased by 500,000."
Mr Robertson said the number of available beds had also declined under the Coalition government, falling by 149 in 2« years. But he said bed numbers was "a very poor measure of hospital system performance, because it is subject to significant estimation error". "There is also no way of verifying data from earlier years to determine whether current definitions were rigorously followed.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 18, 2006
A SOP to Socialized Medicine
Maine has to raise taxes to pay for all the "savings" of its health-care program
Welcome to the Pine Tree state, where a program that the governor claims has saved the state millions of dollars means that your taxes go . . . up. Maine is the home of Democratic Gov. John Baldacci's Dirigo Health, which regulates the state's health-care system and includes a subsidized health-insurance program. (Dirigo is the state's motto, Latin for "I lead.") When the law creating Dirigo Health was signed, proponents said it would reduce cost-shifting and health-system costs and ultimately cover all 130,000 uninsured Mainers within five years, including 31,000 uninsured in year one.
It hasn't worked out that way. Through the first nine months only 1,600 previously uninsured individuals enrolled in Dirigo Health's insurance product, called DirigoChoice. The other 6,000 who enrolled simply traded their private health insurance for taxpayer-subsidized DirigoChoice. The program continues to spend millions subsidizing insurance for those already insured.
Gov. Baldacci promised that his new program would insure the uninsured and save the state money. It's a bit hard to see how, when it cost $19.5 million to cover 1,600 previously uninsured people. Nevertheless, the governor says that it does--and that now Mainers must pay it all back! The reasoning goes like this. By enrolling the uninsured, Dirigo Health would reduce "cost shifting," which happens when unpaid bills are passed along to other paying patients in the form of higher costs. So when individuals have coverage, the insurer pays most of the bills, reducing the chance of unpaid bills. This reduction in bad debt would become savings--which Maine could claim for the state.
The Dirigo Health board of directors hired an outside firm to examine health-care system spending in Maine to determine Dirigo Health's savings. Initially, the governor claimed that Dirigo saved the system about $137 million. That didn't seem right--how could a program that covered a mere 1,600 uninsured people save $137 million?
The insurance commissioner revised the claimed savings to approximately $44 million. Ultimately, less than $3 million was attributed to reductions in uncompensated care. Most of the rest was due to Dirigo regulations that asked the state's hospitals to cap their cost increases at 3% a year. Maine hospitals did so, accounting for almost $34 million in savings, compared with what the governor projected costs would have increased.
Looking further into the issue, one consultant tested the formulas that Maine used to calculate the hospital-generated savings by feeding in data from New Hampshire--which does not have Dirigo Health regulations or subsidies for uninsured health insurance, and which should presumably not show any savings at all. Nevertheless the model showed tens of millions in savings for New Hampshire hospitals. This puzzling result raised questions about the accuracy of the savings that resulted from Dirigo Health. But for now, the $44 million figure stands--and Gov. Baldacci has used it as the excuse to raise taxes.
The Dirigo board is levying a Savings Offset Payment, or SOP--a remarkably innovative name for a new claims tax--to "recover" every dollar that the state says it has "saved." This SOP is similar to a sales tax; a 2.4% surcharge is added to all paid health-care claims. When applied, this new tax will cost the average individual about $70 and the average family about $200 a year--at a time when most individual insurance policyholders are already absorbing a 16% increase in their insurance premiums.
But, you may ask, if the program is saving all this money, why is a new tax necessary? The answer is that without the SOP, Dirigo Health's high costs would bankrupt the program.
The SOP, effective last month, applies only to individuals, small businesses and other businesses buying health insurance from a Maine insurer or using a third-party administrator. By raising insurance costs, this tax may end up compelling some individuals to drop their coverage. But, hey, maybe they too can get subsidized coverage under Dirigo.
Currently, SOP is being challenged in court, for both the calculations of the savings and the ability of the state to tax certain large employers. Some insurers have included a notice on policies highlighting the new tax--and consumers are furious. On Tuesday the Legislature held a public hearing for a bill that would forbid insurers from passing along the cost of the SOP to policyholders. Gov. Baldacci supports this proposal even though it sets the dangerous precedent of the state limiting a private business's ability to pass along a cost of doing business. It also threatens the very financial viability of the private insurance market in Maine. The legislative proposal shows their political concern over the public's reaction to the SOP.
A better alternative for uninsured individuals in Maine is Health Savings Accounts, a tax-deductible personal fund coupled with a high-deductible health-insurance policy. The savings account permits a person to take federal income tax deductions for account contributions and, in most cases, state income tax deductions--though not in Maine. The high-deductible insurance plan, like all insurance, protects the insured from financial loss. And HSAs would cost the state far less than Dirigo.
If Dirigo truly saved money, the program's benefits would exceed its costs. Elementary math indicates that this is not the case; every dollar questionably identified by the state as having been "saved" is taken from consumers thanks to the SOP. Perhaps not surprisingly, several other states are asking whether Maine's Dirigo Health could be a model for them. It could, if they too want to increase taxes, meanwhile doing virtually nothing to help the uninsured. "Dirigo" might come to mean "Don't be misled."
And if legal attempts to challenge it fail, then the Dirigo Savings Offset Payment will probably become permanent and grow in future years. The cry in Maine soon may become "Dirigo, your savings are too taxing."
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
Maine has to raise taxes to pay for all the "savings" of its health-care program
Welcome to the Pine Tree state, where a program that the governor claims has saved the state millions of dollars means that your taxes go . . . up. Maine is the home of Democratic Gov. John Baldacci's Dirigo Health, which regulates the state's health-care system and includes a subsidized health-insurance program. (Dirigo is the state's motto, Latin for "I lead.") When the law creating Dirigo Health was signed, proponents said it would reduce cost-shifting and health-system costs and ultimately cover all 130,000 uninsured Mainers within five years, including 31,000 uninsured in year one.
It hasn't worked out that way. Through the first nine months only 1,600 previously uninsured individuals enrolled in Dirigo Health's insurance product, called DirigoChoice. The other 6,000 who enrolled simply traded their private health insurance for taxpayer-subsidized DirigoChoice. The program continues to spend millions subsidizing insurance for those already insured.
Gov. Baldacci promised that his new program would insure the uninsured and save the state money. It's a bit hard to see how, when it cost $19.5 million to cover 1,600 previously uninsured people. Nevertheless, the governor says that it does--and that now Mainers must pay it all back! The reasoning goes like this. By enrolling the uninsured, Dirigo Health would reduce "cost shifting," which happens when unpaid bills are passed along to other paying patients in the form of higher costs. So when individuals have coverage, the insurer pays most of the bills, reducing the chance of unpaid bills. This reduction in bad debt would become savings--which Maine could claim for the state.
The Dirigo Health board of directors hired an outside firm to examine health-care system spending in Maine to determine Dirigo Health's savings. Initially, the governor claimed that Dirigo saved the system about $137 million. That didn't seem right--how could a program that covered a mere 1,600 uninsured people save $137 million?
The insurance commissioner revised the claimed savings to approximately $44 million. Ultimately, less than $3 million was attributed to reductions in uncompensated care. Most of the rest was due to Dirigo regulations that asked the state's hospitals to cap their cost increases at 3% a year. Maine hospitals did so, accounting for almost $34 million in savings, compared with what the governor projected costs would have increased.
Looking further into the issue, one consultant tested the formulas that Maine used to calculate the hospital-generated savings by feeding in data from New Hampshire--which does not have Dirigo Health regulations or subsidies for uninsured health insurance, and which should presumably not show any savings at all. Nevertheless the model showed tens of millions in savings for New Hampshire hospitals. This puzzling result raised questions about the accuracy of the savings that resulted from Dirigo Health. But for now, the $44 million figure stands--and Gov. Baldacci has used it as the excuse to raise taxes.
The Dirigo board is levying a Savings Offset Payment, or SOP--a remarkably innovative name for a new claims tax--to "recover" every dollar that the state says it has "saved." This SOP is similar to a sales tax; a 2.4% surcharge is added to all paid health-care claims. When applied, this new tax will cost the average individual about $70 and the average family about $200 a year--at a time when most individual insurance policyholders are already absorbing a 16% increase in their insurance premiums.
But, you may ask, if the program is saving all this money, why is a new tax necessary? The answer is that without the SOP, Dirigo Health's high costs would bankrupt the program.
The SOP, effective last month, applies only to individuals, small businesses and other businesses buying health insurance from a Maine insurer or using a third-party administrator. By raising insurance costs, this tax may end up compelling some individuals to drop their coverage. But, hey, maybe they too can get subsidized coverage under Dirigo.
Currently, SOP is being challenged in court, for both the calculations of the savings and the ability of the state to tax certain large employers. Some insurers have included a notice on policies highlighting the new tax--and consumers are furious. On Tuesday the Legislature held a public hearing for a bill that would forbid insurers from passing along the cost of the SOP to policyholders. Gov. Baldacci supports this proposal even though it sets the dangerous precedent of the state limiting a private business's ability to pass along a cost of doing business. It also threatens the very financial viability of the private insurance market in Maine. The legislative proposal shows their political concern over the public's reaction to the SOP.
A better alternative for uninsured individuals in Maine is Health Savings Accounts, a tax-deductible personal fund coupled with a high-deductible health-insurance policy. The savings account permits a person to take federal income tax deductions for account contributions and, in most cases, state income tax deductions--though not in Maine. The high-deductible insurance plan, like all insurance, protects the insured from financial loss. And HSAs would cost the state far less than Dirigo.
If Dirigo truly saved money, the program's benefits would exceed its costs. Elementary math indicates that this is not the case; every dollar questionably identified by the state as having been "saved" is taken from consumers thanks to the SOP. Perhaps not surprisingly, several other states are asking whether Maine's Dirigo Health could be a model for them. It could, if they too want to increase taxes, meanwhile doing virtually nothing to help the uninsured. "Dirigo" might come to mean "Don't be misled."
And if legal attempts to challenge it fail, then the Dirigo Savings Offset Payment will probably become permanent and grow in future years. The cry in Maine soon may become "Dirigo, your savings are too taxing."
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 17, 2006
By the Grace of God, Free Markets Are Healing the Blind
In the Bible, one of the miracles used by the Prophets, Jesus and the Apostles to demonstrate their divine calling was the healing of the blind. One of the plagues of the fallen creation is the loss of the ability to see. I have numerous friends and relatives with vision problems, including an uncle who was totally blind. Since 1975, I have been continually reminded of the blessing of sight because I have been unable to see clearly in my right eye. As recently as last summer, I was told that nothing could be done to remove the scarring from my right cornea short of a $50,000 cornea transplant that had a significant chance of failure. One entrepreneur has changed all of that.
Dr. Ming Wang of Nashville, Tennessee performed a procedure that lasted a scant 20 seconds and even though the recovery period is supposed to be two to four months, I was seeing like I have not seen in 30 years in less than two weeks. Dr. Wang developed the procedure and is continually developing new procedures and hardware to do things that are still believed impossible in some places. The best news is that it cost me less than one tenth of what a cornea transplant would cost and the success rate is much higher to boot.
The really amazing story is that of the entrepreneurial spirit of Dr. Wang, the business model for his Wang Vision Center, and how he came to be a Surgeon and a Laser Physicist. Dr. Wang grew up in Communist China. Although his parents were physicians, they refused to join the Communist Party and were ostracized. As a result, their son, Ming, was denied the opportunity for a formal education after he turned 14 and had graduated from junior high school. In the days of the Cultural Revolution, people not destined to be educated were shipped to the remote provinces to become peasant agricultural laborers. One method of avoiding this fate was to acquire and practice a skill that was approved by the Communist Party. Displaying a flash of his developing entrepreneurial spirit, young Ming Wang learned to play the Er-hu, an ancient Chinese stringed instrument known here as the Chinese violin. This did not get him a comfortable seat in the national orchestra, however. While avoiding peasant labor, he had to play the Er-hu on a street corner in Beijing 15 hours per day rain or shine.
As the Cultural revolution waned and the restrictions eased, Ming was afforded the opportunity again to further his education. He still faced an obstacle. He had to pass entrance examinations. Because he was now years behind in his formal education, he would have been at a severe disadvantage except that he had been receiving instruction at home. Yes, apparently homeschooling worked well even in Communist China. With tutoring from his parents and their colleagues at the medical institute where they taught, he placed fourth in the nation and was admitted to higher education.
After a chance meeting with an American college professor, Ming was given the opportunity to come to The United States. He arrived on February 3, 1982 with $50 in his pocket and as he puts it, "faith in the American Dream." Like the runner who has been shackled with weights for years and suddenly finds himself free of them, he ran like the wind. What was once his handicap is now his strength. Ming Wang graduated magna cum laude from Harvard Medical School and MIT with an M.D. and a Ph.D. in Laser Physics.
Now Dr. Wang has his own business called the Wang Vision Institute. Of all of the doctors' offices I have visited, this one is a model of efficiency. There is no great wall (no pun intended) of medical records primarily kept to satisfy insurance companies. In fact, The Wang Vision Institute will not file insurance claims. Did you ever wonder what that small administrative army costs in you local physician's office? There is also a big difference from the many doctor's offices in Tennessee that are choked with TennCare patients with minor sniffles or other trivial ailments because seeing the doctor is "free" (Tennessee got Hillary's heath care plan even if the rest of the nation escaped it and it has been an unmitigated disaster to the quality of health care in the state). Dr. Wang's staff is extremely professional and courteous. His staff includes several ophthalmologists, and technicians who I am sure he has hand-picked for their skill and proficiency.
Dr. Wang also partitions his time such that he is able to perform initial evaluations, surgeries, and followup visits as well as research into pioneering new procedures and surgical tools. This would not be possible except that he runs his office as a business. I would hope and pray that more physicians would take up this model
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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 the Bible, one of the miracles used by the Prophets, Jesus and the Apostles to demonstrate their divine calling was the healing of the blind. One of the plagues of the fallen creation is the loss of the ability to see. I have numerous friends and relatives with vision problems, including an uncle who was totally blind. Since 1975, I have been continually reminded of the blessing of sight because I have been unable to see clearly in my right eye. As recently as last summer, I was told that nothing could be done to remove the scarring from my right cornea short of a $50,000 cornea transplant that had a significant chance of failure. One entrepreneur has changed all of that.
Dr. Ming Wang of Nashville, Tennessee performed a procedure that lasted a scant 20 seconds and even though the recovery period is supposed to be two to four months, I was seeing like I have not seen in 30 years in less than two weeks. Dr. Wang developed the procedure and is continually developing new procedures and hardware to do things that are still believed impossible in some places. The best news is that it cost me less than one tenth of what a cornea transplant would cost and the success rate is much higher to boot.
The really amazing story is that of the entrepreneurial spirit of Dr. Wang, the business model for his Wang Vision Center, and how he came to be a Surgeon and a Laser Physicist. Dr. Wang grew up in Communist China. Although his parents were physicians, they refused to join the Communist Party and were ostracized. As a result, their son, Ming, was denied the opportunity for a formal education after he turned 14 and had graduated from junior high school. In the days of the Cultural Revolution, people not destined to be educated were shipped to the remote provinces to become peasant agricultural laborers. One method of avoiding this fate was to acquire and practice a skill that was approved by the Communist Party. Displaying a flash of his developing entrepreneurial spirit, young Ming Wang learned to play the Er-hu, an ancient Chinese stringed instrument known here as the Chinese violin. This did not get him a comfortable seat in the national orchestra, however. While avoiding peasant labor, he had to play the Er-hu on a street corner in Beijing 15 hours per day rain or shine.
As the Cultural revolution waned and the restrictions eased, Ming was afforded the opportunity again to further his education. He still faced an obstacle. He had to pass entrance examinations. Because he was now years behind in his formal education, he would have been at a severe disadvantage except that he had been receiving instruction at home. Yes, apparently homeschooling worked well even in Communist China. With tutoring from his parents and their colleagues at the medical institute where they taught, he placed fourth in the nation and was admitted to higher education.
After a chance meeting with an American college professor, Ming was given the opportunity to come to The United States. He arrived on February 3, 1982 with $50 in his pocket and as he puts it, "faith in the American Dream." Like the runner who has been shackled with weights for years and suddenly finds himself free of them, he ran like the wind. What was once his handicap is now his strength. Ming Wang graduated magna cum laude from Harvard Medical School and MIT with an M.D. and a Ph.D. in Laser Physics.
Now Dr. Wang has his own business called the Wang Vision Institute. Of all of the doctors' offices I have visited, this one is a model of efficiency. There is no great wall (no pun intended) of medical records primarily kept to satisfy insurance companies. In fact, The Wang Vision Institute will not file insurance claims. Did you ever wonder what that small administrative army costs in you local physician's office? There is also a big difference from the many doctor's offices in Tennessee that are choked with TennCare patients with minor sniffles or other trivial ailments because seeing the doctor is "free" (Tennessee got Hillary's heath care plan even if the rest of the nation escaped it and it has been an unmitigated disaster to the quality of health care in the state). Dr. Wang's staff is extremely professional and courteous. His staff includes several ophthalmologists, and technicians who I am sure he has hand-picked for their skill and proficiency.
Dr. Wang also partitions his time such that he is able to perform initial evaluations, surgeries, and followup visits as well as research into pioneering new procedures and surgical tools. This would not be possible except that he runs his office as a business. I would hope and pray that more physicians would take up this model
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 16, 2006
LIFESAVING PILL TOO EXPENSIVE FOR BUREAUCRATIZED MEDICINE
A proposal to give every person a pill that combines aspirin, a statin, three agents that lower blood pressure and folic acid could save thousands of lives in Britain each year. But researchers have found that, despite its potential to reduce health problems dramatically, it would not save any money. The daily "polypill" is seen as a possible "magic bullet" for cardiovascular disease (CVD), Britain's biggest killer. Doctors believe that, if taken preventatively, it could slash the risk of coronary artery disease by 88 per cent and stroke by 80 per cent in those aged between 55 and 64.
However, a study by Dutch researchers suggests that even if the polypills cost nothing to make, giving them to everyone, or even only those at moderate risk of CVD, would not save any money because of the huge administrative costs of prescribing them to millions of people. The study, published today in the Journal of Epidemiology and Community Health, found that the polypill could drain global health budgets unless it was carefully targeted and cheap. The formulation, first suggested in 2003, has not been tested on a large number of people, and how the pill's ingredients interact is not known.
To calculate the potential costs, the authors looked at the risk of developing coronary artery disease in different age groups, as well as medical and treatment costs. They used data from the Framingham Heart Study, which monitored more than 5,000 Americans aged between 28 and 62 for heart disease and stroke for almost half a century.
The team from the Erasmus Medical Centre in Rotterdam found that giving the pill to people over 60 or those with a high risk of coronary heart disease would be most beneficial. This proposal was underpinned by analysis of earlier trials of drugs that can lower the risk of cardiovascular disease. More than 750 trials were assessed.
The polypill would be designed to lower the four key risk factors for heart disease: cholesterol, high blood pressure, high homocysteine blood levels and blood platelet function. A statin would reduce high levels of the "bad" low-density lipoprotein cholesterol, cutting the risk of heart disease, while three drugs that lower blood pressure would reduce stroke risk. Folic acid in the pill would cut high homocysteine levels, which can encourage the build-up of fatty plaques in arteries. Aspirin would regulate the function of blood platelets.
The researchers say that giving the polypill to everyone over 60 would prevent between 76 and 179 heart attacks per thousand people and between 11 and 33 strokes per 1,000 people in this age group. "However, this would also imply the medicalisation of a large section of the population and the exposure of otherwise healthy subjects to unwanted adverse effects," they said.
To be cost effective, the annual cost per patient would have to be no more than 208 pounds for those aged 50, and no more than 282 pounds for those aged 60 at high risk of coronary artery disease. The researchers said: "(It) may be the preventive method with potentially the greatest impact on public health in the Western world, but is everything that glisters gold?"
The World Health Organisation has suggested that a 2 per cent annual reduction in chronic disease death rates in Britain, such as from CVD, would result in an economic gain of 1.14 billion pounds over ten years.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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 proposal to give every person a pill that combines aspirin, a statin, three agents that lower blood pressure and folic acid could save thousands of lives in Britain each year. But researchers have found that, despite its potential to reduce health problems dramatically, it would not save any money. The daily "polypill" is seen as a possible "magic bullet" for cardiovascular disease (CVD), Britain's biggest killer. Doctors believe that, if taken preventatively, it could slash the risk of coronary artery disease by 88 per cent and stroke by 80 per cent in those aged between 55 and 64.
However, a study by Dutch researchers suggests that even if the polypills cost nothing to make, giving them to everyone, or even only those at moderate risk of CVD, would not save any money because of the huge administrative costs of prescribing them to millions of people. The study, published today in the Journal of Epidemiology and Community Health, found that the polypill could drain global health budgets unless it was carefully targeted and cheap. The formulation, first suggested in 2003, has not been tested on a large number of people, and how the pill's ingredients interact is not known.
To calculate the potential costs, the authors looked at the risk of developing coronary artery disease in different age groups, as well as medical and treatment costs. They used data from the Framingham Heart Study, which monitored more than 5,000 Americans aged between 28 and 62 for heart disease and stroke for almost half a century.
The team from the Erasmus Medical Centre in Rotterdam found that giving the pill to people over 60 or those with a high risk of coronary heart disease would be most beneficial. This proposal was underpinned by analysis of earlier trials of drugs that can lower the risk of cardiovascular disease. More than 750 trials were assessed.
The polypill would be designed to lower the four key risk factors for heart disease: cholesterol, high blood pressure, high homocysteine blood levels and blood platelet function. A statin would reduce high levels of the "bad" low-density lipoprotein cholesterol, cutting the risk of heart disease, while three drugs that lower blood pressure would reduce stroke risk. Folic acid in the pill would cut high homocysteine levels, which can encourage the build-up of fatty plaques in arteries. Aspirin would regulate the function of blood platelets.
The researchers say that giving the polypill to everyone over 60 would prevent between 76 and 179 heart attacks per thousand people and between 11 and 33 strokes per 1,000 people in this age group. "However, this would also imply the medicalisation of a large section of the population and the exposure of otherwise healthy subjects to unwanted adverse effects," they said.
To be cost effective, the annual cost per patient would have to be no more than 208 pounds for those aged 50, and no more than 282 pounds for those aged 60 at high risk of coronary artery disease. The researchers said: "(It) may be the preventive method with potentially the greatest impact on public health in the Western world, but is everything that glisters gold?"
The World Health Organisation has suggested that a 2 per cent annual reduction in chronic disease death rates in Britain, such as from CVD, would result in an economic gain of 1.14 billion pounds over ten years.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 15, 2006
Europe's drug industry is model for the US to avoid
What happened to Europe's vibrant drug industry? Just a decade ago, more than two-thirds of all drug research was conducted in Europe. Now, 60 percent is conducted in the United States. Major European drug makers--such as Aventis, Novartis, and GlaxoSmithKline--have shifted significant portions of their research operations from the Continent to the U.S. and beyond. Human talent is following the research money: Some 400,000 European science and technology graduates now live in the United States, with thousands more leaving every year.
For all this, European investors, scientists, and patients have their own political leaders to blame. Deliberate government policy, in the form of price controls imposed by national health care systems, is slowly choking off a once-thriving economic sector. Europe's government-run and -dominated health care systems are virtually monopsonies. As the primary buyers in their national markets, they have the power to set drug prices 40 percent to 60 percent lower than the free-market prices in the United States. These price controls have a serious negative effect on innovation.
Price Controls Hamper Research
Research and development are expensive. Researchers at Tufts University in Boston determined drug makers spend at least $800 million just to develop a new medicine, and there is a high risk that a drug could fail after years of testing or flunk the government approval process. In the United States, companies are allowed to recoup their investments and make a profit by charging a price that incorporates their research costs. In Europe, that is seldom the case.
The loss to research caused by price controls was quantified in a recent study by the U.S. Department of Commerce. The study looked at the impact of pharmaceutical price controls in 11 countries, including Holland, France, and Germany, and found they caused a $5 billion to $8 billion annual reduction in funding for drug research and development. What could that amount buy? According to the study, it could lead to the discovery of three or four new potentially life-saving drugs each year. So it's no surprise that from 1998 to 2002 there were only 44 new drug launches in Europe, compared to 85 in the United States.
U.S. R&D Threatened
But now is no time for Americans to be smug. Ironically, there is a bipartisan move afoot in the United States to implement the same policies that have dried up pharmaceutical research in Europe, by having the government "negotiate" drug prices. The U.S. Congress passed legislation in 2003 that added a new prescription drug benefit for the disabled and elderly participating in the country's Medicare program. It also created a novel system to deliver the drug benefit, encouraging private, competing companies to negotiate the best prices they can with drug makers.
Congress included in its legislation a "non-interference" clause that preserves the right of these drug plans to negotiate prices freely with the drug companies, without intervention from the federal government. While Americans have mixed opinions about this gigantic government drug program, one thing is clear: Repealing non-interference would put the U.S. pharmaceutical industry on the European path. Yet it is a top priority of liberals in Congress, who plan to bring up such legislation this year. If non-interference is reversed, it will allow the federal government to step in and set prices for all 40 million Medicare recipients. Since they consume almost half of all prescription medicines sold in the United States, this would effectively amount to nationwide price controls.
Industry Driven East
We've already seen such policies force drug makers out of Europe. Roche Chairman Franz Humer has pointed out that the research-based pharmaceutical companies could just as easily move on to Asia, where technology and education are steadily improving. In fact, Roche has just opened a research center in Shanghai, while other drug makers are flocking to Singapore and India. Of course, if the United States gives drug makers a reason to go on the move again, European governments could make their own pitch by eliminating the interventionist policies that have been undercutting drug innovation in their countries.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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.
***************************
What happened to Europe's vibrant drug industry? Just a decade ago, more than two-thirds of all drug research was conducted in Europe. Now, 60 percent is conducted in the United States. Major European drug makers--such as Aventis, Novartis, and GlaxoSmithKline--have shifted significant portions of their research operations from the Continent to the U.S. and beyond. Human talent is following the research money: Some 400,000 European science and technology graduates now live in the United States, with thousands more leaving every year.
For all this, European investors, scientists, and patients have their own political leaders to blame. Deliberate government policy, in the form of price controls imposed by national health care systems, is slowly choking off a once-thriving economic sector. Europe's government-run and -dominated health care systems are virtually monopsonies. As the primary buyers in their national markets, they have the power to set drug prices 40 percent to 60 percent lower than the free-market prices in the United States. These price controls have a serious negative effect on innovation.
Price Controls Hamper Research
Research and development are expensive. Researchers at Tufts University in Boston determined drug makers spend at least $800 million just to develop a new medicine, and there is a high risk that a drug could fail after years of testing or flunk the government approval process. In the United States, companies are allowed to recoup their investments and make a profit by charging a price that incorporates their research costs. In Europe, that is seldom the case.
The loss to research caused by price controls was quantified in a recent study by the U.S. Department of Commerce. The study looked at the impact of pharmaceutical price controls in 11 countries, including Holland, France, and Germany, and found they caused a $5 billion to $8 billion annual reduction in funding for drug research and development. What could that amount buy? According to the study, it could lead to the discovery of three or four new potentially life-saving drugs each year. So it's no surprise that from 1998 to 2002 there were only 44 new drug launches in Europe, compared to 85 in the United States.
U.S. R&D Threatened
But now is no time for Americans to be smug. Ironically, there is a bipartisan move afoot in the United States to implement the same policies that have dried up pharmaceutical research in Europe, by having the government "negotiate" drug prices. The U.S. Congress passed legislation in 2003 that added a new prescription drug benefit for the disabled and elderly participating in the country's Medicare program. It also created a novel system to deliver the drug benefit, encouraging private, competing companies to negotiate the best prices they can with drug makers.
Congress included in its legislation a "non-interference" clause that preserves the right of these drug plans to negotiate prices freely with the drug companies, without intervention from the federal government. While Americans have mixed opinions about this gigantic government drug program, one thing is clear: Repealing non-interference would put the U.S. pharmaceutical industry on the European path. Yet it is a top priority of liberals in Congress, who plan to bring up such legislation this year. If non-interference is reversed, it will allow the federal government to step in and set prices for all 40 million Medicare recipients. Since they consume almost half of all prescription medicines sold in the United States, this would effectively amount to nationwide price controls.
Industry Driven East
We've already seen such policies force drug makers out of Europe. Roche Chairman Franz Humer has pointed out that the research-based pharmaceutical companies could just as easily move on to Asia, where technology and education are steadily improving. In fact, Roche has just opened a research center in Shanghai, while other drug makers are flocking to Singapore and India. Of course, if the United States gives drug makers a reason to go on the move again, European governments could make their own pitch by eliminating the interventionist policies that have been undercutting drug innovation in their countries.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 14, 2006
Health Savings Accounts Work
In December 2003, President Bush signed a health-care law that had two major components. The first was the new Medicare prescription drug benefit that took effect last month. That big-government program has been widely panned as a disaster. The second was a new health insurance option called health savings accounts, or HSAs, which became available in January 2004.
Unlike the Medicare drug program, the response to HSAs has been overwhelmingly positive. In just two years, three million Americans have signed up for an HSA. More than one-third of HSA enrollees were previously uninsured, which means HSAs already may have reduced the number of uninsured by 1 million. Deloitte Consulting L.L.P. reports that, for two years running, insurance premiums for HSAs and similar plans rose at about one-third the rate of increase for other types of coverage. So in his State of the Union address, Bush proposed expanding and enhancing HSAs. His new Medicare entitlement? He didn't even mention it. Go figure.
Fortunately, his HSA proposals would make health coverage and care better and more affordable for hundreds of millions of Americans. HSAs couple high-deductible health insurance with a tax-free savings account (the HSA) for out-of-pocket medical expenses. Individuals and/or employers can contribute money to HSAs tax-free up to the amount of the insurance deductible. HSAs must be coupled with insurance that has a deductible of at least $1,050 for individuals and $2,100 for families. HSA funds may be withdrawn tax-free for any medical expenses. Once expenses reach the deductible, insurance takes over. Any funds that remain in the HSA roll over from year to year and grow tax-free.
Right off the bat, HSAs save money because high-deductible insurance is cheaper than low-deductible coverage. The Kaiser Family Foundation reports that the difference in premiums between the average HSA-compatible policy and the average for all types of insurance is $1,324. That is more than enough savings to cover the average annual HSA deductible ($1,901) in just two years. Sometimes, the savings covers the entire deductible in the first year.
HSAs also let consumers control more of their health-care dollars and decisions. Since consumers own the money that covers their out-of-pocket expenses, they can see any doctors they like, whenever they like. At the same time, patients scrutinize their medical bills and their doctors' recommendations more carefully because it is their money on the line. The chronically ill, however, likely would use up all their HSA deposits in a given year and have little opportunity to save for future medical needs. Even with HSAs, consumers without access to employer-sponsored insurance still pay a hefty tax penalty when they purchase health insurance on their own.
To address those problems, the President proposes essentially doubling the limits on HSA contributions and allowing people to purchase health insurance with tax-free HSA funds. The higher contribution limits ($5,250 for individuals and $10,500 for families) would help the chronically ill and their families by allowing them to put more money aside tax-free for their medical needs. Allowing HSA funds to purchase health insurance would provide tax equity to millions who are unfairly punished by the tax code.
Critics claim that HSAs are only good for the healthy or wealthy. If true, that would mean HSAs benefit only about 80 percent of the population. Not bad, that. But in fact, eHealthInsurance.com reports that half of HSA enrollees are over 40 years old, 20 percent earn less than $35,000, and 40 percent earn less than $50,000. Unfortunately, the President's proposals are unnecessarily complex and would continue to restrict HSAs to those who purchase high-deductible insurance. There is no reason why HSA holders should not be able to choose their health plan themselves. Nonetheless, Bush has made a solid proposal that would improve the quality and affordability of private-sector health insurance and medical care. As for Medicare, well...
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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 December 2003, President Bush signed a health-care law that had two major components. The first was the new Medicare prescription drug benefit that took effect last month. That big-government program has been widely panned as a disaster. The second was a new health insurance option called health savings accounts, or HSAs, which became available in January 2004.
Unlike the Medicare drug program, the response to HSAs has been overwhelmingly positive. In just two years, three million Americans have signed up for an HSA. More than one-third of HSA enrollees were previously uninsured, which means HSAs already may have reduced the number of uninsured by 1 million. Deloitte Consulting L.L.P. reports that, for two years running, insurance premiums for HSAs and similar plans rose at about one-third the rate of increase for other types of coverage. So in his State of the Union address, Bush proposed expanding and enhancing HSAs. His new Medicare entitlement? He didn't even mention it. Go figure.
Fortunately, his HSA proposals would make health coverage and care better and more affordable for hundreds of millions of Americans. HSAs couple high-deductible health insurance with a tax-free savings account (the HSA) for out-of-pocket medical expenses. Individuals and/or employers can contribute money to HSAs tax-free up to the amount of the insurance deductible. HSAs must be coupled with insurance that has a deductible of at least $1,050 for individuals and $2,100 for families. HSA funds may be withdrawn tax-free for any medical expenses. Once expenses reach the deductible, insurance takes over. Any funds that remain in the HSA roll over from year to year and grow tax-free.
Right off the bat, HSAs save money because high-deductible insurance is cheaper than low-deductible coverage. The Kaiser Family Foundation reports that the difference in premiums between the average HSA-compatible policy and the average for all types of insurance is $1,324. That is more than enough savings to cover the average annual HSA deductible ($1,901) in just two years. Sometimes, the savings covers the entire deductible in the first year.
HSAs also let consumers control more of their health-care dollars and decisions. Since consumers own the money that covers their out-of-pocket expenses, they can see any doctors they like, whenever they like. At the same time, patients scrutinize their medical bills and their doctors' recommendations more carefully because it is their money on the line. The chronically ill, however, likely would use up all their HSA deposits in a given year and have little opportunity to save for future medical needs. Even with HSAs, consumers without access to employer-sponsored insurance still pay a hefty tax penalty when they purchase health insurance on their own.
To address those problems, the President proposes essentially doubling the limits on HSA contributions and allowing people to purchase health insurance with tax-free HSA funds. The higher contribution limits ($5,250 for individuals and $10,500 for families) would help the chronically ill and their families by allowing them to put more money aside tax-free for their medical needs. Allowing HSA funds to purchase health insurance would provide tax equity to millions who are unfairly punished by the tax code.
Critics claim that HSAs are only good for the healthy or wealthy. If true, that would mean HSAs benefit only about 80 percent of the population. Not bad, that. But in fact, eHealthInsurance.com reports that half of HSA enrollees are over 40 years old, 20 percent earn less than $35,000, and 40 percent earn less than $50,000. Unfortunately, the President's proposals are unnecessarily complex and would continue to restrict HSAs to those who purchase high-deductible insurance. There is no reason why HSA holders should not be able to choose their health plan themselves. Nonetheless, Bush has made a solid proposal that would improve the quality and affordability of private-sector health insurance and medical care. As for Medicare, well...
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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, February 13, 2006
A COUNTERPRODUCTIVE BRITISH GOVERNMENT HEALTH IDEA
The government's proposed 'health MOTs' will merely encourage more and more people to see themselves as ill and dependant says Dr Michael Fitzpatrick
One of the central features of last week's health White Paper is the plan to provide free medical check-ups at key life stages through the National Health Service (NHS). The proposal for periodic 'health MOTs' emerged as the 'top people's priority' in the government's much-vaunted consultation exercises.
Health ministers are keen to encourage people 'to look after themselves' and thus 'to reduce demand on conventional health and care services'. The latter aspiration is destined to be disappointed. The most likely outcome of the health checkups programme is that it will boost the ranks of the 2.7million people already claiming long-term incapacity benefit (a figure that another government programme is striving to reduce).
There is a paradox at the heart of the White Paper. It proclaims that people should play an independent role in relation to their health - yet it also insists that they need comprehensive professional intervention if they are to achieve the goals of healthy living: 'People want to keep themselves well, and take control of their own health. This came through clearly in our consultation. People asked for more help to do this, through better information, advice and support.' (p31)
'Support' is the key concept of the White Paper, recurring in every section and defining the relationship between an earnestly health-promoting government and the newly health-conscious citizen at every stage of life. This relationship of support is mediated by a burgeoning army of professionals, including not merely the familiar doctors, nurses and teachers, but extending to counsellors, therapists and the new 'health trainers', the barefoot doctors of the Blair healthcare revolution.
The Life Check programme aims 'to help people - particularly at critical points in their lives - to assess their own risk of ill-health', by focusing on 'major risk factors', such as obesity, smoking, binge drinking, mental illness and stress, and sexually transmitted infections. It 'will be a personalised service in two parts'. The first part is an initial assessment, which people will complete for themselves. This is merely the prelude to the second part - a discussion with a 'health trainer' providing 'offers of specific advice and support on the action people can take to maintain and improve health, and, if necessary, referral for more specialist diagnoses for those who need it.' (p35)
Let's look more closely at the conception of health promoted in the White Paper and its consequences. Take this quotation from a participant at the Citizen's Summit in Birmingham: '[As a young person] I feel that better education is needed for young people.. We don't think about our health until it's not there. We need to encourage that way of thinking right from the start.' (p26)
This quotation - set out at the head of the section of the White Paper detailing proposals for implementing the Life Check programme in childhood - reflects the government's emphasis on the role of education in promoting awareness of the risks of disease and of the measures deemed necessary to achieve and sustain health from infancy onwards. (Indeed, the section opens with the statement that 'healthy living starts before we are born', and proceeds to indicate risks to be avoided in pregnancy.) But if health becomes the goal of life - as in the terms of the World Health Organisation (WHO) definition 'a state of complete physical, mental and social wellbeing' - then it becomes an unattainable ideal, a state of perfection that may be striven for but never reached. From this perspective, health becomes exceptional - and illness, understood as the inevitable failure to achieve the ultimate goal, becomes normal. This is the new doctrine that the government wants to preach in schools - and it has already persuaded many young people that this is the way forward.
The new approach to health and illness marks a dramatic break with tradition - but not a progressive one. In the recent past, health was regarded as the normal state of affairs and illness was considered an exceptional departure from normality, a transient state through which the patient passed - with the blessing of medical authority (even if no great benefit accrued from medical intervention ) - before returning to good health and a familiar level of social functioning. Now health has become a state that can only be attained through a high level of personal awareness and commitment to a prescribed lifestyle, through intense vigilance against health risks and through a willingness to submit to regular professional intervention in the cause of preventing disease (or at least of detecting it at an early stage). At the same time, illness has lost much of its stigma and even confers a series of socially approved identities - 'person with HIV/Aids', 'cancer survivor', 'sufferer from stress', 'victim of bullying' - confirmed by patient organisations, celebrity sponsorship, soap opera story lines, autobiographical accounts and other forms of media coverage.
If health becomes the goal of life, then when individuals encounter dissatisfaction and disappointment, these are likely to be experienced as forms of illness, which may well find expression in physical or psychological symptoms. 'Doc, I just don't feel well' is a familiar cry of existential distress in my surgery, uttered by ever-younger patients, and followed by the request, now endorsed by the government, for 'a complete check-up'.
According to the section of the White Paper on 'mental health and emotional well-being', 'there is much that can be done to reduce the frequency of the more common illnesses such as anxiety and depression, and the widespread misery that does not reach the threshold for clinical diagnosis but nevertheless reduces the quality of life of thousands of people' (p36). In fact, the 'much that can be done' amounts to little more than offering banalities about 'eating well' and 'valuing yourself and others' and 'getting involved and making a contribution'. Yet, once the sphere of therapeutic intervention is expanded to include everyday misery, then illness has become the universal condition of humanity and health a utopian - if not a celestial - vision.
As health awareness has grown over the past two decades so have a number of indicators of illness. Surveys reveal that more and more people report feeling unwell, the numbers of people consulting their GPs and other health professionals (and alternative practitioners) have multiplied and levels of sickness absence from work have increased steadily. The intensive promotion of disease awareness fosters a climate of fear around issues of health, as people worry about their risks (and the risks of their loved ones) of succumbing to cancer or heart disease as a result of their deviant or merely deficient lifestyles. The particular virulence of the campaign against obesity creates enormous misery among those designated overweight, who are the targets of unrestrained popular and medical prejudice.
Perhaps the most dramatic indicator of the rising tide of ill health is the number of people claiming incapacity benefit (for which they become eligible after six months sickness absence). The total is now 2.7million, more than three times the level when Margaret Thatcher became prime minister in 1979, and more than the number officially registered as unemployed. It is clear that the major explanation for this increase lies in the growth of conditions which are subjectively defined by the individual concerned and often cannot be objectively verified by any doctor - or welfare bureaucrat. More than one million people, some 40 per cent of the total, are claiming incapacity benefit with diagnoses of anxiety and depression and stress, a four-fold increase in 20 years.
The second leading cause of sickness absence is back pain; again numbers have increased steadily over recent decades - among non-manual workers as much as among manual workers. As it is often impossible to correlate complaints of pain and stiffness with the results of X-rays or other imaging techniques, the key judgement is the patient's - if they do not feel well enough to work, then they are eligible for benefits. Other claimants suffer from a range of 'unexplained physical symptoms', such as joint pains, fatigue, abdominal discomfort and distension. These may be described as 'fibromyalgia', 'chronic fatigue syndrome/ME' or 'irritable bowel syndrome' but these labels merely provide medical legitimacy for the experience of illness: they offer neither rational diagnosis nor effective treatment.
The government may take steps to tighten up the provision of incapacity benefit, but these measures will do nothing to stop the growth of illness that results from wider cultural forces that its wider health promotion policies have done much to encourage. Given the focus of official health promotion propaganda on young people, it is worth noting that half of all people on incapacity benefits are under the age of 50. Long-term incapacity is often a life sentence: though two thirds of claimants get a job within two years, those who do not are more likely to retire (or die) on benefit than return to work.
In a chapter entitled 'Enabling health, independence and well-being', the White Paper makes clear that self-monitoring of lifestyle in the cause of better health is not enough. 'Independence' here means subordination to health professionals, from antenatal clinic to residential care home; 'empowerment ' means surrender to the authority of the health trainer. At every stage of life the responsible citizen must seek professional assistance to discover the appropriate form of support for their needs.
The White Paper details the support required by prospective parents and by parents of young children, the support needed by children at primary school and in the transition from primary to secondary school and beyond - here 'joined up' or 'new integrated forms of support' will be provided by health, education and social care agencies. 'People of working age' also need support, whether they are in work or unemployed (when they need additional support). There is no respite for the elderly: 'older people' are the targets of programmes to increase exercise and of measures 'to increase uptake of evidence-based disease prevention programmes'.
In fact, there is little evidence for the efficacy of any of the disease prevention programmes included in the White Paper. Though it is true that smoking is bad for health and stopping smoking is beneficial, the evidence that either moral exhortation or therapeutic intervention is successful in reducing levels of smoking or smoking-related illness remains contentious. Despite four decades of anti-smoking propaganda and therapies, nearly a quarter of the population is still smoking. In relation to other lifestyle factors - such as diet and exercise - the evidence that these cause disease and or that campaigns to change behaviour in these areas have any preventive value is either weak or non-existent. By contrast, there is very good evidence that the approach to tackling obesity that has been pursued for the past 50 years by health professionals and is implicitly followed by the White Paper - telling people to eat less and exercise more - simply does not work: hence more people are overweight.
However, we should not worry too much about this, because it also apparent that we are living longer. The White Paper's claim, emphasised in bold print, that 'our children will not live as long as their parents unless there is a shift towards healthier living', is quite absurd. (The authority for this claim is the discredited 2004 House of Commons Health Committee report on obesity - see Choking on the facts, by Brendan O'Neill). In the USA, while obesity has steadily increased over the past 50 years, life expectancy has increased by more than seven years (2). The only modern case of a population in an advanced industrial society in which life expectancy has declined is the former Soviet Union, where a profound social, economic and moral crisis was accompanied by the collapse of the public health system.
It is not surprising to find that those deemed to be in most need of support are those on incapacity benefit. Having been supported into chronic invalidity, they must now be given extra support in the quest to return to the world of work. Pilot schemes have been established with an army of support workers - including personal advisors, job coaches, occupational health specialists, finance and debt counsellors - aiming to provide the systematic support deemed necessary to encourage the chronically ill down 'pathways to work'. While punitive measures to curtail benefits may succeed in intimidating some claimants, it seems likely that all this support will only further undermine the capacity of the long-term sick to pursue an independent life.
Behind the 'empowerment' rhetoric of health promotion lies the presumption of individual incapacity. The consequences of this approach are already evident in the trends of the past two decades: elevating health to become the goal of all human endeavour is making more and more people ill. It is causing an epidemic of subjectively defined ill-health, an increased demand for healthcare services in all forms and a growing burden of state expenditure on welfare benefits.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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 government's proposed 'health MOTs' will merely encourage more and more people to see themselves as ill and dependant says Dr Michael Fitzpatrick
One of the central features of last week's health White Paper is the plan to provide free medical check-ups at key life stages through the National Health Service (NHS). The proposal for periodic 'health MOTs' emerged as the 'top people's priority' in the government's much-vaunted consultation exercises.
Health ministers are keen to encourage people 'to look after themselves' and thus 'to reduce demand on conventional health and care services'. The latter aspiration is destined to be disappointed. The most likely outcome of the health checkups programme is that it will boost the ranks of the 2.7million people already claiming long-term incapacity benefit (a figure that another government programme is striving to reduce).
There is a paradox at the heart of the White Paper. It proclaims that people should play an independent role in relation to their health - yet it also insists that they need comprehensive professional intervention if they are to achieve the goals of healthy living: 'People want to keep themselves well, and take control of their own health. This came through clearly in our consultation. People asked for more help to do this, through better information, advice and support.' (p31)
'Support' is the key concept of the White Paper, recurring in every section and defining the relationship between an earnestly health-promoting government and the newly health-conscious citizen at every stage of life. This relationship of support is mediated by a burgeoning army of professionals, including not merely the familiar doctors, nurses and teachers, but extending to counsellors, therapists and the new 'health trainers', the barefoot doctors of the Blair healthcare revolution.
The Life Check programme aims 'to help people - particularly at critical points in their lives - to assess their own risk of ill-health', by focusing on 'major risk factors', such as obesity, smoking, binge drinking, mental illness and stress, and sexually transmitted infections. It 'will be a personalised service in two parts'. The first part is an initial assessment, which people will complete for themselves. This is merely the prelude to the second part - a discussion with a 'health trainer' providing 'offers of specific advice and support on the action people can take to maintain and improve health, and, if necessary, referral for more specialist diagnoses for those who need it.' (p35)
Let's look more closely at the conception of health promoted in the White Paper and its consequences. Take this quotation from a participant at the Citizen's Summit in Birmingham: '[As a young person] I feel that better education is needed for young people.. We don't think about our health until it's not there. We need to encourage that way of thinking right from the start.' (p26)
This quotation - set out at the head of the section of the White Paper detailing proposals for implementing the Life Check programme in childhood - reflects the government's emphasis on the role of education in promoting awareness of the risks of disease and of the measures deemed necessary to achieve and sustain health from infancy onwards. (Indeed, the section opens with the statement that 'healthy living starts before we are born', and proceeds to indicate risks to be avoided in pregnancy.) But if health becomes the goal of life - as in the terms of the World Health Organisation (WHO) definition 'a state of complete physical, mental and social wellbeing' - then it becomes an unattainable ideal, a state of perfection that may be striven for but never reached. From this perspective, health becomes exceptional - and illness, understood as the inevitable failure to achieve the ultimate goal, becomes normal. This is the new doctrine that the government wants to preach in schools - and it has already persuaded many young people that this is the way forward.
The new approach to health and illness marks a dramatic break with tradition - but not a progressive one. In the recent past, health was regarded as the normal state of affairs and illness was considered an exceptional departure from normality, a transient state through which the patient passed - with the blessing of medical authority (even if no great benefit accrued from medical intervention ) - before returning to good health and a familiar level of social functioning. Now health has become a state that can only be attained through a high level of personal awareness and commitment to a prescribed lifestyle, through intense vigilance against health risks and through a willingness to submit to regular professional intervention in the cause of preventing disease (or at least of detecting it at an early stage). At the same time, illness has lost much of its stigma and even confers a series of socially approved identities - 'person with HIV/Aids', 'cancer survivor', 'sufferer from stress', 'victim of bullying' - confirmed by patient organisations, celebrity sponsorship, soap opera story lines, autobiographical accounts and other forms of media coverage.
If health becomes the goal of life, then when individuals encounter dissatisfaction and disappointment, these are likely to be experienced as forms of illness, which may well find expression in physical or psychological symptoms. 'Doc, I just don't feel well' is a familiar cry of existential distress in my surgery, uttered by ever-younger patients, and followed by the request, now endorsed by the government, for 'a complete check-up'.
According to the section of the White Paper on 'mental health and emotional well-being', 'there is much that can be done to reduce the frequency of the more common illnesses such as anxiety and depression, and the widespread misery that does not reach the threshold for clinical diagnosis but nevertheless reduces the quality of life of thousands of people' (p36). In fact, the 'much that can be done' amounts to little more than offering banalities about 'eating well' and 'valuing yourself and others' and 'getting involved and making a contribution'. Yet, once the sphere of therapeutic intervention is expanded to include everyday misery, then illness has become the universal condition of humanity and health a utopian - if not a celestial - vision.
As health awareness has grown over the past two decades so have a number of indicators of illness. Surveys reveal that more and more people report feeling unwell, the numbers of people consulting their GPs and other health professionals (and alternative practitioners) have multiplied and levels of sickness absence from work have increased steadily. The intensive promotion of disease awareness fosters a climate of fear around issues of health, as people worry about their risks (and the risks of their loved ones) of succumbing to cancer or heart disease as a result of their deviant or merely deficient lifestyles. The particular virulence of the campaign against obesity creates enormous misery among those designated overweight, who are the targets of unrestrained popular and medical prejudice.
Perhaps the most dramatic indicator of the rising tide of ill health is the number of people claiming incapacity benefit (for which they become eligible after six months sickness absence). The total is now 2.7million, more than three times the level when Margaret Thatcher became prime minister in 1979, and more than the number officially registered as unemployed. It is clear that the major explanation for this increase lies in the growth of conditions which are subjectively defined by the individual concerned and often cannot be objectively verified by any doctor - or welfare bureaucrat. More than one million people, some 40 per cent of the total, are claiming incapacity benefit with diagnoses of anxiety and depression and stress, a four-fold increase in 20 years.
The second leading cause of sickness absence is back pain; again numbers have increased steadily over recent decades - among non-manual workers as much as among manual workers. As it is often impossible to correlate complaints of pain and stiffness with the results of X-rays or other imaging techniques, the key judgement is the patient's - if they do not feel well enough to work, then they are eligible for benefits. Other claimants suffer from a range of 'unexplained physical symptoms', such as joint pains, fatigue, abdominal discomfort and distension. These may be described as 'fibromyalgia', 'chronic fatigue syndrome/ME' or 'irritable bowel syndrome' but these labels merely provide medical legitimacy for the experience of illness: they offer neither rational diagnosis nor effective treatment.
The government may take steps to tighten up the provision of incapacity benefit, but these measures will do nothing to stop the growth of illness that results from wider cultural forces that its wider health promotion policies have done much to encourage. Given the focus of official health promotion propaganda on young people, it is worth noting that half of all people on incapacity benefits are under the age of 50. Long-term incapacity is often a life sentence: though two thirds of claimants get a job within two years, those who do not are more likely to retire (or die) on benefit than return to work.
In a chapter entitled 'Enabling health, independence and well-being', the White Paper makes clear that self-monitoring of lifestyle in the cause of better health is not enough. 'Independence' here means subordination to health professionals, from antenatal clinic to residential care home; 'empowerment ' means surrender to the authority of the health trainer. At every stage of life the responsible citizen must seek professional assistance to discover the appropriate form of support for their needs.
The White Paper details the support required by prospective parents and by parents of young children, the support needed by children at primary school and in the transition from primary to secondary school and beyond - here 'joined up' or 'new integrated forms of support' will be provided by health, education and social care agencies. 'People of working age' also need support, whether they are in work or unemployed (when they need additional support). There is no respite for the elderly: 'older people' are the targets of programmes to increase exercise and of measures 'to increase uptake of evidence-based disease prevention programmes'.
In fact, there is little evidence for the efficacy of any of the disease prevention programmes included in the White Paper. Though it is true that smoking is bad for health and stopping smoking is beneficial, the evidence that either moral exhortation or therapeutic intervention is successful in reducing levels of smoking or smoking-related illness remains contentious. Despite four decades of anti-smoking propaganda and therapies, nearly a quarter of the population is still smoking. In relation to other lifestyle factors - such as diet and exercise - the evidence that these cause disease and or that campaigns to change behaviour in these areas have any preventive value is either weak or non-existent. By contrast, there is very good evidence that the approach to tackling obesity that has been pursued for the past 50 years by health professionals and is implicitly followed by the White Paper - telling people to eat less and exercise more - simply does not work: hence more people are overweight.
However, we should not worry too much about this, because it also apparent that we are living longer. The White Paper's claim, emphasised in bold print, that 'our children will not live as long as their parents unless there is a shift towards healthier living', is quite absurd. (The authority for this claim is the discredited 2004 House of Commons Health Committee report on obesity - see Choking on the facts, by Brendan O'Neill). In the USA, while obesity has steadily increased over the past 50 years, life expectancy has increased by more than seven years (2). The only modern case of a population in an advanced industrial society in which life expectancy has declined is the former Soviet Union, where a profound social, economic and moral crisis was accompanied by the collapse of the public health system.
It is not surprising to find that those deemed to be in most need of support are those on incapacity benefit. Having been supported into chronic invalidity, they must now be given extra support in the quest to return to the world of work. Pilot schemes have been established with an army of support workers - including personal advisors, job coaches, occupational health specialists, finance and debt counsellors - aiming to provide the systematic support deemed necessary to encourage the chronically ill down 'pathways to work'. While punitive measures to curtail benefits may succeed in intimidating some claimants, it seems likely that all this support will only further undermine the capacity of the long-term sick to pursue an independent life.
Behind the 'empowerment' rhetoric of health promotion lies the presumption of individual incapacity. The consequences of this approach are already evident in the trends of the past two decades: elevating health to become the goal of all human endeavour is making more and more people ill. It is causing an epidemic of subjectively defined ill-health, an increased demand for healthcare services in all forms and a growing burden of state expenditure on welfare benefits.
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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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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