THE GOOD OLD GENEROUS AMERICAN TAXPAYER

The recent state budget debate over whether California should provide health insurance for children who are undocumented immigrants largely overlooked one key fact: The government already spends almost $1 billion a year for some health care services for the undocumented through Medi-Cal.

Amid a renewed national focus on illegal immigration, health services for undocumented immigrants in California returned as a political flash point this year for the first time since debate over Proposition 187 roiled the state in the 1990s. Republican lawmakers persuaded Democrats and GOP Gov. Arnold Schwarzenegger to drop $23 million for new insurance coverage for undocumented children. But almost no one was talking about the programs that Proposition 187 was intended to cut before it was blocked in court in the late 1990s: prenatal care, nursing home care and other services funded by Medi-Cal for undocumented immigrants.

Over the past decade, those services have grown by 50 percent into a $1 billion annual program serving hundreds of thousands of people each year. Spending growth has been slower than in the Medi-Cal program overall, which went up more than 100 percent in the past decade, to about $35 billion annually. Both the number of people receiving services and the cost of those services have risen: The number of undocumented women giving birth covered by Medi-Cal rose almost 25 percent from 85,000 in 1995 to 105,000 in 2004. Meanwhile, the overall costs of those births rose by about 135 percent during that time.

State officials say the increases are largely due to inflation in health care costs and to a change in the rules allowing more people to qualify for Medi-Cal. Republican lawmakers say the fight over Proposition 187 has limited their ability to try to cut existing programs. So they're focusing on trying to stop any efforts to expand services to the undocumented. "We've realized our hands are pretty much tied by the fact that the Proposition 187 appeal was dropped in court," said Sen. Dennis Hollingsworth, R-Murietta, one of the lawmakers leading this year's budget fight.

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U.K.: NHS FAILURES GO RIGHT TO THE TOP

Poor leadership, bad management and inadequate board members are the main reasons for hospitals and primary care trusts running up deficits, the Audit Commission has found. While managements tend to blame the system, the fault lies not in their stars but in themselves, the commission says. In 2005-06, the commission published 25 public interest reports, in which local auditors were sufficiently alarmed about the financial state of NHS bodies to make their concerns public.

Now the lessons of these reports have been gathered in a single document, Learning the Lessons from Financial Failure in the NHS. Last year the NHS ran up a large deficit, even though it is mandated to balance its books. Although the majority of NHS organisations did so, a minority failed, some by huge margins.

Steve Bundred, the chief executive of the commission, denied that parts of the NHS were underfunded. He said that organisations that ran into difficulties had been warned but had failed to make changes. Of 25 trusts examined the total deficit in 2005-06 was 173.6 million pounds, in spite of “financial support” from other parts of the NHS worth 86 million pounds.

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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?

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