Legal appeal forces the NHS into the modern world
A cancer sufferer who spent 70,000 pounds on a drug that he believed would prolong his life has been told it can now be prescribed on the NHS. Keith Ditchfield, 53, a businessman who lives in Stonyhurst, Lancashire, is terminally ill. He learnt of Nexavar while receiving treatment in Germany. When he asked for the medication to be prescribed on the health service last year, he was turned down.
Since then Mr Ditchfield, has been buying the drug and believes that it has prolonged his life and left him, at least temporarily, in remission.
He has now been told that his appeal against the decision by East Lancashire Primary Care Trust has been successful. Nexavar was approved by the US Food and Drug Administration in 2005 and is widely prescribed in Europe for advanced cancers.
Source
HAVING GOOD CONTACTS STILL MATTERS IN BRITISH MEDICAL CARE
Exactly what the NHS was designed to obviate
Peter Ashley was told that he had dementia seven years ago, after enduring three years of treatment for a series of wrongly diagnosed conditions that culminated in electric shock therapy.
The retired company director from Warrington recalls very well the day he and his wife were given the diagnosis of Lewy bodies dementia, a rarer form of the disease with characteristics of Parkinson's. "We literally fell apart. It was the summer, and I remember we sat on the patio for days just crying - and we are not really that sort of couple. I just did not know what it meant for my retirement plans, our plans for more holidays and, most importantly, what it would mean for my three daughters and my wife," he said.
However Mr Ashley, 71, has been fortunate, receiving excellent medical and psychiatric treatment, and he continues to live a fulfilling life. Fortunately, a neighbour held a senior post in the local mental health care trust, so he was given prompt and up-to-date advice on treatment. Unusually for early-stage dementia, he was approved for drug therapy, although only on the basis of a trial. He takes Exelon, which helps to retain cognitive function.
"I also adopted a `use it or lose it' strategy and began to lecture on dementia and sat on the NICE Guideline Development Group, which came up with recommendations for treatment. I have very bad short-term memory problems and I cannot get around very well. My spatial awareness is very poor. But I am convinced that the drugs have been a key element in helping me to retain a great deal of my mental capability," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Wednesday, February 28, 2007
Tuesday, February 27, 2007
STATE GOVERNORS WANT FEDERAL HANDOUT FOR BACKDOOR SOCIALIZATION OF MEDICINE
U.S. state governors appealed Sunday for President George W. Bush and Congress to provide more money for a health-care program that insures millions of children. At stake is coverage for six million people, overwhelmingly children, as well as the hopes of many governors of tackling the larger challenge of the uninsured. All governors rely on the program, intended to aid uninsured working families. "We can come to a consensus that children should be the first priority," said Georgia Gov. Sonny Perdue.
State leaders met privately to discuss the State Children's Health Insurance Program at their annual winter meeting of the National Governors Association. "This is one area where I think people stand entirely together," said New Jersey Gov. Jon Corzine. Georgia and New Jersey are two of 14 states that are expected to run out of money for the program before the next budget year begins in October; in Georgia, it could be as soon as March. The governors want two things: enough money to keep the program afloat through October and changes to Bush's budget.
Analysts say his spending plan would shortchange the health program, even if the number of people served did not grow. The figure is put at US$10 billion to $15 billion over the next five years. U.S. Health and Human Services Secretary Mike Leavitt said he met privately with governors and would keep talking. But he offered little hope the administration would accept governors' demands.
The program, approved in 1997, covers uninsured children whose families earn too much to fall under Medicaid, the joint state-federal health care service for the poor. More than a dozen states have expanded the SCHIP program, with consent of the U.S. government, to cover adults in those families. The program now insures an estimated 639,000 adults among its six million.
Many governors said the administration's efforts to scale back the program would undermine state efforts to craft universal health care plans. Many of these have started with a target of insuring all children. "Many, many states seek to expand it as a step on the way to universal health care," said Arizona Gov. Janet Napolitano. "Governors are doing more on health care than anyone else."
California, Massachusetts and Pennsylvania have developed some of the most ambitious proposals to try for universal health-care coverage. Most states have just tried to strengthen their health-care system to cover more people. At their private session Sunday, governors said there is bipartisan support for help on the immediate needs and a long-term commitment to the current program.
Leavitt said Sunday there is enough money among states to cover short-term shortfalls, if states with surpluses share with those with deficits, an idea that has little support among governors. And Bush wants the SCHIP program to remain focused on poor children, not all children and not adults, beyond those states where it's already allowed, Leavitt said.
Napolitano, who heads the NGA, said the issue would come up Monday when governors meet with members of Bush's cabinet. A bipartisan group of 13 governors has written congressional leaders asking them to cover the money shortfall before the budget year ends. "We built all that up. We don't want to pull the rug out," said Rhode Island Gov. Don Carcieri. With aggressive enrolment, his state had enrolled 94 per cent of children before administrative hurdles and other problems lowered that number, he said.
Maryland Gov. Martin O'Malley said in their private lunch, many governors were "visibly frustrated" at the administration's approach. In public, several governors said they were confident they could work out a compromise. Pennsylvania Gov. Ed Rendell unrolled a plan this year to extend coverage to nearly all his state's citizens. He said the administration had been helpful to his efforts and just last week approved a waiver allowing the state to raise its eligibility for the program to 350 per cent of federal poverty levels. "This covers about our last 180,000 children who aren't covered," Rendell said. "I want to give the administration high praise."
Amid all the discussion about dollars and percentages, the real cost is being ignored, some governors said. "I think more about what it means to be a parent, a parent who can't go to sleep at night without worrying that if my kid gets ill tomorrow or gets in an accident, he won't have adequate coverage," said Virginia Gov. Tim Kaine. "I can't imagine more anxiety."
Source
Sick elderly left starving in Australian public hospitals
As many as four in every 10 elderly patients in Queensland hospitals could be slowly starving in their beds. Health staff are failing to notice the signs of malnutrition and are too busy to check whether patients are eating properly, The Courier-Mail can reveal. Malnutrition can delay recovery times and in severe cases quicken a patient's death.
Merrilyn Banks, director of nutrition at the Royal Brisbane and Women's Hospital, said: "We think malnutrition only happens in Third World countries, but it is a problem in aged care and hospitals here. "We have found that 30 to 40 per cent of elderly patients are affected. There's generally not enough awareness of the issue because we are used to treating disease and are just not looking for under-nutrition."
Malnutrition can cause the condition of a patient admitted to hospital with a minor illness to rapidly deteriorate. "When people get ill they have trouble with their appetite and it becomes more difficult for them to eat," Ms Banks said. "Malnutrition can actually increase the rate of infection and may slow rehabilitation." She said medical staff were not necessarily to blame for patients failing to eat. "In a lot of cases malnutrition is just not obvious," she said. "Everybody in the health system is very busy."
Anthony Power, a Brisbane private practice nutritionist, said he saw up to 10 elderly patients each week suffering from malnutrition after being discharged from hospital. In one case, a woman in her 60s had lost almost 20kg after she developed a post-operative infection. "It can happen very quickly. They may be recovering from an illness and don't have the energy to eat and then develop vitamin and mineral deficiencies which further impair their digestion. "The system needs to do more to tackle this."
Ms Banks has received funding from the hospital's Research Foundation to assess how much the problem is costing Queensland Health through longer hospital stays and the treatment of associated complications. One solution might be the appointment of dedicated care assistants to ensure elderly people eat properly while on the wards.
Val French, president of Queensland pressure group Older People Speak Out, said: "Older people are the least likely to ever complain." Gay Hawksworth, secretary of the Queensland Nurses Union, added: "There is a shortage of nurses . . . but nurses are well aware of the need to make sure patients are eating and drinking." [The notoriously low attractiveness of public hospital food surely does not help. And the recent move to make it "healthy" has almost certainly reduced its attractiveness even further. People are not rabbits and elderly people in particular are most unlikely to change lifetime dietary habits]
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 Pages are here or here or here.
***************************
U.S. state governors appealed Sunday for President George W. Bush and Congress to provide more money for a health-care program that insures millions of children. At stake is coverage for six million people, overwhelmingly children, as well as the hopes of many governors of tackling the larger challenge of the uninsured. All governors rely on the program, intended to aid uninsured working families. "We can come to a consensus that children should be the first priority," said Georgia Gov. Sonny Perdue.
State leaders met privately to discuss the State Children's Health Insurance Program at their annual winter meeting of the National Governors Association. "This is one area where I think people stand entirely together," said New Jersey Gov. Jon Corzine. Georgia and New Jersey are two of 14 states that are expected to run out of money for the program before the next budget year begins in October; in Georgia, it could be as soon as March. The governors want two things: enough money to keep the program afloat through October and changes to Bush's budget.
Analysts say his spending plan would shortchange the health program, even if the number of people served did not grow. The figure is put at US$10 billion to $15 billion over the next five years. U.S. Health and Human Services Secretary Mike Leavitt said he met privately with governors and would keep talking. But he offered little hope the administration would accept governors' demands.
The program, approved in 1997, covers uninsured children whose families earn too much to fall under Medicaid, the joint state-federal health care service for the poor. More than a dozen states have expanded the SCHIP program, with consent of the U.S. government, to cover adults in those families. The program now insures an estimated 639,000 adults among its six million.
Many governors said the administration's efforts to scale back the program would undermine state efforts to craft universal health care plans. Many of these have started with a target of insuring all children. "Many, many states seek to expand it as a step on the way to universal health care," said Arizona Gov. Janet Napolitano. "Governors are doing more on health care than anyone else."
California, Massachusetts and Pennsylvania have developed some of the most ambitious proposals to try for universal health-care coverage. Most states have just tried to strengthen their health-care system to cover more people. At their private session Sunday, governors said there is bipartisan support for help on the immediate needs and a long-term commitment to the current program.
Leavitt said Sunday there is enough money among states to cover short-term shortfalls, if states with surpluses share with those with deficits, an idea that has little support among governors. And Bush wants the SCHIP program to remain focused on poor children, not all children and not adults, beyond those states where it's already allowed, Leavitt said.
Napolitano, who heads the NGA, said the issue would come up Monday when governors meet with members of Bush's cabinet. A bipartisan group of 13 governors has written congressional leaders asking them to cover the money shortfall before the budget year ends. "We built all that up. We don't want to pull the rug out," said Rhode Island Gov. Don Carcieri. With aggressive enrolment, his state had enrolled 94 per cent of children before administrative hurdles and other problems lowered that number, he said.
Maryland Gov. Martin O'Malley said in their private lunch, many governors were "visibly frustrated" at the administration's approach. In public, several governors said they were confident they could work out a compromise. Pennsylvania Gov. Ed Rendell unrolled a plan this year to extend coverage to nearly all his state's citizens. He said the administration had been helpful to his efforts and just last week approved a waiver allowing the state to raise its eligibility for the program to 350 per cent of federal poverty levels. "This covers about our last 180,000 children who aren't covered," Rendell said. "I want to give the administration high praise."
Amid all the discussion about dollars and percentages, the real cost is being ignored, some governors said. "I think more about what it means to be a parent, a parent who can't go to sleep at night without worrying that if my kid gets ill tomorrow or gets in an accident, he won't have adequate coverage," said Virginia Gov. Tim Kaine. "I can't imagine more anxiety."
Source
Sick elderly left starving in Australian public hospitals
As many as four in every 10 elderly patients in Queensland hospitals could be slowly starving in their beds. Health staff are failing to notice the signs of malnutrition and are too busy to check whether patients are eating properly, The Courier-Mail can reveal. Malnutrition can delay recovery times and in severe cases quicken a patient's death.
Merrilyn Banks, director of nutrition at the Royal Brisbane and Women's Hospital, said: "We think malnutrition only happens in Third World countries, but it is a problem in aged care and hospitals here. "We have found that 30 to 40 per cent of elderly patients are affected. There's generally not enough awareness of the issue because we are used to treating disease and are just not looking for under-nutrition."
Malnutrition can cause the condition of a patient admitted to hospital with a minor illness to rapidly deteriorate. "When people get ill they have trouble with their appetite and it becomes more difficult for them to eat," Ms Banks said. "Malnutrition can actually increase the rate of infection and may slow rehabilitation." She said medical staff were not necessarily to blame for patients failing to eat. "In a lot of cases malnutrition is just not obvious," she said. "Everybody in the health system is very busy."
Anthony Power, a Brisbane private practice nutritionist, said he saw up to 10 elderly patients each week suffering from malnutrition after being discharged from hospital. In one case, a woman in her 60s had lost almost 20kg after she developed a post-operative infection. "It can happen very quickly. They may be recovering from an illness and don't have the energy to eat and then develop vitamin and mineral deficiencies which further impair their digestion. "The system needs to do more to tackle this."
Ms Banks has received funding from the hospital's Research Foundation to assess how much the problem is costing Queensland Health through longer hospital stays and the treatment of associated complications. One solution might be the appointment of dedicated care assistants to ensure elderly people eat properly while on the wards.
Val French, president of Queensland pressure group Older People Speak Out, said: "Older people are the least likely to ever complain." Gay Hawksworth, secretary of the Queensland Nurses Union, added: "There is a shortage of nurses . . . but nurses are well aware of the need to make sure patients are eating and drinking." [The notoriously low attractiveness of public hospital food surely does not help. And the recent move to make it "healthy" has almost certainly reduced its attractiveness even further. People are not rabbits and elderly people in particular are most unlikely to change lifetime dietary habits]
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 Pages are here or here or here.
***************************
Sunday, February 25, 2007
BRITISH AMBULANCE MESS
Two thirds of the ambulance trusts in England are missing targets to attend life-threatening emergencies quickly because of a shortage of funding, The Times has learnt. Millions of pounds needed to fund extra vehicles and crews are instead being withheld as local health authorities struggle to balance their books before the end of the financial year, ambulance leaders say.
The number of 999 ambulance calls has more than doubled in a decade and has risen even this year as patients have become concerned about access to out-of-hours GP services, the Ambulance Service Association (ASA) said. But despite a streamlining of the service last year designed to improve performance, the latest figures obtained by The Times reveal that 8 of the 12 mainland ambulance services are failing to achieve a 75 per cent success rate for attending serious emergency calls within eight minutes.
The current situation, using year-to-date figures, compares with the end of the previous financial year when three quarters of the 31 ambulance trusts in England were hitting the target for 75 per cent of ambulances to attend priority calls within eight minutes.
Richard Diment, chief executive of the ASA, said that the reorganisation of the service, an increase in demand and a lack of funding had all contributed to a fall in performance since July. “The number of category A calls has risen by about 10 per cent week-on-week compared with last year, and the total number of calls by 6 to 8 per cent,” he said. “The public and the Department of Health expect ambulance trusts to perform to national standards, yet PCTs are saying, ‘We know these are the targets but we just do not have the resources to help you meet them’.”
Mr Diment criticised local NHS primary care trusts (PCTs), which fund the ambulance service, for letting emergency response times slip while they struggled to balance their books and meet the 18-week maximum waiting times target for hospital referrals.
Ambulance trusts in North West, West Country, South East Coast and London are among the trusts currently missing the category A target. Some say that they hope to catch up by the end of the financial year. Other trusts have recorded huge variations in the different patches they cover, suggesting that high-performing areas could be masking low achievement elsewhere. For example, in South Western Ambulance Service, Dorset hits the target consistently , while Somerset and Cornwall have failed every month since last July.
Ken Wenman, chief executive of the South Western Ambulance Service, said: “It is historically more difficult to achieve these exacting performance targets in more rural areas. However, this has been recognised by our commissioners, and work is being undertaken to assess the financial implications of meeting them.”
Targets for the ambulance service are due to be toughened from next year, when the response time clock will start from the moment a call was made rather than when all a caller’s details had been taken. Trusts will also be expected to meet a new target to answer 95 per cent of all calls within five seconds. The total number of emergency calls rose from 5.6 million calls in 2004-05 to nearly six million last year
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 Pages are here or here or here.
***************************
Two thirds of the ambulance trusts in England are missing targets to attend life-threatening emergencies quickly because of a shortage of funding, The Times has learnt. Millions of pounds needed to fund extra vehicles and crews are instead being withheld as local health authorities struggle to balance their books before the end of the financial year, ambulance leaders say.
The number of 999 ambulance calls has more than doubled in a decade and has risen even this year as patients have become concerned about access to out-of-hours GP services, the Ambulance Service Association (ASA) said. But despite a streamlining of the service last year designed to improve performance, the latest figures obtained by The Times reveal that 8 of the 12 mainland ambulance services are failing to achieve a 75 per cent success rate for attending serious emergency calls within eight minutes.
The current situation, using year-to-date figures, compares with the end of the previous financial year when three quarters of the 31 ambulance trusts in England were hitting the target for 75 per cent of ambulances to attend priority calls within eight minutes.
Richard Diment, chief executive of the ASA, said that the reorganisation of the service, an increase in demand and a lack of funding had all contributed to a fall in performance since July. “The number of category A calls has risen by about 10 per cent week-on-week compared with last year, and the total number of calls by 6 to 8 per cent,” he said. “The public and the Department of Health expect ambulance trusts to perform to national standards, yet PCTs are saying, ‘We know these are the targets but we just do not have the resources to help you meet them’.”
Mr Diment criticised local NHS primary care trusts (PCTs), which fund the ambulance service, for letting emergency response times slip while they struggled to balance their books and meet the 18-week maximum waiting times target for hospital referrals.
Ambulance trusts in North West, West Country, South East Coast and London are among the trusts currently missing the category A target. Some say that they hope to catch up by the end of the financial year. Other trusts have recorded huge variations in the different patches they cover, suggesting that high-performing areas could be masking low achievement elsewhere. For example, in South Western Ambulance Service, Dorset hits the target consistently , while Somerset and Cornwall have failed every month since last July.
Ken Wenman, chief executive of the South Western Ambulance Service, said: “It is historically more difficult to achieve these exacting performance targets in more rural areas. However, this has been recognised by our commissioners, and work is being undertaken to assess the financial implications of meeting them.”
Targets for the ambulance service are due to be toughened from next year, when the response time clock will start from the moment a call was made rather than when all a caller’s details had been taken. Trusts will also be expected to meet a new target to answer 95 per cent of all calls within five seconds. The total number of emergency calls rose from 5.6 million calls in 2004-05 to nearly six million last year
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 Pages are here or here or here.
***************************
Saturday, February 24, 2007
FINANCIAL FIDDLING IN THE NHS
The NHS is set to break even this year, redeeming the promise made by Patricia Hewitt, the Health Secretary. But figures released yesterday covering the third quarter of the 2006-07 financial year paint a mixed picture. The most deficit-ridden of the NHS organisations appear to have got even further into trouble, but their deficits should be balanced by surpluses made elsewhere to create a small overall surplus of 13 million.
Last year, the gross deficit (the figure resulting from adding up the deficits of all NHS organisations that were in deficit) was 1,312 million. This year it is forecast to be 1,318 million. There are also more organisations forecasting a deficit (35 per cent) this year than there were last (33 per cent).
But the figures are misleading because the income of these organisations was “top-sliced” to create a reserve at the beginning of the year. This reduced their income, plunging more into deficit. The top-slicing removed 1.14 billion from primary care trust [PCT] budgets, and another 450 million was saved from training and public health budgets. An official said yesterday that up to 300 million might be restored to the trusts before the end of the financial year, which would enable many to present a better picture.
The economies have been made by delaying operations, not replacing staff and by deferring orders for supplies wherever possible until the next financial year. There will also be 1,446 compulsory redundancies in 2006-07, compared with 200-300 in a typical year.
Niall Dickson, chief executive of the King’s Fund health think-tank, said what had been done smacked of “a short-term fix for a long-standing problem”. He said: “The goal this year has been to ensure that the NHS as a whole makes a net surplus — turning around last year’s net deficit of 547 million. By holding back around 1.6 billion from PCT and other budgets this year the NHS will achieve this goal. “But financial performance across NHS organisations remains variable; in part as a result of these tactics, nearly half of all PCTs and a third of trusts forecast a deficit by the end of this year — an increase on last year. “Today’s figures once again highlight that if the NHS is going to survive and prosper it will need to get to grips with the underlying causes of the financial deficits.
“There is a need now to tackle low productivity, and deal with the widespread and often unexplained variations in performance. For some organisations this will demand a very different approach to delivery.” The report said that the NHS budget grew to 75 billion in 2006/07, an increase of 5.4 billion. But almost 700 million of that cash was used to pay off deficits from previous years.
Norman Lamb, the Liberal Democrat health spoksman, said: “The Government is employing all sorts of tricks by shifting debts from one organisation to another. These accounting rules would make Del Boy proud but won’t make the problem disappear.”
Andrew Lansley, the Shadow Health Secretary, said: “Labour are able to claim that the NHS will finish this year in surplus, but the surplus they have generated is a sham. “There are more NHS organisations, saddled with worse deficits, than there were last year. “Patricia Hewitt’s skin is being saved only by savage cuts to centrally held budgets, which will all need to be restored in the years to come.”
Peter Carter, general secretary of the Royal College of Nursing, said: “Ministers today might try to claim a small NHS surplus but this figure has only been achieved by raiding essential NHS training budgets, freezing posts, shedding jobs and cutting patient services.”
Source
BUREAUCRATIC INDIFFERENCE KILLING AUSTRALIAN PUBLIC HOSPITAL PATIENTS
Inaction allows superbugs to spread in NSW hospitals
PATIENTS may be getting potentially fatal infections in hospitals because the State Government has yet to allocate any of the $1.6 million it promised to combat drug-resistant superbugs. Professor Lyn Gilbert, who heads an expert panel looking at the problem, said she was surprised more people were not taking legal action. "People are dying of diseases that should have been prevented," she said. "What surprises me is how infrequently people sue hospitals."
Professor Gilbert, who chairs the NSW expert group on multiresistant organisms and the director of Westmead Hospital's Centre for Infectious Diseases and Microbiology, said hospital managers recognised the importance of infection control, "but they are limited by resources". "None have enough [money] to do surveillance work. They put out fires, really," she said.
The NSW Government has long accepted that patients at highest risk of developing potentially lethal bacterial infections - those having joint replacements, heart or vascular surgery and those in intensive care - should be screened before their treatment to check whether the bugs are present on their skin. This is because usually harmless bacterial "colonisation" can cause serious illness if it enters a surgical wound. But hospitals cannot proceed with planned improvements because they have still received none of the funding, promised a year ago to carry out screening and other recommendations of an expert committee convened in the wake of disease outbreaks.
In the western Sydney area alone, said Professor Gilbert, it would cost about $220,000 a year to screen all patients using pathology tests. But hospitals would incur even greater costs if they isolated patients who had been infected or colonised by the virulent organisms. Associate Professor Peter Collignon, director of microbiology and infectious diseases at Canberra Hospital, said up to 5000 Australians developed septicemia from golden staph bacteria while in hospital. "One-third of those will die," he said. "These cause more deaths than the road toll. My firm belief is half of these infections at least are preventable." He said surveillance for pathogens was essential, because hospitals could not act unless they knew they had a problem.
Dr Tom Gottlieb, the vice-president of the Australasian Society for Infectious Diseases, said there was "a kind of nihilism" in the response of health authorities to hospital infections as neither challenged high rates of preventable illness. Dr Gottlieb, a Sydney specialist, said surveillance was expensive and inevitably would identify only a small number of colonised patients compared with the total screened. But it was worth screening for antibiotic-resistant golden staph, in particular, because of its high death rate, he said. If the bacteria affected an artificial joint, it could require three years or longer of antibiotic treatment and repeat surgery.
In a statement to the Herald, a Department of Health spokeswoman blamed "consultation to finalise an equitable split of the funds" and the need to put in place "performance indicators" for the long delay.
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 Pages are here or here or here.
***************************
The NHS is set to break even this year, redeeming the promise made by Patricia Hewitt, the Health Secretary. But figures released yesterday covering the third quarter of the 2006-07 financial year paint a mixed picture. The most deficit-ridden of the NHS organisations appear to have got even further into trouble, but their deficits should be balanced by surpluses made elsewhere to create a small overall surplus of 13 million.
Last year, the gross deficit (the figure resulting from adding up the deficits of all NHS organisations that were in deficit) was 1,312 million. This year it is forecast to be 1,318 million. There are also more organisations forecasting a deficit (35 per cent) this year than there were last (33 per cent).
But the figures are misleading because the income of these organisations was “top-sliced” to create a reserve at the beginning of the year. This reduced their income, plunging more into deficit. The top-slicing removed 1.14 billion from primary care trust [PCT] budgets, and another 450 million was saved from training and public health budgets. An official said yesterday that up to 300 million might be restored to the trusts before the end of the financial year, which would enable many to present a better picture.
The economies have been made by delaying operations, not replacing staff and by deferring orders for supplies wherever possible until the next financial year. There will also be 1,446 compulsory redundancies in 2006-07, compared with 200-300 in a typical year.
Niall Dickson, chief executive of the King’s Fund health think-tank, said what had been done smacked of “a short-term fix for a long-standing problem”. He said: “The goal this year has been to ensure that the NHS as a whole makes a net surplus — turning around last year’s net deficit of 547 million. By holding back around 1.6 billion from PCT and other budgets this year the NHS will achieve this goal. “But financial performance across NHS organisations remains variable; in part as a result of these tactics, nearly half of all PCTs and a third of trusts forecast a deficit by the end of this year — an increase on last year. “Today’s figures once again highlight that if the NHS is going to survive and prosper it will need to get to grips with the underlying causes of the financial deficits.
“There is a need now to tackle low productivity, and deal with the widespread and often unexplained variations in performance. For some organisations this will demand a very different approach to delivery.” The report said that the NHS budget grew to 75 billion in 2006/07, an increase of 5.4 billion. But almost 700 million of that cash was used to pay off deficits from previous years.
Norman Lamb, the Liberal Democrat health spoksman, said: “The Government is employing all sorts of tricks by shifting debts from one organisation to another. These accounting rules would make Del Boy proud but won’t make the problem disappear.”
Andrew Lansley, the Shadow Health Secretary, said: “Labour are able to claim that the NHS will finish this year in surplus, but the surplus they have generated is a sham. “There are more NHS organisations, saddled with worse deficits, than there were last year. “Patricia Hewitt’s skin is being saved only by savage cuts to centrally held budgets, which will all need to be restored in the years to come.”
Peter Carter, general secretary of the Royal College of Nursing, said: “Ministers today might try to claim a small NHS surplus but this figure has only been achieved by raiding essential NHS training budgets, freezing posts, shedding jobs and cutting patient services.”
Source
BUREAUCRATIC INDIFFERENCE KILLING AUSTRALIAN PUBLIC HOSPITAL PATIENTS
Inaction allows superbugs to spread in NSW hospitals
PATIENTS may be getting potentially fatal infections in hospitals because the State Government has yet to allocate any of the $1.6 million it promised to combat drug-resistant superbugs. Professor Lyn Gilbert, who heads an expert panel looking at the problem, said she was surprised more people were not taking legal action. "People are dying of diseases that should have been prevented," she said. "What surprises me is how infrequently people sue hospitals."
Professor Gilbert, who chairs the NSW expert group on multiresistant organisms and the director of Westmead Hospital's Centre for Infectious Diseases and Microbiology, said hospital managers recognised the importance of infection control, "but they are limited by resources". "None have enough [money] to do surveillance work. They put out fires, really," she said.
The NSW Government has long accepted that patients at highest risk of developing potentially lethal bacterial infections - those having joint replacements, heart or vascular surgery and those in intensive care - should be screened before their treatment to check whether the bugs are present on their skin. This is because usually harmless bacterial "colonisation" can cause serious illness if it enters a surgical wound. But hospitals cannot proceed with planned improvements because they have still received none of the funding, promised a year ago to carry out screening and other recommendations of an expert committee convened in the wake of disease outbreaks.
In the western Sydney area alone, said Professor Gilbert, it would cost about $220,000 a year to screen all patients using pathology tests. But hospitals would incur even greater costs if they isolated patients who had been infected or colonised by the virulent organisms. Associate Professor Peter Collignon, director of microbiology and infectious diseases at Canberra Hospital, said up to 5000 Australians developed septicemia from golden staph bacteria while in hospital. "One-third of those will die," he said. "These cause more deaths than the road toll. My firm belief is half of these infections at least are preventable." He said surveillance for pathogens was essential, because hospitals could not act unless they knew they had a problem.
Dr Tom Gottlieb, the vice-president of the Australasian Society for Infectious Diseases, said there was "a kind of nihilism" in the response of health authorities to hospital infections as neither challenged high rates of preventable illness. Dr Gottlieb, a Sydney specialist, said surveillance was expensive and inevitably would identify only a small number of colonised patients compared with the total screened. But it was worth screening for antibiotic-resistant golden staph, in particular, because of its high death rate, he said. If the bacteria affected an artificial joint, it could require three years or longer of antibiotic treatment and repeat surgery.
In a statement to the Herald, a Department of Health spokeswoman blamed "consultation to finalise an equitable split of the funds" and the need to put in place "performance indicators" for the long delay.
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 Pages are here or here or here.
***************************
Friday, February 23, 2007
Healthcare reform: Some unclear on the concept
The backlash against President Bush's healthcare reform proposal, as expressed in his State of the Union speech last month, has been swift and widespread. From the progressive left comes the very real challenge that the plan calls for no real restraints on insurance premiums, but merely hopes to offset those steadily rising numbers by offering everyone a tax credit, so that those skyrocketing rates continue, being paid for with pre-tax dollars. From the conservative side, there is concern that the Bush plan may penalize those who already have good insurance coverage through their employers.
But perhaps the most ludicrous criticism stems from the claims by the American Association for Retired People and other advocacy groups, that the Bush plan might endanger Social Security funding. According to a McClatchy Newspapers column by Dave Helling, entitled Benefit Dilemma, the question being raised is, "Would you trade health insurance today for tomorrow's check?" He quotes AARP legislative policy director David Certner as saying, "We don't think there should be a trade-off between a health benefit today and a pension benefit tomorrow."
The concern they are raising is that since the tax deduction ($7,500 for individuals, or $15,000 for a family) applies not only to the withholding taken out in weekly paychecks, but to the FICA payroll tax as well. The reason for this, as the article notes, is that if FICA were excluded from the deduction, about a third of all taxpayers would get no benefit at all from the tax-break.
This has AARP and other "elderly advocacy" groups up in arms, since it appears to put working folks in an iimediate bind: choosing between good health today and comfortable retirement later on. The argument goes as follows: If you pay less in payroll taxes along the way, your eventual benefits from Social Security will be smaller. Even supporters of the Bush plan, from such pro-liberty thinktanks as the Cato Institute and the National Center for Policy Analysis, admit that this is "possible" as a result of the proposed system. http://www.cato.org/pub_display.php?pub_id=7171 Michael Cannon, Cato's director of health policy studies, reportedly admits the problem could exist, although he notes that ""Social Security benefits don't help you if you're dead."
And this is where the argument fails, actually. Although AARP is vested in the continuation of Social Security as we know it, the reality is, those current benefits are funded by the ongoing "contributions" of today's working folks,. There is no "lockbox" . and there's no guarantee that twenty years down the road the money will be there for those wishing to "retire" under today's requirements. The "trust fund" is a figment of politicians' imaginations, not a true sequestered funding-source, either now or in the future.
However, there is a much larger question involved here, one the AARP seems to overlook. "Retirement" today has very little to do with ending productive behavior in the world. For most of the Baby Boomer generation, all this means is a shifting from conventional employment to something the heart always wanted to do; more often than not, this means embarking on a whole new career-path, not sitting back in the rocking chairs and waiting for death, as has been presented as the model for retiring in the past.
And the most important factor, or at least one of them, for someone making a decision to continue as a producer in society, is continued health and wellness. Without a sound body and mind, one is hard-pressed to become that writer, artist or whatever that has been crying to be unleashed from within; if illness or frailty is holding you back, the chances are that creative spark will have a hard time reaching the surface. Even for those who do not feel that special creative bent, retirement life in the future is well enhanced by good health, and if not dealing with a roster of physical ailments allows one a much greater chance to keep doing something of value to the world. (In other words, the only people truly affected by this choice are those whose retirement plans consist of "doin' nuthin' the rest of my life"; as studies show, those people won't live very long, without something they truly care about doing to keep the life-spark alive.)
The AARP is of course irate about this, since their existence depends on keeping the "elderly" convinced that they need someone to look out for their interests. Like any other political pressure group, this requires a docile herd of sheep, rather than a hale and hearty assortment of strong and vital individuals, who just happen to be advanced chronologically. As an alternative to the Bush prescription, they are pushing for replacing the proposed tax deduction with a direct tax-credit for healthcare, one which would not touch FICA payments, thereby leaving the retirement issue out of the picture. His expectation is that younger workers at lower pay-rates might apply the credits to paying taxes and then use the extra money for healthcare.
However, this model still promotes the idea that working hard now is the road to leisure and stagnation later on. If the intention is to produce healthier and happier people today, there seems little point in promoting that sedentary life of payback in our later years. For those who truly intend to remain at least somewhat productive, despite advancing years, this diversion of funding to deal with today's issues seems only a logical outcome of that shifting paradigm.
Bottom-line, solving the healthcare mess now, and then focusing our energies on having longer, healthier lives down the road, seems a far better course to take, than continuing to walk the same weathered pathways that have given us the current crisis in healthcare. Although the Bush plan is far from perfect, it does at least in this aspect have the right goals in mind: helping people pay for their own health and wellness, by reducing their tax-burdens otherwise.
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 Pages are here or here or here.
***************************
The backlash against President Bush's healthcare reform proposal, as expressed in his State of the Union speech last month, has been swift and widespread. From the progressive left comes the very real challenge that the plan calls for no real restraints on insurance premiums, but merely hopes to offset those steadily rising numbers by offering everyone a tax credit, so that those skyrocketing rates continue, being paid for with pre-tax dollars. From the conservative side, there is concern that the Bush plan may penalize those who already have good insurance coverage through their employers.
But perhaps the most ludicrous criticism stems from the claims by the American Association for Retired People and other advocacy groups, that the Bush plan might endanger Social Security funding. According to a McClatchy Newspapers column by Dave Helling, entitled Benefit Dilemma, the question being raised is, "Would you trade health insurance today for tomorrow's check?" He quotes AARP legislative policy director David Certner as saying, "We don't think there should be a trade-off between a health benefit today and a pension benefit tomorrow."
The concern they are raising is that since the tax deduction ($7,500 for individuals, or $15,000 for a family) applies not only to the withholding taken out in weekly paychecks, but to the FICA payroll tax as well. The reason for this, as the article notes, is that if FICA were excluded from the deduction, about a third of all taxpayers would get no benefit at all from the tax-break.
This has AARP and other "elderly advocacy" groups up in arms, since it appears to put working folks in an iimediate bind: choosing between good health today and comfortable retirement later on. The argument goes as follows: If you pay less in payroll taxes along the way, your eventual benefits from Social Security will be smaller. Even supporters of the Bush plan, from such pro-liberty thinktanks as the Cato Institute and the National Center for Policy Analysis, admit that this is "possible" as a result of the proposed system. http://www.cato.org/pub_display.php?pub_id=7171 Michael Cannon, Cato's director of health policy studies, reportedly admits the problem could exist, although he notes that ""Social Security benefits don't help you if you're dead."
And this is where the argument fails, actually. Although AARP is vested in the continuation of Social Security as we know it, the reality is, those current benefits are funded by the ongoing "contributions" of today's working folks,. There is no "lockbox" . and there's no guarantee that twenty years down the road the money will be there for those wishing to "retire" under today's requirements. The "trust fund" is a figment of politicians' imaginations, not a true sequestered funding-source, either now or in the future.
However, there is a much larger question involved here, one the AARP seems to overlook. "Retirement" today has very little to do with ending productive behavior in the world. For most of the Baby Boomer generation, all this means is a shifting from conventional employment to something the heart always wanted to do; more often than not, this means embarking on a whole new career-path, not sitting back in the rocking chairs and waiting for death, as has been presented as the model for retiring in the past.
And the most important factor, or at least one of them, for someone making a decision to continue as a producer in society, is continued health and wellness. Without a sound body and mind, one is hard-pressed to become that writer, artist or whatever that has been crying to be unleashed from within; if illness or frailty is holding you back, the chances are that creative spark will have a hard time reaching the surface. Even for those who do not feel that special creative bent, retirement life in the future is well enhanced by good health, and if not dealing with a roster of physical ailments allows one a much greater chance to keep doing something of value to the world. (In other words, the only people truly affected by this choice are those whose retirement plans consist of "doin' nuthin' the rest of my life"; as studies show, those people won't live very long, without something they truly care about doing to keep the life-spark alive.)
The AARP is of course irate about this, since their existence depends on keeping the "elderly" convinced that they need someone to look out for their interests. Like any other political pressure group, this requires a docile herd of sheep, rather than a hale and hearty assortment of strong and vital individuals, who just happen to be advanced chronologically. As an alternative to the Bush prescription, they are pushing for replacing the proposed tax deduction with a direct tax-credit for healthcare, one which would not touch FICA payments, thereby leaving the retirement issue out of the picture. His expectation is that younger workers at lower pay-rates might apply the credits to paying taxes and then use the extra money for healthcare.
However, this model still promotes the idea that working hard now is the road to leisure and stagnation later on. If the intention is to produce healthier and happier people today, there seems little point in promoting that sedentary life of payback in our later years. For those who truly intend to remain at least somewhat productive, despite advancing years, this diversion of funding to deal with today's issues seems only a logical outcome of that shifting paradigm.
Bottom-line, solving the healthcare mess now, and then focusing our energies on having longer, healthier lives down the road, seems a far better course to take, than continuing to walk the same weathered pathways that have given us the current crisis in healthcare. Although the Bush plan is far from perfect, it does at least in this aspect have the right goals in mind: helping people pay for their own health and wellness, by reducing their tax-burdens otherwise.
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 Pages are here or here or here.
***************************
Thursday, February 22, 2007
Tangle of NHS red tape brings on thoughts of early retirement
Working for the NHS may once have been a decision that lasted the length of a doctor's career but many of today's medics are now considering early retirement or work abroad, The Times/Doctors.net poll reveals. While few are openly contemplating a move to the private sector, almost half of respondents said they were planning early retirement or taking up positions outside Britain. Just over a third said they expected to work for the NHS until normal retirement age.
Many said they still felt that the NHS was one of the best health services in the world but their loyalty was being sorely tested by what they viewed as excessive bureaucracy. Only a minority believed the Government's reform agenda would maintain or improve standards of care. These are not doctors disillusioned with the NHS per se (although a minority are) but with the direction it has taken under Labour.
Nowhere is this shown more clearly than in the answers to questions about the National Programme for IT, a 20 billion plan to put every patient's medical record on line and provide doctors with access to it. Asked if they were optimistic that it would change the way the health service is run, 91 per cent said no, and only 9 per cent yes. More than three quarters (76 per cent) agreed that "overall it has been a frustrating project", but only 14 per cent believed it should be abandoned.
However, few favoured pouring more money into the scheme to ensure success. A massive majority (93 per cent) opposed that idea, with a mere 7 per cent in favour.
Asked what they would like to see changed, doctors voted for less bureaucracy (49 per cent) and less administration (13 per cent). No other changes, including more doctors or more funding, claimed more than 7 per cent support.
Individual comments spelt out the frustrations. While some asked for the sky - "better politicians" - many more backed the idea of keeping politicians out of the NHS altogether, and running it with a nonpolitical governing body like the one that sets interest rates for the Bank of England. Once even suggested that Richard Branson should be recruited to run the NHS. Depoliticisation was a recurrent theme, while many doctors called for greater medical involvement in decision-making, and fewer changes from the top, or for political ends. "Devise a plan and stick to it" one doctor said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Working for the NHS may once have been a decision that lasted the length of a doctor's career but many of today's medics are now considering early retirement or work abroad, The Times/Doctors.net poll reveals. While few are openly contemplating a move to the private sector, almost half of respondents said they were planning early retirement or taking up positions outside Britain. Just over a third said they expected to work for the NHS until normal retirement age.
Many said they still felt that the NHS was one of the best health services in the world but their loyalty was being sorely tested by what they viewed as excessive bureaucracy. Only a minority believed the Government's reform agenda would maintain or improve standards of care. These are not doctors disillusioned with the NHS per se (although a minority are) but with the direction it has taken under Labour.
Nowhere is this shown more clearly than in the answers to questions about the National Programme for IT, a 20 billion plan to put every patient's medical record on line and provide doctors with access to it. Asked if they were optimistic that it would change the way the health service is run, 91 per cent said no, and only 9 per cent yes. More than three quarters (76 per cent) agreed that "overall it has been a frustrating project", but only 14 per cent believed it should be abandoned.
However, few favoured pouring more money into the scheme to ensure success. A massive majority (93 per cent) opposed that idea, with a mere 7 per cent in favour.
Asked what they would like to see changed, doctors voted for less bureaucracy (49 per cent) and less administration (13 per cent). No other changes, including more doctors or more funding, claimed more than 7 per cent support.
Individual comments spelt out the frustrations. While some asked for the sky - "better politicians" - many more backed the idea of keeping politicians out of the NHS altogether, and running it with a nonpolitical governing body like the one that sets interest rates for the Bank of England. Once even suggested that Richard Branson should be recruited to run the NHS. Depoliticisation was a recurrent theme, while many doctors called for greater medical involvement in decision-making, and fewer changes from the top, or for political ends. "Devise a plan and stick to it" one doctor said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Wednesday, February 21, 2007
Don't get ill late at night in Britain
Because I have a perversely nocturnal brain I often write late into the night. So I had only just gone to bed last Thursday when the phone rang. My bedside clock said 3.11am. I answered with a sense of foreboding. Aside from the odd wrong number, any call we get between three and seven in the morning usually means that someone we know well is in some sort of trouble.
So it proved. We had been called by a service called Lifeline. If you are old, infirm or housebound and live by yourself, you wear an electronic device like a pendant round your neck. Should you take a tumble and can't get up, you press it to speak to a central operator who has the phone numbers of your nearest and dearest. It's a reasonable system, though I can't help thinking guiltily that if we - we as individuals, and we as society - really cared about our elderly we wouldn't leave them quite so much to fend for themselves.
Anyway, we flung on pullovers and whizzed two miles up the road to see what had happened to the lady concerned: a close relative, aged 86. The sight that greeted us was shocking. She had fallen on her way to the loo, opened up an ulcer, was shivering and half-conscious. Her skin was a ghastly blue. Worst of all, she was crumpled into a pool of her own blood. To my untutored eye, she seemed to have lost pints.
It was just after 3.30am. I dialled 999. When I described the old lady's condition the operator gave clear, concise first-aid instructions and said an ambulance was on its way. We found blankets, made her as comfortable as we could, and prayed that help wouldn't arrive too late.
Alas, this is Britain, 2007. At around 3.45am the phone rang. It was the London Ambulance Service. The essence of the call was: we're a bit busy tonight, sorry; can you cope? We said we would do our best. Seven minutes later our patient lost consciousness. Panicking, we called 999 again. Hang on in there, we were told. More agonising minutes passed. There is no helplessness worse than watching someone's life slip away for lack of prompt medical care in the middle of one of the richest, most sophisticated cities on the planet.
At 4.05am we heard a noise outside and glimpsed a flashing blue light coming along the road. I raced down the stairs to guide the ambulance to the flat. But the surreal sight that greeted me almost made me keel over with amazement. It was a fire engine.
The crew were already running towards me, breathing-gear and hoses at the ready. "Where's the incident?" one shouted. "What incident?" I replied. "The incident at this address," he said. "Someone phoned 999 for the fire service." "We called for an ambulance," I said. "An old lady's had a bad fall."
The firemen looked bemused but undaunted. They leapt up the stairs with every bit of medical clobber they could find. But I sensed that the spectacle in the flat alarmed them almost as much as it terrified us. By now the pool of blood stretched a couple of feet in every direction from where the woman lay. It was 4.10am - 40 minutes after we had made the 999 call. Luckily, skilled help was soon on hand. A paramedic turned up in a car. She administered oxygen and issued an urgent request for an ambulance on her radio. Only then did it transpire that there were no ambulances available in our area: a huge swath of northwest London. One would have to be despatched from Islington. "Eight minutes max, this time of night," said one of the firemen, trying to be reassuring.
It took 25. At 4.35am, about 65 minutes after we had made the first call, the ambulance arrived. The old lady finally got to hospital more than two hours after she had pressed her alarm.
Interestingly, A&E was virtually empty. There had been - surprise, surprise - no horrific incident tying up all the ambulances in North London in the early hours of last Thursday morning. The truth, it seemed, was that there was only one manned ambulance covering the entire area that night. Why? Because (we were informally told) the authority concerned had suspended ambulance crews' overtime, presumably in an attempt to alleviate its well-publicised financial problems.
Once again, as so often in Blair's Britain, we had encountered a colossal gap between what the politicians tell us is right with the country, and what our own eyes and brains tell us is wrong. More than 92 billion of our taxes is poured into the health service annually. That's around 1,800 pounds a year for every man, woman and child in England and Wales. We are assured that things are getting better all the time. The NHS certainly boasts more bureaucrats and fancy computer programs than ever before. Yet a semiconscious 86-year-old lies in a pool of her blood for 65 minutes waiting for an ambulance. In what sense is that progress? What are the NHS's priorities, if not for dealing with that?
The old lady, you will be pleased to know, is slowly recovering. Those Blitz-generation Londoners are as tough as nails. I'm the one who's still in shock. Where on earth did that fire engine come from?
Source
Australia: Lawyers squealing about damages cap
Insurance premiums will be reviewed to ensure that they have fallen in the wake of reforms to personal injury laws which capped compensation payouts, the State Government says. Premier Peter Beattie yesterday stopped short of endorsing Attorney-General Kerry Shine's claim that the laws were unfair, but said the Government was willing to check whether the changes made in 2002 were still working.
However, he warned lawyers they should not expect the laws to be significantly relaxed. "I just want to be really clear that ambulance chasers shouldn't get too excited," Mr Beattie said. "We are not going to go back to the bad old days when we couldn't get insurance to cover our doctors. "(But) the insurance industry had an obligation to reduce their premiums. I don't think it's unreasonable that we should actually have a look at that too, to make sure they have done that."
In an earlier interview with The Courier-Mail, Mr Shine had criticised the laws, saying they had unfairly blocked people with minor injuries claiming compensation, because their court costs could not be covered. He accused insurance companies of profiting from the crackdown, which was aimed at addressing the public liability insurance crisis when soaring premiums were sending community groups and charities to the wall. Under the changes, general damages were capped at $250,000 and court costs limited on payouts of less than $50,000.
Australian Lawyers Alliance state president Ian Brown welcomed the Attorney-General's comments and called for an immediate overhaul. "It is now widely accepted that the so-called insurance crisis was not the result of an increase in claims, but rather inherent problems within the insurance industry and external global financial factors," Mr Brown said. "Of course insurance companies must remain profitable, but not at the price now being paid by Queenslanders - and particularly our most vulnerable, the elderly and children, who have almost completely lost the right to fair compensation for injury caused by the wrongdoing of another."
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 Pages are here or here or here.
***************************
Because I have a perversely nocturnal brain I often write late into the night. So I had only just gone to bed last Thursday when the phone rang. My bedside clock said 3.11am. I answered with a sense of foreboding. Aside from the odd wrong number, any call we get between three and seven in the morning usually means that someone we know well is in some sort of trouble.
So it proved. We had been called by a service called Lifeline. If you are old, infirm or housebound and live by yourself, you wear an electronic device like a pendant round your neck. Should you take a tumble and can't get up, you press it to speak to a central operator who has the phone numbers of your nearest and dearest. It's a reasonable system, though I can't help thinking guiltily that if we - we as individuals, and we as society - really cared about our elderly we wouldn't leave them quite so much to fend for themselves.
Anyway, we flung on pullovers and whizzed two miles up the road to see what had happened to the lady concerned: a close relative, aged 86. The sight that greeted us was shocking. She had fallen on her way to the loo, opened up an ulcer, was shivering and half-conscious. Her skin was a ghastly blue. Worst of all, she was crumpled into a pool of her own blood. To my untutored eye, she seemed to have lost pints.
It was just after 3.30am. I dialled 999. When I described the old lady's condition the operator gave clear, concise first-aid instructions and said an ambulance was on its way. We found blankets, made her as comfortable as we could, and prayed that help wouldn't arrive too late.
Alas, this is Britain, 2007. At around 3.45am the phone rang. It was the London Ambulance Service. The essence of the call was: we're a bit busy tonight, sorry; can you cope? We said we would do our best. Seven minutes later our patient lost consciousness. Panicking, we called 999 again. Hang on in there, we were told. More agonising minutes passed. There is no helplessness worse than watching someone's life slip away for lack of prompt medical care in the middle of one of the richest, most sophisticated cities on the planet.
At 4.05am we heard a noise outside and glimpsed a flashing blue light coming along the road. I raced down the stairs to guide the ambulance to the flat. But the surreal sight that greeted me almost made me keel over with amazement. It was a fire engine.
The crew were already running towards me, breathing-gear and hoses at the ready. "Where's the incident?" one shouted. "What incident?" I replied. "The incident at this address," he said. "Someone phoned 999 for the fire service." "We called for an ambulance," I said. "An old lady's had a bad fall."
The firemen looked bemused but undaunted. They leapt up the stairs with every bit of medical clobber they could find. But I sensed that the spectacle in the flat alarmed them almost as much as it terrified us. By now the pool of blood stretched a couple of feet in every direction from where the woman lay. It was 4.10am - 40 minutes after we had made the 999 call. Luckily, skilled help was soon on hand. A paramedic turned up in a car. She administered oxygen and issued an urgent request for an ambulance on her radio. Only then did it transpire that there were no ambulances available in our area: a huge swath of northwest London. One would have to be despatched from Islington. "Eight minutes max, this time of night," said one of the firemen, trying to be reassuring.
It took 25. At 4.35am, about 65 minutes after we had made the first call, the ambulance arrived. The old lady finally got to hospital more than two hours after she had pressed her alarm.
Interestingly, A&E was virtually empty. There had been - surprise, surprise - no horrific incident tying up all the ambulances in North London in the early hours of last Thursday morning. The truth, it seemed, was that there was only one manned ambulance covering the entire area that night. Why? Because (we were informally told) the authority concerned had suspended ambulance crews' overtime, presumably in an attempt to alleviate its well-publicised financial problems.
Once again, as so often in Blair's Britain, we had encountered a colossal gap between what the politicians tell us is right with the country, and what our own eyes and brains tell us is wrong. More than 92 billion of our taxes is poured into the health service annually. That's around 1,800 pounds a year for every man, woman and child in England and Wales. We are assured that things are getting better all the time. The NHS certainly boasts more bureaucrats and fancy computer programs than ever before. Yet a semiconscious 86-year-old lies in a pool of her blood for 65 minutes waiting for an ambulance. In what sense is that progress? What are the NHS's priorities, if not for dealing with that?
The old lady, you will be pleased to know, is slowly recovering. Those Blitz-generation Londoners are as tough as nails. I'm the one who's still in shock. Where on earth did that fire engine come from?
Source
Australia: Lawyers squealing about damages cap
Insurance premiums will be reviewed to ensure that they have fallen in the wake of reforms to personal injury laws which capped compensation payouts, the State Government says. Premier Peter Beattie yesterday stopped short of endorsing Attorney-General Kerry Shine's claim that the laws were unfair, but said the Government was willing to check whether the changes made in 2002 were still working.
However, he warned lawyers they should not expect the laws to be significantly relaxed. "I just want to be really clear that ambulance chasers shouldn't get too excited," Mr Beattie said. "We are not going to go back to the bad old days when we couldn't get insurance to cover our doctors. "(But) the insurance industry had an obligation to reduce their premiums. I don't think it's unreasonable that we should actually have a look at that too, to make sure they have done that."
In an earlier interview with The Courier-Mail, Mr Shine had criticised the laws, saying they had unfairly blocked people with minor injuries claiming compensation, because their court costs could not be covered. He accused insurance companies of profiting from the crackdown, which was aimed at addressing the public liability insurance crisis when soaring premiums were sending community groups and charities to the wall. Under the changes, general damages were capped at $250,000 and court costs limited on payouts of less than $50,000.
Australian Lawyers Alliance state president Ian Brown welcomed the Attorney-General's comments and called for an immediate overhaul. "It is now widely accepted that the so-called insurance crisis was not the result of an increase in claims, but rather inherent problems within the insurance industry and external global financial factors," Mr Brown said. "Of course insurance companies must remain profitable, but not at the price now being paid by Queenslanders - and particularly our most vulnerable, the elderly and children, who have almost completely lost the right to fair compensation for injury caused by the wrongdoing of another."
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 Pages are here or here or here.
***************************
Tuesday, February 20, 2007
Disillusioned doctors say Labour decade of reform has failed NHS
Most doctors believe that Labour has failed to reform the NHS and that funding by taxation alone will not improve the quality of care. An online poll of more than 3,000 doctors carried out for The Times offers the most striking picture yet of the level of disillusionment within the profession. Most say that the billions of pounds injected into the service since 2002 have not been well spent and that services have not improved.
Faith in Labour's ability to put it right is rock-bottom. Nearly twice as many doctors would trust the NHS with David Cameron, the Opposition Leader, than with Gordon Brown, though a larger number trust neither of them.
The poll, carried out by doctors.net, Britain's busiest medical website, shows a profession disillusioned with central control, angered by the growth of bureaucracy, and deeply sceptical of initiatives such as the 20 billion pound IT system. Even more worrying for Labour, more than two fifths of the 3,092 doctors who responded are young, having graduated since 2000. More than half of respondents (56 per cent) said that there had been no improvement in the NHS since 2002, when the Government increased funding. Only 27 per cent thought there had been. Almost three quarters (72 per cent) did not believe that the extra money had been well spent, while 11 per cent said that it had. Similar views were held on the quality of care: 72 per cent said that there had been no improvement; 15 per cent said that there had been.
In a surprisingly strong rejection of the Government's belief that taxation is the only way to pay for the NHS, 79 per cent of respondents doubted that the highest standards expected of the NHS could be sustained through taxation alone after 2008, when the huge annual increases in funding will drop off.
Neil Bacon, who launched doctors.net in 1999, was not surprised by the results of the survey. "Doctors support the NHS, but they have a great deal of concern that the underlying problems are not being addressed," he said. Mark Porter, deputy chairman of the British Medical Association's consultants' committee, said: "The results of this survey are disturbing and give a snapshot view of how demoralised and frustrated some doctors are feeling. "It is of major concern that a majority of respondents to this survey are saying that they do not believe the NHS has improved since 2002 and that they do not think the increase in NHS expenditure has been well spent. It is also worrying that so many of them say they plan to retire early. "The survey also reveals a deep anxiety among doctors about what will happen after 2008, when the rate of increased funding is due to end. "It is tragic that the Government has used so much of the increased expenditure on wasteful initiatives like independent sector treatment centres and PFI. The private sector has certainly done well out of the increased funding."
Andrew Haldenby, of the think-tank Reform, which wants funding of the NHS to be opened up, said that he was heartened by the degree of support doctors had shown for the idea. "The real issue is whether the tax model can work. This poll requires all the politicians to rethink their positions," he said. "This poll suggests very strongly that at least part of the medical community has been taking notice, and it is particularly interesting that so many younger doctors have contributed."
Source
Contaminated blood inquiry
An independent public inquiry is to be held into the supply to haemophiliacs of contaminated NHS blood The Labour peer Lord Archer of Sandwell, a former Solicitor-General, is to conduct the inquiry after a campaign by Lord Morris of Manchester, president of the Haemophilia Society and a former Minister for the Disabled, who said that 1,757 haemophilia patients who were exposed to HIV and/or hepatitis C-contaminated NHS blood and blood products had died since being infected. "Many more are now terminally ill," the peer claimed.
Lord Morris said that, of 4,670 such patients exposed to hepatitis C, 1,243 were also exposed to HIV and that, notwithstanding improvements in treatments, only 2,552 patients with hepatitis C and 361 with HIV were still alive. The situation has been described by Professor Lord Winston as "the worst treatment disaster in the history of the NHS".
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 Pages are here or here or here.
***************************
Most doctors believe that Labour has failed to reform the NHS and that funding by taxation alone will not improve the quality of care. An online poll of more than 3,000 doctors carried out for The Times offers the most striking picture yet of the level of disillusionment within the profession. Most say that the billions of pounds injected into the service since 2002 have not been well spent and that services have not improved.
Faith in Labour's ability to put it right is rock-bottom. Nearly twice as many doctors would trust the NHS with David Cameron, the Opposition Leader, than with Gordon Brown, though a larger number trust neither of them.
The poll, carried out by doctors.net, Britain's busiest medical website, shows a profession disillusioned with central control, angered by the growth of bureaucracy, and deeply sceptical of initiatives such as the 20 billion pound IT system. Even more worrying for Labour, more than two fifths of the 3,092 doctors who responded are young, having graduated since 2000. More than half of respondents (56 per cent) said that there had been no improvement in the NHS since 2002, when the Government increased funding. Only 27 per cent thought there had been. Almost three quarters (72 per cent) did not believe that the extra money had been well spent, while 11 per cent said that it had. Similar views were held on the quality of care: 72 per cent said that there had been no improvement; 15 per cent said that there had been.
In a surprisingly strong rejection of the Government's belief that taxation is the only way to pay for the NHS, 79 per cent of respondents doubted that the highest standards expected of the NHS could be sustained through taxation alone after 2008, when the huge annual increases in funding will drop off.
Neil Bacon, who launched doctors.net in 1999, was not surprised by the results of the survey. "Doctors support the NHS, but they have a great deal of concern that the underlying problems are not being addressed," he said. Mark Porter, deputy chairman of the British Medical Association's consultants' committee, said: "The results of this survey are disturbing and give a snapshot view of how demoralised and frustrated some doctors are feeling. "It is of major concern that a majority of respondents to this survey are saying that they do not believe the NHS has improved since 2002 and that they do not think the increase in NHS expenditure has been well spent. It is also worrying that so many of them say they plan to retire early. "The survey also reveals a deep anxiety among doctors about what will happen after 2008, when the rate of increased funding is due to end. "It is tragic that the Government has used so much of the increased expenditure on wasteful initiatives like independent sector treatment centres and PFI. The private sector has certainly done well out of the increased funding."
Andrew Haldenby, of the think-tank Reform, which wants funding of the NHS to be opened up, said that he was heartened by the degree of support doctors had shown for the idea. "The real issue is whether the tax model can work. This poll requires all the politicians to rethink their positions," he said. "This poll suggests very strongly that at least part of the medical community has been taking notice, and it is particularly interesting that so many younger doctors have contributed."
Source
Contaminated blood inquiry
An independent public inquiry is to be held into the supply to haemophiliacs of contaminated NHS blood The Labour peer Lord Archer of Sandwell, a former Solicitor-General, is to conduct the inquiry after a campaign by Lord Morris of Manchester, president of the Haemophilia Society and a former Minister for the Disabled, who said that 1,757 haemophilia patients who were exposed to HIV and/or hepatitis C-contaminated NHS blood and blood products had died since being infected. "Many more are now terminally ill," the peer claimed.
Lord Morris said that, of 4,670 such patients exposed to hepatitis C, 1,243 were also exposed to HIV and that, notwithstanding improvements in treatments, only 2,552 patients with hepatitis C and 361 with HIV were still alive. The situation has been described by Professor Lord Winston as "the worst treatment disaster in the history of the NHS".
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 Pages are here or here or here.
***************************
Monday, February 19, 2007
California warned on health plan's cost
Governor's projected price tag could be more than $3 billion too low, says nonpartisan analyst
Gov. Arnold Schwarzenegger may have underestimated the cost of his health care overhaul by $150 million to more than $3 billion, the Legislature's nonpartisan budget adviser said Thursday. The governor estimates that his plan to bring down insurance costs and extend coverage to the 6.5 million people without health care will cost $12 billion annually. But the actual costs may be higher, the Legislative Analyst's Office told the Senate Health Committee during the first hearing on the proposal.
Marcus Stanley of the analyst's office said the plan would cost more if medical care outpaces inflation, if the numbers of uninsured are higher than estimated, or if insurance company premiums are higher than anticipated. Though Schwarzenegger released the plan in January, Thursday marked the first time lawmakers have been able to ask questions about it in an official setting.
The proposal would require individuals to buy coverage, employers to help pay for it, and insurers to sell it to anyone who wants it. Doctors and hospitals would also be asked to chip in to help fund the expansion, which would also rely on a significant amount of new federal funding.
The debate Thursday centered on whether the Republican governor's financial model was realistic. Kim Belshe, California secretary of health and human services, testified that the governor's plan would change the health care marketplace, making insurance more affordable for working families who would be required to purchase it because more people would be participating in the system. Many of those people would be young and healthy, she said, making them relatively cheap to insure.
But several members of the Senate Health Committee said the plan relies heavily on theoretical models without guaranteeing that insurers would offer premiums that people could afford. "I don't see anything in the proposal that helps us feel confident that affordability will be achieved," said Sen. Sheila Kuehl, a Democrat from Santa Monica who chairs the committee. Kuehl said the health care debate reminded her of the debate over deregulating electricity that occurred in the 1990s. Financial models showed that, in theory, energy prices should be lower. But companies such as Enron ended up gaming the system, leading to high prices and rolling blackouts. "We should have hired a pirate to show us how the system could be gamed" during the electricity debate, Kuehl said. "We need to hire a pirate, I think ... so we can see what's coming."
The governor's staff said models show that insurance would be cheap enough that the health plan would not cause a hardship for working families. But even insurers said their prices under the new system would depend heavily on the makeup of the population they would be forced to insure. In other states that have required insurers to sell coverage to everyone, people with expensive medical needs entering the system had raised the cost for everyone, said Charles Bacchi of the California Association of Health Plans. Requiring insurers to cover everyone "is one piece of the proposal, and with that in mind we're willing to work constructively to see if we can make it work," Bacchi said. "But we do so with caution."
The California Nurses Association, which has led high-profile efforts opposing various Schwarzenegger policies since he took office, resurfaced at the hearing. Deborah Burger, Nurses Association president, said the best solution is one that Schwarzenegger is not even proposing: abolishing all health insurance and replacing it with a system of universal coverage run by the state. The insurance industry "is structurally set up to make profit by denying care, wastes 30 percent in administrative overhead [She should see the administrative overhead in a fully socialized system! Try 75%], and is the root of the present cost and quality crisis," Burger said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Governor's projected price tag could be more than $3 billion too low, says nonpartisan analyst
Gov. Arnold Schwarzenegger may have underestimated the cost of his health care overhaul by $150 million to more than $3 billion, the Legislature's nonpartisan budget adviser said Thursday. The governor estimates that his plan to bring down insurance costs and extend coverage to the 6.5 million people without health care will cost $12 billion annually. But the actual costs may be higher, the Legislative Analyst's Office told the Senate Health Committee during the first hearing on the proposal.
Marcus Stanley of the analyst's office said the plan would cost more if medical care outpaces inflation, if the numbers of uninsured are higher than estimated, or if insurance company premiums are higher than anticipated. Though Schwarzenegger released the plan in January, Thursday marked the first time lawmakers have been able to ask questions about it in an official setting.
The proposal would require individuals to buy coverage, employers to help pay for it, and insurers to sell it to anyone who wants it. Doctors and hospitals would also be asked to chip in to help fund the expansion, which would also rely on a significant amount of new federal funding.
The debate Thursday centered on whether the Republican governor's financial model was realistic. Kim Belshe, California secretary of health and human services, testified that the governor's plan would change the health care marketplace, making insurance more affordable for working families who would be required to purchase it because more people would be participating in the system. Many of those people would be young and healthy, she said, making them relatively cheap to insure.
But several members of the Senate Health Committee said the plan relies heavily on theoretical models without guaranteeing that insurers would offer premiums that people could afford. "I don't see anything in the proposal that helps us feel confident that affordability will be achieved," said Sen. Sheila Kuehl, a Democrat from Santa Monica who chairs the committee. Kuehl said the health care debate reminded her of the debate over deregulating electricity that occurred in the 1990s. Financial models showed that, in theory, energy prices should be lower. But companies such as Enron ended up gaming the system, leading to high prices and rolling blackouts. "We should have hired a pirate to show us how the system could be gamed" during the electricity debate, Kuehl said. "We need to hire a pirate, I think ... so we can see what's coming."
The governor's staff said models show that insurance would be cheap enough that the health plan would not cause a hardship for working families. But even insurers said their prices under the new system would depend heavily on the makeup of the population they would be forced to insure. In other states that have required insurers to sell coverage to everyone, people with expensive medical needs entering the system had raised the cost for everyone, said Charles Bacchi of the California Association of Health Plans. Requiring insurers to cover everyone "is one piece of the proposal, and with that in mind we're willing to work constructively to see if we can make it work," Bacchi said. "But we do so with caution."
The California Nurses Association, which has led high-profile efforts opposing various Schwarzenegger policies since he took office, resurfaced at the hearing. Deborah Burger, Nurses Association president, said the best solution is one that Schwarzenegger is not even proposing: abolishing all health insurance and replacing it with a system of universal coverage run by the state. The insurance industry "is structurally set up to make profit by denying care, wastes 30 percent in administrative overhead [She should see the administrative overhead in a fully socialized system! Try 75%], and is the root of the present cost and quality crisis," Burger said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Sunday, February 18, 2007
Congressional cures?
Part 1 of this article series described the FDA's recent attempts to convince its critics that it takes drug safety seriously. In fact, no one who is familiar with the FDA culture and mind-set could possibly doubt that drug safety is paramount - if for no other reason, approving a product that proves to be dangerous can ruin a government career.
Although all drugs have side effects - which can be serious and/or frequent - modern pharmaceuticals have never been safer, more effective, more innovative - or more stringently regulated. But that seems to have escaped the notice of many members of Congress. This month senators introduced two separate bills that will further obstruct innovation and threaten public health.
Senators Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyoming), the chairman and ranking Republican, respectively, of the Health, Education, Labor and Pensions Committee, proposed legislation that would grant the FDA new authority to impose safety requirements on medicines after they have been approved for marketing and would also would require registration of clinical trials and the reporting of their results in public databases. In addition, Senators Chris Dodd (D-Conn.) and Charles Grassley (R-Iowa) introduced legislation that would create within the FDA a center to oversee the safety of drugs after they go on the market.
These bills are the culmination of years of drug company-bashing by a small number of activists and members of congress who have seized on high-profile events such as deficiencies in the labeling of antidepressants and the discovery of previously unknown side effects of various widely used drugs. They will discourage drug development by making it more difficult and expensive and less profitable, at a time when an aging American population desperately needs new and improved (and cheaper) medicines, and when pharmaceutical R&D is already ailing. During the past twenty years the costs have skyrocketed, with direct and indirect expenses now exceeding $900 million dollars to bring an average drug to market. Other trends related to costs are ominous as well: The length of clinical testing for the average drug is increasing, fewer drugs are being approved, and the number of applications to FDA by industry for marketing approval has been declining for more than a decade.
The FDA is already the nation's most powerful and omnipresent regulator, but the Kennedy-Enzi bill would grant new authority, supposedly to ensure the safety of drugs. Among other unwise innovations, it would require the imposition of "risk management action plans (RiskMAPs)" when drugs are approved. Not only does the FDA already have the authority to require these when regulators feel that they are necessary, but they have been overused and abusive: At times the exhaustive (and exhausting) list of requirements for physicians, pharmacists and patients seems more appropriate for weapons-grade plutonium than a pharmaceutical. Some RiskMAPS have contained requirements such as mandatory enrollment in patient registries, limited distribution, and prescribed patient behavior (such as the use of two kinds of contraception, in the case of one drug).
The requirement that drug companies disclose advanced clinical trials in a public database is based on concerns that "negative" results are often obscured or simply not reported. It is intended to prevent companies from "cherry picking" studies, divulging only those that yield favorable results and suppressing the rest.
These concerns are exaggerated. Nothing in our society is currently more stringently regulated and monitored than drug development. During each phase of clinical testing, the FDA reviews and must grant permission for every clinical trial and has access to all of the proprietary information about the drug. When the manufacturer has accumulated evidence that the drug is safe and effective, as part of the application for marketing approval the results of every trial and everything else that is known about the drug, both in the United States and abroad, must be reported to the FDA. Statistical analysis must be performed in an appropriate and pre-specified manner. Moreover, the FDA serves as a repository for data on similar drugs made by other manufacturers. All of this prevents statistical "cherry-picking" or "data mining" that could mislead regulators.
Clinical trials databases are useful to individual patients who wish to ascertain whether they are eligible for a clinical trial that is under way - a function already served by www.ClinicalTrials.gov. But, except for offering a bonanza to plaintiffs' attorneys trolling for business, the benefit of a publicly available database of clinical trial results would be minimal.
There is also the question of the meaning of "negative results" in clinical trials. In the context of scientific and clinical experiments, the term has a meaning very different from the common usage. Such trials are seldom "negative" in the sense of revealing that the drug being tested inflicts harm but for a variety of reasons, they may not be useful or applicable to the indications (uses) for which approval is being sought. The reasons can include: insufficient statistical power (that is, number of patients) in the study; inappropriate choice of route, dose or frequency of administration, or in the stratification of subjects; or simply a failure of the drug to be effective for the indication for which it was tried.
The Dodd-Grassley proposal is even worse. It would create within the FDA an anti-drug entity with strong incentives to argue for the non-approval or withdrawal from the market drugs that have significant side effects even if they offer huge net benefits. (We have seen this already from certain factions within the agency.)
These proposed legislative remedies for the FDA's problems, with more planned for later in the year in both the House and Senate, are analogous to the discredited medical practice of bleeding the patient with leeches. By intensifying the FDA's notorious risk aversion, the new measures will inflate even further the costs, difficulty and uncertainty of drug development and reduce the number of drug candidates that begin and complete clinical testing. They will drain the life's blood from innovation and inflict harm on patients. If these pieces of legislation are enacted, they will validate yet again Will Rogers's observation about Congress: "Every time they make a joke, it's a law. And every time they make a law, it's a joke." And as usual, the joke will be on us.
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 Pages are here or here or here.
***************************
Part 1 of this article series described the FDA's recent attempts to convince its critics that it takes drug safety seriously. In fact, no one who is familiar with the FDA culture and mind-set could possibly doubt that drug safety is paramount - if for no other reason, approving a product that proves to be dangerous can ruin a government career.
Although all drugs have side effects - which can be serious and/or frequent - modern pharmaceuticals have never been safer, more effective, more innovative - or more stringently regulated. But that seems to have escaped the notice of many members of Congress. This month senators introduced two separate bills that will further obstruct innovation and threaten public health.
Senators Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyoming), the chairman and ranking Republican, respectively, of the Health, Education, Labor and Pensions Committee, proposed legislation that would grant the FDA new authority to impose safety requirements on medicines after they have been approved for marketing and would also would require registration of clinical trials and the reporting of their results in public databases. In addition, Senators Chris Dodd (D-Conn.) and Charles Grassley (R-Iowa) introduced legislation that would create within the FDA a center to oversee the safety of drugs after they go on the market.
These bills are the culmination of years of drug company-bashing by a small number of activists and members of congress who have seized on high-profile events such as deficiencies in the labeling of antidepressants and the discovery of previously unknown side effects of various widely used drugs. They will discourage drug development by making it more difficult and expensive and less profitable, at a time when an aging American population desperately needs new and improved (and cheaper) medicines, and when pharmaceutical R&D is already ailing. During the past twenty years the costs have skyrocketed, with direct and indirect expenses now exceeding $900 million dollars to bring an average drug to market. Other trends related to costs are ominous as well: The length of clinical testing for the average drug is increasing, fewer drugs are being approved, and the number of applications to FDA by industry for marketing approval has been declining for more than a decade.
The FDA is already the nation's most powerful and omnipresent regulator, but the Kennedy-Enzi bill would grant new authority, supposedly to ensure the safety of drugs. Among other unwise innovations, it would require the imposition of "risk management action plans (RiskMAPs)" when drugs are approved. Not only does the FDA already have the authority to require these when regulators feel that they are necessary, but they have been overused and abusive: At times the exhaustive (and exhausting) list of requirements for physicians, pharmacists and patients seems more appropriate for weapons-grade plutonium than a pharmaceutical. Some RiskMAPS have contained requirements such as mandatory enrollment in patient registries, limited distribution, and prescribed patient behavior (such as the use of two kinds of contraception, in the case of one drug).
The requirement that drug companies disclose advanced clinical trials in a public database is based on concerns that "negative" results are often obscured or simply not reported. It is intended to prevent companies from "cherry picking" studies, divulging only those that yield favorable results and suppressing the rest.
These concerns are exaggerated. Nothing in our society is currently more stringently regulated and monitored than drug development. During each phase of clinical testing, the FDA reviews and must grant permission for every clinical trial and has access to all of the proprietary information about the drug. When the manufacturer has accumulated evidence that the drug is safe and effective, as part of the application for marketing approval the results of every trial and everything else that is known about the drug, both in the United States and abroad, must be reported to the FDA. Statistical analysis must be performed in an appropriate and pre-specified manner. Moreover, the FDA serves as a repository for data on similar drugs made by other manufacturers. All of this prevents statistical "cherry-picking" or "data mining" that could mislead regulators.
Clinical trials databases are useful to individual patients who wish to ascertain whether they are eligible for a clinical trial that is under way - a function already served by www.ClinicalTrials.gov. But, except for offering a bonanza to plaintiffs' attorneys trolling for business, the benefit of a publicly available database of clinical trial results would be minimal.
There is also the question of the meaning of "negative results" in clinical trials. In the context of scientific and clinical experiments, the term has a meaning very different from the common usage. Such trials are seldom "negative" in the sense of revealing that the drug being tested inflicts harm but for a variety of reasons, they may not be useful or applicable to the indications (uses) for which approval is being sought. The reasons can include: insufficient statistical power (that is, number of patients) in the study; inappropriate choice of route, dose or frequency of administration, or in the stratification of subjects; or simply a failure of the drug to be effective for the indication for which it was tried.
The Dodd-Grassley proposal is even worse. It would create within the FDA an anti-drug entity with strong incentives to argue for the non-approval or withdrawal from the market drugs that have significant side effects even if they offer huge net benefits. (We have seen this already from certain factions within the agency.)
These proposed legislative remedies for the FDA's problems, with more planned for later in the year in both the House and Senate, are analogous to the discredited medical practice of bleeding the patient with leeches. By intensifying the FDA's notorious risk aversion, the new measures will inflate even further the costs, difficulty and uncertainty of drug development and reduce the number of drug candidates that begin and complete clinical testing. They will drain the life's blood from innovation and inflict harm on patients. If these pieces of legislation are enacted, they will validate yet again Will Rogers's observation about Congress: "Every time they make a joke, it's a law. And every time they make a law, it's a joke." And as usual, the joke will be on us.
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 Pages are here or here or here.
***************************
Saturday, February 17, 2007
Health insurance, without the "insulation"
When we build a home, or buy one that has been previously owned, one of the major concerns is about how well insulated it is, as well as with what materials. Keeping out the cold in the winter, or extreme heat in the summer, is essential, unless we wish to pay exorbitant heating and cooling bills year-round. However, the same does not necessary go for paying to maintain our physical well-being; sometimes paying for services at the point of service can actually save us money, and sometimes too much "insulation" can be a bad thing.
The lead commentary on this page this week (at least at the beginning of it) appears to coin a phrase this editor has been groping at for some time now. In his Cato Unbound piece, Arnold Kling poses the confrontation of Insulation vs. Insurance, thereby concisely defining the real battleground upon which healthcare reform must be fought. As he notes quite correctly, the biggest obstacle to true reform in the system is tied to how quickly we can wean people off the viewpoint that "health insurance" should be a first-dollar-spent process, covering every minor incidental expense, and how rapidly they can adjust to it as the emergency-brake on catastrophic expenditures it was initially intended to be.
Kling's take on the matter is simple: He terms current American health coverage "insulation, not insurance. Rather than insuring them against risk, most families' health plans insulate them from paying for most health care bills, large and small." Real insurance, he notes, "such as fire insurance, provides protection against rare, severe risk . [and] is characterized by: low premiums, infrequent claims and large claims." He contrasts this with most employer-provided insurance and Medicare, and policies written for the vast majority of Americans: "Families typically are paid claims several times per year, often for small amounts. Premiums are high - often exceed[ing] $10,000 per year per family."
The problem is, since most families only pay those premiums via the reduced take-home pay their employers might be giving them instead, they have no idea how much the services are costing, except in the often trivial co-payments they may be making. As Kling notes, "Real insurance would pay for treatments that are unavoidable, prohibitively expensive, or for illnesses that occur relatively rarely. Instead, insulation reimburses even relatively low-cost services, such as a test for strep throat or a new pair of eyeglasses."
As noted above, this editor has been trying to make this point for some time now: Until the concept of "health insurance" becomes about ensuring against huge financial calamities, instead of covering every sniffle and headache, we can hardly expect that "reform" is remotely possible. If there is to be any chance of shifting the paradigm, it must begin with the self-responsible among us taking charge: opting out of full coverage policies for catastrophic-only coverage, switching our primary healthcare allocations into medical savings accounts, and relying on continued wellness as the goal, not perfect insulation from the vagaries of life.
By focusing our attentions on the relatively low cost of annual checkups and screenings, and paying out of our own pockets at the time of service, we not only minimize the amount that goes out for "insurance," but we also may save considerably over the actual cost of such services, through discounts offered by beleaguered healthcare providers who get to save on all the paperwork and bureaucracy being sidestepped.
But what about those situations where there truly is a major ailment and expense involved. Kling again offers a scenario. Citing his own book, Crisis of Abundance, as reference, he notes that "Real health insurance would pay claims to people who come down with expensive illnesses. Typically, these expenses accumulate over a period of years." He postulates "a health insurance policy that you buy this year, but reimburses you in five years, based on cumulative expenses. Such a policy might pay nothing if your total expenses over the next five years are less than $30,000. It might pay 100 percent of expenses thereafter." Buying a string of such policies, overlapping by a year or so, would, in Kling's view, "provide a better safety net than the annual policies that we have today. The typical catastrophic illness does not stop requiring treatment on December 31."
Another option he presents is a policy that only kicks in with specific payments for specific major ailments: "First-stage breast cancer might result in a $25,000 payment. A heart condition requiring major surgery might result in a $40,000 payment. And so on. Only major medical problems would trigger claims, and payments would be for fixed amounts, not for reimbursement for procedures."
Once again, a prescription for a pathway out of this morass is presented. The question now is, what can we do to perpetuate this free-choice meme throughout the culture, so that the current outcries from all across the political spectrum for nationalizing the problem may be turned aside? It's not going to be easy, but it is going to be necessary.
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 Pages are here or here or here.
***************************
When we build a home, or buy one that has been previously owned, one of the major concerns is about how well insulated it is, as well as with what materials. Keeping out the cold in the winter, or extreme heat in the summer, is essential, unless we wish to pay exorbitant heating and cooling bills year-round. However, the same does not necessary go for paying to maintain our physical well-being; sometimes paying for services at the point of service can actually save us money, and sometimes too much "insulation" can be a bad thing.
The lead commentary on this page this week (at least at the beginning of it) appears to coin a phrase this editor has been groping at for some time now. In his Cato Unbound piece, Arnold Kling poses the confrontation of Insulation vs. Insurance, thereby concisely defining the real battleground upon which healthcare reform must be fought. As he notes quite correctly, the biggest obstacle to true reform in the system is tied to how quickly we can wean people off the viewpoint that "health insurance" should be a first-dollar-spent process, covering every minor incidental expense, and how rapidly they can adjust to it as the emergency-brake on catastrophic expenditures it was initially intended to be.
Kling's take on the matter is simple: He terms current American health coverage "insulation, not insurance. Rather than insuring them against risk, most families' health plans insulate them from paying for most health care bills, large and small." Real insurance, he notes, "such as fire insurance, provides protection against rare, severe risk . [and] is characterized by: low premiums, infrequent claims and large claims." He contrasts this with most employer-provided insurance and Medicare, and policies written for the vast majority of Americans: "Families typically are paid claims several times per year, often for small amounts. Premiums are high - often exceed[ing] $10,000 per year per family."
The problem is, since most families only pay those premiums via the reduced take-home pay their employers might be giving them instead, they have no idea how much the services are costing, except in the often trivial co-payments they may be making. As Kling notes, "Real insurance would pay for treatments that are unavoidable, prohibitively expensive, or for illnesses that occur relatively rarely. Instead, insulation reimburses even relatively low-cost services, such as a test for strep throat or a new pair of eyeglasses."
As noted above, this editor has been trying to make this point for some time now: Until the concept of "health insurance" becomes about ensuring against huge financial calamities, instead of covering every sniffle and headache, we can hardly expect that "reform" is remotely possible. If there is to be any chance of shifting the paradigm, it must begin with the self-responsible among us taking charge: opting out of full coverage policies for catastrophic-only coverage, switching our primary healthcare allocations into medical savings accounts, and relying on continued wellness as the goal, not perfect insulation from the vagaries of life.
By focusing our attentions on the relatively low cost of annual checkups and screenings, and paying out of our own pockets at the time of service, we not only minimize the amount that goes out for "insurance," but we also may save considerably over the actual cost of such services, through discounts offered by beleaguered healthcare providers who get to save on all the paperwork and bureaucracy being sidestepped.
But what about those situations where there truly is a major ailment and expense involved. Kling again offers a scenario. Citing his own book, Crisis of Abundance, as reference, he notes that "Real health insurance would pay claims to people who come down with expensive illnesses. Typically, these expenses accumulate over a period of years." He postulates "a health insurance policy that you buy this year, but reimburses you in five years, based on cumulative expenses. Such a policy might pay nothing if your total expenses over the next five years are less than $30,000. It might pay 100 percent of expenses thereafter." Buying a string of such policies, overlapping by a year or so, would, in Kling's view, "provide a better safety net than the annual policies that we have today. The typical catastrophic illness does not stop requiring treatment on December 31."
Another option he presents is a policy that only kicks in with specific payments for specific major ailments: "First-stage breast cancer might result in a $25,000 payment. A heart condition requiring major surgery might result in a $40,000 payment. And so on. Only major medical problems would trigger claims, and payments would be for fixed amounts, not for reimbursement for procedures."
Once again, a prescription for a pathway out of this morass is presented. The question now is, what can we do to perpetuate this free-choice meme throughout the culture, so that the current outcries from all across the political spectrum for nationalizing the problem may be turned aside? It's not going to be easy, but it is going to be necessary.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Friday, February 16, 2007
Britain: Faulty software puts child health at risk
The health of children is at risk because an NHS computer system wrecked 20 years of accurate immunisation records
Faulty software introduced in 2005 has left some primary care trusts (PCTs) unable to track whether children have been vaccinated and screened for genetic conditions, raising fears that many are unprotected against diseases. Parents are not being reminded when their children are due for jabs and check-ups. The Health Protection Agency cannot publish full statistics on the uptake of vaccines because the five worst-affected London trusts cannot provide accurate data.
When the shortcomings of the Child Health Interim Application (CHIA) software were disclosed by The Times a year ago, the Department of Health stated that the problems were being addressed. Staff were said yesterday to be "in despair" at continuing difficulties with the system supplied by BT. Christine Sloczynska, consultant community paediatri-cian at Waltham Forest PCT, in East London, said: "I'm sure there will be kids who slip through the net and will be unimmunised. Our immunisation take-up has fallen from 94 per cent to 58 per cent, but we don't know how much it is due to children missing their vaccinations, or to lack of data."
The Health Protection Agency said that five trusts had been excluded from national figures for uptake of MMR and other vaccinations as their data were considered unreliable. Pat Troop, head of the agency, said: "There is still a gap in the data, and it's something the local NHS are concerned about, not just us. Not monitoring coverage of measles is how infections might happen." Mike Catchpole, of the agency, said that it was not possible to predict when the affected PCTs could provide the data.
The CHIA software was introduced in ten London trusts when an older system was withdrawn. Dr Slocynzska said that the system could not be used to generate lists of those who match particular criteria, such as missing vaccinations. This makes it difficult for GPs to issue reminders. Parents are still issued with a "red book" listing a vaccination schedule, but the problems with the computer make it hard to tell them when new jabs are available. Birth records formerly sent online from maternity units must be entered by hand, and there is a backlog. "We are sometimes told of a child's death before we know it has been born," Dr Sloczynska said. BT has promised to replace the software.
Source
NHS corruption
SUSSEX: An NHS trust that gave a former public health director a payoff of 243,000 pounds after working less than three weeks also paid lawyers 12,000 for advice on how to manage the case. Sussex Downs Primary Care Trust revealed that it made the payments to Capsticks Solicitors, of London. The legal advice concerned the treatment of Iheadi Onwukwe, 41, who was appointed in September 2002. He worked briefly for Eastbourne Downs Primary Care Trust, which later merged with Sussex Downs Primary Care Trust, and was reported to have been paid a salary for almost three years while on “gardening leave” before leaving his post. Gina Brocklehurst, former chief executive of the trust, received 230,000 to leave as part of the reorganisation. Norman Baker, MP for Lewes, said: “This shows how endemic the problem is of the NHS writing out blank cheques with our money.”
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 Pages are here or here or here.
***************************
The health of children is at risk because an NHS computer system wrecked 20 years of accurate immunisation records
Faulty software introduced in 2005 has left some primary care trusts (PCTs) unable to track whether children have been vaccinated and screened for genetic conditions, raising fears that many are unprotected against diseases. Parents are not being reminded when their children are due for jabs and check-ups. The Health Protection Agency cannot publish full statistics on the uptake of vaccines because the five worst-affected London trusts cannot provide accurate data.
When the shortcomings of the Child Health Interim Application (CHIA) software were disclosed by The Times a year ago, the Department of Health stated that the problems were being addressed. Staff were said yesterday to be "in despair" at continuing difficulties with the system supplied by BT. Christine Sloczynska, consultant community paediatri-cian at Waltham Forest PCT, in East London, said: "I'm sure there will be kids who slip through the net and will be unimmunised. Our immunisation take-up has fallen from 94 per cent to 58 per cent, but we don't know how much it is due to children missing their vaccinations, or to lack of data."
The Health Protection Agency said that five trusts had been excluded from national figures for uptake of MMR and other vaccinations as their data were considered unreliable. Pat Troop, head of the agency, said: "There is still a gap in the data, and it's something the local NHS are concerned about, not just us. Not monitoring coverage of measles is how infections might happen." Mike Catchpole, of the agency, said that it was not possible to predict when the affected PCTs could provide the data.
The CHIA software was introduced in ten London trusts when an older system was withdrawn. Dr Slocynzska said that the system could not be used to generate lists of those who match particular criteria, such as missing vaccinations. This makes it difficult for GPs to issue reminders. Parents are still issued with a "red book" listing a vaccination schedule, but the problems with the computer make it hard to tell them when new jabs are available. Birth records formerly sent online from maternity units must be entered by hand, and there is a backlog. "We are sometimes told of a child's death before we know it has been born," Dr Sloczynska said. BT has promised to replace the software.
Source
NHS corruption
SUSSEX: An NHS trust that gave a former public health director a payoff of 243,000 pounds after working less than three weeks also paid lawyers 12,000 for advice on how to manage the case. Sussex Downs Primary Care Trust revealed that it made the payments to Capsticks Solicitors, of London. The legal advice concerned the treatment of Iheadi Onwukwe, 41, who was appointed in September 2002. He worked briefly for Eastbourne Downs Primary Care Trust, which later merged with Sussex Downs Primary Care Trust, and was reported to have been paid a salary for almost three years while on “gardening leave” before leaving his post. Gina Brocklehurst, former chief executive of the trust, received 230,000 to leave as part of the reorganisation. Norman Baker, MP for Lewes, said: “This shows how endemic the problem is of the NHS writing out blank cheques with our money.”
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 Pages are here or here or here.
***************************
Thursday, February 15, 2007
Don't get old in Britain
Many doctors discriminate against older patients, giving them poorer advice and worse treatment than younger people with the same symptoms. A study has found that elderly patients with angina are less likely to be prescribed a statin to lower their cholesterol, given appropriate tests or to be offered surgical treatments. Instead they were often given a minor change in prescription and told to come back later, in spite of studies that show that all patients, regardless of age, benefit from modern treatments.
The survey, published in the journal Quality and Safety in Health Care, found that patients over 65 were given different care from those who were younger. Twenty-eight general practitioners, 28 elderly care specialists and 29 cardiologists from across southern England and the Midlands were questioned. A total of 72 fictional patients with angina were presented to the doctors as part of a computer programme, and the doctors were interviewed. The fictional patients were aged between 45 and 92, with varying degrees of heart problems.
Overall, the study found that older patients were less likely to be referred to a cardiologist and given an angiogram or exercise tolerance tests compared with middle-aged patients. They were also less likely to be offered revascularisation (opening up of blood vessels). The authors, led by Professor Ann Bowling, from University College London, found that the doctors who were influenced by age were on average five years older than those who were 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 Pages are here or here or here.
***************************
Many doctors discriminate against older patients, giving them poorer advice and worse treatment than younger people with the same symptoms. A study has found that elderly patients with angina are less likely to be prescribed a statin to lower their cholesterol, given appropriate tests or to be offered surgical treatments. Instead they were often given a minor change in prescription and told to come back later, in spite of studies that show that all patients, regardless of age, benefit from modern treatments.
The survey, published in the journal Quality and Safety in Health Care, found that patients over 65 were given different care from those who were younger. Twenty-eight general practitioners, 28 elderly care specialists and 29 cardiologists from across southern England and the Midlands were questioned. A total of 72 fictional patients with angina were presented to the doctors as part of a computer programme, and the doctors were interviewed. The fictional patients were aged between 45 and 92, with varying degrees of heart problems.
Overall, the study found that older patients were less likely to be referred to a cardiologist and given an angiogram or exercise tolerance tests compared with middle-aged patients. They were also less likely to be offered revascularisation (opening up of blood vessels). The authors, led by Professor Ann Bowling, from University College London, found that the doctors who were influenced by age were on average five years older than those who were 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 Pages are here or here or here.
***************************
Wednesday, February 14, 2007
20 billion pound NHS computer system 'doomed to fail'
Labour's multi-billion- pound project to create the NHS's first ever national computer system "isn't working and isn't going to work", a senior insider has warned.
The damning verdict on the ambitious 20 billion pound plans to store patients' records, and allow people to book hospital appointments, on a central computer network has been delivered by a top executive at one of the system's main suppliers. Andrew Rollerson, the health-care consultancy practice lead at the computer giant Fujitsu, warned that there was a risk that firms involved in the project would end up delivering "a camel and not the racehorse that we might try to produce".
His bleak assessment was delivered in a speech on the health service's national programme for IT that he delivered to a conference of computer experts last week and which is reported in today's Computer Weekly magazine. Fujitsu is one of the main firms involved in the project after winning a 896 million pound contract to deliver systems in the South of England.
Mr Rollerson underlined his message with a series of downbeat slides, including one showing a huge oil tanker being hit by a tidal wave, one with the word "Lost?" alongside a picture of a desert island and one with a man walking a tightrope. Another slide declared "visionary leadership is still missing" alongside the famous World War One poster of Lord Kitchener declaring "Your country needs you". His presentation even featured a picture of a huge alligator with the message "We have become obsessed by the alligators nearest the boat." The final slide showed two women mud-wrestling and asked: "Where would you rather be?"
In his speech, Mr Rollerson voiced concern at the direction of the NHS programme and the lack of vision on how the health service can make best use of new technology. "What we are trying to do is run an enormous programme with the techniques that we are absolutely familiar with for running small projects. And it isn't working. And it isn't going to work," he told his audience. "Unless we do some serious thinking about that - about the challenges of scale and how you scale up to an appropriate size - then I think we're out on a limb."
Mr Rollerson added: "There is a belief that the national programme is somehow going to propel transformation in the NHS simply by delivering an IT system. Nothing could be further from the truth. A vacuum, a chasm, is opening up."
His comments are the latest sign of problems in the ambitious project, which is expected to cost the taxpayer around 7.6 billion more than estimated. Last year it emerged that there had been 110 "major incidents" involving the system in just four months. A letter signed by 23 leading computer scientists urged the Commons health select committee to launch an inquiry to "establish the scale of the risks" facing the project.
Stephen O'Brien, the shadow health minister, said: "Even those from inside the programme are now telling the Government that it is coming apart at the seams. "This is another example of the heavy-handed, top-down failing approach of this Labour Government."
The Department of Health last night insisted that the programme was a pivotal part of NHS reform. [How unwise to say that!] A spokesman said: "David Nicholson, the chief executive of the NHS, is fully committed to the national programme for IT as it is a necessary part of modern health service. "He sees this as one of his key strategic priorities as it is key to the successful delivery of patient centred care."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Labour's multi-billion- pound project to create the NHS's first ever national computer system "isn't working and isn't going to work", a senior insider has warned.
The damning verdict on the ambitious 20 billion pound plans to store patients' records, and allow people to book hospital appointments, on a central computer network has been delivered by a top executive at one of the system's main suppliers. Andrew Rollerson, the health-care consultancy practice lead at the computer giant Fujitsu, warned that there was a risk that firms involved in the project would end up delivering "a camel and not the racehorse that we might try to produce".
His bleak assessment was delivered in a speech on the health service's national programme for IT that he delivered to a conference of computer experts last week and which is reported in today's Computer Weekly magazine. Fujitsu is one of the main firms involved in the project after winning a 896 million pound contract to deliver systems in the South of England.
Mr Rollerson underlined his message with a series of downbeat slides, including one showing a huge oil tanker being hit by a tidal wave, one with the word "Lost?" alongside a picture of a desert island and one with a man walking a tightrope. Another slide declared "visionary leadership is still missing" alongside the famous World War One poster of Lord Kitchener declaring "Your country needs you". His presentation even featured a picture of a huge alligator with the message "We have become obsessed by the alligators nearest the boat." The final slide showed two women mud-wrestling and asked: "Where would you rather be?"
In his speech, Mr Rollerson voiced concern at the direction of the NHS programme and the lack of vision on how the health service can make best use of new technology. "What we are trying to do is run an enormous programme with the techniques that we are absolutely familiar with for running small projects. And it isn't working. And it isn't going to work," he told his audience. "Unless we do some serious thinking about that - about the challenges of scale and how you scale up to an appropriate size - then I think we're out on a limb."
Mr Rollerson added: "There is a belief that the national programme is somehow going to propel transformation in the NHS simply by delivering an IT system. Nothing could be further from the truth. A vacuum, a chasm, is opening up."
His comments are the latest sign of problems in the ambitious project, which is expected to cost the taxpayer around 7.6 billion more than estimated. Last year it emerged that there had been 110 "major incidents" involving the system in just four months. A letter signed by 23 leading computer scientists urged the Commons health select committee to launch an inquiry to "establish the scale of the risks" facing the project.
Stephen O'Brien, the shadow health minister, said: "Even those from inside the programme are now telling the Government that it is coming apart at the seams. "This is another example of the heavy-handed, top-down failing approach of this Labour Government."
The Department of Health last night insisted that the programme was a pivotal part of NHS reform. [How unwise to say that!] A spokesman said: "David Nicholson, the chief executive of the NHS, is fully committed to the national programme for IT as it is a necessary part of modern health service. "He sees this as one of his key strategic priorities as it is key to the successful delivery of patient centred care."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Tuesday, February 13, 2007
If bird flu grips Britain, NHS doctors will need guns
The NHS will be unable to handle a pandemic
Towards the end of the film Dr Strangelove, Peter Sellers discusses who will go into the mines to survive. A surreal echo came for myself and colleagues recently when we were in discussions about planning for a bird flu pandemic in the UK as part of an ethics committee. If a true pandemic of bird flu hits these shores then our notions of what we can expect from the National Health Service will have to change. Some people will have to be denied potentially life-saving treatment: there simply will not be enough beds.
Managing such a pandemic is unimaginable. While it is possible to work out what will happen if a bomb goes off in central London - we can empty intensive care units, mobilise extra staff and stop elective work - what we cannot plan for is 200,000 extra patients who need a life support machine. Arnie Schwarzenegger, the governor of California, says his state will buy thousands more machines, but who will man them? A gut reaction is to blame the government for underresourcing. It is true that we have a chronic underinvestment in intensive care compared with the United States, Australia or other European countries. In any normal situation such a criticism would be valid, but in a pandemic it becomes a statistical irrelevancy.
Who will decide, and on what criteria, those getting the chance of survival? If you and a friend get bird flu and you both end up in hospital, the estimates are that within 48 hours one of you will need life support. At conservative estimates the need for intensive care will be about 2 times more than we can provide. Allocation of such resources will have to be either on a first come first served basis or on an explicitly utilitarian basis of capacity to benefit. This shift from an egalitarian free access to a limited one based on expected outcome represents a profound shift in how we deliver healthcare.
Exclusion criteria have already been drawn up in Canada and the United States and include such contentious issues as restriction based on age or on preexisting disease such as cystic fibrosis or metastatic cancer. Saying "no" to a desperately ill child with cystic fibrosis or to a previously fit 85-year-old is not something we are morally or emotionally prepared for. By an ethical analysis it may be the correct thing to do, but will patients or their relatives be prepared to accept it?
Such arguments may, of course, be purely academic. Assumptions as to what we can do are based on the doctors and nurses, porters and technicians turning up to work. But if we do not have enough masks to protect staff dealing with infected patients, then do the staff have a moral duty to turn up for work and get infected themselves? It may be that they go to work but only once - who will want to return home and potentially infect their own family?
In Victoria, Australia, it was suggested that patients would not go to the GP but to a "flu centre". The idea that patients would go to where flu is concentrated displays an astounding lack of comprehension of human nature. Similarly, staff will be reluctant to put themselves at risk. HSBC, the banking group, was accused of scaremongering when it announced that perhaps 40% of its staff would not turn up for work in the event of a pandemic, but the NHS may suffer just as badly.
It is not only the risk of infection that may stop staff turning up to work. With such limited access to intensive care, it would be expected that hospitals might not be safe places at all. If I decide not to ventilate someone, his or her relatives might not be too happy. Threats to staff are all too common and many are worried about personal security. Consequently it has been suggested that the decision as to who gets the intensive care bed should be taken away from frontline staff in order to protect them.
At a discussion over how we would react to a biological emergency, where casualties would be decontaminated before we resuscitated them, it was asked who would protect the staff. The answer given was hospital security. Pleasant and helpful as they are, these guys are hardly equipped to deal with an angry mob. One doctor said that the most useful thing staff could be given in such an event was a gun.
Another concern is the legal position of staff who refuse treatment. In the absence of any measures put in place to protect them, one can imagine a raft of legal actions being taken out against them. If attempting to allocate resources on the basis of capacity to benefit is the right thing to do, then those making the decisions need to be protected, otherwise people will not make the decisions required. Perhaps the only equitable and fair way is to shut the intensive care units and limit treatment to the best we can achieve without artificial ventilation.
Source
Australia: Entrenched and rigid bureaucracy driving away public hospital staff
More than 12 per cent of clinical staff at Queensland Health quit in 16 months, The Sunday Mail can reveal. While the State Government trumpets a successful recruitment drive, the latest figures reveal 4438 employees in the 36.000-strong workforce resigned between June 2005 and September last year - or 277 a month.
The Australian Medical Association said doctors were fed up trying to work in hospitals without enough beds or operating theatres. Queensland AMA president Zelle Hodge said: "It is so frustrating for staff, and eventually people just say they've had enough of it and leave. "Unless the culture in Queensland Health is changed, and the focus is on the people at the coalface and how they treat their patients rather than bureaucracy, then people will continue to resign." The Forster review, released in the wake of the Jayant Patel scandal at Bundaberg, said that unless the culture of secrecy and poor working conditions in Queensland Health was addressed, the high attrition of health-workers would continue to cripple the system.
One doctor who did not want to be named because Queensland Health has banned him from talking to the media. said he did not feel valued. "We are still chronically understaffed and people are so fed up with working long hours to combat the shortage that they are saying enough is enough, he said. "Queensland Health keep telling us they are addressing the problems, but it's just all talk. Nothing changes."
Figures show 1048 doctors and 2196 nurses resigned between July 2005 and September 2006. In addition, 1194 allied health professionals such as radiographers. occupational therapists and physiotherapists quit.
Queensland Health, which boasts of "caring for people" in its latest annual report, is advertising 407 jobs. Queensland University of Technology business researcher Megan Tones said: "To have 12 per cent of staff leave in just over a year is a huge amount. Obviously not enough is being done to retain staff.
But Joshua Cooney, spokesman for Health Minister Stephen Robertson, said the rate of resignations was "normal" for Queensland Health [So that is good??]. He said all the departing staff had been replaced, with an extra 2910 employed. ''The minister has spoken on many occasions about changing the culture in Queensland Health and that is what we're doing," he said.
Opposition health spokesman John-Paul Langbroek said Mr Cooney needed to stop the spin. "I am getting calls from doctors saying nothing's changed," he said. "The Government needs to start developing strategies to retain the professionals."
The above report by Hannah Davies appeared in the Brisbane "Sunday Mail" on February 11, 2007
***************************
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 Pages are here or here or here.
***************************
The NHS will be unable to handle a pandemic
Towards the end of the film Dr Strangelove, Peter Sellers discusses who will go into the mines to survive. A surreal echo came for myself and colleagues recently when we were in discussions about planning for a bird flu pandemic in the UK as part of an ethics committee. If a true pandemic of bird flu hits these shores then our notions of what we can expect from the National Health Service will have to change. Some people will have to be denied potentially life-saving treatment: there simply will not be enough beds.
Managing such a pandemic is unimaginable. While it is possible to work out what will happen if a bomb goes off in central London - we can empty intensive care units, mobilise extra staff and stop elective work - what we cannot plan for is 200,000 extra patients who need a life support machine. Arnie Schwarzenegger, the governor of California, says his state will buy thousands more machines, but who will man them? A gut reaction is to blame the government for underresourcing. It is true that we have a chronic underinvestment in intensive care compared with the United States, Australia or other European countries. In any normal situation such a criticism would be valid, but in a pandemic it becomes a statistical irrelevancy.
Who will decide, and on what criteria, those getting the chance of survival? If you and a friend get bird flu and you both end up in hospital, the estimates are that within 48 hours one of you will need life support. At conservative estimates the need for intensive care will be about 2 times more than we can provide. Allocation of such resources will have to be either on a first come first served basis or on an explicitly utilitarian basis of capacity to benefit. This shift from an egalitarian free access to a limited one based on expected outcome represents a profound shift in how we deliver healthcare.
Exclusion criteria have already been drawn up in Canada and the United States and include such contentious issues as restriction based on age or on preexisting disease such as cystic fibrosis or metastatic cancer. Saying "no" to a desperately ill child with cystic fibrosis or to a previously fit 85-year-old is not something we are morally or emotionally prepared for. By an ethical analysis it may be the correct thing to do, but will patients or their relatives be prepared to accept it?
Such arguments may, of course, be purely academic. Assumptions as to what we can do are based on the doctors and nurses, porters and technicians turning up to work. But if we do not have enough masks to protect staff dealing with infected patients, then do the staff have a moral duty to turn up for work and get infected themselves? It may be that they go to work but only once - who will want to return home and potentially infect their own family?
In Victoria, Australia, it was suggested that patients would not go to the GP but to a "flu centre". The idea that patients would go to where flu is concentrated displays an astounding lack of comprehension of human nature. Similarly, staff will be reluctant to put themselves at risk. HSBC, the banking group, was accused of scaremongering when it announced that perhaps 40% of its staff would not turn up for work in the event of a pandemic, but the NHS may suffer just as badly.
It is not only the risk of infection that may stop staff turning up to work. With such limited access to intensive care, it would be expected that hospitals might not be safe places at all. If I decide not to ventilate someone, his or her relatives might not be too happy. Threats to staff are all too common and many are worried about personal security. Consequently it has been suggested that the decision as to who gets the intensive care bed should be taken away from frontline staff in order to protect them.
At a discussion over how we would react to a biological emergency, where casualties would be decontaminated before we resuscitated them, it was asked who would protect the staff. The answer given was hospital security. Pleasant and helpful as they are, these guys are hardly equipped to deal with an angry mob. One doctor said that the most useful thing staff could be given in such an event was a gun.
Another concern is the legal position of staff who refuse treatment. In the absence of any measures put in place to protect them, one can imagine a raft of legal actions being taken out against them. If attempting to allocate resources on the basis of capacity to benefit is the right thing to do, then those making the decisions need to be protected, otherwise people will not make the decisions required. Perhaps the only equitable and fair way is to shut the intensive care units and limit treatment to the best we can achieve without artificial ventilation.
Source
Australia: Entrenched and rigid bureaucracy driving away public hospital staff
More than 12 per cent of clinical staff at Queensland Health quit in 16 months, The Sunday Mail can reveal. While the State Government trumpets a successful recruitment drive, the latest figures reveal 4438 employees in the 36.000-strong workforce resigned between June 2005 and September last year - or 277 a month.
The Australian Medical Association said doctors were fed up trying to work in hospitals without enough beds or operating theatres. Queensland AMA president Zelle Hodge said: "It is so frustrating for staff, and eventually people just say they've had enough of it and leave. "Unless the culture in Queensland Health is changed, and the focus is on the people at the coalface and how they treat their patients rather than bureaucracy, then people will continue to resign." The Forster review, released in the wake of the Jayant Patel scandal at Bundaberg, said that unless the culture of secrecy and poor working conditions in Queensland Health was addressed, the high attrition of health-workers would continue to cripple the system.
One doctor who did not want to be named because Queensland Health has banned him from talking to the media. said he did not feel valued. "We are still chronically understaffed and people are so fed up with working long hours to combat the shortage that they are saying enough is enough, he said. "Queensland Health keep telling us they are addressing the problems, but it's just all talk. Nothing changes."
Figures show 1048 doctors and 2196 nurses resigned between July 2005 and September 2006. In addition, 1194 allied health professionals such as radiographers. occupational therapists and physiotherapists quit.
Queensland Health, which boasts of "caring for people" in its latest annual report, is advertising 407 jobs. Queensland University of Technology business researcher Megan Tones said: "To have 12 per cent of staff leave in just over a year is a huge amount. Obviously not enough is being done to retain staff.
But Joshua Cooney, spokesman for Health Minister Stephen Robertson, said the rate of resignations was "normal" for Queensland Health [So that is good??]. He said all the departing staff had been replaced, with an extra 2910 employed. ''The minister has spoken on many occasions about changing the culture in Queensland Health and that is what we're doing," he said.
Opposition health spokesman John-Paul Langbroek said Mr Cooney needed to stop the spin. "I am getting calls from doctors saying nothing's changed," he said. "The Government needs to start developing strategies to retain the professionals."
The above report by Hannah Davies appeared in the Brisbane "Sunday Mail" on February 11, 2007
***************************
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 Pages are here or here or here.
***************************
Monday, February 12, 2007
Why health care isn't fair
Bush's health insurance plan would eliminate a pernicious tax preference
You may be wondering how President Bush's health insurance plan would affect you, the taxpayer. The answer depends on whether you have medical coverage, where you get it, and how much it costs. My family, for example, gets health insurance through my wife's employer, and it costs...actually, I have no idea what it costs. That's one of the problems Bush wants to address by eliminating the tax code's bias in favor of employer-provided medical coverage, which distorts the insurance market, promotes insecurity, and raises health care costs.
This bias was created more or less by accident. During World War II, businesses competing to attract scarce workers got around wage and price controls by offering health insurance instead of higher pay. In 1943 the Internal Revenue Service decided not to count this increasingly popular fringe benefit as taxable income, a policy codified by Congress in 1954.
In effect, notes John Goodman, president of the National Center for Policy Analysis, someone in the 25 percent income tax bracket may receive a subsidy of close to 50 percent for employer-provided medical coverage, once you consider state income taxes and the 15.3 percent payroll tax that funds Social Security and Medicare. If he buys insurance on his own, he typically gets no tax break at all.
The upshot is that most Americans get medical coverage through their employers, which is a strange situation when you think about it. People do not, as a rule, expect their employers to pay for their car insurance, their life insurance, or their homeowner's insurance. Why should employers pay for their health insurance?
In a system based on employer-provided insurance, people lose their medical coverage when they lose their jobs, a problem that becomes increasingly serious as they get older and sicker. At the same time, the seemingly free coverage makes health care more expensive for everyone.
Not only are you unlikely to know or care how much your employer spends on health insurance, but the coverage may be more generous than you would choose on your own, which means you are unlikely to know or care how much particular services cost. If you were using your own money to buy insurance, you might opt for a cheaper policy with a higher deductible, in which case you would be more conscious of things like the fee for an office visit or the difference in price between name-brand and generic drugs. Indifference to such considerations contributes to escalating health care costs.
Bush's solution to these problems is straightforward. He would reverse the policy of excluding health insurance from taxable income. To avoid an overall tax increase, he would give taxpayers with health insurance a standard deduction of $7,500 for individuals and $15,000 for families.
The White House estimates that 80 percent of taxpayers who get health insurance through their employers would receive tax cuts as a result of these changes because their coverage costs less than the deduction. (The average cost of employer-sponsored medical coverage last year was about $4,200 for individuals and $11,500 for families.) The other 20 percent would pay higher taxes, which might encourage them to seek less generous coverage and get more of their compensation in cash.
Everyone who buys his own health insurance would pay lower taxes under Bush's plan. Some people who currently cannot afford coverage might be able to swing it as a result of the tax break, which (in the example favored by the Bush administration) would amount to $4,500 for a family of four earning $60,000.
The complaint that changing the tax treatment of health insurance would encourage employers to stop providing it misses the point: If employers are offering medical coverage instead of extra pay purely for tax reasons, they should stop. Eliminating the pernicious preference for employer-provided insurance would promote a greater diversity of options and help people choose the coverage that makes the most sense for them.
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 Pages are here or here or here.
***************************
Bush's health insurance plan would eliminate a pernicious tax preference
You may be wondering how President Bush's health insurance plan would affect you, the taxpayer. The answer depends on whether you have medical coverage, where you get it, and how much it costs. My family, for example, gets health insurance through my wife's employer, and it costs...actually, I have no idea what it costs. That's one of the problems Bush wants to address by eliminating the tax code's bias in favor of employer-provided medical coverage, which distorts the insurance market, promotes insecurity, and raises health care costs.
This bias was created more or less by accident. During World War II, businesses competing to attract scarce workers got around wage and price controls by offering health insurance instead of higher pay. In 1943 the Internal Revenue Service decided not to count this increasingly popular fringe benefit as taxable income, a policy codified by Congress in 1954.
In effect, notes John Goodman, president of the National Center for Policy Analysis, someone in the 25 percent income tax bracket may receive a subsidy of close to 50 percent for employer-provided medical coverage, once you consider state income taxes and the 15.3 percent payroll tax that funds Social Security and Medicare. If he buys insurance on his own, he typically gets no tax break at all.
The upshot is that most Americans get medical coverage through their employers, which is a strange situation when you think about it. People do not, as a rule, expect their employers to pay for their car insurance, their life insurance, or their homeowner's insurance. Why should employers pay for their health insurance?
In a system based on employer-provided insurance, people lose their medical coverage when they lose their jobs, a problem that becomes increasingly serious as they get older and sicker. At the same time, the seemingly free coverage makes health care more expensive for everyone.
Not only are you unlikely to know or care how much your employer spends on health insurance, but the coverage may be more generous than you would choose on your own, which means you are unlikely to know or care how much particular services cost. If you were using your own money to buy insurance, you might opt for a cheaper policy with a higher deductible, in which case you would be more conscious of things like the fee for an office visit or the difference in price between name-brand and generic drugs. Indifference to such considerations contributes to escalating health care costs.
Bush's solution to these problems is straightforward. He would reverse the policy of excluding health insurance from taxable income. To avoid an overall tax increase, he would give taxpayers with health insurance a standard deduction of $7,500 for individuals and $15,000 for families.
The White House estimates that 80 percent of taxpayers who get health insurance through their employers would receive tax cuts as a result of these changes because their coverage costs less than the deduction. (The average cost of employer-sponsored medical coverage last year was about $4,200 for individuals and $11,500 for families.) The other 20 percent would pay higher taxes, which might encourage them to seek less generous coverage and get more of their compensation in cash.
Everyone who buys his own health insurance would pay lower taxes under Bush's plan. Some people who currently cannot afford coverage might be able to swing it as a result of the tax break, which (in the example favored by the Bush administration) would amount to $4,500 for a family of four earning $60,000.
The complaint that changing the tax treatment of health insurance would encourage employers to stop providing it misses the point: If employers are offering medical coverage instead of extra pay purely for tax reasons, they should stop. Eliminating the pernicious preference for employer-provided insurance would promote a greater diversity of options and help people choose the coverage that makes the most sense for them.
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 Pages are here or here or here.
***************************
Sunday, February 11, 2007
The bipartisan war on medical liberty
These days it sometimes seems like a foregone conclusion that we're going to have socialized healthcare in this country. This is quite a tragedy to contemplate.
America, for all its militarism and prisons, has had one sector where there has remained more room for freedom and less for bureaucratic power than can be seen in other Western nations: the healthcare industry. Some of these nations are much less cruel to foreigners and much less draconian with prisoners and outcasts, including those guilty only of victimless crimes. But there are some ways in which America still scores some major libertarian points over Canada and Sweden, and one of the most significant is that the US has not nationalized its healthcare sector. So for years after young Americans stopped fleeing to Canada to escape military slavery, Canadians have fled to America to avoid socialist medicine and rationing and pay cash to get operations they needed.
The conservatives have for decades rightly warned about socialized healthcare in America. It was a big goal of the communists, then the socialists, then the social democrats. Now it seems like a centrist policy goal.
National healthcare along with global warming was the progressive left's biggest issue, perhaps, before 9/11 forced them into their more libertarian stands on war and civil liberties. But they still want socialized medicine bad, as is apparent whenever you hear them defend practically any foreign government, no matter how dictatorial, so long as it finances clinics and penicillin for its subjects. The left still seems to oppose capitalism in healthcare more vociferously than in nearly any other area.
Not that America currently has a free market in medicine. First off, there is licensing, a horrible injustice by which the medical establishment protects itself by forbidding free competition. Then there're Medicare and Medicaid, which constantly deplete supply and inflate demand. And we must never forget the Food and Drug Administration, a corporatist agency that distorts the market, imposes huge costs on drug production and tramples the fundamental individual right to consume whatever one wishes to. In so doing, it has kept live-saving drugs off the market at the cost of many, many thousands of Americans dead.
America's healthcare system has long been a twisted hybrid between free enterprise and fascism. The fascist part - the part that destroys individual choice and empowers Big Pharma and the medical establishment - should be the part that leftists decry, but instead they have for the most part focused on our remaining medical freedom as the supposed ill. They are correct when they say America spends more than some other countries on healthcare, sometimes for less actual benefit to the consumer than people get under more egalitarian socialist systems. But this isn't America's free market at work; it's America's government. The only solution is freedom.
In any event, despite the many problems, there are pockets of medical liberty we still have that others don't, such as with the aforementioned operations that attract Canadian refugees. We would lose most of these remaining spheres of freedom if the left were to get its way.
The Republicans, for their part, have not mounted an organized resistance to nationalizing healthcare since gaining federal power. Far from it. With Bush's prescription drug program, Republicans saddled us with the largest expansion of medical socialism at the national level since the introduction of Medicare. In his last State of the Union, Bush did say some free-market-sounding stuff about tax deductions and health savings accounts - but he also alluded to something quite frightening: He wants the feds to dole out money to states that come up with programs to give free health insurance to the poor. This comes, perhaps not coincidentally, within weeks of Republican Governor Arnold Schwarzenegger's proposal for socialized health insurance for the poor in California, and to make it illegal not to have health insurance in the state. This medical despotism is a grave, horrific assault on the fundamental rights over one's personal life.
Unfortunately, the masses, generally more favorable to the market on other issues, have been duped by nonsensical arguments that healthcare prices are bound to rise steadily in a market economy, and only the government can fix the problem. Supposedly, technology and new innovations make rising costs inevitable - and yet in every other sector not so strangled by regulation, we see real prices drop and ever-increasing quality. Troublingly, the masses don't see how much of a role government has played in ruining healthcare.
Somehow, the left's healthcare agenda, which was seen as subversively collectivist and pinko fifteen years ago, has now become a popular priority and something top Republicans can talk openly about implementing over time. Indeed, the Republicans have already been giving us all the worst of Hillary-care, one piece at a time, and are poised to do more through "market-reform" gimmicks and with the state governments as proxies, along with some extra gigantic programs to protect the profits of their friends in the medical industry.
When you think about it, we shouldn't have expected medical freedom from the Republicans. How could conservative drug warriors, for example, really be enemies of the FDA? Take away the FDA's power to nationalize choices of what medicines and drugs one can consume, and the drug war disappears. Give the feds this kind of awesome power, and fascist or socialist medicine can't be too far away.
Leftists, on the other hand, have long been either clueless or disingenuous on these issues. They have called for more regulation of herbal supplements and alternative medicine, na‹vely thinking that anything worth promoting is worth getting the federal government interested in. They defend the FDA not realizing it is the twin of the DEA, as well as the great ally of the established pharmaceutical companies. Most hypocritically and unrealistically, the left claims to want freedom over their bodies even as they don't want the responsibility of taking care of them.
So the mainstream Republicans, almost all Democrats, and the ideological left are horrible on healthcare issues. Most moderates support moving toward more centralized control. We appear to be doomed for the short term on this issue. It is a supreme tragedy that America might lose what's left of its medical freedom. It would be one of our greatest domestic losses in some time.
What's more, if the US government becomes adamant enough, it could even use imperialism to spread its version of "healthcare freedom and democracy" around the world. Just as it has tried to push US labor regulations, US disability regulations, and, indeed, pharmaceutical regulations on the rest of the world, perhaps the US will become even more internationally belligerent in regard to the global democratic revolution of socialized medicine. A right to healthcare already made it into the US-approved Iraqi Constitution. The US already pressures virtually every other major country to accept its policy on drugs and pharmaceuticals - "regulatory harmonization" is the imperialist euphemism. And what if the US begins forbidding Americans from going abroad, such as to Thailand, as many of them already do, to get medical services less encumbered by paperwork and thus cheaper? What if the US tries to impose its hospital and licensing regulations on these other countries? What if socialized medicine is indeed a goal of world government, as the 1990s rightwing feared, and yet it will be implemented not by the men in blue helmets, but by soldiers donning Old Glory?
There are a million reasons we should have medical freedom, and they must be articulated if we are to avoid a disaster in the next several years. Libertarians must go beyond what we often hear from free-market wonks: the usual denial that there's anything wrong at all with the system, as if it's already a free market, and the usual defenses of the largest pharmaceutical companies as the most persecuted minority, what with its inflated, FDA-protected, federal-patent-ensured mega-profits under attack. We must mount a principled, radical and informed intellectual assault on the fascist and socialist threats to medical liberty if we are to restore it or even defend what's left of it.
The economics should speak for itself, but the right to control one's own life and body is the core, moral argument for medical freedom. Life and death are intimately involved with the healthcare issue as with few others. Unfortunately, for the time being, it appears that creeping healthcare totalitarianism is on the agenda of both parties. They only disagree on how fast to run us off the cliff, and who should navigate us there.
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 Pages are here or here or here.
***************************
These days it sometimes seems like a foregone conclusion that we're going to have socialized healthcare in this country. This is quite a tragedy to contemplate.
America, for all its militarism and prisons, has had one sector where there has remained more room for freedom and less for bureaucratic power than can be seen in other Western nations: the healthcare industry. Some of these nations are much less cruel to foreigners and much less draconian with prisoners and outcasts, including those guilty only of victimless crimes. But there are some ways in which America still scores some major libertarian points over Canada and Sweden, and one of the most significant is that the US has not nationalized its healthcare sector. So for years after young Americans stopped fleeing to Canada to escape military slavery, Canadians have fled to America to avoid socialist medicine and rationing and pay cash to get operations they needed.
The conservatives have for decades rightly warned about socialized healthcare in America. It was a big goal of the communists, then the socialists, then the social democrats. Now it seems like a centrist policy goal.
National healthcare along with global warming was the progressive left's biggest issue, perhaps, before 9/11 forced them into their more libertarian stands on war and civil liberties. But they still want socialized medicine bad, as is apparent whenever you hear them defend practically any foreign government, no matter how dictatorial, so long as it finances clinics and penicillin for its subjects. The left still seems to oppose capitalism in healthcare more vociferously than in nearly any other area.
Not that America currently has a free market in medicine. First off, there is licensing, a horrible injustice by which the medical establishment protects itself by forbidding free competition. Then there're Medicare and Medicaid, which constantly deplete supply and inflate demand. And we must never forget the Food and Drug Administration, a corporatist agency that distorts the market, imposes huge costs on drug production and tramples the fundamental individual right to consume whatever one wishes to. In so doing, it has kept live-saving drugs off the market at the cost of many, many thousands of Americans dead.
America's healthcare system has long been a twisted hybrid between free enterprise and fascism. The fascist part - the part that destroys individual choice and empowers Big Pharma and the medical establishment - should be the part that leftists decry, but instead they have for the most part focused on our remaining medical freedom as the supposed ill. They are correct when they say America spends more than some other countries on healthcare, sometimes for less actual benefit to the consumer than people get under more egalitarian socialist systems. But this isn't America's free market at work; it's America's government. The only solution is freedom.
In any event, despite the many problems, there are pockets of medical liberty we still have that others don't, such as with the aforementioned operations that attract Canadian refugees. We would lose most of these remaining spheres of freedom if the left were to get its way.
The Republicans, for their part, have not mounted an organized resistance to nationalizing healthcare since gaining federal power. Far from it. With Bush's prescription drug program, Republicans saddled us with the largest expansion of medical socialism at the national level since the introduction of Medicare. In his last State of the Union, Bush did say some free-market-sounding stuff about tax deductions and health savings accounts - but he also alluded to something quite frightening: He wants the feds to dole out money to states that come up with programs to give free health insurance to the poor. This comes, perhaps not coincidentally, within weeks of Republican Governor Arnold Schwarzenegger's proposal for socialized health insurance for the poor in California, and to make it illegal not to have health insurance in the state. This medical despotism is a grave, horrific assault on the fundamental rights over one's personal life.
Unfortunately, the masses, generally more favorable to the market on other issues, have been duped by nonsensical arguments that healthcare prices are bound to rise steadily in a market economy, and only the government can fix the problem. Supposedly, technology and new innovations make rising costs inevitable - and yet in every other sector not so strangled by regulation, we see real prices drop and ever-increasing quality. Troublingly, the masses don't see how much of a role government has played in ruining healthcare.
Somehow, the left's healthcare agenda, which was seen as subversively collectivist and pinko fifteen years ago, has now become a popular priority and something top Republicans can talk openly about implementing over time. Indeed, the Republicans have already been giving us all the worst of Hillary-care, one piece at a time, and are poised to do more through "market-reform" gimmicks and with the state governments as proxies, along with some extra gigantic programs to protect the profits of their friends in the medical industry.
When you think about it, we shouldn't have expected medical freedom from the Republicans. How could conservative drug warriors, for example, really be enemies of the FDA? Take away the FDA's power to nationalize choices of what medicines and drugs one can consume, and the drug war disappears. Give the feds this kind of awesome power, and fascist or socialist medicine can't be too far away.
Leftists, on the other hand, have long been either clueless or disingenuous on these issues. They have called for more regulation of herbal supplements and alternative medicine, na‹vely thinking that anything worth promoting is worth getting the federal government interested in. They defend the FDA not realizing it is the twin of the DEA, as well as the great ally of the established pharmaceutical companies. Most hypocritically and unrealistically, the left claims to want freedom over their bodies even as they don't want the responsibility of taking care of them.
So the mainstream Republicans, almost all Democrats, and the ideological left are horrible on healthcare issues. Most moderates support moving toward more centralized control. We appear to be doomed for the short term on this issue. It is a supreme tragedy that America might lose what's left of its medical freedom. It would be one of our greatest domestic losses in some time.
What's more, if the US government becomes adamant enough, it could even use imperialism to spread its version of "healthcare freedom and democracy" around the world. Just as it has tried to push US labor regulations, US disability regulations, and, indeed, pharmaceutical regulations on the rest of the world, perhaps the US will become even more internationally belligerent in regard to the global democratic revolution of socialized medicine. A right to healthcare already made it into the US-approved Iraqi Constitution. The US already pressures virtually every other major country to accept its policy on drugs and pharmaceuticals - "regulatory harmonization" is the imperialist euphemism. And what if the US begins forbidding Americans from going abroad, such as to Thailand, as many of them already do, to get medical services less encumbered by paperwork and thus cheaper? What if the US tries to impose its hospital and licensing regulations on these other countries? What if socialized medicine is indeed a goal of world government, as the 1990s rightwing feared, and yet it will be implemented not by the men in blue helmets, but by soldiers donning Old Glory?
There are a million reasons we should have medical freedom, and they must be articulated if we are to avoid a disaster in the next several years. Libertarians must go beyond what we often hear from free-market wonks: the usual denial that there's anything wrong at all with the system, as if it's already a free market, and the usual defenses of the largest pharmaceutical companies as the most persecuted minority, what with its inflated, FDA-protected, federal-patent-ensured mega-profits under attack. We must mount a principled, radical and informed intellectual assault on the fascist and socialist threats to medical liberty if we are to restore it or even defend what's left of it.
The economics should speak for itself, but the right to control one's own life and body is the core, moral argument for medical freedom. Life and death are intimately involved with the healthcare issue as with few others. Unfortunately, for the time being, it appears that creeping healthcare totalitarianism is on the agenda of both parties. They only disagree on how fast to run us off the cliff, and who should navigate us there.
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 Pages are here or here or here.
***************************
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