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."

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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]

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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