REALITY DAWNS IN CONNECTICUT

In a year when legislators pledged to cure the state's health care ills, the most ambitious plan of all would have the state fund coverage for everyone in Connecticut under age 65. But a staggering price tag - as much as $18 billion - left the plan on life support Monday, and legislators are virtually certain to pull the plug. The cost is slightly more than the entire state budget proposed by the governor. Without a cost affixed to it, the so-called single-payer plan was approved 12-7 by the legislature's insurance committee last month. It is awaiting action by the House of Representatives and the Senate.

The legislature's nonpartisan Office of Fiscal Analysis estimated the costs at $11.8 billion to $17.7 billion, depending on variables. Gov. M. Jodi Rell has proposed a state budget of $17.5 billion. The estimate sent shock waves through the state Capitol Monday, prompting key legislators to say that passing universal health care this year is unrealistic. "There are reality checks when you put a fiscal note to a bill," said House Speaker James Amann, a Milford Democrat. "There are some ideas that are so unattainable, so far out of reach, that you have to have a reality check."

Amann Monday evening said lawmakers would have to scale back plans to a level that is affordable over a sustained period. There is only "a very slim hope" that all of those currently without health insurance could be covered by the legislature this session, he said. Instead, Amann said he would work to improve access for children who have not been signed up for the state's HUSKY health insurance program. While the estimates vary, state officials say there are thousands of children who are eligible for the program and have not yet been signed up by their parents.

Among health care watchers in Connecticut, the estimate for providing health coverage for nearly 3 million people was the biggest topic of the day. The cost would be $17.7 billion if annual health insurance premiums were $6,000 per person; $11.8 billion if annual premiums were $4,000 per person. "Even we were quite shocked [by] the enormity of the cost. ... A lot of people are just scratching their heads and saying, `Wow!,'" said Eric George, associate counsel of the Connecticut Business and Industry Association, the state's largest business lobby.

The Republican governor does not support the "single-payer" option, saying that 94 percent of Connecticut residents are currently covered by programs such as Medicaid, Medicare, and employer-subsidized insurance. "Why would we spend $17 billion when the target we need to hit [the uninsured] is 6 percent of the population?" asked Christopher Cooper, Rell's spokesman. "The price tag is unrealistic. I'm sure that's going to have a chilling effect on the next committee to look at it - appropriations." The budget-writing appropriations committee is still crafting its formal response to the budget proposal Rell unveiled two months ago. The committee planned to finish its work this week with a wide variety of recommendations on spending - including health care.

Senate President Pro Tem Donald Williams, the highest-ranking senator, said he expects the committee to offer improved access to the HUSKY program for children, which many legislators believe is underused because eligible families have failed to sign up. Williams also expects to see more money for Medicaid reimbursements for doctors and hospitals, along with money for community health centers and school-based clinics. "On the one hand, $17 billion seems staggering, and it is," Williams said in the Capitol press room. "At the same time, the Connecticut Business Policy Council estimated that in Connecticut we spend $22 billion on health care costs each year - and that was in 2004 - for 3.5 million people." Williams conceded that the legislature will be unable to resolve all the issues by the time the legislative session ends at midnight on June 6. "No state has done what I would like to see us do, which is to have a Medicare-for-all type system," Williams said. "It will be difficult to get it all done this year."

Based on predictions made late last year, health care was supposed to be the predominant issue in this year's legislative session. But Rell has largely stolen the spotlight from the Democrats by offering a $3.4 billion, five-year education plan. She would fund it with a 10 percent increase in the state income tax, retroactive to Jan. 1. She dominated the news again by calling for a 3 percent spending cap on municipal budgets, with certain exceptions, to ensure that the increased state aid for schools would lead to property tax relief. Regarding HUSKY, Rell has said the number of children enrolled increased for eight consecutive months as nearly 9,000 children enrolled for the first time between July 2006 and March. Overall, more than 223,000 children are covered by the program. Cooper added that the state needs to focus on helping those who have not been placed in any state programs. "If 6 percent of the people need health insurance, the program should be focused on those 6 percent," Cooper said.

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Australia: Arrogant government ambulance service

The Victorian ambulance service has been the target of frequent complaints but, despite government huffing and puffing, it never seems to improve

PARAMEDICS have been accused of refusing to take a woman with a life-threatening brain aneurism to hospital because they believed she was drug-affected. The Metropolitan Ambulance Service is now examining a number of allegations that seriously ill patients have been refused transport. Premier Steve Bracks has called for an investigation. Others complaints involve a teenager with bile leaking behind her liver, a man with a burst stomach ulcer and a cancer patient who died. The MAS said human error or a failure to follow proper processes were probably the cause of any problems.

On November 26 last year, a 6mm aneurism burst in the front of Greensborough mother Melinda Fort's brain. Paramedics allegedly diagnosed her as drug-affected and refused to transport her. Her terrified 14-year-old daughter called a second ambulance five hours later. Ms Fort spent five weeks in intensive care. "All I want is those two drivers to come to my house, look me in the eye and apologise," Ms Fort said. "Even if I was a druggie I still wasn't well, so why wasn't I taken?"

Jade Olsen, 18, of Wantirna said she was denied an ambulance last Saturday when a paramedic told her by phone that the pain she was suffering after a gall bladder operation was not life-threatening. Her mother drove her to Knox Private Hospital, where she had emergency surgery to remove 500ml of toxic bile that had leaked behind her liver. "I'm pretty angry about it. It could have been somebody else with a much more serious matter that could have led to death," Ms Olsen said.

On March 20, Greta Galley called an ambulance for her terminally ill husband John, 72. But she said she was told his pain had to be assessed by a triage nurse first. She drove him to Frankston Hospital, where he died five days later. "It's not as if you call an ambulance for nothing," she said.

Mr Bracks urged the MAS to examine the cases, saying its resources were adequate. "If there are instances where triaging has not worked effectively . . . that will be investigated, and I have urged the MAS to (do so)," he said. MAS general manager of operations Keith Young said an investigation of Ms Olsen's complaint had begun and the others would be examined. "We certainly take these matters seriously. . . but . . . we receive a very small number of complaints. Many times, it is often a misunderstanding or not substantiated," he said.

Liberal health spokeswoman Helen Shardey said she'd be shocked if paramedics were trying to perform triage by phone rather than in person

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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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