MEDICAID SOCIALIZES HEALTH CARE

Roughly a quarter of all taxpayer spending at the state level is now on socialized medicine in all but name. It's the largest single spending budget item in many a state capitol, says Jack Markowitz in the Pittsburgh Tribune-Review. In Texas, for example:

* Medicaid costs have doubled in the last decade and the program now covers 2.7 million people.

* The program now costs $17 billion and accounts for 26 percent of the state budget, including $6.7 billion in state funds and $10.5 billion in federal funds.

Nationally, it's not any better says Markowitz:

* In generous states, you could earn triple the poverty level, $61,332 for a family of four, and still be eligible.

* About 53 million people are covered, better than one out of six, and counting.

* Meanwhile, the total projected cost this year will be about typical, inflating another 6 percent, to $336 billion.

The program's original intent wasn't of the sort that's easy to attack. But states have tended to expand the eligibility, says Markowitz. Restricting it just to the poor lets out so many people who could use a break, elected officials figure. And ti doesn't bring in the max in matching funds from Uncle Sam, which can range as high as $3 for every $1 locally taxed.

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At last the NHS does something sensible

The NHS is turning its back on homoeopathy and other unproven alternative medicines in the face of a financial crisis and pressure from doctors. More than half of the primary care trusts (PCTs) in England are now refusing to pay for homoeopathy or severely restricting access a year after The Times revealed that 13 senior doctors had urged them to fund only therapies that were backed up by scientific evidence.

Figures obtained by Les Rose, one of the doctors, and The Times under the Freedom of Information Act show that at least 86 of the 147 trusts have either stopped sending patients to the four homoeopathic hospitals, or are introducing strict measures to limit referrals. Another 40 trusts have yet to provide data. More than 20 have taken action since receiving a letter organised a year ago today by Professor Michael Baum, a cancer specialist at University College London, which argued that "unproven or disproved treatments" such as homoeopathy and reflexology ought not to be available free to patients. The NHS should not be funding such therapies while it had to refuse or ration access to effective cancer drugs such as Herceptin and Velcade, the authors said. Financial issues have also contributed to the trend. The NHS overspent by œ547 million in 2005-06 and many trusts have made savings on homoeopathy to avoid cuts.

The move away from homoeopathy has been so significant that two homoeopathic hospitals are threatened with closure. West Kent PCT is consulting over plans to shut Tunbridge Wells Homoeopathic Hospital and the Royal London Homoeopathic Hospital (RLHH) has asked supporters to lobby trusts and MPs. London trusts have been particularly tough, partly as they have had to reduce some of the largest deficits in the country. Six trusts, including some of the RLHH's most important financial backers such as Barnet and Islington, have introduced referral management systems that will restrict spending. At least ten more from London and southeast England have cancelled their contracts.

Homoeopathy involves treating patients with substances that have been diluted so many times that there is often no active ingredient left. It is popular with members of the Royal Family but derided by most scientists. Research suggests that it has no benefits beyond being a placebo.

Doctors behind the original letter sent a second document to PCTs yesterday, providing a sample commissioning paper that many trusts have used to reduce homoeopathy funding. Gustav Born, Emeritus Professor of Pharmacology at King's College London, its lead author, said: "Progress has been slower than we'd like and there are still trusts that continue to use these unproven remedies through clinics and prescriptions. That is why we have written again to all the PCTs urging them to follow the commissioning example set by others."

Hilary Pickles, director of public health at Hillington PCT, said: "It isn't just that there is no evidence base for homoeopathy; it is also a question of spending priorities. Every time you decide to spend NHS money on one thing, something else is losing out. It is completely inappropriate to spend money on homoeopathy that is unproven, as it means less money for other treatments that are known to be effective."

One person who could benefit from a switch is Anne Fleming, 58, who had multiple myeloma diagnosed 2« years ago. She has been told that she will need treatment with Velcade, an anticancer drug that costs up to œ25,000 for eight cycles. Her primary care trust in South Cambridgeshire has diverted funds from homoeopathy to conventional medicine. She said that the NHS should also abandon non-essential treatments. "I feel very strongly about using public money on tattoo removal. Things on the national health should be about life or death," she said.

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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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