Monday, June 18, 2007

California health care plans are shaky

The political hoopla about extending health insurance to the 6.5 million Californians who lack it escalated this week -- including a much-hyped visit to the Capitol on Tuesday by propagandistic filmmaker Michael Moore, whose latest production, entitled "Sicko," deals with the issue.

Gov. Arnold Schwarzenegger has a plan, or at least an outline of a plan, Assembly Speaker Fabian N£¤ez has a plan, Senate President Pro Tem Don Perata has a plan and those to the left of the legislative leaders are backing still another plan by Sen. Sheila Kuehl for "single-payer" coverage. Even conservative Republicans are presenting health care plans of a sort.

Schwarzenegger continued to tout his version of universal care this week, telling a "town hall" meeting in Chico that "the bottom line is, we will do it (because we) all agree that it is a broken system and that we will fix it this year." The pledges from Schwarzenegger and Democratic leaders raise hopes among the uninsured and fears among the many factions in the state's $150 billion-plus health care industry.

The politics of the situation, however, are Byzantine, with "who pays" the central stumbling block, thus making it a full-employment situation for Capitol lobbyists. Schwarzenegger has adopted a "shared burden" strategy that taps consumers, employers and health care providers but shuns general taxes while N£¤ez and Perata would hit employers, and Kuehl's plan relies on broad income tax increases.

Even if one assumes that the countless political ramifications of health care could somehow be compromised -- a faint hope at best -- none of the principal political players wants to even talk about two immense legal impediments, one state and one federal, to any major expansion of health coverage in California.

Proposition 13, adopted by voters in 1978, not only reduced and limited property taxes, but imposed a rigid two-thirds legislative vote requirement for any increase in state taxes. That means that votes from stalwartly anti-tax Republican legislators would be needed to pass a health care plan that includes new taxes.

Schwarzenegger and legislative leaders have insisted that the billions of dollars in new levies on employers or health care providers they propose are "fees" and therefore exempt from the two-thirds vote mandate. But the argument is shaky on its face, and now the Legislature's own legal counsel has sided with Republican legislators and business groups in their contention that the levies are taxes.

Assemblyman Rick Keene, R-Chico, sought the legal analysis of Schwarzenegger's health plan from the legislative counsel's office. Deputy Legislative Counsel Linda Dozier responded with an 11-page dissection, concluding flatly that the levies on employers and health care providers "constitute a tax" under the state constitution and therefore would require two-thirds legislative votes. Dozier didn't analyze the Legislature's plans but there's no reason to believe that her conclusion wouldn't apply to them as well.

Last January, ruling on a Maryland plan, a federal appeals court said that a plan, aimed at Wal-Mart, requiring large employers to provide health care or pay into a health system violates the federal Employee Retirement Income Security Act, which was enacted in 1974 to protect employers from differing state-by-state benefit rules. Tellingly, Maryland Attorney General Douglas Gansler decided not to appeal to the U.S. Supreme Court, saying he could not win. Thus, state-level "pay or play" schemes such as those being proposed in California are likely illegal. Ultimately, all of the promises and hoopla expanding health care could be merely that -- and something of a cruel joke on those whose hopes for coverage have been raised.


Dangerous to get sick outside normal working hours in Britain

The British government is aware of the problem but has no idea how to deal with it

The shake-up of out-of-hours GP services was condemned as a 'shambles' yesterday. Patients who become ill at night or weekends have been left battling to find proper NHS care since GPs handed over responsibility to primary care trusts. Only one in 50 services is meeting the performance targets set to ensure patients get proper advice and treatment. The result, according to a damning report from MPs, is that patients have been left worse off.

Only doctors have 'done well' out of the deal, it says. Confusion over availability of out- of-hours services has also resulted in a ten per cent increase in emergency calls for ambulances in the past year. More patients, simply unsure where to turn, are arriving at hospital A&E departments.

The report, from the influential Commons Public Accounts Committee, says the Health Department took a back seat in negotiations over the new system that allowed GPs to stop working unsocial hours in return for relatively small pay cut of 6,000 pounds. Although the service introduced three years ago is now starting to improve, the performance of trusts against key targets is 'still not good enough', it says. Just 2 per cent of services comply with standards such as answering calls promptly.

The report follows concern over pay deals struck by the Health Department which have seen GPs' pay break the 100,000 pound barrier. The report also reveals soaring costs took the shake-up 70 million over budget - at a time when the NHS is axing jobs and patient services to save money. Before April 2004, GPs were responsible for out- of-hours patient care - between 6.30pm and 8am on weekdays and 24 hours at weekends and bank holidays. Now primary care trusts are responsible for around nine million patients receiving care out of hours in England each year. These services are provided by a range of organisations, including in-house trust teams, GP cooperatives and private companies. But they have been plagued with problems from the start, with patients complaining of delays and disorganisation.

One service came to prominence last year during the inquest into the death of Penny Campbell, a 41-year-old journalist from North London, who died of multiple organ failure in 2005. In the four days leading up to her death, she had six telephone consultations and two face-to-face meetings with doctors working for the service Camidoc. A coroner ruled that the doctors she saw contributed to her death by failing to recognise the seriousness of her illness. The PCT and Camidoc are undertaking a review.

The Public Accounts Committee chairman Edward Leigh, Tory MP for Gainsborough, said the new system had increased financial pressure within the NHS and the Department had failed to get value for money for the taxpayer. Costs have risen from the original estimate of 322 million to 392 million a year. The cross-party committee's report said: "We found that preparations for the new service were shambolic, both at the national and local level. "The department took part in the negotiation of the new General Medical Services contract only as an observer, and only the doctors did well out of the deal on out- of-hours costs." Mr Leigh added: "The new service is getting better. But the needs of patients are not best served by the ending of Saturday morning surgeries. "They are not best served where access to advice and treatment is often extremely difficult and slow."

Joyce Robins, co-director of Patient Concern, said: "It's a muddle. Patients have no idea what the service is supposed to be doing so they end up going to A&E."

Dr Hamish Meldrum, chairman of the British Medical Association's GPs' Committee, denied family doctors had benefited at the expense of patients. "We would reject the implication that GPs were the only ones to do well out of this deal and that the Government was not really involved. Family doctors had been taken advantage of for years, working long hours on the cheap."

A spokesman for the Department of Health said: "We are aware that some areas face more challenges than others, including in very rural and very urban areas, and we are determined to ensure that out-of-hours services in every area match the standards of the best."


Prof Brignell comments:

Now that the Englishman has joined sufferers in our Out-of-hours club, it is a suitable time to launch our very own neologism. Number Watcher Graham Dawson, having taken the precaution of marrying a classicist, is able to provide the word that Number Watch recently requested. It will not mean much to those who live outside Blair's Britain, but it means an awful lot to those who live under the tender care of the National Health Service (except those who did not survive, of course). Anyway, thanks to the negotiating skills of the Blair Team, this is the system that we now enjoy. So rally round you lexicographers and insert this in your entries:

Acairasthenephobia, Ah-kai-ras-then-eh-phobia, n, a fear of falling ill out of hours (Gr negative prefix A; cairo (or kairos) - right time; asthenes - ill; and phobia, qv).

Now the Greeks have a word for it. We hope that makes you all feel better.

Your bending author typed out the above piece, uploaded it and trundled off to bed. As eyes drooped and it was time to put the ancient paperback thriller under the pillow, a sudden thought intruded. My God! The BMA really DO think they put one over on the Government! After all these years they really think they are negotiating with the Government! They are so na‹ve that they still do not realise that negotiations are not just two-way; they are a sandwich, one that it arranged like this:

The Government - Sir Humphrey - The Rest

Like a farmed trout, they leapt at the luxurious barbed fly, rather than the scanty but nutritive live midge, just as they were meant to. A wily native fish would have been more circumspect. Why would they be offered a mere 6,000 pounds to provide an out of hours service? It was so derisory that it was never meant to be accepted. The BMA, being a trade union, were only thinking about money, but Sir Humphrey was thinking about power. What does it matter that the alternative is to provide a ludicrously expensive chauffeur driven, if ineffective, service. It is only money, and not even real money, just taxpayers' money. The alternative is to have medical professionals, rather than bureaucrats, in control of a vital part of the health service. Unthinkable!

The Government, in their turn, think they are negotiating with the medical profession, when they too are actually also negotiating with Sir Humphrey. Why are these bastards so intractable? We'll show 'em! We will set up our own system, however much it costs. What is a bit of misery and a few deaths when principle is involved?

The way the modern political system works is that ministers, who have never run anything in their lives, suddenly find themselves plunged into a jungle inhabited by, to catch the mood of the moment, feral beasts. It is particularly true of those women, the so-called Blair babes, whose token presence is an affront to the just cause of the liberation of women. They are lost, they fail, they are inadequate. People experience pain, they suffer, they die. So what? The system rolls on.


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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when is playing up, there are mirrors of this site here and here.


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