Saturday, March 31, 2007

Single payer: is there anything it can't do?

Americans are a litigious people. We love to sue each other. We’re so eager to take our neighbors to court that, sometimes, we’ll file suit even when we don’t have a case. Doctors and hospitals are prime targets of the lawsuit industry. Hey, they cut people open on purpose at hospitals. It’s their job. Mistakes – real and imagined – can happen.

Some of us think this is driving up the cost of health care. Every lawsuit against a doctor or hospital means cost – legal fees, time lost, etc. A lost case or a settlement means the defendant has to pay the damages, or, more likely, the defendant’s insurance has to pay. Both defendant and insurance have to make a profit. Thus, the cost of lawsuits is reflected in the cost of health care. So. Tort reform. Lawsuit reform. Bringing some sanity to the legal system. Making it harder to pursue frivolous cases. Putting limits on punitive damages. Given the unrelenting wailing and gnashing of teeth over the state of American health care today, these are all legitimate ideas.

But the Tomah Journal takes it even farther. Instead of just reforming the legal system, they opine, let’s remove it from the equation entirely: "There’s a better approach: Join the rest of the industrialized world and establish single-payer universal health care. Billions of dollars worth of lawsuits would suddenly evaporate if lawyers could no longer haggle over million-dollar medical bills." That’s an interesting suggestion. Or, at least, an original one. They’re right: make it a single-payer system, and suddenly there’s nobody to sue. Your insurance company doesn’t have to pick up the tab for somebody else’s mistake.

Sure, there’d still be pain and suffering. Lost wages. That sort of thing. I’m sure the government would take steps to protect itself from lawsuits. Heck, they already do. When it’s the government being sued, suddenly limits on damage awards are in the public interest.

I’ll do the Journal one better: let’s nationalize all industry in the country. Because if government owns industry, “billions of dollars” of product liability lawsuits would “suddenly evaporate,” too. Anyone who’s been following the story of Walter Reed Army Medical Center – the veterans’ hospital that is treating its patients worse than the Marines at Gitmo treat their prisoners – knows just how well the government handles big things like health care. If that’s not enough, consider Great Britain’s National Health Service – an actual example of nationalized health care. Childbirth mortality has grown by 21% over the past three years.

"Record numbers of women are being harmed or dying as a direct result of childbirth in what doctors are labelling a "crisis" in maternity care.

The UK now has one of the highest rates of maternal mortality in Europe, with 13 deaths per 100,000. Britain ranks below countries including Poland and Hungary, and is above Bulgaria, Bosnia, Belarus, Romania, Armenia and Albania."

And the Tomah Journal may want to read this part (emphasis added):

"The scale of the maltreatment has led to soaring medical negligence claims from mothers. The bill to the NHS has hit 1 billion pounds for the past five years. Two-thirds of the 100 largest payouts by NHS trusts for medical negligence are now to women who have suffered traumatic childbirth experiences…"

Yep, sounds like socialized, nationalized, single-payer health care is just the answer we need.

Nobody claims our system of delivering health care is perfect. It’s not. But expecting government to make the imperfect perfect is like expecting Randy Moss to make the Packers a playoff team. You’re just exchanging one set of problems for another. Over time, our government will expand on the services covered by a nationalized health care plan. Little by little by little, every time another tragic tale of an uncovered illness or injury emerged, the program will get that much bigger.

And as more and more people realize they can go to the doctor as much as they want for free, they’ll start doing just that. Which means more bills piling up for the single payer – government – us - to pay. Which leads to government trying to contain costs. Which leads to…well, read that story in The Independent again. It all leads to that.



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Friday, March 30, 2007

NHS crisis is forcing cuts to maternity care, charity warns

Support for pregnant women is being cut because of the NHS's financial troubles, a healthcare charity has warned. The National Childbirth Trust (NCT) says it is receiving "increasing reports" that NHS antenatal classes, breastfeeding services and postnatal visits are being cancelled.

NHS antenatal classes have been cut or suspended in at least 10 areas in England and Wales, according to the NCT. These are Romsey in Hampshire; Worcestershire; Newham in London; Watford; Gwent in south Wales; south-west Kent; Nottinghamshire; Gloucestershire; Hemel Hempstead in Hertfordshire; and Wiltshire.

The NCT said it also understood that postnatal home visits have been stopped or are facing cuts in Wiltshire and in east and north Hertfordshire, which would mean new mothers have to travel to a clinic in order to receive after-birth care. An NCT spokeswoman said: "These cuts in maternity services may reflect a more widespread pattern. "The NCT is concerned that these short-term measures to ease financial deficits are having a negative effect on new parents and parents-to-be, preventing them from getting the information and support they need at this important stage in their lives."

The Department of Health (DoH) said it expected local NHS trusts to follow guidelines set down in the children's national service framework which says good antenatal care will include access to parenting education and preparation for birth "as classes or through other means".

A DoH spokesman said: "The soon-to-be-published maternity strategy will set out how we will achieve services that provide real choice and support for women in all settings, from antenatal care through to the early child years."



There's a gazillion ways the body can break down, and some folks want every last one of them covered by insurance. And if that weren't enough, we're seeing pressure to cover things that don't threaten health. Such things as birth control, fertility treatments, Viagra, abortions, sex change operations, cosmetic surgery; what folks once called non-essentials and electives. Expanding the number of things covered by insurance increases demand.

All of which redounds to this: EVERYONE with health insurance is going to be filing a claim. That's a hyperbole of course, as there are a few genetically blessed individuals who neither get sick nor need sex change operations. But the statement is close enough for government work. And it is a violation of the basic laws of the insurance business.

But wait. It gets better. There's a movement afoot to insure EVERYONE. We're talking about adding 46.6 million souls to the insurance rolls. Many of the uninsured are either unemployed or unemployable, and those who are employed have employers who cannot afford to pay for their health insurance. So it will fall to the taxpayer to pick up the tab. Life expectancy continues to rise, which means we have more time in which to file claims. And California governor Schwarzenegger wants to insure illegal aliens.

Bottom line: We have "unlimited" demand for a product in limited supply-and someone else is supposed to pay for it.

HOW can the health insurance business survive?

Well, it's not supposed to. At least that's the position of the political left, which wants to nationalize healthcare. The left doesn't like the baggage that comes with "national healthcare" and "socialized medicine". They prefer to talk about "universal healthcare", "single-payer", "social insurance", or some other softer-sounding thing. But it's all the same thing.

NYTimes columnist Paul Krugman posits the "starve the beast" strategy of the right. But there's a leftist analog: "ride the beast into the ground". That is, load up so many mandates and requirements on the beast-the health insurance business-that it collapses and folds. Then the socialists step into the breech like white knights and save the day with their government system. The reason one might believe such a conspiracy theory is because the socialist reformers aren't putting forth any serious proposals to keep costs down, and without such the beast will indeed buckle, collapse, and go out of business.

Part of the solution to the problem of escalating healthcare costs is simple-reduce demand. Get healthy, so you don't have to use the healthcare system. Change your "lifestyle", go on a diet, start exercising, stop smoking, moderate your drinking, and give up the drugs. Indeed, if America were to have a universal single-payer healthcare system, wouldn't it be everyone's duty to get healthy so that we can get healthcare costs down? But are the healthcare reformers going to demand that folks do the right thing and start taking care of themselves so that healthcare costs don't spiral further out of control? They aren't-because they can't. And that is the dirty little secret of the reformists.

The government can't be constantly monitoring everybody, making sure they eat their spinach, and walk their 5 miles a day. It would involve a mammoth bureaucracy. Besides, people have a right to be unhealthy. They have a right to eat whatever the heck they want, and in super-sized portions. They have a right to gorge on trans-fats, swill booze, smoke cigs, dip snuff, or whatever, and to their hearts' content, and if it ruins their health-tough. Folks aren't going to change their "lifestyle" just so some utopian universal healthcare system can be made feasible. And if the feds try to take away the sole pleasures in our dreary little lives, there'll be hell to pay and a nice revolution to boot. People have a right to be irresponsible, as long as it doesn't hurt anyone else. But what the utopian reformists don't understand and won't accept is that the rest of us-the tofu-eating, jogging, responsible rest of us-shouldn't have to subsidize irresponsibility and bad behavior by paying the medical bills of the slobs. Escalating healthcare costs due to self-inflicted diseases and imprudent "lifestyle" are going to "run the beast into the ground".

Are there any conservatives out there?

The new universal healthcare plans enacted in Massachusetts and proposed in California require individuals to purchase health insurance. Despite what they tell you, this is not analogous to requiring auto insurance; folks can choose not to drive, and some are unable to drive or are not allowed to. No, this requirement is of a different order altogether; it's worse than a poll tax-it's an existence tax. But if government can demand that individuals buy health insurance for themselves as well as pay taxes for those who can't afford to buy it, shouldn't government at least be able to demand that individuals improve their "lifestyle" and habits so that those who are paying won't have to pay so much? We've been down this road before, during Prohibition. Is America really ready for it again? Just what kind of fascist police state are you willing to put up with?

So it appears that universal healthcare is going to require the responsible, prudent, taxpaying adults amongst us, who delay gratification and regularly save and invest for the future, to subsidize with their taxes behavior they would never countenance in themselves. The reformers think folks should be able to lead a life of dissipation and then check in at the nearest hospital saying, "fix me", and that you should pay for it. But aren't the socialists forcing the taxpayer to take part in immorality? It seems a bit much to ask.

And another thing: Just how "comprehensive" is universal healthcare supposed to be? Are those getting a free ride supposed to get the very same healthcare as those who pay? Is every unemployed, homeless cirrhotic wino supposed to get a liver transplant? And will they be put at the back of the waiting list? How much are we willing to pay for the psychiatric care for the drug-addled underclass? What are the healthcare reform grandees going to require of these people to keep costs down? These are the kinds of the questions that must be answered by the reformers.


David Walker, the U.S. Comptroller General, the nation's top accountant, is horrified by the actuarial nightmare imposed by entitlements. Walker told Steve Kroft of CBS News: "the real problem, Steve, is health care costs. Our health care problem is much more significant than Social Security." Walker assures us that our present course with entitlement spending is unsustainable and immoral. But socialists want more.

Entitlements account for an ever-growing share of the federal budget; way over half. Entitlements, after having "run the beast into the ground", will run the federal government into the ground. In trying to make government a cornucopia, the reformers simply lack the ability to say "no". Instead of throwing yet more money at this problem, we should instead institute a "freeze" or a budget cap on entitlements. Which could involve means testing or cross-the-board cuts. We should also institute a mechanism that requires all redemptions of federal "trust fund" treasuries to come only out of general fund surpluses (if any), which this writer has urged here.

The federal government, including its entitlement programs, operates entirely on a cash-flow basis. Incoming revenue is immediately spent. If there's a surplus, the feds must spend it as well; e.g., by retiring debt. Medicare isn't amassing reserve funds for your next round of chemotherapy; the money will come from future tax revenue. The federal government has no legal mechanism to save money. The so-called "trust funds" are full of nothing but IOUs.

But corporations and individuals can't operate like the feds; they must set money aside. Folks who don't trust the feds to be there for them, or who are offended by the way the feds operate, or who want to be assured that funds will be waiting for them when they need it, should be allowed to opt out of federal programs....

More here


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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Thursday, March 29, 2007

British man denied "too expensive" heart surgery

Health insurance that isn't

A seriously ill man has been told he cannot have a potentially life-saving operation on the NHS because his local primary care trust will not pay for it. Paul Carter, 66, of Malvern, was told by a specialist he needed biventricular pacing fitted for his enlarged heart. But Worcestershire Primary Health Care Trust has refused, saying the advanced pacemaker surgery would cost 8,000 pounds. It said it could not afford the 400,000 pounds it would cost each year to provide the surgery to patients.

The primary care trust's Dr Richard Harling said: "Any funding would have to come from other services. "For the PCT to justify introducing (biventricular pacing) we would have to be sure that it was a better use of this money than our other local services."

Mr Carter's wife Marjorie said: "We are very upset. Working all your life and having to face an operation and then you can't get it done is a bit distressing."

The National Institute for Health and Clinical Excellence (Nice), which offers guidance to primary care trusts over whether a treatment is cost effective, is due to make a decision over the treatment in July. The Department of Health said, until Nice's guidance was published, the final decision on funding lay with individual trusts.


Wonder drug NHS bosses can't afford to offer cancer victims

CASH-strapped NHS bosses are denying thousands of Midland kidney cancer patients two new 'wonder drugs' that could prolong their lives. A Birmingham oncologist has likened the scandal surrounding Sutent and Nexavar to that of breast cancer treatment Herceptin, which was denied to sufferers until a public outcry last year. Professor Nicholas James revealed that Midland health chiefs are refusing to fund some of his patients with the kidney cancer treatments, licensed for use in Britain last August.

Trials have shown that Sutent and Nexavar can offer patients a dramatic improvement in quality of life - and increase life expectancy by two years. That compares favourably to Interferon-alpha, the kidney cancer treatment currently available on the NHS, which lengthens lives by just five months on average.

But Sutent and Nexavar cost 3,000 pounds a month to fund, and have not yet been approved as 'cost-effective' by the National Institute for Clinical Excellence (NICE). As a result, funding decisions are currently being taken by individual Primary Care Trusts (PCTs), who are said to be rejecting most NHS patients. Kidney cancer sufferers are so desperate to experience the drugs' life-extending benefits that they are cashing in pensions and selling homes to fund the treatment themselves.

Prof James, a clinical oncology expert from Birmingham University's Wellcome Institute, said: "Around 6,000 people in Britain are diagnosed with kidney cancer every year, and it kills up to 4,000 people every 12 months. "Initially, you can be treated with radiotherapy, chemotherapy and surgery. But, until August last year, if it came back there was no hope. "The approval by the Medicines and Healthcare products Regulatory Agency (MHRA) of Sutent and Nexavar, licensed last August, has changed all that.

"It was a big step forward in terms of treatment options for kidney cancer patients. "But although the drugs had been approved by the Agency, NICE has not yet given them the go-ahead as being cost-effective for NHS patients. "This is where our problem lies. We have drugs available to treat our patients, but they are not routinely available on the NHS because they have not been approved by NICE. "This means I have some patients who were involved in the trials for these drugs who can continue treatment. "But others have to rely on decisions of their individual PCTs to see if they will fund them.

"When this happened with Herceptin, there was a huge uproar. NICE eventually approved the drug. "Up to 40,000 women are diagnosed with breast cancer each year in Britain, so the numbers affected were far greater and they could kick up a bigger fuss. "Meanwhile, there are thousands of kidney cancer patients who could benefit from these new drugs, but who are finding it difficult to make their voices heard."

Two men for every woman is diagnosed with kidney cancer, which tends to affect those aged from 30 to 60. Prof James added: "It's a ridiculous situation. If a drug is approved by the MHRA, it should automatically be approved by NICE. "It is unfair that some patients can have access to the drugs, which have proved to be highly effective at prolonging life and improving life quality, yet others aren't.

"It is a ghastly decision for the PCT to have to make. "There are several Midland patients who can't afford the drugs, while others have remortgaged their homes and cashed in their pensions so they can be treated."

Radio presenter James Whale, who has kidney cancer, is backing the campaign to have Sutent and Nexavar offered free to NHS patients. "In the past, people with advanced kidney cancer had little hope," he said. "Now, drugs like Sutent and Nexavar are their only chance of precious extra months of life."

A Department of Health Spokesman said: "Our guidance makes it clear to NHS organisations that they should not refuse to fund a treatment simply because NICE guidance does not yet exist. "Until NICE has issued final guidance on a treatment, NHS bodies should continue with local arrangements for the managed introduction of new technologies, taking into account all the available evidence."



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Wednesday, March 28, 2007

Democrat’s strange healthcare mathematics

As I was reading about the Democratic candidates forum in Nevada yesterday, I realized that both Bill Richardson and John Edwards need some math help. Both claimed that for between $90 and $120 Billion dollars a year they can provide “universal health care” for America. Now, the WaPo and website don’t make it clear if that price is for all 320 million of us, or just the 46 million without health coverage. Either way, these guys need to look at their numbers, and to give them the benefit of the doubt, I’ll use the premise they are only talking about the uninsured. If I speculated that they were going to cover all of us then it becomes too funny to think about.

Back to the math, if either or both are only talking about the 45 million or so without coverage, that means that they are going to get Medicare to cover them for about $2600 per year. Currently Medicare covers just over 30 million people with a budget of $300 Billion. That comes out to $10,000 per year per person covered. How exactly are they going to get that number cut by 75%?

And, if it’s possible to do that, why not just lower the cost for everyone covered? Using their claimed numbers from yesterday we should be able to cut the Medicare budget by 1/3 from it’s current level and still cover the 76 million uninsured and elderly who would be eligible.

Universal health care polls great. Folks love the idea of everyone being covered, and no worries about health care. The truth is though, universal coverage isn’t going to come cheap, and it’s not going to come easy.

More here

Strange NHS priorities

Tom and Donna (not their real names) are professional shamen. They teach classes in shamanism at a “foundation”, where you can learn “soul retrieval healing”, help the dead “continue their journey into the Hereafter”, and investigate “the Fairy Kingdom”. These soul retrievers and Fairy Kingdom investigators also work for the NHS — where, according to Tom’s foundation profile, they “use complementary therapies to help those with mental health difficulties”.

Shaman therapies are not the only unorthodox treatments for which the NHS will gladly pay. Taxpayers are also subsidising Emotional Freedom Technique (EFT) “therapy”, in which, according to one NHS trust, “subtle energies” are reordered via “tapping with the fingertips to stimulate certain meridian energy points while the client is ‘tuned in’ to the problem”. The inventor of EFT notes on his website that he “is not a licensed health professional”, which doesn’t stop him promoting it as an effective treatment for diabetes — unsurprising, since it works for “just about every emotional, health and performance issue you can name”.

If EFT doesn’t do the job, an NHS foot massage might help. Reflexologists believe that each part of the foot maps to a different organ, and that massaging a particular point can treat that organ. Medical doctors think it’s absurd. This is not to say that the NHS doesn’t have a sceptical side — even it is dubious about homeopathy, pointing out that “no evidence has been found” to support the key homeopathic principle that water retains a “memory” of molecules that have been filtered out of it, and that pure distilled water is an effective treatment for a host of conditions.

Since the NHS believes that the entire basis of homeopathy is “contrary to scientific knowledge”, the obvious question becomes: why is it funding five homeopathic hospitals? Most depressing of all for the rational taxpayer is the NHS Directory for Alternative and Complementary Medicine, which aims to promote “dowsers”, “flower therapists” and “crystal healers”.

We’ve just learnt that some hospitals are removing every third light bulb to save money, and that nurses are being paid half the minimum wage — or being asked to work for nothing — at others. That’s how bad the financial crisis has become. Meanwhile, the National Health Service is employing shaman fairy enthusiasts as psychological counsellors, enthusiastically providing treatments invented by “an ordained minister and a personal performance coach” who thinks tapping your body can cure diabetes, promoting dowsers and crystal healers and spending vast amounts on therapies that can’t be scientifically supported.



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Tuesday, March 27, 2007

Whose life is it anyway?

University of Virginia student Abigail Burroughs died of head and neck cancer at age 21 on June 9, 2001. She died while fighting to gain access to promising experimental anti-cancer drugs recommended by her oncologist at Johns Hopkins University Hospital. Her father, Frank Burroughs, founded the Abigail Alliance for Better Access to Developmental Drugs and sued the Food and Drug Administration, arguing that terminal cancer patients have a constitutional right to try to gain access to developmental medicines that the agency has not yet approved.

In May 2006, the Alliance won its case before the U.S. Court of Appeals for the District of Columbia which ruled that "barring a terminally ill patient from the use of a potentially lifesaving treatment impinges on this right of self-preservation." The Appeals Court sent the case back to District Court to consider if the protected liberty interests of terminally patients outweigh the FDA's interest in insuring the provision of safe and effective drugs. Yesterday, March 1, the full Appeals Court reheard the case at the request of the FDA.

Earlier this week, the Food and Drug Law Institute held a colloquium, "Whose Life Is It Anyway?," on the issue. Scott Ballenger, the lawyer who is representing the Abigail Alliance before the Appeals Court, noted that the legal question before the court is what standard should apply to the case. Is trying to gain access to potentially life-saving medicines unapproved by the FDA a fundamental right or merely an economic right subject to regulations established by political authorities? Can the government properly assert that it has a compelling interest to deny dying patients access to potentially life-saving drugs?

Ballenger compared the situation to self-defense. "Self defense is the most obvious and self-evident rights of men," he asserted. "No state can deny someone self-defense in the face of an attack." Ballenger argued that if the law recognizes that people have the right to defend themselves from attack by a bear or infectious bacteria, then surely they have the right to defend themselves against a rogue cancer cell.

At the colloquium, food and drug lawyer Richard Cooper agreed that the issue is whether some rights are so fundamental that we do not entrust them to decisions made by elected officials. Until recently, establishing agencies to regulate the safety and efficacy of drugs was thought to be within the purview of Congress. "I doubt that most people thought that they had a constitutional right to buy investigational drugs," said Cooper. "It's a wholly new, unheard of right with no antecedents in Anglo-American law." If people want to change the way the FDA regulates patient access to investigational drugs, Cooper argued, they can petition the FDA and Congress and eventually vote out members of Congress who refuse to change the regulations.

Cooper noted that the Supreme Court ruled in 1979 that cancer patients did not have a constitutional right to access the cancer treatment laetrile. The court reasoned that access to the drug might be restricted on the grounds that laetrile had not passed the hurdle of FDA safety testing. However, the Alliance argues that this ruling does not apply because it is asking only for the same right of access enjoyed by those terminally ill patients who are lucky enough to be enrolled in an FDA-approved efficacy trial.

Ballenger continued that federal courts have recognized a number of fundamental rights and not all of them deal with life and death issues, including the right to teach your children German, educate them in private school, live with family members under one roof, view pornography at home, and engage in homosexual sodomy. Some other fundamental rights recognized by federal courts are the right to interracial marriage, to use contraception, to worship, and to obtain abortions.

University of Pennsylvania bioethicist Arthur Caplan pointed out that it was difficult to figure out who qualifies for the category "terminally ill." He also asked wyhy terminal illness in and of itself should give a patient a privilege or a right. After all, a patient who has exhausted standard treatments for some kind of severe disability, say, Parkinsonism, macular degeneration, or dementia, could argue that they have a right to access potentially better drugs that the FDA has not yet approved.

Scott Gottlieb, who has just stepped down as deputy commissioner at the FDA, thinks that "terminal patients should have access to experimental drugs after exhausting other treatments" He noted that FDA bureaucrats are concerned that opening access to investigational drugs to terminal patients might imperil the agency's ability to collect good data on drug safety and efficacy. They think that they are balancing individuals' interests in getting cutting edge treatments now against society's interest in obtaining more information in order to get more drugs to more people eventually.

Gottlieb noted that there is a marketplace issue. Companies have a disincentive to offer access outside of clinical trials. Why? Because side effects or other adverse events would be reported from patients who had not met the criteria for clinical trials. The companies fear that an already hyper-cautious agency would use such adverse event reports from outside of clinical trials as a justification for slowing the approval of a drug. Gottlieb told the colloquium that many inside the FDA believe that it is more important and better for society in the long run to gain good clinical data about a drug than it is to try to save the lives of individual patients. "I don't think the choice is that stark," said Gottlieb. "The FDA could pursue both goals."

Gottlieb asserted that the FDA is failing to use its authority to strike a balance on this issue. He suggested that the agency could start to develop alternatives to randomized placebo controlled clinical trials, perhaps incorporating Bayesian techniques. The FDA could also develop and validate surrogate clinical endpoints so that results can be known sooner than the results from trials that rely on long term survival rates. Gottlieb pointed out that new cancer drugs are rarely held up on safety grounds, so research should focus more quickly on efficacy. He does worry that the agency has begun to refuse to approve drugs that have fewer side effects but are less efficacious than earlier more brutal treatments. The agency fears that patients would trade off a higher risk of dying for fewer side effects. Why mentally competent people in consultation with their physicians should not be allowed to make such tradeoffs is not at all clear.

Mark Gately, a Baltimore attorney who defends pharmaceutical firms, pointed out another big issue in this debate -- the fact that federal law forbids a patient using experimental drugs from waiving negligence. Gately litigated the case involving patients enrolled in clinical trials for the drug GDNF, developed by Amgen to control Parkinsonism. The clinical trial did not find the drug to be efficacious, but many patients, who believed that they did benefit from it, sued the company demanding continued access to it. The company refused because it was worried by research that showed that the drug caused some brain damage in monkeys. According to Gately, a Kentucky judge asked the lawyer who represented two of a clinical trial participants, "What happens when one dies?" The lawyer answered, "They know what they are getting into. There will be no lawsuit." The judge replied, "This is America. If one dies, there will be a lawsuit." The bottom line for Gately: "Drug companies will be hard pressed to provide these drugs unless they are provided some protection from legal attacks."

For Frank Palumbo, who is the executive director of the University of Maryland's School of Pharmacy Center on Drugs and Public Policy, the central question is: "If patients are allowed access to these investigational drugs for the purpose of treating terminal illness, how can they afford them?" Newer cancer therapies are very expensive, some costing $10,000 per month.

After the somewhat dispassionate presentations of the panelists, representatives from the Abigail Alliance made themselves heard during the question and answer period. Steve Walker, the chief advisor to the Alliance explained what had happened to Abigail. She had exhausted all of the approved therapies. Her oncologist believed that the then-investigational anti-cancer therapy, Erbitux, being developed by ImClone might work for her because the drug was targeted against the EGFR receptor that encourages cancers to grow. Abigail's cancer had a very high EGFR expression. Despite preliminary evidence that it was an effective treatment for head and neck cancer, she did not qualify for clinical trials which were being run at the time only for colon cancer. The FDA approved the drug for treating head and neck cancer in March 2006. Erbitux boosts average head and neck cancer survival rates by about 2 years.

Walker noted that the current clinical trial system was devised 50 years ago in an era of medical ignorance. Today, researchers use genomic information to develop targeted drugs. Walker pointed to a current clinical trial involving a drug that early trials show works "unbelievably well" against metastatic kidney cancer. According to Walker, the FDA is insisting on randomized placebo controlled trial for approval. "Everyone knows the drug works," said Walker. So the end result is that the cancers in patients enrolled in the placebo end of the trial will have gotten worse by the time the FDA approves the drug in the next 4 or 5 months.

Ballenger pointed out that the American Society of Clinical Oncology (ASCO) had actually made the argument in its amicus brief in the current Abigail Alliance suit that terminal patients are desperate so they can't give informed consent, yet somehow ASCO also argues that such desperate patients can give informed consent to participate in clinical trials. Is ASCO willing to sacrifice patients who might benefit from investigational treatments in order to maintain a pool of research subjects? Ballenger said, "I do not think that this is an ethical line of argumentation."

Ballenger added, "I am more than happy to concede that the FDA has a compelling state interest to protect medical progress if the FDA can prove that expanded access to investigational drugs will imperil clinical trials. The fact is that most trials are over enrolled and that most people asking for expanded access don't qualify for the trials anyway. Standing in the way of expanded access is just perverse."

Abigail's father Frank Burroughs wrapped up the presentation for the colloquium participants. "Every drug that we've pushed for early access to over the past six years--all are now approved by the FDA." Thousands died waiting for the FDA bureaucracy to let cancer drugs that would have lengthened and perhaps even saved their lives onto the market. Perhaps finding that mentally competent terminal cancer patients do have a fundamental right to access investigational drugs will finally spur the FDA to stop clinging to an outdated mid-20th century cancer clinical trial system and embrace one more suited to the 21st century science. The millions of us who will one day develop cancer had better hope so.


Australia: Amazing bureaucracy stymies vital checks on foreign doctors

Since overseas-trained doctors, mainly from India, have done great harm to Australian patients (including deaths) this is a matter of considerable importance

Plans to establish a national system to rigorously assess the competence of overseas-trained doctors have stalled after the NSW Government rejected a range of measures backed by the other states and territories. The recommendations include standardised supervision guidelines for all overseas-trained doctors and the creation of an independent body to assess doctors' qualifications and clinical skills.

"All the jurisdictions have signed off on the improved standards to assess doctors trained overseas, bar one," said Australian Medical Association president Mukesh Haikerwal. "I don't know why NSW is dragging its feet."

The Council of Australian Governments announced in July last year that new nationally consistent guidelines to assess doctors would replace the ad hoc state-based systems. Overseas-trained doctors working in Australia are normally assessed by the Australian Medical Council. However, doctors who come from countries with similar medical systems to Australia's can enter the country on temporary visas and are not required to take the AMC's examinations if they agree to work in an area of need.

A report commissioned by the Howard Government, but never released, found more than 3500 doctors enter Australia every year on temporary visas and are given jobs without having their competence assessed by the AMC. The report recommends that all overseas-trained doctors should undergo a standardised assessment process before commencing work in this country.

Lesleyanne Hawthorne, associate dean international of the University of Melbourne's faculty of medicine and author of the report, warned that it was unlikely all the states would agree on how doctors should be evaluated. "The idea of getting uniform screening standards that every state will sign up to is a pipedream, because the states are competing with each other to attract overseas-trained doctors," Dr Hawthorne said.

The NSW Department of Health would not explain why it opposed the changes. "The commonwealth and the states are still in discussion on the matter to develop final proposals for agreement by health ministers," the department said in a statement. "NSW continues to work closely with other states and territories to ensure doctors from countries which have been assessed as having equal standards to Australia do not face unnecessary restrictive barriers to employment."



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Monday, March 26, 2007

Increased Canadian government health-care spending not helping

The federal government has provided provinces with an extra $36 billion in transfers for health care since 1997, yet Canada's health care system is in worse shape now than it was 10 years ago, according to a new report by the Fraser Institute. Consider:

* Between 1980 and 1997, federal transfers for health care spending were relatively stable, and from 1988-89 to 1997-98, the average annual growth rate in federal health care transfers was 1.4 per cent.

* But starting in1997-98, spending ballooned to 12.9 per cent, when just 3.1 per cent would have been required to keep pace with population growth and inflation.

* In total, the federal government has provided the provinces with $234.5 billion in cash transfers for health since 1980-81, but more than half that amount -- $115.7 billion -- has come since 1997-98.

Meanwhile, says the Institute:

* In 2006, the average Canadian could expect to wait 17.8 weeks from the time of a referral from a General Practitioner to the time a specialist delivered the treatment required, compared to 11.9 weeks in 1997; a nearly 50 percent increase.

* Total wait time for treatment was the result of a 72.5 per cent increase in the wait time to see a specialist after referral by a general practitioner, and a 32.4 percent increase in the wait time to receive treatment after an appointment with a specialist.

* The wait time for a CT scan increased from 4.1 weeks to 4.3 weeks between 1997 and 2006 while the wait time for an MRI scan went from 9.6 weeks in 1997 to 10.3 weeks in 2006 -- indicating that additional funding has not improved technology.

Source: "Canadian health care system shows little improvement despite extra $36 billion in federal transfers since 1997," CNW Group, March 13, 2007.


Australia: New mothers badly treated in government hospitals

A CRISIS in Queensland's maternity service is leaving one in three mothers traumatised and endangering the health of their babies. A Sunday Mail investigation has revealed shocking lapses in care in overcrowded maternity units, with mothers going into labour in corridors and others pressured into having unnecessary caesarean deliveries. Poor post-natal care has led to some women needing emergency hysterectomies after developing avoidable infections.

A new study by Jenny Gamble, state president of the Australian College of Midwives, has found 30 per cent of mums experience symptoms of psychological stress after giving birth in Queensland hospitals. Lobby group the Maternity Coalition said overcrowding was now a problem statewide following the closure of 38 maternity units. In rural Queensland, a different study shows five women a week give birth before reaching a hospital with specialised maternity care.

The State Government was warned of the appalling state of maternity services two years ago, but midwives say it has so far failed to help frontline staff or their patients.

A Sunshine Coast couple have launched a court action against Queensland Health, alleging their son was born with cerebral palsy as a result of an emergency caesarean. On Thursday, an inquest was told that a young Brisbane mother suffered a fatal brain haemorrhage after another caesarean delivery.

Maternity Coalition president Joanne Smethurst said Australia's standard of care was almost "Third World". "The health of mothers and babies is suffering every day, but the Government has wasted two years doing nothing," she said, adding that hospitals were encouraging women to be induced and undergo caesareans because of a shortage of midwives and beds. Queensland has a caesarean rate of 32 per cent. The World Health Organisation recommends 10-15 per cent. Dr Gamble, who also runs the midwifery program at Griffith University, wants a community midwife scheme introduced: "We know what the problems are, we just need the Government to get on with it."

Since 1995, Queensland Health has received 20 reports on the state of its maternity services. The most recent, presented by the department's maternity services steering committee, said action was needed to improve care for women in rural areas and called for the introduction of post-birth care for all. In the past two years, the steering committee has spent almost $1 million on paperwork to prepare for the creation of yet another committee on the crisis. Steering committee chairwoman Cherrell Hirst said State Cabinet still had to approve the second committee and would make a decision by the end of the month.

She said it could be four years before any improvements in care were seen. "Stage one was setting up the interim committee, ahead of establishing the second committee," she said.

Opposition health spokesman John-Paul Langbroek said the situation was outrageous. "We get review after taskforce after investigation, and meanwhile services suffer," he said. A spokeswoman for Queensland Health said "moves are under way" for change. The Gold Coast Health Service District Birthing Centre, opened in May 2006, offers an "alternative model of care for birthing", but nothing has been rolled out state-wide



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Sunday, March 25, 2007

Republican Rx: GOP alternatives to HillaryCare

It's been mostly doom-and-gloom days for Republicans--a lost majority, Iraq, U.S. attorneys, soul-searching over just what happened to the party of Reagan. So it's worth noting a new intellectual debate that's rumbling to life in the party wings, one that could signal whether the GOP is capable of rediscovering its free-market principles.

That debate is about the future of health-care reform, and it got some momentum this week when Oklahoma Sen. Tom Coburn released a big-ideas blueprint for restructuring the entire health-care system--the tax code, Medicare, tort liability, insurance laws--along free-market lines. Dr. Coburn's plan builds on the White House's own bold proposal in January to revamp tax laws so as to put consumers back in control of their health-care decisions. Both plans are about fundamental, bottom-up health-care reforms, cast in the language of markets, consumers and individual control.

They're also the polar opposite of the health-care "reforms" that won GOP Govs. Arnold Schwarzenegger and Mitt Romney media huzzahs this past year, and have thus captivated no small few in the Republican party. The state plans are heavy on regulation, wrapped in red tape, and happy for taxes, though much of the bad has been squeezed behind a few fig leaves of market reform. This is mini-me Republicanism, but it has also allowed its creators to boast that they are offering "universal coverage"--a phrase that polls fabulously.

Which side wins? Who knows. But what is clear is that the scrap has come at a crucial moment. Americans are howling for relief for spiraling health-care costs and companies are drowning in doctor bills. Yet until recently, Democrats have been alone in offering a comprehensive answer to the problem: government-run health care. These liberals never offer details about the extraordinary costs, the miserable service, the wait lines, the Walter-Reed-like facilities, but then again, they don't have to. They have an easy-to-describe "plan," which is more than can be said of the other party.

This has led to some glumness in conservatives ranks, and a feeling that the debate has already been lost. That pessimism helps explain the Schwarzenegger and Romney programs, both of which ape the left's mantra of "universal coverage." Yet all that underestimates just how much intellectual progress conservatives have made since 1993 and the HillaryCare debate, when they were forced to start thinking seriously about health issues.

Conservative health-care guru John Goodman remembers going to Washington in the early 1990s to get Republicans interested in individual health savings accounts, and "only about five guys would even meet with me," he recalls. Now, HSAs "are a religion" among the right, he notes, and Republicans used their last years in the majority to significantly expand access to these accounts. In the past 15 years, the GOP has also planted the roots of Medicare reform, looked at interstate trade in health insurance, and got behind competitive Medicare reforms in their states.

The recent White House and Senate proposals are meant to package these ideas into a more unified, free-market whole. Mr. Coburn, like the White House, would remove the subsidy corporations get for health care, and instead give the money to individuals--putting them in charge of their health expenditures. It would expand HSAs, and allow consumers to buy insurance from any state, thereby avoiding costly regulations. It would modernize Medicare, allowing workers to invest their payroll taxes into a savings account and control their care in their retirement years. It would free up the states to inject Medicaid with new flexibility and competition.

There's plenty of big ideas in these new proposals over which conservatives can argue. Do they get behind tax rebates (… la Coburn) or tax deductibility (… la President Bush)? Do you leave medical liability to the states, or intervene with federal legislation to set up state "health courts"? Or do they write all this off as too hard a political sell, and run for the Schwarzenegger "universal coverage" cover?

The important thing is that debate equals education, which equals understanding, which equals precisely what the GOP needs right now. The Heritage Foundation's Mike Franc says Republicans are still too preoccupied with health-care small-ball--which procedures should be covered by Medicare, how much should generics cost--to get their heads around the broader subject. "This is still outside their intellectual comfort zone, and Republicans never do well in that situation," he says. "But to win this debate--the defining issue of the next 40 or 50 years--they're going to have to address it forcefully, head-on, and with every bit of their intellectual firepower."

You'd have thought the right would have figured this out by now, given its success at reframing other policy issues. When Republicans railed about welfare queens, they were viewed as the heartless party. When they turned the debate into one about the vicious cycle of dependency and poverty that welfare causes, they captured voters' imagination--they captured even Bill Clinton's imagination--and pushed through entitlement reform. Today, even the left agrees welfare-recipients should work.

Americans similarly tuned out the GOP's gripes about federal education spending, and reasonably so. All parents knew was that their kids were failing, and that Democrats were warning that fewer dollars would make things worse. Only when the GOP reframed the debate, and explained that this was a question of competition, of accountability, of greater parental choice, did they tap into long-held American ideals. Flowering charter schools and vouchers are one result. Ted Kennedy's admission that standards matter is another.

Those on the free-market side are starting to understand the need for a new language, especially if they are to coax more nervous elements of their party into embracing radical change. When President Bush unveiled his health-care tax overhaul in the State of the Union, he stressed that health-care decisions needed to be made by "patients and doctors," not government or insurance companies. Mr. Coburn's bill summary is littered with the words "choice," "empowerment," "competition," "flexibility," "control"--which is not only an honest assessment of what his proposal would provide, but one with which Americans can identify.

With Democrats running the show, Republicans now have the quality time to hash through this debate, and if they're smart, that'll be a priority. The left is so confident it owns the health-care issue, and so bereft of creative ideas, it risks squandering its advantage--just as the GOP lost its own credibility on fiscal restraint. But first, Republicans need to figure out what they believe.



Long claimed as why socialism is superior to "chaotic" private enterprise

NHS planning has been a disastrous failure, leading to an uncontrolled boom in the workforce followed by a bust in budgets, a report by MPs says. The health service set out in 1999 to recruit 20,000 more nurses by 2004 but hired 67,878 - 340 per cent over target. It also recruited twice as many GPs as planned and 69 per cent more health professionals, such as physiotherapists. As the inflated workforce had to be paid, hospitals and trusts plunged into deficit, the Commons Health Select Committee report says. Now posts are being left empty or lost, and a few NHS workers are being made compulsorily redundant. More than half of newly qualified physiotherapists have failed to find work in the NHS.

The MPs are scathing about the failure to maintain a link between staff numbers and the money available to pay them. Instead of raising productivity to meet targets, the NHS "threw new staff into the task rather than consider the most cost-effective way of doing the job", the report says. It calls the staff expansion "reckless and uncontrolled" and says that funding increases were often seen as a blank cheque for recruiting new staff. There is also criticism of generous contracts. "Large pay increases were granted without adequate steps being taken to ensure increases in productivity in return," it said. The committee urged the Government to make workforce planning a priority [When will they ever learn?], and for an end to constant health service reorganisation.

Stephen O'Brien, the Shadow Health Minister, said: "Top-down workforce targets imposed by Labour have created confusion amongst NHS staff. Patients are bewildered about where all the money has gone, and hard-working staff are losing confidence by the day in Labour's stewardship of the NHS."

The British Medical Association did not entirely endorse the report, however. Sam Everington, its deputy chairman, said: "While agreeing wholeheartedly that integrated workforce planning must be a priority... we do not agree that the expansion of the medical workforce was reckless and uncontrolled and that pay increases for doctors have not seen a return in productivity. "The UK is still critically short of doctors and the BMA has always believed that government goals to increase doctor numbers were too low."

Andy Burnham, the Health Minister, said: "While the pay contracts cost more than we or the trade unions and professional associations first anticipated, we must remember that we were setting right an NHS system with widespread recruitment difficulties. We have been able to eliminate these and reward hard-working professionals with the pay they deserve."



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Saturday, March 24, 2007

Dirty NHS hospital kills patient

And a coverup fails. How many more deaths from negligence is this hospital concealing?

A father of three died after he contracted an infection from a hospital shower on the day that he was due to be discharged after successful treatment for leukaemia. The hospital had failed for many years to act on guidance about the safety of its ageing hot water system, a court was told. The failure led to Daryl Eyles, 37, contracting legionnaires’ disease from a dirty shower head. He had just been told that he was in complete remission after enduring months of chemotherapy. At Bath Magistrates’ Court, the Royal United Hospital (RUH) in Bath admitted two charges of failing to act on safety warnings.

Jennifer Gunning, chairwoman of the bench, said: “Guidance was available for more than ten years, but this was blatantly not followed. The RUH management was inadequate. Mr Eyles died as a result of those failings and many other vulnerable patients were put at risk.” Referring the case to Bristol Crown Court for sentencing, she said: “We believe this to be so serious that our sentencing powers are not sufficient.”

Mr Eyles, a security guard at Bath University, had leukaemia diagnosed in August 2003 after developing a painful abscess while on holiday in Cyprus. The cancer went into remission after his first course of chemotherapy, but he was told that he needed two more sessions to make sure that it did not come back. He spent Christmas at home with his family before returning to the hospital for his final session in January 2004.

His wife, Andrea, 31, had previously told how her husband was desparate to get home and had tried to discharge himself early but was advised to wait a few days. She said: “I saw him after he finished his chemotherapy and he just wanted to come home. He felt fine and was looking forward to getting back to work. “He said he had more chance of catching something in hospital than he did at home, but the doctors advised him to stay in hospital.”

On February 7 Mr Eyles took a shower at the William Budd Oncology Unit, where he was being treated. He became ill and was prescribed antibiotics, but they failed to prevent his death a week later. Doctors initially told Mrs Eyles that her husband had died of pneumonia and septicaemia. She discovered the true cause only after taking legal action. An investigation found that the shower head was contaminated with Legionella bacteria. She said: “I just wanted to know the truth about what happened and I’m furious that it took legal action to get it.” The couple, from Bath, had two children: Georgina, 10, and Mitchell, 8. Daryl also had a son, Christopher, 14, from a previous relationship.

After the hearing Mark Davies, the chief executive of the Royal United Hospital Bath NHS Trust, said: “The RUH took this incident extremely seriously and we have learnt from this very sad case. “We were all shocked by the sudden death of Daryl Eyles in February 2004. The trust accepted liability in October 2004 and has since reached a settlement in response to the family’s claim. At the time the trust fully cooperated with the Health and Safety Executive and has complied with all its recommendations to minimise further risk of Legionella.” The hospital trust will be sentenced on March 29.


Mixed-sex wards fury in Australia too

It's a big issue in British government hospitals

QUEENSLAND Health has been accused of robbing patients of their dignity by forcing men and women to share hospital wards. Doctors say the practice has become widespread across the state because of the chronic bed shortage in public hospitals. The state has fewer beds than it did 10 years ago - even though its population has grown by one million.

One nurse who protested over the opening of a mixed-sex unit at her regional hospital said: "The patients don't like it, but many of them are elderly and don't like to complain. "Vulnerable patients rely on us for care but the system has no respect for them. "It astounds me that anyone could ever think this was acceptable."

A 45-year-old female patient said she was appalled to be placed with two men in a four-bed bay when she was admitted to the Royal Brisbane and Women's Hospital. "A friend of mine had discharged herself when she was put in a mixed ward," she said. "I thought it couldn't be that bad - until I was put in one myself. One of the men had dementia and kept getting out of bed and undressing in front of me. "It was embarrassing for me and demeaning for him. "I'm no prude, but mixed-sex wards cannot be justified."

Dr Ross Cartmill, a urologist at Brisbane's Princess Alexandra Hospital and a spokesman for the Australian Medical Association, said: "The problem occurs at every hospital with a bed shortage - which is most hospitals. "Patients growl about it, but most think it's just better to have a bed than none at all."

Opposition health spokesman John-Paul Langbroek warned that mixed-sex wards could open patients to allegations of voyeurism and inappropriate behaviour. Chief Health Officer Jeannette Young said it was more efficient to place patients in mixed wards if they required specialist treatment, such as cardiac and neurological care. "All hospitals understand the need to be sensitive to their patients whilst being flexible, so that they can provide a bed for every individual who needs one," Dr Young said.



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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Friday, March 23, 2007

National health insurance: A medical disaster

Affordable health care has become one of the most important social issues of our time. Every news broadcast seems to have a special report on “America’s health care crisis” or a politician demanding “universal health insurance.” Evidence cited for the need for immediate and drastic government action includes:

High medical costs. The United States reportedly has the highest per capita medical expenditures of any country in the world. According to Insight magazine, U.S. citizens spent an average of $2,051 on health care in 1990, compared to $1,483 for Canadians and $1,093 for West Germans.

Rapid increase in medical expenditures. The average American now spends 11.1 percent of his income on medical care. If current trends continue, health care will consume over 17 percent of the Gross Domestic Product within 15 years.

High administrative costs. In the U.S., administrative costs consume nearly 12 percent of health dollars compared to one percent under Canada’s socialized system. More than 1,100 different insurance forms are now in use in the United States.

Americans without insurance coverage. At any given time, over 13 percent of Americans have incomes that are too high to qualify for Medicare or Medicaid, but are too low to pay for medical insurance themselves.

The free market in health care, we are told, has failed. The solution offered by a growing chorus of commentators and candidates is universal, mandatory, national health insurance; in other words, socialized medicine. Is socialized medicine the answer, or will it only make things worse?

How Well Has Socialized Medicine Worked Elsewhere?

Most of the developed countries of the world presently have some form of socialized medicine. How well has it worked?

Great Britain. Great Britain adopted socialized medicine in 1948, with the creation of the National Health Service (NHS). The political rhetoric in Britain exhorting the adoption of nationalized health insurance is similar to what we are heating in the U.S. today. In 1942, Prime Minister Winston Churchill declared:

The discoveries of healing science must be the inheritance of all . . . . Disease must be attacked whether it occurs in the poorest or the richest man or woman, simply on the ground that it is the enemy . . . . Our policy is to create a national health service, in order to secure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal Opportunities to benefit from the best and most up- to-date medical and allied services available.

With the adoption of national health insurance, Labour Minister Dr. David Owen predicted, “We were going to finance everything, cure the nation and then spending would drop.” Unfortunately things didn’t work out exactly as planned.

The first problem with Britain’s National Health Service was skyrocketing demand. With health care paid for entirely by the government, there was no reason not to go to a doctor. Why take aspirin or wait out a cold, when professional medical care is free? As Michael Foot observed, within months “the demand [for health care] was exceeding anything [its creators] had dreamt of.” First-year operating costs of NHS were 52 million pounds higher than original estimates.

NHS soon found itself in direct competition for funds with national defense, pensions, and all other governmental functions. Budget cuts for NHS quickly followed. British economists John and Sylvia Jewkes estimated that between 1950 and 1959 the United States spent six times more per capita on hospital construction than England. As a result, there was a steady deterioration in the quality of British medical care.

By 1977, British general practitioners rarely had any medical instruments except for stethoscopes and blood- pressure meters. They had to send their patients to hospitals even for such routine procedures as X-rays and blood tests. The waiting time for routine, non-emergency surgery had increased to years. By the mid-1970s, more than 700,000 English men, women, and children were on hospital waiting lists at any given time. The average British doctor now has over 3,000 patients, compared to 500-600 for the average American doctor. NHS doctors spend an average of less than five minutes with their patients, who usually wait hours to see them.

In 1975 Bernard Dixon, then editor of the British magazine New Scientist, provided this summary of the state of National Health Insurance:

The plight of Britain’s Health Service conflicts desperately with the avowedly utopian ideals of its founders. For most of us, it is only when we join a year-long hospital waiting list, or have to take an injured child to a hospital casualty department, that we realize just how threadbare and starved financially the service really is. Not only is there an acute shortage of resources, but the expertise and facilities that are available are all too often dispensed via a conveyer-belt system which can at times be positively inhuman.

As a result of widespread public dissatisfaction, in 1989 the British government began dismantling its National Health Service, and reintroduced mar-ket-based health care competition.

Canada. What of the Canadian National Health System, which many U.S. politicians are now championing as a less expensive and more efficient alternative to our supposed free market system?

Canada has had socialized medicine for 20 years, and the same pattern of deteriorating facilities, overburdened doctors, and long hospital waiting lists is clear. A quarter of a million Canadians (out of a population of only 26 million) are now on waiting lists for surgery. The average waiting period for elective surgery is four years. Women wait up to five months for Pap smears and eight months for mammograms. Since 1987, the entire country spent less money on hospital improvements than the city of Washington, D.C., which has a population of only 618,000. As a result, sophisticated diagnostic equipment is scarce in Canada and growing scarcer. There are more MRIs (magnetic resonance imagers) in Washington State, which has a population of 4.6 million, than in all of Canada, which has a population of 26 million.

In Canada, as in Britain under socialized medicine, patients are denied care, forced to cope with increasingly antiquated hospitals and equipment, and can die while waiting for treatment. Canada controls health care costs the same way Britain and Russia do: by denying modern treatment to the sick and letting the severely ill and old die.

Despite standards far below those of the United States, when variables such as America’s higher crime and teenage pregnancy rates are factored out, and when concealed government overhead costs are factored in, Canada spends as high a percentage of its GNP on health care as the United States. Today a growing chorus of Canadians, including many former champions of socialized medicine, are calling for return to a market-based system.

The Worldwide Failure of Socialized Medicine

Throughout the world the story is the same: socialized medicine results in skyrocketing demand for nominally “free” health care, doctors are overburdened, medical services steadily deteriorate, and there are endless waiting lists for health care. In the Soviet Union before the collapse of Communism, anesthetics, painkillers, and most drugs were rationed; 57 percent of hospitals had no hot running water; and it was standard practice to clean needles with steel wool and reuse them. In New Zealand, which has a population of just 3 million, there is a waiting list of 50,000 for surgery.

Socialized medicine doesn’t even fulfill its promise of equal access to treatment regardless of ability to pay. For example, in Canada “a small child with a skin rash is 22 times more likely to see a dermatologist if the child is living in Vancouver [a major city] than in the East Kootenay district [a remote rural area].” In Brazil, “residents of urban areas experience nine times more medical visits, 15 times more related services, 2.7 times more dental visits and 4.5 times more hospitalizations,” than do rural dwellers.

Throughout the world, there are more and more refugees from socialized medicine. Middle-class Canadians flock across the U.S. border to avoid waiting months or years for routine procedures. In England a system of private, quasi-legal clinics has developed to care for patients who can no longer tolerate the abysmal medical services provided by national health insurance. In Russia, desperate patients bribe doctors and secretly visit them after hours to get decent treatment and scarce drugs.

Socialized medicine, like all forms of socialism, has been a world-wide failure. As people throughout the world from the Soviet Union to South America are learning, socialism cannot work. Socialism is fundamentally incompatible with human nature.

Socialism fails bemuse it denies and degrades our essential humanity by treating us as objects. Socialized medicine takes away our control over our own health and body, and gives that power to the state. Under a socialized medical system, the government, • not you or your doctor, decides what treatments, doctors, and drugs you get. If you don’t like the service the government gives you, your only alternative is to flee to another country or to break the law and bribe a doctor. Under socialized medicine, the exercise of free choice becomes a crime.

Even after it destroys quality health care and individual liberty, socialized medicine still cannot achieve equal treatment for all. When planners try to make all people equal, they confront the inescapable paradox of equality: Abolishing inequality requires massive government power. But power by its nature is unequal: there are those that have it and those that do not. Giving government the power to make everyone equal necessarily creates the worst form of inequality: that of master and subject. In practice under socialized medicine, those with more money and friends in the government get vastly better health care than those without power and connections.

Socialized medicine will not work any better in the United States than it has in England, Canada, Russia or elsewhere. Consider just the economics of socialized medicine in the U.S. Medicare and Medicaid costs are already skyrocketing out of control. State governments cannot afford the 20 percent of theft budgets that Medicare and Medicaid now consume. Where will government get hundreds of billions of dollars more for national health insurance? A complete Canadian-style national health insurance system for the U.S. would initially cost over $339 billion and require that payroll taxes be nearly doubled, or require a new, national 10 percent business tax.

Socialized medicine does not work, but has the free market failed as well? If freedom works, why is American health care now in crisis?

Government Intervention and Health Care Costs

The answer is that America does not have a free market in health care, and in fact has not had one for 50 years. What we have had is a half century of mounting government encroachment upon medical freedom, leading to more and more health care problems.

Over 42 percent of funds spent on American medical care are now controlled by government. Over 700 state laws, some hundreds of pages long, govern all health care providers and institutions. According to some estimates, for every man-hour of health services provided by doctors, two hours are spent by clerks filling out government paperwork. Dr. Francis A. Davis estimated in the March 1991 issue of Private Practice that government regulations have already increased the cost of medical care by up to 50 percent!

Government regulations and controls now intrude upon virtually every area of health care in America. These regulations increase tremendously the cost of health care. Here are some examples:

The War on Drugs. U.S. federal drug certification requirements are the most burdensome in the world. It presently can cost $231 million and takes 12 years to develop, test, and certify a single new drug in the U.S. The introduction of many drugs, which have been thoroughly studied and used safely in Europe, has been delayed for years or even decades in the U.S. by the Food and Drug Administration. FDA delays in the introduction of just one drug, the beta-blocker propranolol, used to treat angina and hypertension, caused at least 30,000 avoidable deaths in the U.S.

Literally hundreds of thousands of Americans have died in the last two decades, and millions have suffered needless pain and expense, as a result of government drug regulations. Further, the prohibition of marijuana, heroin, and cocaine has created a growing public health crisis in America.

Consider the medical implications of the government’s ban on marijuana. On September 6, 1988, Drug Enforcement Administration (DEA) Administrative Law Judge Francis L. Young stated: “The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record.”

Judge Young concluded that many classes of patients could potentially benefit from medicinal use of marijuana, including sufferers from glaucoma, chemotherapy, multiple-sclerosis, spasticity, and hyperparathyroidisim. Glaucoma sufferers alone currently number over two million Americans. Despite this finding by the DEA’s own administrative judge, marijuana continues to be totally banned for all uses, including medical applications. Indeed, penalties for possession and use of marijuana have steadily increased over the last 20 years.

Medicare, Medicaid, and Tax Policy. A growing chorus of politicians and social activists decry the “high cost” of medical care in the United States and the increasing percentage of our Gross Domestic Product that it consumes. What is seldom mentioned is that mounting health care spending and prices are largely a result of escalating demand, public policies, government health care entitlements, and tax policies.

Medicare and Medicaid, our major health care entitlements, were enacted in 1965. Closely allied with the Social Security system, Medicare provides health insurance for approximately 30 million Americans, primarily the elderly. Medicaid provides health care for tens of millions more of the disabled and indigent, and is administered by the states. In the last 25 years Medicare and Medicaid expenditures have soared: from less than $5 billion in 1967, to $79 billion in 1984, to over $160 billion in 1990.

Prior to 1983, Medicaid used a “cost-phis” system for reimbursing medical providers. Doctors were allowed to base their billings upon the cost of the services they provided. Thus the higher a doctor’s costs, the more a doctor would make. The cost-phis system made it in a doctor’s self-interest to make his costs as high as possible, contributing to a rapid growth in health care costs.

Overall, the effect of Medicare, Medicaid, and other rapidly expanding government health care spending has been greatly to increase the demand for medical services and facilities of all types, which has led to rising health care prices.

Government tax policies are another major factor in escalating demand for and prices of medical services. When health insurance is provided as an employee benefit it is fully tax-deductible; in other words, it is paid for with pre-tax dollars. But when health care is paid for by employees directly, it is paid for with very expensive after-tax dollars, and is not fully tax-deductible. Hence there is an incentive for health care to be provided by employers in the form of insurance, rather than for employees to pay for health care directly out of their own pockets. Largely as a result of U.S. tax policies, “The share of health care spending paid by business increased from 17 percent in 1965 to 28 percent in 1987, while the share paid directly by individuals fell from almost 90 percent in 1930 to just 25 percent in 1987.”

The growing reliance of Americans upon insurers (public and private) to pay their medical bills has destroyed virtually all incentive for health care consumers to monitor and control costs. As Louise B. Russell noted in her 1977 Brookings Institution study:

This incentive structure means that at the point at which decisions are made about the use of resources, the people who make those decisions are able to act as if the resources are free. Rationally they can and do make decisions that bring little or no benefit to the patient, since the resource costs of the decisions—to the people making them—are also little or nothing . . . . [T]here are virtually no economic constraints left to prevent decisionmakers in medical care from doing everything they can think of, no matter how small the benefits nor to whom they accrue.

More here


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, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.


Thursday, March 22, 2007

NHS may be restricted to core services

The NHS is slowly moving in the direction of becoming a very costly organization that consists solely of bureaucrats and provides no services at all

The National Health Service might provide only core services, with patients forced to pay for any other treatment or meet it from private insurance, the government has revealed on Monday.

News that ministers were examining the possibility of defining the services that the NHS is obliged to provide free to everyone was disclosed in the small print of the public services policy review launched on Monday by Tony Blair, the prime minister, and Gordon Brown, the chancellor. It says the government should “look at the possibility of drawing up a package of services that all users are entitled to”. Nice, the National Institute for Health and Clinical Excellence, could be asked to do that.

The health department confirmed it was “looking at the possibility in the normal process of policy development” and agreed that deciding what everyone was entitled to would also involve deciding “what they are not entitled to”.

Academics said that amounted to defining a “basic basket” of services the NHS would fund, but warned it was fraught with technical and political difficulties. Anna Dixon, deputy director of policy at the King’s Fund think-tank, and a specialist on international health systems, said: “It sounds like establishing a core package of benefits that the NHS will fund – and that is something that has long been debated in academic circles. But politicians ... have always shied away from being more explicit about entitlements.”

Social insurance systems tended to be much more explicit about what was and was not covered, with private insurance markets developing to cover excluded treatments, she said. But she warned that when lists of exclusions were drawn up, “they often do not feel right to the public”. It was “a very difficult exercise” and one that, if undertaken, “is going to be very controversial”. It would raise issues over whether infertility treatment, or so-called lifestyle drugs for obesity or impotence, should be included.

David Hunter, professor of health policy at Durham University, said: “It is very difficult to define what is in the basket, so either it doesn’t get done or very little gets left out. You don’t save much, and you are still left with the issues of how to ration care and assess quality and cost effectiveness” – something Nice was already doing but “in a rather less prescriptive way”.

Patricia Hewitt, the health secretary, was deputy chairman of a pharmaceutical industry-financed study in 1995 that called for restrictions on free services. But she disowned the report on becoming health secretary, saying the government’s big increase in NHS spending removed the need for such measures.


Australia: Anger over 8-year wait for surgery

MORE than 1500 patients from across Queensland face a wait of up to eight years for operations. The Australian Medical Association says hundreds of those waiting for ear, nose and throat surgery at the Royal Brisbane Hospital may never be treated. Patients are not being told the likely wait and many give up waiting and seek private treatment.

People with the longest waits are those classified as Category 3 patients - needing operations to fix sinus problems and recurrent tonsillitis. They are constantly pushed to the bottom of the list while surgeons treat more urgent cases. State president of the Australian Medical Association Zelle Hodge said the waiting time had blown out due to a lack of resources. She said 1500 patients were waiting for surgery. "People aren't told by the hospital how long the waiting list is and I think when they eventually find out they just don't believe it," she said. "Even I find it boggling to think of an eight-year wait, but it is true. "Although people will move up the waiting list, they keep getting pushed down again because of new urgent cases that keep coming in. "Unfortunately the Royal Brisbane looks after the majority of ear nose and throat patients in the state so that makes the situation worse. "Many people give up waiting and seek treatment from private hospitals, while others who can't afford to do that will continue to wait and never get their operation."

Queensland Health says that it has reduced waiting times for patients classified as urgent and life threatening cases. In January there were 187 patients waiting longer than the clinically recommended time of 30 days, compared with 360 in October last year. But figures also reveal an increase in semi-urgent and non-urgent patients waiting longer than the target times. A quarter of semi-urgent Category 2 patients now wait longer than the target of 90 days, and more than one third of Category 3 non-urgent patients are waiting longer than the recommended 365 days. The total number of patients waiting longer than recommended is 10,200.

The Queensland Cancer Council said even cancer patients were being forced to wait too long. Coalition health spokesman John-Paul Langbroek said that Queensland Health performed fewer operations than the public health system in other states. "ENT is failing patients anyway, but to be saying eight years to people, well they might as well be saying they can't provide the service at all," he said. Queensland Health said emergency surgery must always take priority over ot,her surgery.

The above article by HANNAH DAVIES appeared in the Brisbane "Sunday Mail" on March 18, 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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH 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.