Sunday, January 18, 2009

Another reduction of medical services in a socialized medical system

In both Britain and Australia, "caring" Leftist governments have a mania for closing down hospitals and shrinking the number of beds available. The pretext is that they want to combine several hospitals into one to provide bigger, better and brighter services. It is utter crap, of course. It is about cost-cutting and nothing else. Standards decline rather than rise. We see the latest iteration of this "compassionate" Leftist policy in Queensland, Australia, where the government wants to replace two childrens' hospitals with one new one. Result? Everyone is going to be shortchanged. Even the size of consulting rooms has been reduced to the point where they are too small to fit a wheelchair in. And this is a hospital?

One of Queensland's leading doctors sent a disturbing email to nearly 100 colleagues that was leaked to me last week. Dr Brent Masters, a specialist in respiratory medicine at the Royal Children's Hospital asked if anyone was happy with the planned move to the new Queensland Children's Hospital. The planning process was "truly getting out of hand", he wrote. "I recommend you all read the book On Bullshit: you can buy it at the Medical School bookshop for about $15," he said. "It points out that basing decisions on bullshit are (sic) fraught with dire consequences - indeed worse than basing decisions on lies . . .

"The complete lack of intellectual honesty has let pediatrics down badly in this state . . . "I again point out that this hospital should not be about secondary level pediatrics (the bullshit factor) but about tertiary pediatrics: You can not have a world class hospital based on secondary-level pediatrics." Then he gave an ominous warning about underfunded hospitals. "You can cross the road 100 times with your eyes closed and you will get away with it 90 times," he said.

Despite some positive announcements on the new hospital this week, Dr Masters, like many other specialists, remains sceptical. He has to be. He leads a team treating 350 young cystic fibrosis patients. "People come from all over the world to train with them," said a doctor. They are that good." He is backed up by Dr Ann Chang, a leading researcher and devout Catholic who is a world authority on respiratory disease. This week Chang is in Darwin and soon she heads to New York and Miami to present papers to international medical forums.

For Dr Masters it is a demanding clinical load. CF is an unforgiving genetic disease characterised by frequent lung infections. It is incurable. Even lung transplants have only a 50 per cent success rate. Masters and Chang fear the new hospital simply doesn't have enough space to treat existing cases, let alone the 125 new cases who will come onstream in the next five years. And hospital planners neither seem to understand nor care about necessary research. This is a common complaint among specialists, from pathology to neurology.

Gastroenterologists fear they have been sidelined by planners who "stole" some of their space for respiratory medicine. "Gastroenterology is seriously compromised at QCH, with the complete disintegration of our diagnostic unit," said Dr Looi Ee last week.

Doctors practising nuclear medicine and medical imaging fear they, too, have been short-changed, with not enough MRI scanners.

Professor Jenny Batch told colleagues she needed rooms for diabetics and growth hormone therapy and a permanent patient-family education centre. "I share the concerns that there will not be adequate rooms," she said in another email leaked to me.

Space shortages also worried Dr Jane Peake, a pediatric immunologist who deals in allergies, eczema and auto-immune deficiencies. She feared there would not even be enough space to store research papers. She thought she was looking at a "poorly designed rabbit warren" with "small and grossly inadequate consulting rooms".

Dr Kate Sinclair agrees. She says proposed, open-plan office space will be unsuitable. Privacy will be endangered and deeply personal conversations with patients will be difficult.

Several doctors also questioned plans to cut queues at the new hospital by running clinical sessions in a day starting at 7am and finishing at 8pm.

Dr Lynne McKinlay, the director of pediatric rehabilitation at the Royal, noted the apparent lack of large consulting rooms. She said rooms would be "unsuitable" for children who arrived with both parents, siblings and a stroller, "let alone children who come with wheelchairs and walkers".

The proposed research centre remains unfunded and clinicians in allied health, genetics and dentistry believe their patients, too, will suffer in the shift to South Brisbane.


Socialized health care fundamentally changes the relationship between citizens and state

For most of our nation's history, our approach to economics has favored enterprise, self-reliance and the free market. While the American economy has never been entirely laissez-faire, we have historically cared more about equality of opportunity than equality of results. And while Americans have embraced elements of the New Deal, the Great Society and progressive taxation, we have traditionally viewed welfare as a way to help those in dire need, not as a way of life for the middle class. We have grasped, perhaps more than any other nation, that there is a long-run cost to dependency on the state, including an aversion to risk that eventually enervates the entrepreneurial spirit necessary for innovation and prosperity.

This outlook, once assumed, is now under attack due to a recent series of political and economic events. The first is the unprecedented intervention by the federal government, in the form of a $700 billion relief package intended for our financial institutions after the credit crisis last September. This was followed by extending billions of dollars of federal assistance to America's auto makers in order to prevent their imminent bankruptcy -- the first emergency bailout that went to companies outside the financial sector. We understand why the federal government did this, and even supported legislation that, while hardly perfect, prevented an economic meltdown.

Nonetheless, the consequences of this undertaking are enormous. Not only has the size of the expenditures been staggering -- there is talk of another stimulus package worth an estimated $825 billion -- but we are witnessing a fundamental transformation of government's relationship with the polity and the economy.

The last several months are a foreshadowing of a new era of government activism, rather than an unfortunate but necessary (and anomalous) emergency action. We will soon shift from a market-based economy to a political one in which the government picks winners and losers and extends its reach and power in unprecedented ways.

This shift is exemplified by the desire of President-elect Barack Obama and the Democratic Congress to push us toward government-run health care. For all his talk of allowing consumers to select their own health-care coverage, Mr. Obama's proposal, as he laid it out in his campaign, will provide strong financial incentives for employers and individuals to sign up with a new, Medicare-style government plan for working-age people and their families. This plan will almost certainly use a price-control system similar to the one in place for Medicare, allowing it to charge artificially low premiums by paying fees well below private rates. These low premiums will serve as a magnet for enrollment and will devastate the private companies trying to compete in the health-insurance market. The result will be the nationalization of the health-care sector, which today accounts for 16% of U.S. gross domestic product.

Nationalizing health care will be profoundly detrimental to the quality of American medicine. In the name of cost control, the government would make private investment in medical innovation far riskier, and thus delay the development of potentially lifesaving treatments.

It will also put America on a glide path toward European-style socialism. We need only look to Great Britain and elsewhere to see the effects of socialized health care on the broader economy. Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care -- an argument that would resonate with middle-class families entirely dependent on the government for access to doctors and hospitals.

Of course, this health-care plan is occurring against our particular fiscal backdrop: Without major reform, our federal entitlement programs will soon double the size of government. The result will be a crushing burden of debt and taxes. In short, we may be approaching a tipping point for democratic capitalism.

While the scope of the challenge should not be underestimated, those of us worried about this fundamental reorientation of politics and economics have several things working in our favor. Among them is that a public accustomed to iTunes, Facebook, Google, eBay, Amazon and WebMD is not clamoring for centralized, bureaucratic government. The strong American instinct for individual initiative and entrepreneurship remains intact. In addition, confidence in government -- from Congress to those responsible for oversight of the financial system -- is quite low.

Our sense is that at the moment, the public is not thinking in terms of "big government" or "small government." Instead, Americans want efficient government -- one that is modern, responsive and adaptive. People want government to act as a fair referee, providing guardrails that allow individuals to rise without intrusively dictating individual decisions.
If conservatives hope to win converts to our cause, we need to understand this new moment and put forward an agenda that reforms key institutions in a way that advances individual freedom, without creating an unacceptable level of insecurity. This is no easy task, and it must begin with providing a compelling alternative to what contemporary liberalism and Mr. Obama are about to offer. This especially includes health care, where we must start by recalling that our current health-insurance system was designed to meet the needs of a 20th century economy and World War II-era employment laws. It is hopelessly outdated, yet the Obama plan would make the system even more sclerotic.

The core of our message needs to be a commitment to creating a health-care plan that meets the demands of the modern economy. We need to convince concerned citizens that we can help the uninsured find coverage in the private sector and use market incentives to contain costs. The result will be a system that makes it possible for everyone to afford health insurance, including those with pre-existing conditions. Tax credits, high-risk pools, insurance choice and regulatory reform can form the basis of a transformation from today's enormously costly and inefficient third-party system into one driven by ownership, choice and competition. And at the nucleus of this redesigned system will be the patient-doctor relationship.

If we hope to succeed in making our case, it will require a concerted education campaign that relies on hard data and facts, rigorous and accessible public arguments, and persuasive public advocates. This is quite a tall order. But if we do not succeed in resisting greater state involvement in the economy -- and health care is meant to be the beachhead of this effort -- we will move from a limited welfare state into a full-blown one. This will reshape, in deep and enduring ways, our nation's historic sensibilities. It will lead here, as it has elsewhere, to passivity and dependence on the state. Such habits, once acquired, are hard to shake. Between now and the end of this decade may be one of those rare moments in which among other things will turn decisively one way or the other. The stakes could hardly be higher for our way of life.


Embryo screening funding is 'postcode lottery' in Britain, researchers say

Handicapped children are a better deal, apparently. Amazingly short-sighted thinking. But that's governments for you

More than half of couples seeking embryo screening to protect their offspring from inherited genetic diseases such as breast cancer are being prevented from doing so, researchers say. Evidence from one of the country's leading gene-screening clinics suggests that local health authorities frequently refuse to fund treatment for patients who wish to avoid passing defective genes to their children.

Scientists predict an increase in demand for the technique, known as preimplantation genetic diagnosis (PGD), after the start of a pilot programme screening an entire adult community for faulty genes. The Times revealed last week that the London community of Ashkenazi Jews is being offered screening for BRCA genes that raise risks of breast, ovarian and prostate cancers. Britain's first baby screened to ensure that it was free of a genetic risk of breast cancer carried by a parent was born last week, and hailed as an important advance in the fight against genetic disease. The girl was born after embryos created through IVF treatment were screened to exclude the faulty BRCA1 gene.

PGD, which costs between 5,000 and 20,000 pounds, depending on the number of IVF cycles required, is available to dozens of selected couples each year who wish to have children but do not want to run the risk of passing on potentially fatal disorders to their offspring. It is licensed for more than 60 different conditions, including cystic fibrosis, Huntington's disease and some forms of cancer, which are triggered when a child inherits a key genetic mutation from one of its parents.

Joy Delhanty, Professor of Human Genetics at the University College London PGD centre, said that many couples were being refused NHS funding because the technique had not been considered by the National Institute for Health and Clinical Excellence (NICE), the value-for-money watchdog. "Funding for the procedure is a postcode lottery. More than 100 couples a year are referred to us from all over the country but more than 50 per cent have problems with funding in the absence of guidelines from NICE. "If local PCTs [primary care trusts] do not see this as a priority then they do not provide funding, it is as simple as that, but they do not consider the potential money they save by ensuring a child will be free of a disease."

Professor Delhanty declined to name individual trusts but said that couples living in the North of England seemed to have a greater chance of PGD applications being funded by their local PCT, while those living in London and the South East may be forced to pay thousands of pounds for private treatment.

Only a few hundred couples a year are eligible for PGD. To benefit from the technique, families must first know that they have a defective gene, usually discovered through a recurring family history of illness. Once the risk is confirmed by a clinical geneticist, embryos generated and fertilised through IVF treatment can then be screened and implanted in the womb if they are free of the faulty gene.

The Department of Health said last night: "PGD is available on the NHS but is considered on a case by case basis."


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