Tuesday, January 13, 2009

The GOP Should Fight Health-Care Rationing

Obama's HMO deserves principled opposition

Perhaps the greatest missed opportunity of the past eight years was the chance for Republicans to fundamentally reform the terribly broken American health-care system. Access to quality health care has long been a professed priority, yet Republicans have been reluctant to tackle the issue.

As a physician, this is deeply disappointing to me because patient-centered health care is, at its core, conservative. Health care is fundamentally a personal relationship between patients and doctors. To honor this relationship -- consistent with Republican ideals -- our goal should be to provide a system that allows access to affordable, quality health care for all Americans, in a way that ensures medical decisions are made in doctors' offices, not Washington.

Republican unwillingness to address the issue, however, has left us facing an emboldened Democratic Party well equipped to push a government-centered health-care agenda. While Democrats are still dangerously misguided in their policies, this time they are prepared to avoid the political mistakes of the Clinton administration.

For a preview, look no further than "What We Can Do About the Health-Care Crisis," a book published this year by former Sen. Tom Daschle, President-elect Barack Obama's choice for secretary of Health and Human Services. Atop the list of worrisome ideas proposed by Mr. Daschle is the creation of an innocently termed "Federal Health Advisory Board."

This board would offer recommendations to private insurers and create a single standard of care for all public programs, including which procedures doctors may perform, which drugs patients may take, and how many diagnostic machines hospitals really need. As with Medicare, for any care provided outside the board's guidelines, patients and physicians would not be reimbursed.

Mr. Daschle is quick to note the board's standards would serve only as a suggestion to the private market. Yet to ensure that there are no rogue private insurers, he has proposed making the employer tax deduction for providing health insurance dependent on compliance with the board's standards. In an overtly political ruse, Democrats will claim they are dictating nothing to private providers, while whipping noncompliant insurers in place through the tax code.

To be sure, this strategy seeks to eliminate private providers completely. Forced into accepting rigid Washington rules and unsustainable financing mechanisms under Mr. Daschle's plan, most private insurers would be quickly eradicated. Or, as Mr. Daschle soberly predicts in his book, "the health-care industry would have to reconsider its business plan."

If we fail to recognize the scope and scale of Democratic ambition on this issue, we will find ourselves with a permanent Washington bureaucracy prescribing patient care. Our goal, however, must not be confined to defeating a Democratic proposal. Instead, we must advocate for a positive approach to health-care reform that does not sacrifice patient care to achieve its goals. This patient-centered approach must be built upon two pillars: access to coverage for all Americans and coverage that is truly owned by patients.

First, we must fundamentally reform the tax code so that it makes sense for all people to have health insurance. This may be readily accomplished through the adoption of tax equity for the purchase of insurance, active pooling mechanisms for increased purchasing power, and focused use of tax deductions and credits. Through positive changes in the tax code we can make health-care cost effective and create incentives so there is no reason to be uninsured. This way, care is purchased without government interference between you and your doctor.

Secondly, we must transform our health-care model to one that is owned and controlled by patients. Currently, most Americans receive coverage through a third party, leaving health-care decisions to an employer or the government. By creating a new system in which Americans are provided the opportunity to purchase whichever health-coverage product fits their personal needs, insurers would be forced to focus on patients. Not until patients truly own their own health plans will we see the accountability and flexibility needed to ensure quality care and necessary cost-lowering efficiencies.

A historic debate about American health care is fast approaching. We are not doomed to a Washington-run bureaucratic health-care system, so long as Republicans push for the right remedy for health care and return to being the party of solutions.


Four-hour wait for a lifesaving British ambulance trip

They actually keep ambulances out of action for bureaucratic reasons!

Patients with life --threatening conditions are waiting up to four hours for an ambulance. One man with suspected poisoning had to wait three hours 47 minutes for an ambulance to drive less than a mile to treat him. Others suffering from severe breathing difficulties have had to wait two hours for medical help to arrive. Government targets say ambulance trusts should reach such 'category-A' patients within eight minutes in 75 per cent of cases. But the lack of a maximum time means some are waiting hours.

The cases were uncovered in Freedom of Information requests. The figures, from 2007/08, also showed that some 'category-B' patients - those with illnesses that need urgent hospital treatment but are not life-threatening - are waiting as long as nine hours before help arrives, even though trusts are supposed to attend 95 per cent of such calls within 19 minutes.

A patient with severe back pain waited nine hours 11 minutes for paramedics to show up in London. The ambulance trust blamed a lack of vehicles. Many of the slowest responses occurred over the 2007/08 New Year period, when paramedics had to deal with thousands of drunken revellers and an upsurge in flu and breathing problems.

There was massive variation across the country in the slowest response time for a category-A case. In the North West it was just 38 minutes, but in the East Midlands, the longest response took two hours and 34 minutes, and in Wales, three hours 47 minutes - the suspected poisoning case.

Critics blamed the failures on Labour's strict four-hour maximum waiting time for hospital accident and emergency units. As this is only counted from when the patient steps through the casualty department doors, ambulances often queue outside hospitals, dropping off patients only when they are certain to be seen within the allotted time.

A Department of Health spokesman said: 'We often see an increase in demand for ambulances during the winter season and this year is no different. 'The NHS is coping well with this increased demand. We have done a lot of work in recent years across the country to share best practice. Our staff are working hard and doing great work to respond to the extra demand.'


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