Thursday, March 19, 2009

No Miracle in Massachusetts

It was only a matter of time before this story appeared, as it did in yesterday's New York Times. Having promised lavish subsidies for expansive health insurance, it seems state officials in Massachusetts have finally begun to admit that their health-care reform program, passed in 2006, is unaffordable for the state's taxpayers.

This should surprise no one. Whatever else might be said about the Massachusetts plan, it was clear from the get-go that it would overwhelm the state's budget - it was just a matter of time. All the state really did was buy hundreds of thousands of residents into heavily regulated insurance plans by moving around some existing pots of money and raising taxes. They didn't build a functioning marketplace with cost-conscious consumers, nor did they pursue - initially - the kinds of heavy-handed, government-imposed cost controls that many Democrats actually favor. In short, there was never any reason to expect health-care premiums in the state to escalate less rapidly after the "reform" than they did before the plan was adopted.

But, just as predictably, now that it is difficult to turn back and start over (hundreds of thousands of Massachusetts households are now enrolled in newly-subsidized insurance), the state wants to impose cost-controls. There is much talk of new whiz-bang systems for paying doctors and hospitals, devised by government officials, which reward more efficient ways of delivering care. Don't count on it. Inevitably, when the government tries to micro-manage payments and prices, the result is indiscriminate, across-the-board cuts, protection of incumbents, and strong disincentives for innovation. Indeed, Massachusetts' Democratic Governor Deval Patrick has already signaled where this is all likely to head: state-imposed caps on private health insurance premiums.

There are lessons here for the unfolding debate in Washington. The Obama team is essentially pursuing the Massachusetts political strategy - cover everybody first with a massive new entitlement program and worry about imposing cost-controls later. In fact, Sen. Ted Kennedy's top lieutenant assigned to pulling together a health-care bill was a principal architect of the Massachusetts's approach. And, on costs, the Obama administration keeps touting the same benign-sounding initiatives - like expanded use of health information technology - that Massachusetts officials used to cite, even though the Congressional Budget Office (CBO) has already said these kinds of steps won't come close to solving the cost problem. It is obvious that the administration is hoping it can get a bill passed without endorsing the kinds of measures which would rightly be attacked as rationing care.

But make no mistake: If President Obama succeeds, he and the Congress will be back in a year or two or three - when the coverage train has already left the station - to say the financial future of the country depends on agreeing to government-imposed cost constraints, just as Massachusetts officials are doing today.

Even the Times story hints at what's really at stake here. If we don't rely on market principles to allocate health-care resources, the country will inevitably turn to the government to keep premiums in line with income. And, as some anonymous "experts" candidly admit in the Times piece, government-written "payment practices" are highly unlikely to do the trick. Instead, these "experts" say, "the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care."


Baby dies from infection days after two NHS midwives tell mother to ignore prescribed antibiotics

A newborn baby died from an infection just days after two midwives told the mother not to bother giving him antibiotics, a misconduct hearing was told today. Andrea Street, 34, and Jennifer Ansell, 39, told the new mother - a research doctor - it was not necessary to feed her baby boy vital medication, the Nursing and Midwifery Council heard. But the small youngster's body could not fight off an umbilical cord infection and he died two days after leaving the Royal Sussex County Hospital, Brighton, in January 2006. It is claimed Ms Street and Ms Ansell, both employed by Brighton and Sussex University Hospital NHS Trust, failed to properly care for the infant, referred to as Baby L.

The infant had been prescribed antibiotics by a hospital doctor after he developed a suspected umbilical cord infection a few hours after birth. Clare Strickland, for the NMC, said: 'Shortly after his birth there had been two episodes where he had turned blue so there were concerns about his respiratory function and there were concerns about his feeding as his blood sugar level was low. 'The first time it appeared there were any concerns about his umbilical cord were on Friday, January 27. 'A nursery nurse noticed Baby L's cord seemed wet and mucusy so she took a swab and sent it for analysis.' A doctor then prescribed antibiotics the following day, the NMC heard.

'Although there were no signs of active infection, because he had problems following birth and he was a vulnerable baby, she took a cautious approach and prescribed a five-day course of antibiotics,' added Miss Strickland. But when Ms Street discharged the mum - referred to as Dr B - she told her 'the cords look fine, don't worry about them', the hearing was told. The mother took her baby son home and put the unopened medication in the fridge.

Miss Strickland said: 'She didn't give them the option to ask questions and left them with the impression they didn't need to give the antibiotics at all. 'Because the medication was clearly prescribed by the doctor, it was the responsibility of midwife Miss Street as the discharging midwife to ensure that the patient knew about the drug, the dosage and the administration. 'She shouldn't have said or done anything that would have suggested the antibiotics should not be given.'

When community midwife Ms Ansell saw Baby L at home the next day, the mother was worried about the antibiotics. But Ms Ansell brushed off her worries and left without inspecting the antibiotics. Miss Strickland added: 'Having found out about this unusual position, if she was not sure, she should have checked with medical staff and the hospital and should certainly have checked the medication and the dosage. 'Whether this would have made a difference to his outcome, this can never be answered. 'There was due to be another visit from the community midwife the next day but Baby L died before then.'

Baby L was born on January 25, 2006 and died five days later from a bacterial infection. Miss Strickland added: 'A post mortem was carried out and the report concluded that on the balance of probabilities his death was due to a staphylococcus aureas infection. 'The Council says there was a failure to provide an appropriate level of care for this infant.' Andrea Louise Street, from Wick, Littlehampton, West Sussex, and Jennifer Maria Ansell, of Shoreham-By-Sea, West Sussex, both deny failing to provide inadequate care.


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