Sunday, June 28, 2009

Health care reform: Questions for the president

Health care reform is on life support," says Rep. Jim Cooper of Tennessee. And he's a Democrat. President Obama has spent months building momentum for health care reform. But when the Congressional Budget Office put the price tag near $2 trillion, it stopped reform dead in its tracks.

What Senate Finance Committee chairman Max Baucus, D-Mont., once called "nearly inevitable" now seems much less so — and that's before supporters have confronted the really tough questions. Before this debate is over, Obama should answer a few questions about his plans for reform, including:

Mr. President, in your inaugural address and elsewhere, you said you are not interested in ideology, only what works. Economists Helen Levy of the University of Michigan and David Meltzer of the University of Chicago, where you used to teach, have researched what works. They conclude there is "no evidence" that universal health insurance coverage is the best way to improve public health. Before enacting universal coverage, shouldn't you spend at least some of the $1 billion you dedicated to comparative-effectiveness research to determine whether universal coverage is comparatively effective? Absent such evidence, isn't pursuing universal coverage by definition an ideological crusade?

A draft congressional report said that comparative-effectiveness research would "yield significant payoffs" because some treatments "will no longer be prescribed." Who will decide which treatments will get the axe? Since government pays for half of all treatments, is it plausible to suggest that government will not insert itself into medical decisions? Or is it reasonable for patients to fear that government will deny them care?

You recently said the United States spends "almost 50 percent more per person than the next most costly nation. And yet ... the quality of our care is often lower, and we aren't any healthier." Achieving universal coverage could require us to spend an additional $2 trillion over the next 10 years. If America already spends too much on health care, why are you asking Americans to spend even more?

You have said, "Making health care affordable for all Americans will cost somewhere on the order of $1 trillion." Precise dollar figures aside, isn't that a contradiction in terms?

Last year, you told a competitiveness summit that rising health care costs are "a major anchor on the ability of American business to compete." In May, you wrote, "Getting spiraling health care costs under control is essential to ... making our businesses more competitive." The head of your Council of Economic Advisors says such claims are "schlocky." Who is right: you or your top economist?

You recently told an audience, "No matter how we reform health care, we will keep this promise to the American people. ... If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what." The Associated Press subsequently reported, "White House officials suggest the president's rhetoric shouldn't be taken literally." You then clarified, "What I'm saying is the government is not going to make you change plans under health reform." Would your reforms encourage employers to drop their health plans?

You found $600 billion worth of inefficiencies that you want to cut from Medicare and Medicaid. If government health programs generate that much waste, why do you want to create another?

You and your advisors argue that Medicare creates misaligned financial incentives that discourage preventive care, comparative-effectiveness research, electronic medical records, and efforts to reduce medical errors. Medicare's payment system is the product of the political process. What gives you faith that the political process can devise less-perverse financial incentives this time?

You claim a new government program would create "a better range of choices, make the health care market more competitive, and keep insurance companies honest." Since when is having the government enter a market the remedy for insufficient competition? Should the government have launched its own software company to compete with Microsoft? Are there better ways to create more choices and more competition?

When government entered the markets for workers compensation insurance, crop and flood insurance, and disaster insurance, it often completely crowded out private options. Do you expect a new government health insurance program would do the same?

You have said there are "legitimate concerns" that the government might give its new health plan an unfair advantage through taxpayer subsidies or by "printing money." How do you propose to prevent this Congress and future Congresses from creating any unfair advantages?

President Obama needs to address questions these directly. The health of millions depends on his answers.


Whistleblower helpline for NHS doctors as concerns for patient safety grow

Hospital doctors wanting to raise fears about patient safety are to be given an anonymous “whistleblower” helpline because of growing evidence of staff reluctance to speak out for fear of recriminations. The dedicated phoneline has been set up as part of new guidelines issued by the British Medical Association, and seen by The Times, designed to help to formalise the process of “whistleblowing” in the NHS.

Doctors will be presented with two motions at the BMA annual conference next week calling for action to address staff concerns about reporting malpractice. One motion, proposed by the BMA’s agenda committee, warns that the NHS risks another patient safety scandal like that of Mid-Staffordshire where 400 deaths were linked to poor care, such is the scale of the problem. It calls for trusts and regulators to pool all complaints from clinicians to identify worrying trends. A second motion, proposed by junior doctors, calls on the General Medical Council to recognise formally that the harassment of whistleblowers is a serious breach of medical regulations. It also requests guidance on whistle-blowing.

Tom Dolphin, a junior doctor specialising in anaesthesia based in East London, said he had felt compelled to act after hearing of the experiences of colleagues who had to work without some patient-monitoring equipment. “One colleague needed equipment that wasn’t there, and was told there wasn’t any. There can be a culture of ‘that’s the way it's always been and no one’s come to harm yet anyway’. Others tried to raise concerns, got nowhere and had pretty much given up.”

The BMA guidelines, released today, follow research suggesting hospital doctors are frequently frustrated in their attempts to raise concerns about standards of care, despite recommendations by the Department of Health for the development of whistleblowing policies six years ago. A survey of 565 doctors working in hospitals in England and Wales found that three quarters had had concerns about issues relating to patient safety, malpractice or bullying in the NHS, the majority linked to standards of patient care.

Many said that their experiences of reporting issues had been negative — either because they were ignored or because their complaint was shared more widely than they were comfortable with. One in six doctors who reported concerns said that their trusts had indicated that their employment could be negatively affected.

The BMA advises hospital doctors to err on the side of raising any concerns about malpractice or systemic failures, and to do it as soon as they can, rather than allowing the situation to reach a point where patient safety is threatened. It points out that employees who are victimised after raising their concerns can go to an employment tribunal, and that employers can be heavily fined. “If told not to raise or pursue any concern, even by a person in authority such as a manager, you should not agree to remain silent,” it states, adding that “raising concerns is not just a matter of personal conscience — in some circumstances it is a professional obligation”.

Last month Jonathan Fielden, the chairman of the BMA consultants committee, called for sweeping changes to reporting problems in the NHS. He said that “a culture of inactivity and despair is preventing issues from coming to light, and putting patient care at risk”.

Margaret Haywood, a nurse, is appealing to the High Court against a decision by the Nursing and Midwifery Council to strike her off the register for secretly filming at a Brighton hospital. Footage showed examples of neglect, including an elderly patient sitting in clothes he had soiled the night before.

Earlier this month the National Patient Safety Agency (NPSA) called for greater reporting of safety issues in hospitals in a report on paediatric healthcare. It said that 10,000 alerts over medication given to children were being issued annually in the NHS, including errors in the calculation of drug doses and health workers forgetting to give patients their medicine. The NPSA report concludes that over the period of a year 33 children and 39 newborn babies died with “indicators of avoidable factors”.



medical insurance said...

Market-based policies are more cost effective for the government - and therefore the taxpayers- than publicly funded healthcare. According to the Kaiser Commission on Medicaid and the Uninsured, January 2005, if every uninsured individual was covered by a government program such as Medicaid, the cost to the federal and state governments is approximately $2000 each. If, however, low-income and modest-income Americans could purchase their own health insurance by utilizing a $1000 tax credit, the federal government would save 50% of that money. With over 45 million uninsured Americans, that savings would be substantial indeed.

Affordable medical insurance said...

Having grown up in England I am very well aware of the problems with the socialized system.

I hope we do not see anything like that in the US. In Britian they are very good at hiding the problem in their system!!