Saturday, June 13, 2009

How to Stop Socialized Health Care

Five arguments Republicans must make


It was a sobering breakfast with one of the smartest Republicans on Capitol Hill. We can fix a lot of bad stuff President Barack Obama might do, he told me. But if Mr. Obama signs into law a "public option," government-run insurance program as part of health-care reform we won't be able to undo the damage. I'd go the Republican member of Congress one further: If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state. To prevent this from happening, there are five arguments Republicans must make.

The first is it's unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That's competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 -- nearly 41% less than predicted. No government plan was needed to guarantee competition's benefits.

Second, a public option will undercut private insurers and pass the tab to taxpayers and health providers just as it does in existing government-run programs. For example, Medicare pays hospitals 71% and doctors 81% of what private insurers pay.

Who covers the rest? Government passes the bill for the outstanding balance to providers and families not covered by government programs. This cost-shifting amounts to a forced subsidy. Families pay about $1,800 more a year for someone else's health care as a result, according to a recent study by Milliman Inc. It's also why many doctors limit how many Medicare patients they take: They can afford only so much charity care.

Fixing prices at less than market rates will continue under any public option. Sen. Edward Kennedy's proposal, for example, has Washington paying providers what Medicare does plus 10%. That will lead to health providers offering less care.

Third, government-run health insurance would crater the private insurance market, forcing most Americans onto the government plan. The Lewin Group estimates 70% of people with private insurance -- 120 million Americans -- will quickly lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage. They'd be happy to shift some of the expense -- and all of the administration headaches -- to Washington. And once the private insurance market has been dismantled it will be gone.

Fourth, the public option is far too expensive. The cost of Medicare -- the purest form of a government-run "public choice" for seniors -- will start exceeding its payroll-tax "trust fund" in 2017. The Obama administration estimates its health reforms will cost as much as $1.5 trillion over the next 10 years. It is no coincidence the Obama budget nearly triples the national debt over that same period.

Medicare and Medicaid cost much more than estimated when they were adopted. One reason is there's no competition for these government-run insurance programs. In the same way, Americans can expect a public option to cost far more than the Obama administration's rosy estimates.

Fifth, the public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you'll change to another company.

In other words, the public option is just phony. It's a bait-and-switch tactic meant to reassure people that the president's goals are less radical than they are. Mr. Obama's real aim, as some candid Democrats admit, is a single-payer, government-run health-care system.

Health care desperately needs far-reaching reforms that put patients and their doctors in charge, bring the benefits of competition and market forces to bear, and ensure access to affordable and portable health care for every American. Republicans have plans to achieve this, and they must make their case for reform in every available forum.

Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse.


NHS faces its biggest cash crisis, with £15bn shortfall, report warns

The National Health Service faces the biggest financial challenge in its history as a result of the economic downturn, with a £15 billion funding shortfall likely in the next decade, according to a report published today.

The NHS Confederation, which represents 90 per cent of NHS organisations, said the next two years would be “tough but manageable” but beyond 2010-11 it would be “very different and extremely challenging”.

Its report — Dealing with the downturn: The greatest ever leadership challenge for the NHS? — said the service should expect a funding shortfall of £15 billion in real terms as a result of the impact of the recession and rising costs. “With little or no cash increase, from 2011-12 the NHS will need to plan for real terms funding to fall by 2.5-3 per cent per annum,” the study said. “This is equivalent to a cut of between £8-10 billion over the next Comprehensive Spending Review and up to £15 billion over five years.”

The report called for immediate action if the service is to continue to keep to its founding principles of providing free care to everyone at the point of need. It warned against “diluting” the quality of patient care and extending waiting lists, or making cuts to training budgets. A solution to the crisis lies in NHS leaders embracing innovation, change and improving efficiency, it said.

Steve Barnett, chief executive of the NHS Confederation, said that with little or no cash increase from 2011-12, the NHS would need to make “hard decisions about which programmes to fund, how to reward staff and how to reorganise services now”. “If it does not, then the mistakes of the past could be repeated and shortages in funding will translate to the kind of across-the-board cuts which could see waiting lists lengthen, standards fall and dissatisfaction with the service grow among patients and staff,” he said. “The NHS needs to take the opportunity to find efficiencies and savings — I believe it has the people, the ideas and the capacity to meet this challenge but we should be under no illusions of the size of the task ahead.”

Nigel Edwards, the NHS Confederation’s director of policy and author of the report, warned against losing significant improvements in the NHS through “short-term cuts and crude approaches to cost control”. He added: “Quality improvements through greater efficiency and redesigning services can provide the budget savings necessary to navigate this crisis.”

The NHS budget in 2009-10 stands at £102.7 billion — a 7.5 per cent real terms increase on the previous year, according to the Department of Health. Next year, the budget will be £105.8 billion, which it said was a 1.6 per cent increase in real terms.

Hamish Meldrum, chairman of the British Medical Association, said that a funding crisis could be very dangerous for the NHS. “It has the potential to seriously threaten patient services,” Dr Meldrum said. “We agree with the NHS Confederation that difficult choices will have to be made.


Australia: Negligent NSW public hospital kills young woman

The death of a 29-year-old woman after the delivery of her third child could have been prevented if staff were better trained and more rigorous policies had been in place, a NSW coroner found today. Rebecca Murray died from hemorrhaging after an emergency caesarean at Bathurst Hospital in June 2007. She lost a litre of blood following the surgery, but the hospital had not previously checked her blood type and ensured it had adequate supplies, so blood had to be transported from Orange.

Deputy State Coroner Carl Milovanovich also found that the nurse in charge of her recovery had been inadequately trained, and did not alert medical staff in time when Ms Murray's condition rapidly deteriorated. Bathurst Hospital has since introduced a new policy which requires staff to do a full blood count on all women having elective or emergency caesareans and ensure there are supplies on hand.

Mr Milovanovich recommended that all hospitals in NSW be required to follow suit. "If the unexpected and avoidable death of a young mother at Bathurst Hospital justifies a change in policy at Bathurst Hospital, why should that policy not extend to statewide?" Mr Milovanivich asked. "Do we have to wait for another mother to die in similar circumstances ... before there is some change?"

Ms Murray's father, Lewis Furner, said outside the Westmead coroner's court that responsibility for her death lay with the hospital administration, and not the nurse who had not been properly trained. But he was not optimistic that any changes would be made to the health system. "The last health minister, Reba Meagher, had the hide to say in parliament that NSW has got one of the best health systems in the world,'' Mr Furner said. "Now while we've got a government that thinks like that I don't hink there's going to be any changes. It's from the top down, that it's failing. It's just disgusting.''

But Ms Murray's mother, Adrienne Furness, was tearful on behalf of the three children. "It's a shame that they're not going to know her, just a shame,'' she said.


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