Tuesday, July 28, 2009

Australian mother sues public Hospital after nearly bleeding to death

A DIABETIC mother has begun legal action against Ipswich Hospital, alleging staff's negligence nearly caused her to bleed to death during childbirth. The 32-year-old has served Ipswich Hospital, west of Brisbane, with a notice of claim for negligence.

The Ipswich mother of four, who only wanted to be known by her first name Kylie, said she was traumatised after haemorrhaging 1.5 litres of blood two hours after giving birth in May. "Instead of sending me to the operating theatre, they were giving me morphine and trying to fix the clotting by reaching into my cervix not just once but four agonising times," she said. "I was screaming in agony and they had my legs pinned down telling me to be quiet.

"My daughter, who was there holding the newborn, was crying and my sister was crying because the midwives and the doctor wouldn't listen."

Her lawyer Olamide Kowalik said Kylie had begun action against the hospital over her treatment and also for the trauma her 12-year-old daughter suffered from witnessing her mother's ordeal.

Ipswich Hospital was served the notice of claim in early July and has 30 days to respond and supply medical records. The hospital's executive director, Dr Gerry Costello, declined to comment, saying it was inappropriate due to ongoing legal action.

Ms Kowalik said the hospital should have been aware there would be complications because medical records showed Kylie bled through her three previous pregnancies.


Another big government medical bungle in Australia

Something very similar happened in Britain a couple of years ago but do governments ever learn? Rhetorical question

HUNDREDS of international medical students were told this week they would not be guaranteed internships in NSW public hospitals because there are not enough staff to supervise them. The warning comes despite the Federal Government ramping up university places in the past three years to solve the state's crippling shortage of doctors.

The students, who each paid about $200,000 in course fees, are furious, saying it is now too late for them to get internships in their home countries and any forced break between the end of their studies this month and starting work in a hospital was "career suicide".

For the first time, the State Government invoked a priority system this year when 879 students applied for 670 positions, saying it did not have enough money to offer internships to all graduates wanting to work in NSW.

The Institute of Medical Education and Training, which allocates internships, has blamed a surge in the number of interstate students applying for jobs in NSW because they have been unable to find enough supervised roles in their home states. It said the problem was compounded by some students accepting multiple internships in several states, then not showing up for work when the rotations began in January.

Under the priority system, NSW students are offered places first, then Australian and New Zealand residents from interstate, then other international students studying in Sydney.

But overseas students have been told final offers will not be made until January, well after interns overseas have started their hospital rotations. "We're shell-shocked," one student said. "All along we've been assured we would get placements, then on Monday afternoon we got a two-line email rejecting us. "We wanted to live our lives in Australia and work in the NSW hospital system. Now we don't know what to do. You just can't take a break between university and vocational training. It is virtually impossible to get back in."

Medical student numbers in NSW soared from 493 in 2007 to 1104 last year, prompting universities to issue warnings the health system would not be able to support the rise. "These are people who want to work in the system," the president of the Australian Medical Association, Andrew Pesce, said yesterday. "They've paid for something and they have every right to be angry that they are not getting it. "What is the point in training yourself if you are not able to work as a doctor at the end? The Government needs to make a serious commitment to investing properly in training these people. It's an investment, not a cost."

The president of the Australian Medical Students Association, Tiffany Fulde, said hospitals were facing a "student tsunami" which would only worsen with three more medical schools turning out graduates in the next three years. "The system isn't coping now, so where will we be when we have double the number of students?" she said.

In April, the dean of medicine at the University of Sydney, Bruce Robinson, said the restrictions made NSW a "less attractive destination" for international medical students. "[It] places an extraordinary additional stress on them," he said. "International students in every year of their medical studies are rightly expressing deep concerns about their future prospects, and [this] is detracting from their experience of studying here," he said.

International students deserved a "fair go", he said. "We simply would like to be able to offer our international students the same education and training opportunities as we provide for our local students."


Obama has only himself to blame for his faltering healthcare measure

Here’s the dirty secret behind Washington’s health-care “fight”: Democrats won everything in last year’s election. You wouldn’t know it from the way President Barack Obama is blaming the GOP for his flagging health agenda. “There are those [read the GOP] who are advocating delay just as a desperation move to try to kill it,” complained White House budget director Peter Orszag. Republicans are working to “block health-care reform,” groused the president. “Republicans should immediately put an end to their political games,” demanded Democratic Rep. Chris van Hollen.

Indeed. The party of the left owns the White House, a filibuster-proof Senate, and a 70-seat House majority. As one House Republican aide quipped: “We could have every GOP congressman and their parents vote against a Democratic bill, and still not stop it.” All Democrats have to do is agree on something.

You can’t blame the GOP when you own every Washington institution. That they can’t is testimony to Team Obama’s mismanagement of its first big legislative project. The president is a skilled politician and orator, but the real test of a new administration is whether it can shepherd a high-stakes bill through Congress. In retrospect, the mistakes are growing clear.

• Living in the short term: The administration thought it was clever back in February, using its $787 billion “stimulus” as an excuse to pass all manner of non-stimulating spending. But the bill sent deficits soaring, forcing those numbers to the center of today’s health debate and unnerving Democratic deficit hawks. Mr. Obama’s demand that a bill be deficit-neutral enthused House liberals to propose crushing tax hikes that further alienated conservative Democrats.

Mr. Obama boxed himself in on taxes back in his campaign. Senate Finance Chairman Max Baucus and counterpart Chuck Grassley were merrily on their way to a bipartisan deal based on taxing existing health benefits. Yet having slammed John McCain for that idea, the White House vetoed the compromise, derailing an agreement. “The President is not helping us,” bluntly stated Mr. Baucus. “He does not want [that tax]. That’s making it difficult.”

• Unleashing Congress: Not wanting to repeat Hillary Clinton’s mistaken attempt to micromanage Congress, the administration took the equally dangerous path of no management at all. Left to wild impulses, Nancy Pelosi, Henry Waxman and Ted Kennedy took the most radical of Mr. Obama’s proposals (a public option entitlement) as a starting point, and ran left with new mandates, income tax surcharges, and business penalties. The House bill stirred a Blue Dog rebellion and mired the bill in committee. Mrs. Pelosi failed to include enticements for susceptible Republicans, leaving her hard-pressed to poach GOP votes.

The White House’s decision to let Mrs. Pelosi charge ahead with her climate bill has also been a disaster. To get that unpopular energy tax through, Mrs. Pelosi had to strip conservative Democrats of their committee rights and then arm-twist them into votes. Their egos and poll ratings bruised, this crew is balking at taking a second one for the team. “If you’re a member who voted for cap and trade and had a bad experience back home, you’re probably not looking forward to a bad vote on a health-care bill that’s not going to go anywhere in the Senate,” says Pennsylvania Blue Dog Jason Altmire.

• The perils of spin: Selling a huge expansion of government health care in the middle of a recession was never going to be easy. The Obama team hit on the argument that by adding to the government rolls, it would in fact save money and boost the economy.

Bizarre as this claim was, it became the administration’s prime rationale for “reform.” Until last week, when Congressional Budget Office director Douglas Elmendorf blew it up, noting that the existing House and Senate bills would “significantly expand” federal costs. This gave Democratic senators such as North Dakota’s Kent Conrad an excuse to back away from existing bills, and place new emphasis on a highly uncertain Baucus compromise.

• False deadlines: Mr. Obama is right to worry this project is a race against time and falling poll numbers. But the administration’s unwavering demand for bills before recess led to the gridlock it hoped to avoid. The deadline inspired the House leadership to rush out a bill without consensus, further antagonizing the Blue Dogs. In the Senate, the pressure on Mr. Baucus to produce has very nearly pushed away Mr. Grassley, who Democrats need for cover.

A unified Republican message helped raise public alarm. But if they were the problem, Mr. Obama’s campaign arm, Organizing for America, wouldn’t be running TV ads that target his own Democrats. This debate has a stretch to go, and we’re about to see if the administration is nimble enough to adapt its strategy. Some Democrats are even hinting the White House needs to start over. At this point, that might not be bad advice.



How many ways can the "reformers" be wrong?

The effort to reinvent medical care is so full of fallacies and bad logic that it would take volumes to properly expose them. Nevertheless, in this short space, let’s take a crack some of the problems.

To begin, the “reformers” want to compel insurers to cover people who are already sick for the same price charged healthy people pay. But if someone is already sick, no government plan to pay his medical bills can be accurately called “insurance.” Insurance is a voluntary way to spread risk. Risk comes from uncertainty. But someone already sick doesn’t face a risk that he might need medical attention for his ailment. He is certain to require the attention. There’s a reason you can’t buy homeowner’s insurance after your house has burned down or life insurance for a deceased person. Why should one expect to be able to buy insurance to cover medical treatment for a disease one already has contracted? When private donors voluntarily pay the bills, we call it charity or philanthropy or benevolence. When government pays them after extracting money by force from taxpayers or by requiring insurance companies to overcharge healthy people who are compelled to buy coverage, we should call it (at the very least) welfare.

If someone wants to defend medical welfare, let him do so. But don’t let him get away with calling it insurance. He not only does violence to the language; he also clouds the discussion. This is another application of the tacit premise that no one should have to pay for his own medical care. Bastiat’s line about the state being the means by which we all try to live at everyone else’s expense comes to mind.

President Obama says he will finance “reform” by shifting Medicare reimbursement decisions from Congress to an independent board of experts. Too bad he is unaware of the Austrian critique of central planning. Outside the marketplace, no one can know how much doctors and hospitals should be paid. Bureaucrats can’t tell what is too much or little compensation because they can’t have the relevant knowledge. Markets are good at setting prices because that knowledge is communicated through people’s buying and abstention from buying.

This is not just an academic discussion. Prices are information, and when they are “wrong” there are consequences. If the bureaucrats pay too little, costs will be shifted to others and providers will leave the market, creating shortages. If the bureaucrats pay too much, resources and labor will drawn away from other needed areas. With the collapse of the Soviet Union and the continuing examples of Cuba and North Korea, we should all know that government doesn’t know how to set prices.

Obama promises overall “cost containment.” But government has only two ways to accomplish this: rationing or price controls. The drawback to the first is obvious. People are forbidden to buy the services they want, even when they are willing to pay for them themselves. Bureaucrats — rather than individuals and their doctors — decide what tests and procedures are necessary. The drawback to the second is that services will disappear from the marketplace. Price ceilings create shortages.

On the other hand, the market has a method for containing costs. It’s called economizing, and people practice it naturally when they face the costs and consequences of their decisions. People are less likely to buy unnecessary services if they have to pay for them. And if they were buying their own insurance, they wouldn’t typically buy policies that covered smaller, routine expenses. The administrative overhead would make such policies a bad buy.

Conflicting Goals

The New York Times points out that the reformers have two conflicting ostensible goals: “to expand health coverage to nearly all Americans while reducing the growth of health spending.” How can they do both? Obama goes back and forth between stressing universal coverage and cost containment, but he doesn’t discuss one in relation to the other. Newly subsidized coverage will bring new demand for medical services and put more upward pressure on prices. As noted, higher prices can be counteracted only by denying service (say, hip replacements for octogenarians) or by imposing price controls, overtly or covertly.

What is it government’s business how much we spend on medical services? Government’s only concern should be to eliminate the ways it interferes with and influences our choices. The aggregate cost of our freely chosen actions is our concern alone, not the government’s.

But of course, government interferes with and influences our choices in many ways, and by doing so raises the costs. As Obama said the other night, “[T]he biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.”

For once Obama was conceding that the government is at fault. Medicare and Medicaid are two ways the government forces the taxpayers to pay for medical care. Those who obtain their medical care through those programs have no incentive to economize because it’s free to them. That’s why the budgets are out of control — people act rationally according to the incentive system they are in — and why Obama is looking for ways to control costs. As long as those programs exist, he won’t be able control costs without bureaucratic rationing of services one way or another.

If the “reformers” get their way, something much like this failed system will be extended to the general public.

Ending Waste

Obama says two-thirds of the estimated cost of “reform” — at least $1.5 trillion over a decade — will be paid for “by reallocating money that is simply being wasted in federal health care programs.” I wouldn’t take seriously any of the reformers’ numbers. The safe bet is that cost of the program will far exceed what they project, and the most of the savings will never materialize. When Medicare was being put together, the pooh-bahs projected that by 1990, hospitalization coverage would cost only (!) $9 billion. when 1990 arrived, the price tag read $66 billion.

The final third of cost would likely come from surtaxes on upper-income earners. Are high earners likely stand still when targeted for new taxes? No. They will adjust their income-earning activities to minimize the tax take, and that will mean lower-than-projected revenues. Then what? Taxes on the middle class, perhaps. Or more debt and inflation.

Competition and Choice

Does anyone else laugh when politicians promise that government will bring competition, choice, and efficiency to the medical industry? Government routinely can’t account for millions, even billions, of dollars. And competition and choice? As a compulsory monopoly, government is the enemy of those things.

Competition and choice is what you get when the government backs off. You don’t get them by having government interject itself even further in an area of life.

Finally, the way to rig a debate over public policy is to never acknowledge the only genuine alternative your proposal. Obama says, “I’m confident that when people look at the costs of doing nothing they’re going to say, we can make this happen.” Why is “doing nothing” the alternative to a conscious attempt to reinvent the healthcare industry? While it is true that doing nothing would be preferable to what Obama and his congressional allies want to do, it is not the best alternative. The best alternative is the free market. But have you ever heard the advocates of government control offer an argument against the free market? The answer is no, and the reason is that to argue against it would be to acknowledge it as an alternative. And that they cannot afford to do. Better to have the people think we already have a free market in medicine and that it has failed. That way they will be more likely to win support for government control. The “reformers” task would be more difficult if people understood that what has created the problems is government, not the free market.

This effort ignore the market solution is abetted by an alleged limited-government party that is unwilling or unable to speak the truth. That help explains the predicament we are in.


Obama Health Care Bill Contains Race Preferences

Black Activist Speaks Out Against Proposed Unequal Allocation of Health Resources

An examination of the 1018-page "America's Affordable Health Choices Act of 2009" (H.R. 3200) - the official Obama health care bill - finds several cases in which grant money for medical training can be awarded solely on factors of race and class.

Project 21 member Bishop Council Nedd II, an Anglican bishop and director of the Ecumenical Institute for Health Policy Research based at Valley Forge Christian College, is condemning the addition of racial preferences to the President's legislation.

"The U.S. Supreme Court just struck down racial preferences. So why does a newly-introduced bill want to perpetuate something that has just been declared unconstitutional?" asked Project 21's Nedd. "Racial preferences will not improve health care. They will increase tensions when some people are being unfairly put at the front of the line."

Between pages 878 and 909 of H.R. 3200, in an area related to grants for medical training, the Secretary of Health and Human Services is empowered to grant preference in awarding training grants. For the specialties of "family medicine, general internal medicine, general pediatrics, geriatrics and physician assistantship" (pages 878-882); "medical residents on community-based settings" (pages 883-886) and "general, pediatric and public health dentists and dental hygienists" (pages 887-891), it is written that "the Secretary shall give preference to... entities that have a demonstrated record of... training individuals who are from underrepresented minority groups or disadvantaged backgrounds."

Further, the bill amends the Public Health Service Act to give preferences in "advanced education nursing grants" to programs that "increase diversity among advanced education nurses" (pages 892-895). Grants for "enhancing the public health workforce" similarly give preference to "entities that have a demonstrated record of... training individuals who are from underrepresented minority groups or disadvantaged backgrounds" (pages 907-909).

Nedd added: "By making racial preferences a shortcut to federal funding, schools will reduce their quest for the best and turn it into a hunt for the right racial numbers. This, in the long run, will hurt the quality of our nation's health care. We need to stop the social experimentation and focus on cost and performance."


No comments: