Sunday, July 12, 2009

Fury as NHS trust says only women between 39.5 and 40 years old can have IVF

Which, aside from anything else, makes it most likely to be futile. You wonder if it's human beings who are making these decisions. It shows you how low bureaucratically-run medicine can sink

Infertile women have been told they can only have IVF treatment if they are aged between 39 and a half and 40. The 'cruel and bizarre' restrictions were put in place by NHS managers in North Yorkshire struggling to deal with a huge deficit at their health trust. It could mean women with severe fertility problems to wait years for one cycle of IVF treatment. Between the age of 35 and 40, the chance of conception for women halves - and the heart breaking delays will further reduce the chance of having a baby for dozens of women.

The rules were greeted with incredulity by charities. Susan Seenan, from Infertility Network UK, said: 'This policy really is one of the worst we have ever encountered amid the postcode lottery for IVF. 'We have seen some bad policies in other parts of the country, but this is not just cruel, it is bizarre, and it flies in the face of the medical evidence that the best treatment for fertility is to start early.' 'If you seek fertility treatment, and you are told to wait until you are almost 40, at a point when your chances of conception will be massively diminished, if there is any way you can manage to pay for it, you will seek private care. 'The tragedy is for those couples who do not have that option.'

The severe restrictions were put in place by NHS North Yorkshire and York in order to cut its spending. Two couples said they were forced to go private because the health trust would not fund the IVF. They had their treatment at Leeds General Infirmary, alongside couples who lived in a neighbouring primary care trust area who received their treatment for free.

One couple from Harrogate, who now have a three-week-old daughter, following private infertility treatment, said they were 'incredulous' when their consultant explained why they could not receive NHS treatment. The man, aged 40, and his wife, who is now 33, said that even their GP was not aware of the policy. Guidance from the National Institute for health and Clinical Excellence says women should be offered three cycles of IVF treatment free on the NHS, if they have had fertility problems for three years, are aged between 23 and 39, are not obese and do not smoke. The cost of three cycles is around £15,000.

But around three quarters of primary care trusts are providing less IVF treatment. Many reduce to pay for IVF treatment to women below the age of 30. But none are as restrictive as North Yorkshire and York primary care trust, where just 16 women were given IVF treatment in the last year. The PCT said the vast majority of those cases involved women aged between 39 years and six months and 40, but said it was possible for younger women to be granted the treatment if their circumstances were deemed to be 'exceptional'. Managers would not define exceptional, although families in North Yorkshire said it only covered occasions where one of the prospective parents was terminally ill.

NHS North Yorkshire and York PCT said decided to stop routinely funding IVF treatment in May 2007, as part of a plan to tackle its financial problems. All women who were on the waiting list for treatment at the point it was frozen have now been scheduled to have IVF by September of this year. The trust said it was currently reviewing its policy covering women referred since May 2007, and future patients. It said it aimed to ensure that by next April it could remove its age restrictions on treatment, and offer all couples one cycle of treatment.

PCT strategy director David Cockayne said: 'As part of our financial recovery plan, which began in early 2007, the PCT's board had to take some very difficult decisions on what clinical priorities it would pursue.'

Of the 32,000 people who have fertility treatment each year, around three-quarters pay privately for the treatment, which has a success rate of around 25 per cent per cycle.


Blue Dog Democrats negative on Nationalized Health Care

There's blue blood in the water. Congressman Mike Ross (D-AR-CD4), chairman of the Blue Dog Health Care Task Force, dropped a bombshell yesterday on Barack Obama and Nancy Pelosi's plans to implement a so-called public "option" for health care. Ross stated that if the House Majority brings their bill to the floor as proposed, an "overwhelming majority" of his 52 member coalition would vote against it. As well they should, a group that claims that their "top priority will be to refocus Congress on truly balancing the budget and ridding taxpayers of the burden the national debt places on them."

Congressman Ross' statement is encouraging, but it needs to be backed up by action to defeat any proposal that threatens to bankrupt the nation by creating another unsustainable entitlement. With the national debt now soaring above $11.4 trillion, unfunded liabilities in Medicare and Social Security totaling $104 trillion, a proposed annual budget of $3.6 trillion, and a projected deficit of $1.8 trillion this year alone, a vote in favor of a trillion dollar government-run health care plan would decidedly be against Blue Dog, fiscal conservative principles.

And with legislation moving through Congress at a frightening speed this year—trillion dollar "stimulus," carbon energy taxes, nearly a $4 trillion dollar budget, and now healthcare—with only 178 House Republicans, the only chance at saving privately-provided health options will be if Democrats vote against their leadership, and against this legislation.

But that will only happen if pressure is brought to bear on each and every member of the Blue Dog coalition and beyond. They must hear from the more than 201.7 million constituents who possess privately-provided health care as of 2007—and would undoubtedly like to keep it and not be forced to trade it in for a substandard government plan. For, unless the users of health care defend what is rightly theirs, the so-called public "option" will take over the entire system, devouring all other options.

What's worse is the exact details are not yet publicly known of the plan. And it is moving swiftly: House Democrat leaders plan on unveiling it today, and committee votes are expected as early as next week. Only there's just one small problem. They have not even shown it to their Blue Dog colleagues yet.

"We've just got a lot of questions and the top of the list would be how to pay for it," said Congressman Marion Berry (D-AR-CD1). That, of course, is an excellent question, since the only way to pay for any new spending programs with the country in such a steep deficit will be to borrow more cash from overseas, raise taxes, or print more dollars.

And in all of the above financing alternatives, the American people will wind up paying more. Borrowing too much leads to higher interest rates as U.S. debt becomes less attractive of an investment. Raising taxes obviously takes more money away from Americans to purchase their own health options. And firing up the printing presses leads to inflation, which will mean higher prices on just about everything, including health care, thus fueling the bottom line of whatever proposal is enacted.

But that may not even be the worst of it. An even more fundamental question to be answered about the so-called public "option" is: Who will qualify? If it is truly to be an option for all Americans, then in principle everyone would qualify. And if that's the case, say goodbye to private health care, as everyone starts lining up for government freebies.

Advocates of the public "option" claim that it will be "cheaper" than private care. That they want to cut health care costs—which in reality means price controls that unfortunately always lead to shortages. It will also put private insurers who attempt to compete out of business, since they cannot borrow trillions of dollars to stay in the black.

As a result, even if government does not issue free health care outright, and just heavily subsidizes individuals and employers to switch to the government plan, the net effect will still be a state-run monopoly that crowds out private options, long lines at the doctor's office, and a declining quality of care as doctors are forced to take pay cuts and yet work even longer hours.

So, the Blue Dog Democrats really ought to consider the 201.7 million American people who like the quality of their privately-provided health care that is unparalleled anywhere in the world. Because they do not need "more time" to consider this plan. They need to know that there's somebody in Congress who is going to fight to help them keep their options.


There's No Such Thing as Free Health Care

The costly truth about Canada's health care system

President Obama says government will make health care cheaper and better. But there's no free lunch. In England, health care is "free"-as long as you don't mind waiting. People wait so long for dentist appointments that some pull their own teeth. At any one time, half a million people are waiting to get into a British hospital. A British paper reports that one hospital tried to save money by not changing bedsheets. Instead of washing sheets, the staff was encouraged to just turn them over.

Obama insists he is not "trying to bring about government-run healthcare." "But government management does the same thing," says Sally Pipes of the Pacific Research Institute. "To reduce costs they'll have to ration-deny-care."

"People line up for care, some of them die. That's what happens," says Canadian doctor David Gratzer, author of The Cure. He liked Canada's government health care until he started treating patients. "The more time I spent in the Canadian system, the more I came across people waiting for radiation therapy, waiting for the knee replacement so they could finally walk up to the second floor of their house." "You want to see your neurologist because of your stress headache? No problem! Just wait six months. You want an MRI? No problem! Free as the air! Just wait six months."

Polls show most Canadians like their free health care, but most people aren't sick when the poll-taker calls. Canadian doctors told us the system is cracking. One complained that he can't get heart-attack victims into the ICU.

In America, people wait in emergency rooms, too, but it's much worse in Canada. If you're sick enough to be admitted, the average wait is 23 hours. "We can't send these patients to other hospitals. Dr. Eric Letovsky told us. "Every other emergency department in the country is just as packed as we are."

More than a million and a half Canadians say they can't find a family doctor. Some towns hold lotteries to determine who gets a doctor. In Norwood, Ontario, 20/20 videotaped a town clerk pulling the names of the lucky winners out of a lottery box. The losers must wait to see a doctor.

Shirley Healy, like many sick Canadians, came to America for surgery. Her doctor in British Columbia told her she had only a few weeks to live because a blocked artery kept her from digesting food. Yet Canadian officials called her surgery "elective." "The only thing elective about this surgery was I elected to live," she said.

It's true that America's partly profit-driven, partly bureaucratic system is expensive, and sometimes wasteful, but the pursuit of profit reduces waste and costs and gives the world the improvements in medicine that ease pain and save lives. "[America] is the country of medical innovation. This is where people come when they need treatment," Dr. Gratzer says. "Literally we're surrounded by medical miracles. Death by cardiovascular disease has dropped by two-thirds in the last 50 years. You've got to pay a price for that type of advancement."

Canada and England don't pay the price because they freeload off American innovation. If America adopted their systems, we could worry less about paying for health care, but we'd get 2009-level care-forever. Government monopolies don't innovate. Profit seekers do.

We saw this in Canada, where we did find one area of medicine that offers easy access to cutting-edge technology-CT scan, endoscopy, thoracoscopy, laparoscopy, etc. It was open 24/7. Patients didn't have to wait. But you have to bark or meow to get that kind of treatment. Animal care is the one area of medicine that hasn't been taken over by the government. Dogs can get a CT scan in one day. For people, the waiting list is a month.


The misrepresentation of healthcare reform

In the debate over medical reform, everyone can find a public-opinion poll to support his or her position. Robert Reich, who favors deeper government involvement in health care than we already have, wrote recently, “In the most recent Wall Street Journal/NBC News poll, 76% of respondents said it was important that Americans have a choice between a public and private health-insurance plan. In last week’s New York Times/CBSNews poll, 85% said they wanted major health-care reforms.”

Yet Catherine Rampell, economics editor for, reports there has been “no sea change in public opinion” about healthcare reform. She cites Nolan McCarty of Princeton University, who shows that public support for a government overhaul of the medical industry was higher in 1993, when the Clinton plan failed, than it is today.

Of course, we always have reason for suspicion about public opinion polls, since pollsters can get the results they want by how they frame the questions, especially the all-important preliminary questions. People aren’t laboratory rats, and some respondents may be as interested in impressing the pollster as in speaking their minds. Definitive proof of the case for suspicion was provided some years ago by an episode of the satirical BBC television program Yes, Prime Minister, the key scene of which is here. So What?

But let’s not stop there. We may grant that “the public” want (as the British would say) the government to set up an insurance program to compete with private insurers and are even willing “to pay higher taxes so that all Americans have health insurance that they can’t lose no matter what.” So what? By asking this question, I am not displaying naïveté. Politicians of course will use a favorable poll for cover when they do what they want to do anyway.

I mean something else: Why should the people get something through government–that is, at the point of a gun–simply because they want it? We make that assumption reflexively, but why? Fifty-seven percent may be willing to pay higher taxes for universal health insurance, but let’s not overlook what else they are willing to do: tax the 37 percent who aren’t willing to pay higher taxes. (Six percent don’t know if they are willing or not. Sigh.)

H. L. Mencken long ago defined democracy as the “the theory that the common people know what they want, and deserve to get it good and hard.” The problem is that those who don’t want it get it, too. When it comes to government programs, there’s no opt-out provision. Alas, what distinguishes “free” from unfree countries is the freedom to speak out, not to opt out. In the latter respect, all are unfree.

What about that 37 percent who would be ignored? If they don’t count, they needn’t have had their time wasted by the pollster. As Bruno Leoni wrote, “[I]n assuming that 51 voters out of 100 are ‘politically’ equal to 100 voters, and that the remaining 49 (contrary) voters are ‘politically’ equal to zero (which is exactly what happens when a group decision is made according to majority rule) we give much more ‘weight’ to each voter ranking on the side of the winning 51 than to each voter ranking on the side of the losing 49.” (See my article “The Crazy Arithmetic of Voting.”)

Well, it might be said, in our system the majority rules. Standing alone, this principle sounds rather ominous, so the speaker usually hastens to add, “but the rights of the minority are protected.” But really now, which is it? Do the majority rule or are the rights of the minority protected? I really don’t see how you can have it both ways. Our “representatives”–more aptly, our “misrepresentatives”–are supposed to sort out all this complicated stuff, but don’t bet on their squaring the circle any time soon.

The upshot is that they will decide what kind of healthcare system we will have. To the extent they take into consideration what some of the people whom they “represent” want, it is only because they are looking to the next election.

All of which leads me to the question of why we even see these decision-makers as our representatives rather than as our rulers. Think about this: The average congressional district has a population of well over 600,000 people. In Montana, one congressman allegedly represents the state’s entire population of 967,440. The populations of the states range from about half a million (Wyoming) to 36.7 million (California).

Honestly now, who really believes that anyone can actually represent such large and diverse groups of people? (Credit the Antifederalists, or anti-Rats, with another legitimate concern about centralized power.) Are we playing games when we talk about representation under those circumstances?

The Fiction of Representative Government

What got me thinking about this the other day is an essay by the highly respected historian Edmund Morgan, emeritus professor of history at Yale University and prolific author of books on America’s colonial and revolutionary era. His latest book is a collection of previously published papers with the self-explanatory title American Heroes: Profiles of Men and Women Who Shaped Early America. (Hat tip: Jeffrey Rogers Hummel.) But Morgan departs from that theme in a couple of chapters, including Chapter 15, “The Founding Fathers’ Problem: Representation.”

Morgan begins by noting that all governments rest on consent; specifically, the governors are few and the governed are many and thus potentially more powerful than the governors. Therefore the governed must be persuaded to believe that obeying the government is the right thing to do. This is the role ideology plays: It constitutes “opinions to sustain their consent.”

“The few who govern take care to nourish those opinions, and that is no easy task, for the opinions needed to make the many submit to the few are often at variance with the facts,” Morgan writes. “The success of government thus requires the acceptance of fictions, requires the willing suspension of disbelief, requires us to believe that the emperor is clothed even though we can see that he is not.” (Emphasis added.)

In democratic countries such as the United States, those fictions include the idea of representation, as well as the idea that our “representatives” are mere members of the governed like the rest of us. It doesn’t take a lengthy visit to Washington, D.C., or even a state capital, to be disabused of that latter fiction.

Fictions endure only as long as they are useful, and the one regarding representation is quite useful. Morgan writes, “And just as the exaltation of the king could be a means of controlling him, so the exaltation of the people can be a means of controlling them. …In locating the source of authority in the people, they ["the men who first promoted popular government"] thought to locate its exercise in themselves. They intended to speak for a sovereign but silent people, as the king had hitherto spoken for a sovereign but silent God.”

Morgan is unequivocal: “Representation from the beginning was a fiction. If the representative consented [to the king's taxes or laws], his constituents had to make believe that they had done so.” The problem was not only that often a perfect stranger deigned to represent individuals he knew little about, but also that he had a conflicting mandate: to represent his district while also looking out for the welfare of the whole country. This second part was useful in making representative bodies into modern aristocracies. (We leave aside the further problem that for much of the history of representative government, many people were not allowed to vote.)

“The sovereignty of the people was an instrument by which representatives raised themselves to the maximum distance above the particular set of people who chose them,” Morgan adds. “In the name of the people they became all-powerful in government, shedding as much as possible the local, subject character that made them representatives.”

Morgan connects these considerations to the American Revolution, the Articles of Confederation, and the goals of the Constitutional Convention. But bear in mind that he is not a radical critic of the American political system. He’s no anti-Rat. Yet he concedes that centralization of power under the Constitution was intended to restore representation to its fictive status, since it had become more real in the small legislative districts within the states during the Confederation period. As he writes, “The fictions of popular sovereignty embodied in the federal Constitution may have strained credulity, but they did not break it.”

Alas, that topic must be left for another time. For now, as the Senate and House of “Representatives” deliberate whether to give even more control over your health care to bureaucrats, ask yourself what taxation with representation has wrought.


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