Wednesday, July 22, 2009

Gun and car crash victims face long ambulance ride to new British trauma units

British ambulance response times are already erratic .... And time is of the essence in many cases of serious injury

FOUR "super" accident and emergency units designed to treat gun crime and car crash victims in London are to be given the green light today. The most seriously ill patients will be fast-tracked to the major trauma centres for life-saving emergency care. But campaigners said lives will be put at risk as the centres are not spread evenly across London, meaning those on the outskirts face long journeys.

A joint committee of all London's primary care trusts is set to approve the hospital centres which will be set up at the Royal London in Whitechapel, King's College in Denmark Hill, St George's in Tooting and St Mary's in Paddington. The units will be open by the end of next year. NHS body Healthcare for London, which is developing plans for the trauma centres, insisted every Londoner will be a maximum of 45 minutes by ambulance away from one. [That eats up a lot of the "golden hour" (first hour after injury) during which some seriously injured persons can be saved]

But Geoff Martin, chairman of London Health Emergency, said: "Millions of Londoners on the outskirts will now face a dangerously long journey to the centre to access emergency trauma care. We think the 45-minute maximum journey time is optimistic and with only one air ambulance this whole scheme represents a massive gamble with life or death services."

There are also concerns that none of the centres is near Heathrow. Mr Martin added: "It defies belief. That leaves the UK's major airport dangerously exposed and we are demanding an urgent rethink before these plans are cast in stone."

But a spokeswoman for Healthcare for London said most major trauma incidents, such as stabbings, shootings and car accidents, happen in central London. She added: "The important thing is to get the right treatment, even if it means spending an extra 10 minutes in an ambulance."

The trauma centres will be staffed by a consultant at all times and specialists in every discipline, including trauma, orthopaedic and neuro-surgeons. The units will cost £14million a year to run, and the money will come from PCT budgets. Matt Thompson, clinical director for trauma services in London, said: "These patients are some of the most seriously injured patients that any hospital will ever see. It is vitally important that they have access to the right expertise and services if their lives are to be saved and disabilities reduced. "The proposed new trauma system - made up of major trauma centres linked to local trauma centres - would rival the best in the world. It is a fantastic opportunity for London to improve the care of these patients."

The PCT committee is also expected to approve plans to create eight specialist centres for stroke victims at Charing Cross, King's College, Northwick Park, Queen's, St George's, the Princess Royal, the Royal London and University College hospitals. These will provide specialist care for the first 72 hours after a stroke or until a patient is stabilised. They will open by summer 2011 and cost around £23million a year. Patients will be taken to the units within 30 minutes. But acute services in other hospitals are expected to be closed as part of the process. Campaigners fear the Royal Free in Belsize Park will lose its emergency stroke unit.

Dr Nick Losseff, interim clinical director for stroke services in London, said: "Patients and their families can be assured these will save lives and prevent disability."


Support for Obama on healthcare slips - poll

Public support for President Barack Obama's handling of healthcare reform, the pillar of his legislative agenda, has fallen below 50 percent for the first time, a Washington Post-ABC News poll released on Monday said.

Obama and his Democratic allies in Congress have run into stiff opposition this month as they try to pass legislation to restructure the $2.5 trillion U.S. healthcare industry through the creation of a government-run health insurance program. Republicans and some fiscally conservative Democrats argue the plan, with an estimated cost of more than $1 trillion, could hurt small businesses, add to budget deficits and reduce the quality of medical care for many Americans.

Those concerns may be having an impact on the public, according to the poll, which showed 49 percent of respondents approving of Obama's stand on the issue compared to 57 percent in April. Those saying they disapproved rose to 44 percent from 29 percent during the same period.

Obama and the White House have gone on the offensive to drum up support for the plan, which would compete with private insurers, provide cover to many of the 46 million uninsured and try to stem runaway medical costs. With time running out to pass a bill in Congress this year, the battle is shaping up as a major test of Obama's presidency. Delaying legislation until 2010, a congressional election year, could give Republicans and critics in the healthcare sector more time to galvanize opposition to the plan.

But Obama remains more trusted than Republicans in Congress to do a better job on healthcare reform, the poll showed, with 54 percent of respondents putting their faith in the U.S. leader versus 34 percent in favor of Republican lawmakers. His overall approval rating also remains high at 59 percent despite some slippage in approval ratings for his handling of the economy, the federal budget deficit and other leading domestic issues, according to the poll.

It surveyed 1,001 adults randomly by telephone between July 15-18, 2009. The results from the full survey have a margin of error of plus/minus three percentage points.


Inside the Monstrous Obamacare Bureaucracy

If you think government is too big and too costly, wait until Obamacare kicks in. The Congressional Budget Office put the price tag of the House Democrats' health care takeover plans at $1.5 trillion over 10 years. But the CBO's fine print included a telltale caveat:

"We have not yet estimated the administrative costs to the federal government of implementing the specified policies, nor have we accounted for all of the proposal's likely effects on spending for other federal programs."

You don't need an accounting degree or clairvoyant powers. The administrative costs and spillover spending effects will be astronomical. Look at existing federal programs. In 1966, the Office of Management and Budget put the total taxpayer costs for Medicare at $64 million. In 2011, Medicare costs are expected to balloon to nearly $500 billion. Medicaid cost $770 million in 1966. By 2011, that program will cost taxpayers an estimated $264 billion. The Virginia-based Council for Affordable Health Insurance estimated that the administrative expenses of both programs last decade were 66 percent higher than those of private sector health insurance companies.

And we ain't seen nothing yet. House Republicans on the Joint Economic Committee sifted through their opponents' 1,018-page health care bill and released a dizzying flow chart detailing the Byzantine bureaucracy Obamacare would create. Washington would become the home of at least 31 new federal programs, agencies and commissions to oversee the government-run health insurance regime.

Because 32 "czars" isn't enough, the Democratic plan would add another overlord to the Obama administration. The new "Health Choices Commissioner" would helm the new "Health Choices Administration" (section 141 of the bill) -- separate from the already existing Department of Health and Human Services, Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Veterans Health Administration and the Indian Health Service.

Because the government has done such a boffo job managing the near-bankrupt Social Security and Medicare Trust Funds, the Democrats have proposed creating a "Public Health Investment Fund" and a "Health Insurance Exchange Trust Fund." The latter would create a "transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers."

No matter that state insurance departments already operate such systems. Health care must be "fixed." The federal cure is redundancy.

The Obamacare bill also creates a new "Bureau of Health Information" (not to be confused with the already existing National Center for Health Statistics) within the department of Health and Human Services. A new "Assistant Secretary for Health Information" will lead the BHI. The new assistant secretary will coordinate with the recently created "National Coordinator for Health Information Technology" -- who is responsible for monitoring the $19.5 billion in the stimulus law to implement "a nationwide interoperable, privacy-protected health information technology infrastructure."

New bureaucracies always have old special interests to appease. The Bureau of Health Information will house its own "Office of Civil Rights" and "Office of Minority Health." The information czar will be required to collect health statistics in the "primary language" of ethnic minorities -- and, thus, the need for a new "language demonstration program" to showcase their efforts. Obamacare will also ensure "cultural and linguistics competence training" and establish "a youth public health program to expose and recruit high-school students into public health careers." The government health care juggernaut must be fed and staffed, after all.

Providing more stimulus for taxpayer-funded jobs, the Democrats' bill would add a new "Senior Advisor for Health Care Fraud" and require the Attorney General to appoint a "Senior Counsel for Health Care Fraud Enforcement." There's already a national Health Care Fraud and Abuse Control Program, but who's counting?

To coordinate all the new bureaucrats, Obamacare would create a new "Health Care Program Integrity Coordinating Council" to "to coordinate strategic planning among federal agencies involved in health care integrity and oversight."

To make sure all the existing local and state environmental public health agencies don't feel lonely, the Democrats' plan creates a new "Coordinated Environmental Public Health Network" to "build upon and coordinate among existing environmental and health data collection systems and create state environmental public health networks."

A new "National Health Care Workforce Commission" will be "tasked with reviewing health care workforce and projected workforce needs." New funding will be available for a "demonstration program to improve immunization coverage" that would enable government busybodies to send reminders or recalls for patients or providers, or make home visits.

Who'll be looking out for you? The House bill creates a "public plan ombudsman" and a "special health insurance exchange inspector general" to police spending and guard against waste, fraud and abuse. Given the sad fate of aggressive watchdogs in the age of Obama, however, these positions will end up like every other new agency, commission, task force and office created to serve the federal health care beast: black holes.


The “public option” health care scam

Some statements are inherently unbelievable. Such as: "I am an official of the government of Nigeria, and I would like to deposit $60 million in your bank account." Or: "I'm Barry Bonds, and I thought it was flaxseed oil." And this new one: "I'm Barack Obama, and I favor more competition in health insurance."

That, however, is the claim behind his support of a government-run health insurance plan to give consumers one more choice. The president says a "public option" would improve the functioning of the market because it would "force the insurance companies to compete and keep them honest."

He has indicated that while he is willing to discuss a variety of remedies as part of health insurance reform, this one is non-negotiable. House Democrats, not surprisingly, included the government plan in the 1,000-page bill they unveiled Tuesday.

It will come as a surprise to private health insurance providers that they have not had to compete up till now. Nationally, there are some 1,300 companies battling for customers. Critics say in many states, one or two insurers enjoy a dominant position. But market dominance doesn't necessarily mean insufficient competition.

Microsoft's dominance of software didn't prevent the rise of Google, and Google's dominance of search engine traffic didn't prevent Microsoft from offering Bing. If a few health insurance providers were suppressing competition at the expense of consumers, you'd expect to see obscene profits. But net profit margins in the business run about 3 percent, only slightly above the median for all industries.

There are reasons, though, to think that the president's real enthusiasm is not for competition but for government expansion. Free-market advocates want to foster competition by letting consumers in one state buy coverage offered in other states. If WellPoint has more than half the business in Indiana, why not let Indiana residents or companies go to California or Minnesota to see if they can find options that are cheaper or better?

But the administration and its allies show no interest in removing that particular barrier to competition. Maybe that's because it would reduce the power of state regulators to boss insurance companies around.

Nor does Obama believe in fostering competition in other health insurance realms—such as existing government health insurance programs. John Goodman, head of the National Center for Policy Analysis, suggests letting Americans now enrolled in Medicare, Medicaid and the State Children's Health Insurance Program (SCHIP) select a voucher to buy private coverage if they want. Don't hold your breath waiting for the administration to push that idea.

Supporters of the "public option" think it can achieve efficiencies allowing it to underprice existing insurers. But efficiency is to government programs what barbecue sauce is to an ice-cream sundae: not a typical component. Nor is there any reason to think Washington can administer health insurance with appreciably lower overhead than private companies.

Medicare supposedly does so, but that is partly because it doesn't have to engage in marketing to attract customers, which this program would. It also spends less than private companies combating fraud and unwarranted treatments—a type of monitoring that spends dollars while saving more.

As the Congressional Budget Office has pointed out, "The traditional fee-for-service Medicare program does relatively little to manage benefits, which tends to reduce its administrative costs but may raise its overall spending relative to a more tightly managed approach." False economies are one reason Medicare has done a poor job of controlling costs.

But a public program of the sort Democrats propose doesn't have to control costs, because in a pinch it can count on the government to keep it in business. Competition is healthy, but how are private companies supposed to compete with an operation that can tap the Treasury?

Students of the Obama economic policy will also note a curious consistency in its approach to economic issues. Some problems, like the near-collapse of General Motors and Chrysler, came about because competition worked very well at serving consumers and punishing poorly run companies. Some problems, such as high health insurance premiums, came about because competition allegedly didn't work so well. In both cases, the administration proposes the same solution: more federal spending and a bigger federal role.

Will introducing a government-run insurance program work? After all, that Nigerian financial scam works. Just not necessarily the way you hope.


Are the lights on?

How can the hostile takeover of health care businesses and workers by the federal government be okay? Blissful ignorance is one thing, but this is worse. It has to be willful ignorance.

Is there really anybody out there who doesn’t understand that there are a whole lot of people who will over-use free health care service? If asked to think about it, does anyone really expect there are an infinite quantity of heart bypasses and new hip joints sitting in a warehouse somewhere just waiting to be handed out to anyone who wants one?

If they do conclude that health care is a finite good, then are they ready for the next half of the conclusion, that their lovely free universal health care will turn those goods, services and the people who provide them from private to government? Are they ready to have their least favorite politicians deciding who gets care and when?

What other choice is there?

Of course there is the fairyland option where perfect people make perfect decisions. Are there really people out there who have experience with perfect people attaining positions of power?

As we run full speed downhill into the abyss, I am amazed at some of the decisions the politicians get away with. Piles of mistakes are buried under mountains of stupidity. Covering it all is an ocean of greed and corruption.

It seems so obvious to me now, and has for so long that I have to work to understand how anyone can think this is good or even okay. What kind of people think this can work out? I suppose I have to admit that thinking is not involved and belief is the operable word.


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