Thursday, July 16, 2009

NHS tries to avoid treating patients with swine flu

For one mother, the NHS's swine flu response is scarily unresponsive. Dealing with swine flu is confusing and - with the news of the deaths of apparently healthy people - scary. That was brought home by this message I got from a mother trying to negotiate the NHS for her family. She writes:

Yes, more children will probably die in the swine flu epidemic. And it may well be partly because senseless bureaucracy is stopping child victims getting urgent medical help...

It was Saturday morning. My children had been taking Tamiflu for a couple of days, after our GP had diagnosed swine flu on the phone. Now both my husband and my younger son were looking worse. My husband has asthma and my son suffers from recurrent croup (for which he has been hospitalised twice). So I rang Out of Hours Urgent Care, who transferred us to NHS Direct. Surely, I thought, as probable swine flu victims my husband and son would be treatment priorities?

An arrogant telephone operative at NHS Direct told my asthmatic husband he probably didn’t have swine flu and had nothing to worry about. No treatment was offered. So I took my son to the NHS Walk-In Centre. There, when I mentioned Tamiflu, we were ushered into a separate room and then told we would not be seen by a doctor and must leave the building. Because we had swine flu. We should ring NHS Direct for help. I explained why that had failed, whilst my son’s coughing grew more ominous.

I refused to leave, I pleaded, I lost my temper. My child is sick, he is getting croup, he needs to be seen. Children die of this. At length, a kindly nurse arranged a GP Home Visit. We returned home to wait, but within two hours my son was struggling to breathe. A 999 call, ambulance, blue lights, hospital, steroids, oxygen. An emergency that could well have been avoided with the right medical treatment quicker. Admittedly, we got help quickly because I broke the rules given at the time of diagnosis: I rang for an ambulance myself rather than joining the queue for NHS Direct, as I’d been told to do in emergency. I wonder how long I would have waited in a telephone queue whilst my son struggled to breathe.

And my husband? Oh, he ended up in hospital too, for a couple of hours, after the Home Visit GP looked at his condition and recommended I drive him straight to Casualty. He explained that it was breaking the rules, but that my husband needed a nebuliser quickly, and if he tried to arrange it the procedure would take hours, because there were so many protocols for dealing with swine flu patients.

I wish my story was unusual. But a friend in the same village – on the same day – broke the rules too. They’d been diagnosed in hospital that Friday, immediately quarantined and sent home with a helpline number to ring for medicine. They tried for twenty-four hours to get through. They spent thirty pounds on fruitless telephone calls. Then he took his rapidly worsening son back to Casualty.

Leaving him in the car to prevent infection, he went inside and demanded to see a doctor. His treatment was worse than mine. When I lost my temper the Walk-In Centre took me seriously. When he raised his voice, they called the police. He was kept in a private room whilst his sick son was left alone in the car outside. “It’s the lack of compassion that gets me,” he said. “It was like they didn’t care about a sick child.”

He got the medicine, eventually. After breaking the rules and kicking up a fuss. But Tamiflu is only effective if taken at the very beginning of an illness. That twenty-four hour delay in getting medication could have killed my friend’s child. So could untreated croup.

Of course no one wants to spread infection unnecessarily. It is sensible to self-quarantine and ask for home visits. But at the moment Britain’s panic about swine flu has created senseless barriers that are stopping very ill young children getting the treatment they need.


Obama’s tax flip-flop on health benefits

The campaign ad was ominous: "John McCain would make you pay income tax on your health insurance benefits. Taxing health benefits for the first time ever." So warned candidate Barack Obama less than a year ago. In ads and speeches, Obama went on to predict the horrific fallout of McCain's proposal: financial hardship and millions dumped from employer-provided health plans. Today, spokesmen for President Obama are saying a tax on employer-provided health benefits wouldn't be such a bad thing after all.

Roughly 163 million Americans receive health insurance through their employer. While actually a form of compensation, the value of the employer's contribution to that insurance is not taxed under the federal income or payroll taxes. This exclusion is a solidly middle-class tax benefit. More than 70% of middle-income, nonelderly Americans have employer-based health coverage. And about half of people with employer-based coverage have family income of less than $75,000.

Now, in a desperate search for $1 trillion to $2 trillion to pay for Obama's medical insurance reform plan, congressional Democrats are considering proposals to limit or repeal this tax exclusion. And the Obama administration says it may go along.

This reversal is far more than a simple case of hypocrisy or jettisoning a campaign promise once it becomes inconvenient. The McCain proposal that candidate Obama so viciously attacked was part of a plan to shift the overall system toward market-based individual coverage. While it was true that McCain would have eliminated the exclusion for employer-provided health benefits, letting them be taxed like ordinary income, he would have given workers a tax credit for purchasing health insurance on their own or through an employer. The result would have been that most workers would pay the same or less in taxes, with health markets more efficient and coverage more portable.

The proposals now discussed are nothing more than a naked grab for more tax money. There would be no offsetting tax credit. Workers would simply pay more taxes — a lot more taxes. For example, if the income-tax exclusion were repealed, it would impose a $2.3 trillion tax increase over 10 years. On average, employers pay $8,824 for a worker's insurance. Assuming tax rates of 10% to 38%, that means workers could expect to pay from $882 to $3,353 annually in additional taxes. Those with more expensive health plans, such as unionized auto workers, would face even bigger tax hikes.

Rather than fully repealing the exemption, Congress likely will put a cap on the tax exclusion. It would eliminate the income and payroll tax exclusion only for insurance plans with an above-average value or for workers with incomes above a certain level. The problem is that, while more politically palatable, such a partial repeal of the exclusion wouldn't raise nearly enough money to pay for medical insurance reform. Eliminating the exclusion only for insurance plans with an above-average value would raise only $165 billion over 10 years.

And all this is only one of the middle-class tax increases Congress is considering to pay the enormous cost of the president's plan. Payroll tax hikes, a value-added tax, income tax surcharges, even taxes on beer and soft drinks are all on the table. In the words of humorist P.J. O'Rourke: "If you think health care is expensive now — just wait until it's free."

Congress seems determined to pass medical insurance reform no matter what the price. And if the president has to break a few campaign promises and tax the American middle class, the path he is on indicates he is willing to pay up. Whether middle-class Americans are is a different story.


Wal-Mart has let the side down

The word leadership tends be thrown around a lot in Washington. We see it used endlessly in political campaigns, newsrooms…even by trade associations. It seems everyone wants to lead. But not everyone has what it takes.

With health care reform looming in Congress, everyone is clamoring to claim their corner on the big debate, and the stakes have never been higher. The Obama administration seems to have taken to the notion that reform for reform’s sake is better than nothing at all. What they must fail to realize is that a misstep on health care could quickly push our economic recovery back decades.

One of retailers’ biggest concerns in the health care debate is the idea of an employer mandate provision, which would be catastrophic for our industry. Mandates would drive up costs for retailers while doing nothing to address waste, inefficiencies and lack of competition. Ultimately, employers forced to spend more on insurance would have little choice but to reduce payrolls or raise prices – and that’s the last thing retail employees or shoppers need right now. NRF’s Employee Benefits Counsel has been participating in health care reform discussions behind the scenes for years, working with Congress, associations and businesses alike to arrive at a compromise.

When Wal-Mart sent a letter to President Obama two weeks ago supporting government mandates on businesses as a part of reform, the retail industry was astonished. Seeing the company in lock-step with the unions on this issue was troubling to say the least. Although the move may provide a short-term public relations boost to Wal-Mart, it could have long-lasting, devastating consequences to retailers throughout the country.

This stunning turn of events left NRF with a decision to make. We could stand idly by and allow Wal-Mart to tip the scales on the health care debate, cower and release an innocuous statement that would neither support nor condemn their decision, or stand up for all retailers and come out swinging.

The truth is the decision wasn’t all that difficult. In fact, there was never really any choice. NRF is the retail industry’s association, which means we represent all retailers – large and small – not just a select few. (Wal-Mart is not a member of NRF and, after this dispute, I’m not expecting a dues check from them anytime soon.)

We knew that going up against Wal-Mart would raise some eyebrows – and it did. But, simply put, we could not condone the decision of one retailer, even the largest retailer in the world, if it would come at the expense of everyone else. So, we spoke up.

In the last few weeks, NRF executives have spent quite a bit of time speaking with reporters – from CNBC to the Wall Street Journal to Fox News – expressing our disappointment with Wal-Mart’s decision. On Capitol Hill, we have been working closely with legislators to spell out in no uncertain terms the serious ramifications employer mandates would have on our economy. On top of that, our CEO Health Care Task Force continues to work diligently on real solutions that would help fix our health care system by laying out steps to encourage competition on cost and quality, rather than creating a $2 trillion bill for future generations to pick up.

To truly lead on the health care debate, it is imperative that businesses, associations, and politicians take a stand when it counts and not shy away from deal-breakers like employer mandates. That’s the difference between leadership and lip service. And I think, by now, we’ve all had quite enough of the latter.

If you have any thoughts on NRF’s stance on health care and employer mandates, please let me know.


Weasel language from an Australian government health bureaucracy

A missive from Queensland Health director-general Mick Reid reminding staff about how important it is to be honest with the public now that the Right to Information laws have begun:
Special Broadcast 1/07/2009 6:43 pm

All staff of Queensland Health need to be aware that the Right to Information Act 2009 and the Information Privacy Act 2009 commenced today.

Both of these Acts are key components of the Queensland Government’s Right to Information policy that is aimed at promoting a culture of openness, accountability and transparency, balanced with appropriate protections for certain information, including personal information. In practice, this means that information will be released unless, on balance, its release is contrary to the public interest.

All of the Queensland Public Service need to be aware that the objectives of the Right to Information reform process mean we operate on a presumption of disclosure of government information.

To this end could all staff please note the contents of the attached Statement of Right to Information Principles For the Queensland Public Service issued by the Premier of Queensland.


I think comment would be superfluous

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