Monday, August 10, 2009

Another good one from Australia's medical regulators

Convicted conman working for government. Regulators so often let unqualified and incompetent people run riot that you wonder what they are for. Even when complaints are received, it always seems to take them years to act. DO NOT rely on them to protect you from incompetents. Make your own enquiries when and where you can. Some of these crooks could have been uncovered simply by Googling their names

A CONVICTED conman who claims to be a doctor has been discovered working for the NSW Government - treating police officers and public servants with trauma and psychological injuries. Detectives from Harbourside Local Area Command are investigating David Ali Sarikaya, 45, after a complaint was lodged against him by the NSW Medical Board. Detectives raided his Milsons Point unit and office at the Sydney Trauma Clinic in the CBD on July 31, seizing hundreds of documents and patient files.

Sarikaya lives and works in NSW under the alias Dr David Kaye and has been authorised by WorkCover NSW to treat a range of people, including police officers, prison guards and senior legal figures.

He changed names and moved to NSW more than a decade ago after being convicted and charged of fraud in Victoria. Despite lacking medical credentials, Sarikaya was appointed an "official visitor" for NSW Health, which has allowed him to consult with psychiatric patients in hospitals for the past two years.

In March 2007, after passing a written application and interview, he was approved for the position by then health minister John Hatzistergos. The confidential accreditation signed by Mr Hatzistergos, and sighted by The Sunday Telegraph, granted Sarikaya access to mental facilities and the right to inspect patient records.

About six weeks ago he withdrew from the program after concerns were raised about his credentials. The revelations have deeply embarrassed departmental officials, who last week called for a meeting with police to clarify details about his identity. The NSW Medical Board refused to comment on complaints concerning Sarikaya, but were aware of a police investigation.


Overstretched British public hospitals to have funding REDUCED

This is going to mean even more rationing of medical care. More and more sick people are going to be sent home with nothing more than paracetamol

Hospitals will be forced to make cuts to pay for a massive rise in the bills for Labour's controversial private finance programme after the next general election. Whitehall documents seen by The Sunday Telegraph reveal a financial bombshell which will hit the next Government.

The cost of NHS building deals agreed since 1997 will swell by almost one quarter from 2011 to 2014, necessitating billions of pounds in "efficiency savings", which are already being drawn up by trusts.

Economists described the pressures about to hit the health service as "horrendous" while opposition politicians warned that taxpayers and patients were about to pay the price for "financial recklessness on an unprecedented scale".

More than 100 NHS trusts are operating private finance initiatives (PFIs) agreed since 1997. Under the deals, private companies build hospitals and lease estates and services back to the health service over a period of around 30 years. Of a total £60 billion debt owed to the developers, less than £5 billion will have been paid to them by the time of a likely general election next May, the document, disclosed under the Freedom of Information Act, shows.

The contracts allow trusts to build hospitals that they could not afford to pay for outright, with the bills excluded from Britain's public sector borrowing limits, allowing the Government to take on more debt. Repayments during the next spending review period – from 2011 to 2014 – will reach £4.18 billion, almost £1 billion more than current levels, according to the documents, sent from the Department of Health to the Treasury.

The steep increases come as the NHS prepares for its annual budget to be frozen, meaning cuts in real terms as PFI and other costs rise. As a result, hospitals have been ordered by Sir David Nicholson, the NHS chief executive, to make "efficiency savings" of at least £15 billion over the same period.

The Department of Health returns to the Treasury show the £60 billion total cost of the schemes to taxpayers is more than five times the capital value of the buildings. Annual payments will rise from less than £500 million at the last election, in 2005, to £1.5 billion by 2014, peaking at £2.2 billion by 2029.

The deals, which have always been controversial because of their inflated costs, have encountered extra problems in recent years since the introduction of other policies which threaten hospitals' incomes.

Trusts are now given a standard payment for each person they treat, while patients can choose where to be treated. With PFI sites – which cost around 30 per cent more to run than traditionally-financed deals – struggling to protect their income, trusts are axing other services so they can keep paying contractors debts which will run for decades.

Planners in South London and Kent have concluded that of four hospitals battling debts, closures should occur at Queen Mary's Hospital, in Sidcup, because the other three sites – in Lewisham, Woolwich and Bromley – have PFI bills to pay, limiting the scope to cut fixed costs. Despite local protests, the Accident and Emergency unit in Sidcup will be closed, and maternity services downgraded.

Meanwhile, other parts of the health service, which are trying to cut costs by treating more patients in the community, have left other PFI sites in difficulty.

Prof John Appleby, chief economist at leading health think-tank the King's Fund, said hospitals would face "horrendous pressures" when the rise in the amount owed to contractors in the next spending review coincides with the anticipated freeze in the total NHS budget. "Trusts are locked into contracts which run for 30 years or more," he said. "Now that it turns out they were often built on over-optimistic assumptions, the hospitals' hands are largely tied, because PFI is very inflexible. Rises in repayment costs are very likely to mean cuts in services."

Norman Lamb, the Liberal Democrat health spokesman, said that patients and taxpayers were about to reap "terrible consequences" from an act of financial recklessness which he described as "almost unprecedented" both in its scale, and likely impact. "We aren't against the use of deals like PFI per se," he said. "What concerns me is that the Government made a monumental error in relying on these deals on such a grand scale, in deals which were not properly budgeted. "The result is that they have created a straitjacket for the NHS, which will damage services, while creating an economic time bomb which mortgages current and future generations," he added.

The Department of Health continues to defend the use of PFI, but regulators have cautioned trusts about the level of debts they should take on. Guidance issued earlier this year by Monitor, which regulates foundation trusts, says organisations negotiating construction deals will no longer be allowed to take on annual repayments which are more than 10 per cent of turnover – a figure breached by many of the trusts already making repayments on deals.

A spokesman for the Department of Health said: "Thanks to PFI, we have been able to undertake the biggest hospital building programme in the history of the NHS. All PFI schemes must demonstrate that they are good value for money and affordable when compared with the public funding alternative. "The cost to the public sector of undertaking long term capital investment has always been spread over a number of years." He said hospitals were able to treat more patients after moving to new premises, citing the example of Norfolk and Norwich Hospital which now treats 23,000 more patients a year than the buildings it replaced.


Obama’s health care snake oil

Barack Obama is an extraordinary politician, but not even he can defy the laws of economics and logic.

Obama promises that with enough power government will (1) ensure that everyone has the wherewithal to buy ample medical services, (2) lower the price of care, but (3) not interfere with our choices.

He sounds like the Wizard of Oz. The reason Obama wanted reform passed before the August congressional recess was that he was terrified you would look behind the curtain and find nothing but a bureaucrat who can’t possibly deliver what the “great and powerful wizard” promises.

For the sake of our fiscal and physical health, do pay attention to that man behind the curtain.

Anyone who makes those three promises simultaneously is insulting the intelligence of the American people. That they aren’t buying it should give us hope for the future of this country.

It should be obvious why government cannot possibly increase the demand for a set goods and services, while keeping prices from rising and respecting freedom of choice. In a world of scarcity, when the demand for something increases but the supply does not, prices rise. One of the objectives of health-care reform is to increase demand among those said to be going without (sufficient) medical care. If government pays for or subsidizes their coverage, people will buy more services than they do now. That means higher prices.

But Obama also promises to control rising costs, which he says threaten everyone’s financial well-being.

There is one way for government to make medical care available to the uninsured while keeping a lid on costs, but most people won’t like it: rationing. That is, a medical czar could reallocate medical services from those who have them today to those who (allegedly) don’t.

Yet Obama insists he will not do that. In every speech and news conference, he promises that the system he favors will not interfere with your freedom. You can keep your doctor and your coverage if you are happy with them, he says. (Ignore the fact that Obama-style reform calls for nearly complete control over how insurance companies operate, an extension of the regulation that has been in place for years. “All insurers would have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans would be required to have insurance,” the New York Times reports. You would not be free to pay your own way or to buy a policy tailored to your wishes.)

Obama’s stated objectives have never been accomplished anywhere, and the United States will be no exception.

In Canada and Great Britain people wait in long lines for surgery and doctor visits. Some die while waiting. For a price, firms bring Canadians to the United States for operations. Strained government budgets are pushing France and Germany into rationing, Shikha Dalmia of the Reason Foundation reports. “The most potent form of rationing in France and Germany — and indeed much of Europe — is not overt but covert: delayed access to cutting-edge drugs and therapies that become available to American patients years in advance. The point is that there is no health care model, whether privately or publicly financed, that can offer unlimited access to medical services while containing costs. Ultimately, such a model arrives at a crossroads where it has to either limit access in an arbitrary way or face uncontrolled cost increases. France and Germany, which are mostly publicly funded, are increasingly marching down the first road,” Dalmia writes.

That is where “reform” will get us.

Obama’s conflicting mix of unlimited cheap medicine, insurance control, and freedom of choice is impossible — and he must know it. It’s hard to avoid the conclusion that he is putting political ambition ahead of the public interest. Ironically, there is a way to have freedom and more-affordable services: the free market. For years government has interfered with all aspects of medicine. That’s the problem. Intervention has brought us to where we are. Comprehensive intervention will only exacerbate the problems. It’s good to see that the American people are sensible enough to reject Obama’s snake oil.


Healthcare, democracy, and freedom

Just as in 1993, the issue of government healthcare has risen to the top of the public agenda, taking attention away from war in the middle east. While the iconic “Harry and Louise” have switched sides, the fundamental issues remain the same. Healthcare provides a giant chunk of our national economic activity. Though government is significantly involved through Medicare (now facing future insolvency) and Medicaid, the question is whether the government’s control over healthcare, either direct or indirect, should become even more extensive.

In a fast-paced society, we have a tendency to leap past the basic questions into a morass of detail. Single payer or government as one provider among many? Mandates requiring every citizen to buy health insurance? Control over utilization by some board of experts? These are all important questions, but they should come after a consideration of our core values. The United States prides itself on being a nation with citizens possessed of a freedom given by God and thus not subject to the whims of human government.

The great Wilhelm Roepke, architect of West Germany’s miraculous post-WWII economic recovery, viewed the tendency toward ever larger government with alarm. He correctly ascertained that the more areas of life the government brings under its responsibility, the more it will eventually dictate the basic conditions of those areas of life. Democracy combined with a lack of appreciation for human independence from the government results in a “pre-totalitarian” society.

There are many prudential reasons to oppose the expansion of government healthcare. First, American government has never functioned very well as a “retail” style service provider. The lack of true prices results in rationing on the basis of who is willing to wait the most patiently. Second, we have a federal system in which the states have the role of testing new public policies. State healthcare initiatives have largely failed. Third, the proposed government plans make no provision for preventing the trial lawyer windfalls that are parasitical on the system and have caused tremendous medical inflation. Fourth, government-driven expansion of insurance seems wrongheaded when third party payment is a recipe for increasing cost. In the sectors where patients pay doctors directly (plastic surgery and lasik procedures), real prices have gone down as the procedures have actually improved.

But the prudential reasons are less important than the fundamental questions about our system of government. If we move from being a republic where certain freedoms (not only freedom of speech and religion, but also freedom of contract and freedom to own private property) are basically non-negotiable, to a simple mass democracy in which shifting coalitions of voters extract resources from their opponents, then we have lost the American genius of ordered liberty. The American founders did not set out to achieve a more perfect democracy. They set out to create and maintain a free republic.

The key to running a free republic characterized by ordered liberty is the citizens, themselves. Unless the citizens embrace virtue, convicted by God that they must do what is right rather than merely indulging their wills and appetites, their hard fought liberty will be lost. The fate of a people who will not restrain themselves is rule by a government that will increasingly exercise control over them. The American idea was that our people should be citizens rather than subjects. American citizens, once far more country than city in origin, were to be free to provide for themselves rather than gathering in coalitions to ask for government largesse funded on the backs of the productive efforts of others.

Is healthcare important? Yes. Do we have a common duty to look after our fellow citizens? Indeed. But is this need adequate reason to endanger freedom (the dearest political essence of all) by opening the door to government control of 17% of the domestic economy?

Consider our neighbor Cuba off the shore of Key West. When conservatives criticize Castro’s (permanent) revolutionary regime by noting the utter lack of civil rights and liberties, sympathetic defenders leap forth to proclaim that civil rights aren’t everything. The Cubans, they say, have economic rights. For example, they have socialized medicine. But readers, the defenders of the Cuban travesty have confused economic rights for economic dependency. Private property is an economic right. The fruit of one’s labors is an economic right. Having the government give things to you is more like a voluntary addiction. The Cubans have their healthcare, but they live in a nation where forward progress nearly came to a halt in the 1960s and they have no voice. They are dependent on a government that acts like a bad boyfriend, sometimes kind but more often abusive.

Is it unfair or extreme to bring up the example of Cuba? We are, of course, so very far from their circumstances. The point is not to provoke fear, but to promote reflection. Once government begins to control something, it rarely relinquishes that control. If our government increases its role in providing healthcare to citizens, it will limit the freedoms of doctors, pharmacists, patients, hospitals, and others. Government is a standardizer, a utilization controller, and a default force for secularization. To the extent it promotes dependency, we will become that much less free and resources will be diverted from a productive private sector to a rarely innovative public sector. To the degree to which the state controls utilization, it will be far less resistible than even the most aggressive HMO plan managers. As it creates rules for the behavior of practitioners, it may force doctors, pharmacists, and hospitals with conscientious objections out of a field already characterized by shortages.

The debate over government healthcare is an important one, but let us remind our public servants not to forget first principles. Don’t forget freedom. And remember that many have come to rue the existence of grand projects of man which once initiated are terribly difficult to reverse. Better perhaps, not to ask for an earthly leviathan to care for us.


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