Saturday, August 08, 2009

Another triumph of government healthcare in Australia: Hospital delays cost girl her thumb

10 hour bureaucratic delay to get her into urgent surgery meant it was too late to save the thumb

A 14-YEAR-OLD girl has lost her thumb after an air transfer took too long, arriving too late for successful surgery. Teenager Sarah Smith was forced to endure a six-hour patient transfer process without pain relief after medical staff deemed her injury not to be an emergency. Despite getting to Dubbo Base hospital shortly after 9am, it took another 10 hours before the schoolgirl finally arrived at the Royal North Shore Hospital. "You keep thinking this is what they (medical staff) are supposed to do,'' Sarah's dad Malcolm Smith said.

Sarah's thumb was torn off when a horse started while she was trying to tie it up at a pony club gymkhana day. Hospital staff told Mr Smith his daughter would not be allowed on a commercial flight to Sydney - a one-hour journey - and that a patient transfer would be arranged. By 2.15pm, when the aircraft arrived, Mr Smith could have driven Sarah the five hours from Dubbo to Sydney. The plane took off just after 3pm, stopped for 30 minutes in Orange and landed in Bankstown at 4.45pm, when Sarah was taken by road - stopping at Westmead Hospital - arriving for emergency surgery at Royal North Shore at 7.15pm, 150 minutes after the plane landed.

"She had no pain killers from 2pm until she went into theatre at 8pm," her dad said. A hospital manager telephoned Mr Smith last week to apologise for the delay. [An apology! How big of them! An apology won't give her a thumb back, will it? No word that anybody has been disciplined over it, of course. So similar practices can be expected in the future]


British hospitals creaking under the strain as NHS vacancies are left unfilled

Hospitals across England are experiencing staff shortages, but London is particularly affected. Not many people want to work in such a chaotic environment

Medical leaders have warned that shortages of doctors, nurses and other clinical staff are putting the NHS under unsustainable pressure as a generation of health workers enters retirement amid cutbacks in junior doctors’ working hours.

The number of vacancies for hospital doctors, dentists, nurses and midwives has risen for the first time in five years as trusts struggle to recruit and retain staff. New data from the NHS Information Centre revealed that more than one in twenty medical and dental posts were vacant at the end of March, in some cases for months at a time, while thousands of nursing and midwifery posts were also unfilled.

Of the total number of vacant posts, one in five — 5,500 jobs — had been left unfilled for three months or more, suggesting long-term problems with recruitment. Senior staff leaving the service and the reluctance of younger people to replace them were blamed for the shortfalls as total vacancy rates increased across most staff groups. Doctors’ leaders have also warned that the European Working Time Directive, which from this month limits junior doctors to a maximum 48-hour week, could create shortages, leaving trusts to rely on temporary or locum staff.

The Times reported last week that trusts were spending tens of thousands of pounds to fill vacant posts, with recruitment agencies charging from £90 to £116 an hour to provide nurses and doctors on demand. The latest statistics only cover vacancies where trusts are actively recruiting for a post, however, so may underestimate the true scale of shortages, which are particularly acute in London.

The health service spent more than £584 million on employing agency staff in 2007-08, the latest year for which full data is available. A study published last year by the London School of Economics suggested that trusts that relied heavily on agency nurses to cover vacancies had higher mortality rates among patients who had a heart attack than those with more permanent staff.

Peter Carter, the chief executive of the Royal College of Nursing (RCN), said that the scale of the problem was worrying. “While we are concerned about long-term vacancies, even unfilled short-term ones leave nurses under unsustainable pressure and, with higher workloads, too busy to provide the standard of care they would like,” he said. “Rising vacancy rates are due to a combination of factors — more nurses are retiring and fewer are coming out of training; add to this an increase in demand for nurses, coupled with recent changes in migration policies, restricting recruitment from outside of the EU.”

The number of empty jobs was measured on March 31 this year. Among hospital doctors and dentists, excluding trainees, the vacancy rate was 5.2 per cent, compared with 3.6 per cent in the same month last year. The long-term vacancy rates for this group jumped two thirds from 0.9 per cent to 1.5 per cent. Vacancy rates for GPs increased only slightly from 1.6 per cent to 1.9 per cent.

Medical leaders have said that qualified nurses and midwives are retiring at a greater rate than newly trained staff can enter the professions. For nurses, vacancies rose from 2.5 per cent to 3.1 per cent in a year. London had the highest long-term vacancy rate among qualified nursing staff, increasing from 1.2 per cent in 2008 to 1.6 per cent this year. A poll of more than 8,600 children aged between 7 and 17, conducted for the RCN this year, found that only 1 in 20 considered nursing to be an attractive career.

The Royal College of Midwives (RCM) has also called for 5,000 extra staff to be recruited to fulfil official pledges to improve care and choice of services for mothers and babies. The Government has promised funding for the equivalent of 3,400 posts. Among midwives, vacancies increased from 2.1 per cent in 2008 to 3.4 per cent, with long-term vacancies accounting for about one in four of all empty posts.

Cathy Warwick, general secretary of the RCM, said: “The overall increase in vacancy rates may suggest there are more midwifery jobs available but employers are struggling to fill them. Perhaps increasing numbers of student midwives are not yet resulting in enough newly qualified midwives coming through the system. It could also mean that more midwives are leaving a service suffering from very heavy workloads.”

Anthony Halperin, trustee of the Patients Association, said: “Nursing staff see that there are higher rewards in the private sector while doctors and dentists no longer see medicine as a career for life, or are having their hours cut back by European legislation. All of this has negative outcomes for patients.”

Stephen O’Brien, the Shadow Health Minister, said: “With swine flu continuing to spread and the European Working Time Directive limiting doctors’ working hours, this is the worst time for staff vacancies across the NHS to rise.”

The Government said that more medical staff were working in the NHS or in training than ever before. Ann Keen, the Health Minister, said: “Across most staff groups vacancy rates continue to be low at around 2 per cent. The number of longer-term vacancies show a slight rise on last year but remain lower than 2006.”


Barack Obama faces revolt over health care overhaul

US President Barack Obama faced a growing revolt against his $1.5 trillion health care reforms as his approval rating slumped to an all-time low and Democratic congressmen received death threats.

On the eve of Mr Obama's 200th day as president, his ratings slumped to 50 per cent, while a series of public meetings called by Democrats to promote the reforms have degenerated into mob scenes and a congressman received a death threat.

With progress of a health bill - which the White House had hoped for in July - stalled on Capitol Hill and rising concern over Mr Obama's handling of the economy, his national approval rating fell by seven per cent from last month. The new low is a far cry from the stratospheric ratings of his heady first days in office.

Democratic congressmen charged with selling Mr Obama's controversial plans to reform the US health care system have become a target of public anger over fears that middle income Americans will be hit hardest by rising insurance premiums to cover the cost of improving care for the poor. They have been confronted by jeers, catcalls and accusatory rhetoric at the start of the summer recess - and worse.

Representative Brad Miller of North Carolina said he would not be hosting any "town hall" events this month and would instead make himself available to constituents for private one-on-one discussions about health care reform after his life was threatened. "The call to the DC office was, 'Miller could lose his life over this'," LuAnn Canipe, Mr Miller's communications director, told the Talking Points Memo website. "Our staffer took it so seriously, he confirmed what the guy was saying. He said, 'sir is that a threat?' and at that time our staffer was getting the phone number off caller ID and turning it over to the Capitol Police."

Mr Miller's move came as a bitter political fight escalated between Democrats, who argue that the vitriolic demonstrations were staged by political activists backed by powerful special interests groups, and Republicans, who portray them as spontaneous expressions of opposition to Mr Obama's plans. Miss Canipe said: "Our point is, we're not going to be bullied into having a town hall so it can then be interrupted by the fake grassroots folks."

Which side wins in what has become a war of perception will hold a crucial advantage in the autumn, when Mr Obama had pledged to deliver a new health care law that will massively extend coverage to the uninsured.

Representative Frank Kratovil of Maryland was faced with a life-sized cutout picture of himself with a noose tied around its neck.

The Democratic National Committee has broadcast an advertisement claiming that "desperate Republicans and their well-funded allies are organising angry mobs" in an attempt to "destroy President Obama".

Michael Steele, chairman of the Republican National Committee Chairman, dismissed as a "bunch of baloney" the charge that his party was orchestrating the protests. In a fundraising appeal sent out party supporters, he said: "They're using this fear-and-smear tactic to silence ANY American who disagrees with their risky scheme ... It's a page out of their standard playbook of name calling and outright lies to stifle all debate."

A separate CNN poll found that more Americans consider Mr Obama's administration a failure than those who delivered a similar verdict on the administration of his predecessor President George W. Bush, who left office with a disastrous approval rating of just 34 per cent, at the same point in 2001.


Care Versus Control

by Thomas Sowell

As someone who was once rushed to a hospital in the middle of the night, because of taking a medication that millions of people take every day without the slightest problem, I have a special horror of life and death medical decisions being made by bureaucrats in Washington, about patients they have never laid eyes on.

On another occasion, I was told by a doctor that I would have died if I had not gotten to him in time, after an allergic reaction to eating one of the most healthful foods around. On still another occasion, I was treated with a medication that causes many people big problems and was urged to come back to the hospital immediately if I had a really bad reaction. But I had no reaction at all, went home, felt fine and slept soundly through the night.

My point is that everybody is different. Millions of children eat peanut butter sandwiches every day but some children can die from eating peanut butter. Some vaccines and medications that save many lives can also kill some people.

Are decisions made by doctors who have treated the same patient for years to be over-ruled by bureaucrats sitting in front of computer screens in Washington, following guidelines drawn up with the idea of "bringing down the cost of medical care"?

The idea is even more absurd than the idea that you can add millions of people to a government medical care plan without increasing the costs. It is also more dangerous.

What is both dangerous and mindless is rushing a massive new medical care scheme through Congress so fast that members of Congress do not even have time to read it before voting on it. Legislation that is far less sweeping in its effects can get months of hearings before Congressional committees, followed by debates in the Senate and the House of Representatives, with all sorts of people voicing their views in the media and in letters to Congress, while ads from people on both sides of the issue appear in newspapers and on television.

If this new medical scheme is so wonderful, why can't it stand the light of day or a little time to think about it? The obvious answer is that the administration doesn't want us to know what it is all about or else we would not go along with it. Far better to say that we can't wait, that things are just too urgent. This tactic worked with whizzing the "stimulus" package through Congress, even though the stimulus package itself has not worked.

Any serious discussion of government-run medical care would have to look at other countries where there is government-run medical care. As someone who has done some research on this for my book "Applied Economics," I can tell you that the actual consequences of government-controlled medical care is not a pretty picture, however inspiring the rhetoric that accompanies it.

Thirty thousand Canadians are passing up free medical care at home to go to some other country where they have to pay for it. People don't do that without a reason. But Canadians are better off than people in some other countries with government-controlled medical care, because they have the United States right next door, in case their medical problems get too serious to rely on their own system. But where are Americans to turn if we become like Canada? Where are we to go when we need better medical treatment than Washington bureaucrats will let us have? Mexico? The Caribbean?

Many people do not understand that it is not just a question of whether government bureaucrats will agree to pay for particular medical treatments. The same government-control mindset that decides what should and should not be paid for can also decide that the medical technology or pharmaceutical drugs that they control should not be for sale to those who are willing to pay their own money.

Right now, medications or treatments that have not been approved by the Food and Drug Administration are medications or treatments that you are not allowed to buy with your own money, no matter how desperate your medical condition, and no matter how many years these medications or treatments may have been used without dire effects in other countries.

The crucial word is not "care" but "control."


Another Trillion?

The CBO may have underestimated the cost of health reform

By Stephen T. Parente

The biggest player in the health-care debate right now isn’t Nancy Pelosi, Harry Reid, or even President Obama. It’s the Congressional Budget Office, which is responsible for estimating the costs of proposed legislation. After the director of the CBO testified on July 16 that none of the health-reform bills in the House or Senate would reduce the rate of increase in federal spending on health care, congressional efforts fell into disarray. Many policymakers began searching for a way to get costs below the CBO’s frightening estimate of $1.1 trillion over ten years. Others attacked the CBO, calling its estimates irresponsible.

The CBO is actually being kind to the would-be reformers. Its analysis likely understates—by at least $1 trillion—the true costs of expanding health coverage as current Democratic legislation contemplates. Over the last few months, my colleagues and I at the consulting firm Health Systems Innovations have provided cost estimates of health-care reform to both Republican and Democratic members of Congress, and we’ve posted these estimates on our website as well. We believe that the Democratic bills currently under consideration in the House and Senate would cost $2.1 trillion and $2.4 trillion, respectively—much higher than CBO’s figures.

The discrepancies between our estimates and CBO’s stem from our different assumptions about a key issue. The Democratic plans envision a government-run insurance program, modeled after Medicare, that will compete with private insurers. How many people would opt for coverage under this public insurance? We believe that both large and small employers would have powerful incentives to shift their employees out of private coverage and into the public plan. Like the Urban Institute, we estimate that roughly 40 million people would make the shift. CBO seems to assume, however, that large employers would use the public plan only sparingly and that only 11 million people would move from private to public insurance—which would, of course, result in lower costs.

Why the difference in these estimates? We believe that we have better data on this issue than the CBO, which uses simulation models of health-insurance plans based on much older health-plan data—typically from 2001 or even 2000. Our estimates are grounded in 2006 commercial-insurance data to which the CBO doesn’t have access (the data are not publicly available and the CBO didn’t make provisions to purchase them). These data reflect the advent of much cheaper, high-deductible health plans and limited-provider network plans. If the government modeled its public option on these inexpensive plans, the result would be cheap enough to lure far more people away from private health insurance than the CBO estimates.

Our model has a good track record. The last time government introduced a major health-insurance innovation was 2004, which saw the introduction of Health Savings Accounts. We used the same model to predict that 3 million people would adopt these HSAs by the beginning of 2006. Our estimate, which we published in the peer-reviewed journal Health Affairs, was spot-on, predicting the market response more accurately than most other models, which produced adoption-rate estimates at least one-third lower.

It’s possible, of course, that the CBO is right and that our estimates are too high. If the House or Senate bill passes, we should know who’s right by 2014–15, shortly after the bills take effect and costs start to explode.


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