Britain: Couples are being refused IVF treatment in a ‘postcode lottery’

Couples are still facing problems getting IVF treatment on the NHS, with some trusts refusing to fund procedures or comply with guidelines, such as a woman’s age. Regional disparities mean that the same woman can be too old for treatment in one part of the country and too young in another. Two trusts have provided no IVF treatment in the previous two years.

Research suggests that eight out of ten primary care trusts are still failing to follow government recommendations set out in 2004 by the National Institute for Health and Clinical Excellence (NICE), allowing women three free cycles of IVF. Other eligibility criteria, such as whether one of the couple has a child from a previous relationship, smoking habits and weight, also vary widely, the study shows.

The study, by Grant Shapps, the Conservative MP for Welwyn Hatfield, who has campaigned for better access to fertility treatment, was based on an 80 per cent response rate from trusts in England. It found that provision was worse than two years ago.

In the East Midlands, every trust offered one full cycle of treatment but, in the South East, 41 per cent did not offer IVF to women aged 23 to 39, as set out in the NICE guidance. Some trusts, such as North Lincolnshire, offered IVF only to women between 37 and 39, whereas at least four trusts have an upper age limit of 37. One in eight was failing to comply with guidelines on a woman’s age. In the East Midlands, no trust would offer treatment to couples in which one partner had a child but 70 per cent would in the North East. Overall, 54 per cent of trusts excluded couples from IVF if one partner had a child from a previous relationship.

Almost half of all trusts said that they wanted couples to have been in a relationship for more than three years. Others wanted one or two years while some asked only if the relationship was “stable”. While many trusts refused IVF to couples who smoked, some allowed treatment if the man was the smoker.

The 2004 NICE guidance said that the NHS should fund three cycles of IVF for women under 40. John Reid, then the Health Secretary, said that couples would be offered one free IVF cycle by April 2005, with a view to three cycles being offered in the future. By 2007 this was still not happening. Dawn Primarolo, the Health Minister, wrote to trusts in that year saying that they should be looking to fund three cycles.

Experts have said that the drive to cut the number of multiple births is also being hampered by the lack of access to free IVF. Couples who have the chance of only one cycle on the NHS might wish to have more than one embryo transferred.

The NICE guidance also said that trusts should allow frozen embryos to be transferred as part of one cycle.But very few offered this.

Mr Shapps said that the study, compiled from freedom of information requests, showed that IVF “remains a postcode lottery in this country”. He added: “Budgets are tight and the NHS must set its priorities, but it is wrong to raise expectations in couples who are desperate to start a family only for them to find out later that they won’t get the real help they expected.”

Clare Lewis-Jones, chief executive of the charity Infertility Network UK, said that although there had been an improvement recently in the provision of treatment by some trusts there remained a totally unjustifiable and unfair variation in the criteria used to determine whether couples could have treatment. “This proves that five years on from the issue of the NICE guideline, patients are still facing a postcode lottery when it comes to accessing NHS fertility treatment.” She urged trusts to accept recommendations laid down in a document, Standardising Access Criteria to NHS Fertility Treatment, produced by Infertility Network UK and funded by the Department of Health.

A Department of Health spokesman said that there had been good progress in implementing NICE guidelines and providing access to IVF. He said that 30 per cent of trusts were providing three cycles, 23 per cent two cycles and 47 per cent one cycle. “This shows significant improvements, with only two trusts out of 150 not routinely providing infertility treatment in England.”

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Phantom pains at The Post

Right accused of hyping risk of terminal talks with the aged

By Fred D. Thompson

A Page One article in Saturday's Washington Post blaring the headline "Talk Radio Campaign Frightening Seniors" states, "A campaign on conservative talk radio ... has sparked fear among senior citizens that the health care bill moving through Congress will lead to end-of-life 'rationing' and even 'euthanasia,' " and that the bill has been described as "guiding you in how to die."

The story's continuation inside -- under the headline "Conservatives Have Seniors Fearing 'Euthanasia' as Part of Reform" says that, like arguments about abortion coverage, this has become a distraction to the president's broader health care agenda.

The reader looking for examples of this "talk show" campaign will be disappointed. Not one talk-radio host is quoted, and no specific radio show is mentioned (though The Post does quote an interview done on my radio show, without telling the reader the interview was done on a radio show). However, the article does make use of information supplied by off-the-record "Democratic strategists." One is free to conclude for oneself who has launched a "campaign."

It does seem that the words attributed to unnamed conservative culprits are fairly mild compared to the hysteria coming out of left-wing Web sites and blogs. My favorite is the one found on the Huffington Post, where Republicans are accused of saying that granny would be shot in her wheelchair under a provision in the Obama-Pelosi-Waxman health care bill.

Let's discuss whether these deranged seniors are being misled by people who actually may have read the bill. (Presumably this offense cannot be laid at the feet of their representatives of Congress.) Although I have never said anything like the things attributed to radio talk hosts, the article states that "the attacks on talk radio began when Betsy McCaughey ... told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would 'tell them how to end their life sooner' and would teach the elderly 'how to decline nutrition -- and cut your life short.' "

The basic position of the bill's proponents seems to be that these consultations are totally voluntary, that seniors should have the benefit of such end-of-life consultations and that the consultation provision is nothing more than to get doctors reimbursed when a consultation occurs at the patient's request. The "let's get the doctor paid" rationale was swallowed whole by The Post's writer, Ceci Connolly.

Those concerned by this provision believe it to be mandatory and wonder why the government is involving itself in the doctor-patient relationship and with end-of-life decisions.

Section 1233 of the bill, having to do with Medicare, describes the "advanced care planning consultation" as between the individual (a spouse and next of kin are not mentioned) and a "practitioner," described as a physician, a nurse practitioner or a physician's assistant. (It does not appear that it is a requirement that the physician in question be the patient's physician of record.)

In legislation, an issue as to whether an action is mandatory or not can be resolved quickly by a glance at the statute, which will state that (in this case) the consultation either "shall" be taken or "may" be taken. Remarkably, neither phrase is used in the statute in question.

Rather, the statute just describes what a consultation is and then strictly prescribes in mandatory language what must be included in the consultation as well as what may be included. For example, in Paragraph 4, a consultation "may include the formulation of an order regarding life-sustaining treatment" and may include an order for "the use of artificially administered nutrition and hydration."

The drafters of the provision were either sloppy, befitting a situation in which a complicated, 1,000-plus-page bill, controlling one-sixth of the economy, is rushed through the legislative process. Or it might be that the drafters desired an intentionally vague statute, knowing administration officials would be drafting regulations for the implementation of the bill after it passed.

As it stands, there is more than ample reason to believe the provision was meant to be mandatory with regard to the practitioners. Otherwise, why have the provision in the bill at all? If getting the doctors paid for a voluntary consultation really was the provision's intent, an amendment of two or three lines would have fixed it. As it is, it is two lines in a five-page provision full of specific instructions about what doctors, nurses or doctor's aides must explain to the patients.

Seniors are reminded daily by the media that Medicare is going broke, that the country must cut Medicare costs and that the last days of life are by far the most expensive. Now they are being told by the administration -- one that has been less than transparent on this bill and a host of other issues -- that this bill will cut Medicare costs. They are learning that they are "coincidentally" being asked about end-of-life issues at the government's behest, perhaps by a stranger who is receiving Medicare reimbursement payments. How long do you think it will take a Medicare patient to figure out which decisions will cost the government money and which will save the government money?

This is no reflection on medical professionals. They clearly are being put in a position they neither have asked for nor are completely qualified for. However, I am gratified that a president who can matter-of-factly accuse doctors of routinely removing a child's tonsils solely for financial gain has newfound trust in a doctor's or some hospital employee's ability to consult and even help draw up legal documents regarding end-of-life issues.

If this is all just a misunderstanding about whether this provision is mandatory or not, it can be resolved readily. Let's see if the supporters of the provision are willing to add language to the bill making it clear that there is no requirement that these consultations take place. Better still, they should drop this provision from the bill and let patients discuss these matters with their families, their clergy, lawyers who have expertise in living wills and powers of attorney, or whomever else they desire.

So is this a conspiracy to kill off granny? No. Will seniors be forced to make decisions they don't want to make? No. But will "practitioners" be encouraged to have end-of-life discussions that include when it might be best for patients to allow their life to end earlier than it has to? Of course. And seniors have a right to be satisfied that there is not, at the heart of this process, undo consideration given to cost-cutting.

In the end, it depends on how comfortable one is with having the government in the middle of this process. That is what this discussion is really all about.

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Insurers lash out at Obama, industry critics

Trade group calls tactic 'a major step backward'

President Obama and congressional Democrats are crafting an image of health insurance companies as the industry villain, a growing chorus that insurers are trying to fight as the reform debate goes public.

"For a country that is trying to accomplish what it has failed to do for a century -- pass health care reform -- the same old Washington politics of 'find an enemy and go to war' is a major step backward, not a step forward," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans (AHIP), an industry trade group.

She said the growing anti-insurance rhetoric is a reflection of Americans' doubts about the public option, the government health insurance program proposed by Democrats.

The public option has been a divisive issue even among Democrats. The Progressive Caucus sent a letter to House Speaker Nancy Pelosi on Tuesday reinforcing its message that it will only support a reform bill that includes a "robust" public option, pitting it against conservative Blue Dogs who altered the public plan in a deal crafted with House leaders last week.

The reform debate is going directly to the public this month, as lawmakers head home to their districts to host town hall meetings and gatherings, with some characterizing the industry as profit-seekers who are holding up reform plans.

"Insurance companies are out there in full force carpet-bombing, shock and awe, against a public option; so much so that when you ask people about the plan, they are uncertain about it until you tell them what is in it," Mrs. Pelosi said last week,calling the industry "villains."

The insurance industry is opposed to the public option, but the plan is widely supported by Democrats who say it is necessary to create new competition with insurance companies and drive down costs.

Insurers, in a claim echoed by congressional Republicans, argue that any government plan would set provider reimbursement rates too low to keep competing private insurers in business. They point to existing government programs, such as Medicare and Medicaid, which doctors and other providers say don't fully cover their costs. But the nonpartisan Congressional Budget Office said in a recent report that the public plan wouldn't crowd out private insurers.

The industry also favors a requirement that all individuals carry insurance, which would provide it with more than 40 million new customers.

Other proposals have been put forward that would tax insurance companies who offer the most elite plans, which proponents argue drive up unnecessary costs.

The shift against the insurance companies in the reform debate can even be found in its name. In the early days of the reform debate, it was called "health care reform," but about a month ago Democrats began using the phrase "health insurance reform."

Now insurers are trying to take their campaign public. AHIP began a seven-figure television advertising campaign last month encouraging a bipartisan reform plan that encourages coverage for all people.

The National Association of Health Underwriters later called Mrs. Pelosi's comments "petty name-calling." "We all have a stake in achieving meaningful reform that both preserves Americans' freedom to choose their doctors and lowers long-term health care costs," said Janet Trautwein, CEO of the trade group of insurance agents and brokers. "A public option will accomplish neither."

Some of the anger with insurance companies has centered around its profits. Lawmakers say in order to provide health care coverage to all, each sector in the health field has to take a cut. Over the past eight years, profits at the top 10 health insurers rose 428 percent, said Sen. Charles E. Schumer, citing data from advocacy group Health Care for America Now.

Mr. Schumer, New York Democrat, issued a call last month demanding health insurers agree to cost cutting measures, similar to the deals the Senate Finance Committee and White House arranged with drug makers and hospitals. "Our broken health care system is working all too well for many private health insurers," he said. "They need to become a better partner as we work to enact a health care reform bill without adding to the deficit."

The industry responded by saying it was the first to suggest policy changes, such as an end to denials based on pre-existing conditions.

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How to Fix the Health-Care ‘Wedge’

By ARTHUR B. LAFFER

President Barack Obama is correct when he says that “soaring health-care costs make our current course unsustainable.” Many Americans agree: 55% of respondents to a recent CNN poll think the U.S. health-care system needs a great deal of reform. Yet 70% of Americans are satisfied with their current health-care arrangements, and for good reason—they work.

Consumers are receiving quality medical care at little direct cost to themselves. This creates runaway costs that have to be addressed. But ill-advised reforms can make things much worse.

An effective cure begins with an accurate diagnosis, which is sorely lacking in most policy circles. The proposals currently on offer fail to address the fundamental driver of health-care costs: the health-care wedge.

The health-care wedge is an economic term that reflects the difference between what health-care costs the specific provider and what the patient actually pays. When health care is subsidized, no one should be surprised that people demand more of it and that the costs to produce it increase. Mr. Obama’s health-care plan does nothing to address the gap between the price paid and the price received. Instead, it’s like a negative tax: Costs rise and people demand more than they need.

To pay for the subsidy that the administration and Congress propose, revenues have to come from somewhere. The Obama team has come to the conclusion that we should tax small businesses, large employers and the rich. That won’t work because the health-care recipients will lose their jobs as businesses can no longer afford their employees and the wealthy flee.

The bottom line is that when the government spends money on health care, the patient does not. The patient is then separated from the transaction in the sense that costs are no longer his concern. And when the patient doesn’t care about costs, only those who want higher costs—like doctors and drug companies—care.

Thus, health-care reform should be based on policies that diminish the health-care wedge rather than increase it. Mr. Obama’s reform principles—a public health-insurance option, mandated minimum coverage, mandated coverage of pre-existing conditions, and required purchase of health insurance—only increase the size of the wedge and thus health-care costs.

According to research I performed for the Texas Public Policy Foundation, a $1 trillion increase in federal government health subsidies will accelerate health-care inflation, lead to continued growth in health-care expenditures, and diminish our economic growth even further. Despite these costs, some 30 million people will remain uninsured. Implementing Mr. Obama’s reforms would literally be worse than doing nothing.

The president’s camp is quick to claim that his critics have not offered a viable alternative and would prefer to do nothing. But that argument couldn’t be further from the truth. Rather than expanding the role of government in the health-care market, Congress should implement a patient-centered approach to health-care reform. A patient-centered approach focuses on the patient-doctor relationship and empowers the patient and the doctor to make effective and economical choices.

A patient-centered health-care reform begins with individual ownership of insurance policies and leverages Health Savings Accounts, a low-premium, high-deductible alternative to traditional insurance that includes a tax-advantaged savings account. It allows people to purchase insurance policies across state lines and reduces the number of mandated benefits insurers are required to cover. It reallocates the majority of Medicaid spending into a simple voucher for low-income individuals to purchase their own insurance. And it reduces the cost of medical procedures by reforming tort liability laws.

By empowering patients and doctors to manage health-care decisions, a patient-centered health-care reform will control costs, improve health outcomes, and improve the overall efficiency of the health-care system.

Congress needs to focus on reform that promotes what Americans want most: immediate, measurable ways to make health care more accessible and affordable without jeopardizing quality, individual choice, or personalized care.

Because Mr. Obama has incorrectly diagnosed the problems with our health-care system, any reform based on his priorities would worsen the current inefficiencies. Americans would pay even more for lower quality and less access to care. This doesn’t sound like reform we can believe in.

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Health-Care “Reform” Always Costs More Than Promised

by Hans Bader

When the government creates a new entitlement to health-care, it costs far more than predicted. That’s the depressing truth told by former Congressman Tim Penny (D-MN) and former Senator Rudy Boschwitz (R-MN), casting doubt on whether the trillion-dollar price tag of Obama’s health-care plan even begins to capture its colossal, budget-exploding cost.

“ObamaCare plans to expand the government’s role in insuring the American people,” Penny and Boschwitz write. “The government is already the largest insurer in the health care business through Medicare.”

Medicare offers a cautionary tale, since it costs more than ten times what its sponsors predicted, and far more than they ever imagined, “an astounding increase of 85.5 times over the 40-year period.” As they note,

“Beware of government estimates about the future cost of ObamaCare. When Medicare was being considered in the mid-1960s, the government projected that the outlays for the program 25 years down the road would be $10 billion. Instead, in 1990, 25 years later, the outlays were $107 billion. Government estimates were off by a factor of more than 10! Medicaid, the other large medical program currently in effect, outdid Medicare. Medicaid outlays in 1968 were $1.8 billion. In 2007 they had risen to $190.6 billion, an increase in dollar terms of 105.9 times. And that is only the Federal outlay number. There is a roughly equal Medicaid amount spent by the states due to federal mandates. Without those mandates we would not be reading about the large deficits that most states endure. The idea of expanding the federal role in the medical arena is truly fiscally irresponsible. The claim that money will be saved through government competition with the private insurance system (with government setting the rules!) is the height of fantasy.”

Attempts to provide universal coverage have been much costly than expected at the state level. In Maine and Massachusetts, such efforts have left many people uncovered, while costing far more than anyone anticipated.

One of Obama’s own advisers says the Obama Administration’s health-care plan will harm people with insurance while raising their taxes. CNN says Obamacare will take away 5 freedoms. It will also destroy many affordable health-care plans while breaking Obama’s campaign promises.

The health-care “reform” bills backed by the Administration perversely exempt illegal aliens from the health-insurance taxes and obligations imposed on citizens, effectively giving them preferential treatment, even as they fail to require verification of immigrations status for those seeking “public option” health-care coverage.

While America’s health-care system is very expensive, it is much better at treating and detecting common forms of cancer than most European health-care systems. The Administration’s health-care proposals put these successes in jeopardy, yet they would increase health-care costs even further, while failing to provide health-care coverage as cheap or as universal as in Europe.

For a recent example of how the Obama Administration underestimates the cost of federal programs, look at the Cash-for-Clunkers program, which was slated to cost a billion dollars for the entire year, but ended up running out of money after just days. The cash-for-clunkers program is monumentally wasteful and stupid, destroying perfectly good automobiles, cutting off the supply of cheap used cars needed by poor people, and rewarding people who bought gas guzzlers rather than fuel-efficient vehicles. It also provides surprisingly little benefit to the Detroit automakers that it was intended to bail out, who have already received more than $70 billion from taxpayers, and wipes out jobs at used-car and parts businesses.

The auto bailouts keep expanding. Billions more will soon be spent on wealthy auto-dealers, politically-correct cars few people will buy, and generous benefits for high-paid autoworkers.

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