Monday, August 17, 2009

Death toll from hospital bugs hits new high in British government hospitals

More than 30,000 people have died after contracting the hospital infections MRSA and Clostridium difficile in just five years, official figures will show this week. Most places you go to hospital to get well. In Britain you often go to hospitals to get worse, even to get killed. British government hospitals are very dangerous places for sick people. Isn't that socialist "caring" great? How do 30,000 unnecessary deaths grab you as testimony to the benefits of socialized medicine?

Data from the Office for National Statistics covering 2004 to 2008 is expected to show record numbers of deaths linked to the superbugs in England and Wales. Opposition politicians said the Government had allowed "a horrifying death toll" because of its "slow and sloppy" response to spiralling levels of infection in NHS hospitals.

Official data shows a doubling in the death toll linked to MRSA during the period 2004 to 2007, compared with the previous four years, and a quadrupling in deaths linked to C. diff, when two sets of three-year figures are compared. Between 2004 and 2007 there were more than 20,000 deaths linked to C. diff and more than 6,000 associated with MRSA.

Norman Lamb, the Liberal Democrat health spokesman, said: "These figures describe an absolutely horrifying death toll, and many of these people have lost their lives because of infections which could have been avoided if firm action on infection had been taken a long time ago".

Annual deaths linked to MRSA quadrupled between 1997 and 2007, while those associated with C. diff quadrupled between 2004 and 2007, figures show. The spread of infections into most British hospitals, which occurred under the last Conservative government, had been allowed to "escalate, and become out of control" under Labour, Mr Lamb said, with waiting targets and efficiency prioritised over basic safety and cleanliness.

Katherine Murphy, from the Patients Association, said the statistics showed the gulf between "flowery" Government rhetoric about a war on infection, and poor hygiene which had been allowed to continue unchecked. "The NHS has been told to put other targets ahead of safety, and this is the inevitable outcome," she added.

Infection experts have repeatedly warned that assessments based on the number of death certificates which record the presence of MRSA and C. diff are likely to underestimate the scale of the problem, because doctors are reluctant to admit that basic infections have caused fatalities.

Earlier figures published by the ONS have shown that the worst hospital for C. diff deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006. The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period. The worst-ever outbreak of C. diff in this country occurred between 2004 and 2006 at Maidstone and Tunbridge Wells NHS Trust, where the bug was linked to the deaths of 331 patients.

More than 5,000 people have backed The Sunday Telegraph's Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.


Australia: Negligent doctors and public hospital kill young mother

After all the publicity about swine flu, you would think that the doctors would take that possibility seriously from the outset. If the hospital had given her Tamiflu and admitted her for observation she would almost certainly be alive today. Instead they sent her home with just a household headache medication

A previously healthy 34-year-old mother-of-two who died from swine flu last week was seen by four separate doctors over four days before she was finally admitted to hospital. Her family say her deteriorating health – including difficulty walking – was mostly ignored as she was repeatedly sent home when seeking help for her illness.

Sheridan Wilson died in Brisbane's Prince Charles Hospital on Thursday. She had presented herself at Townsville Hospital's emergency department a week earlier, saying she was in extreme discomfort from flu-like symptoms. Doctors told Mrs Wilson to go home, take some Panadol and get some sleep, her family said. She had no underlying health conditions and was not immediately tested for swine flu. Nor was she given any of the anti-viral drug Tamiflu.

Mrs Wilson's distraught family yesterday pleaded with Queensland Health to stop treating potential swine flu victims like "lumps of meat" and start taking the pandemic seriously. They want Tamiflu offered to everyone with flu symptoms and not just those deemed by the department as being in the "at-risk" group which includes pregnant women, the elderly, the obese, indigenous people and those with other health problems.

Mrs Wilson's mother-in-law Marilyn broke down in tears yesterday as she told The Sunday Mail that Sheridan followed Queensland Health's official advice on swine flu to the letter. She first went to her GP, then later when symptoms worsened, went to the emergency room at Townsville Hospital. She was later transported to Brisbane, where she died. "Sheridan did everything right," Marilyn Wilson said. "She went to a GP first, who sent her home with hardly a second thought.

"Then I took her to the emergency department who put her on a drip for dehydration for two hours before sending her home and telling her to take some Panadol. "She was getting worse so she went to a GP the next morning (Friday), and then another GP on Saturday morning who told her 'wait a few hours and if it gets worse go to the hospital'." After seeing three GPs and a doctor at the hospital's emergency department, Mrs Wilson was finally admitted to Townsville Hospital's ICU last Saturday.

"Sheridan put her life in these people's hands and all the GPs did was take her money and kick her out," she said. "Our family will never be the same again."



Keith Hennessey has analyzed 20 statements made by President Obama during the town hall meeting on health care at Portsmouth, New Hampshire. You can read Hennessey's analysis at his home page. One of the statements Hennessey examines pertains to what, for Obama and many others, is the starting point in the debate - the number of people who are uninsured. In Portsmouth, Obama had this to say:
I don't have to explain to you that nearly 46 million Americans don't have health insurance coverage today. In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don't get the care they need.

Hennessey breaks this group of nearly 46 million into five categories. The first, consisting of about 6.5 million, actually is insured. According to Hennessey, they are enrolled in Medicaid or S-CHIP but didn't tell the census taker. This is called the "Medicaid undercount."

The second group, about 4.5 million, consists of people who are eligible for Medicaid or S-CHIP but have not enrolled. If they need care, the hospital or clinic generally enrolls them. In other words, they do not (as Obama claims) go bankrupt or without treatment. In any case, it would be ridiculous to overhaul our healthcare system to provide insurance to people who are already eligible for government assistance but have failed to avail themselves of it.

The third group, about 9.5 million, is comprised of non-citizens. Hennessey notes that people will disagree about what portion of this group should receive government subsidized health insurance. In my view, none should.

And keep in mind that being uninsured is not the same as having to pay (or pay much) for treatment. I've heard illegal immigrants say that they find ways to receive free or inexpensive treatment for themselves and their children. In general, I've read (though I can't find the source) that the uninsured receive about half the amount of money per capita to pay for medical treatment that the insured receive.

The fourth group, another 10 million, earns an income more than three times the poverty line. As such, they can afford to buy medical insurance. Taxpayers should not be required to buy it for them.

This leaves about 15.5 million (one-third of Obama's 46 million) who actually are uninsured, cannot become insured simply by enrolling in a free program, are U.S. citizens, and cannot easily afford to purchase insurance. About 5 million members of this cohort are childless adults.

It is understandable that many Americans would like to see the government do something for this group, or at least those members who are not young, childless, healthy adults with decent starter salaries who simply think it makes economic sense to assume the small risk that they will incur large medical expenses. But it is also understandable that many Americans favor targeting this group through incremental measures to assist them in purchasing insurance, rather than through a radical overhaul of our healthcare system at a massive cost.

Obama knows he needs a big number of "uninsured" to even get in the vicinity of selling what he has in mind to a skeptical public. But the big number he has selected would not get him in the vicinity if the public better understood who it consists of.

JOHN adds: Many young, single people make a perfectly rational decision not to buy health insurance. Accidents are the biggest threat to their health; car accidents are covered by automobile insurance and work-related accidents are covered by workmen's comp. The chance of a young person contracting a catastrophic disease (leukemia, say) is remote, and people aren't stupid: they know that if they contract such a disease they will be treated whether they can pay or not. And young, single people have not acquired a substantial net worth that they could lose to medical bills. This is why, when Pizza Hut made cheap health insurance available to its part-time employees a few years ago, hardly any of them chose to take advantage of it.

One of the purposes of most health care "reform" proposals, stated or unstated, is to force these young people into the system--to force them, that is, to contribute money to pay the medical bills of others, beyond what they already pay in Medicare taxes. Whatever you think of either the justice or the wisdom of such a policy, it is not worth turning our health care system upside down in order to achieve.


What to Do About Pre-existing Conditions

Most Americans worry about health coverage if they lose their job and get sick. There is a market solution. Even if you don't like the massive health-care package being considered in Congress, you have to admit that health insurance and health care in this country are not working well. There are two basic problems:

First, if you get sick and then lose your job or get divorced, you lose your health insurance. With a pre-existing condition, new insurance will be ruinously expensive, if you can get it at all. This, the central defect of American health insurance, explains why most Americans are happy with their current coverage yet also support reform.

Second, health care costs too much. Yes, we get better treatment, but the cost-cutting revolution that has swept through manufacturing, retail, telecommunications and airlines has not touched health care. The problems are real, but the proposed remedy—even more government intervention—is counterproductive. A market-based, deregulation-focused reform is possible, and it will work.

Health care and insurance are service-oriented, retail businesses. There is only one way to reduce costs in such a business: intense competition for every customer. The idea that the federal government can reduce costs by negotiating harder or telling businesses what to do is a triumph of hope over centuries of experience.

Take the claim that centralized record-keeping can cut costs. In his July 22 press conference, President Barack Obama noted that a new doctor today might run a test again rather than ask for records of a previous result. That seems silly. But maybe it isn't. Maybe the test is cheap, the condition changes, the test can fail, and the cost of setting up an integrated record system between these two doctors isn't worth two tests a year.

The cost-cutting revolutions in other industries didn't settle questions like these with acts of Congress, expert commissions, armies of regulators, or via a "public option"—while leaving in place a system in which consumers have little choice, aren't spending their own money, and suppliers are protected from lower-cost competitors. That approach has never spurred efficiency, and for good reasons. Cost-cutting is painful. Even in Mr. Obama's trivial example, lab technicians and secretaries will lose their jobs to computer programs, and they will complain. Patients might have to get tests at inconvenient times and locations. They will do this when their money is at stake—what people will put up with from airlines for a few dollars is truly amazing—but they will never accept it from the government.

But what about pre-existing conditions?

A truly effective insurance policy would combine coverage for this year's expenses with the right to buy insurance in the future at a set price. Today, employer-based group coverage provides the former but, crucially, not the latter. A "guaranteed renewable" individual insurance contract is the simplest way to deliver both. Once you sign up, you can keep insurance for life, and your premiums do not rise if you get sicker. Term life insurance, for example, is fully guaranteed renewable. Individual health insurance is mostly so. And insurers are getting more creative. UnitedHealth now lets you buy the right to future insurance—insurance against developing a pre-existing condition.

These market solutions can be refined. Insurance policies could separate current insurance and the right to buy future insurance. Then, if you are temporarily covered by an employer, you could keep the pre-existing-condition protection.

Some insurers avoid their guaranteed-renewable obligations by assigning people to pools and raising rates as healthy people leave the pools. Health insurers, like life insurers, could write contracts that treat all of their customers equally.

The right to future insurance could be transferrable to another company, for example, if you move. You could have the right that your company will pay a lump sum, so that a new insurer will take you, with no change in your premiums. Better, this sum could be occasionally placed in a custodial account. If you got sick but had something like a health-savings account to pay high premiums, you could always get new insurance. Insurers would then compete for sick people too. Innovations like these would catch on quickly in a vibrant, deregulated individual insurance market.

How do we know insurers will honor such contracts? What about the stories of insurers who drop customers when they get sick? A competitive market is the best consumer protection. A car insurer that doesn't pay claims quickly loses customers and goes out of business. And courts do still enforce contracts.

How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don't have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money.

More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state?

The bills being considered in Congress address the pre-existing condition problem by forcing insurers to take everybody at the same price. It won't work. Insurers will still avoid sick people and treat them poorly once they come. Regulators will then detail exactly how every disease must be treated. Healthy people will pay too much, so we will need a stern mandate to keep them insured. And this step further reduces competition. Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs.


Obama's Senior Moment

Why the elderly are right to worry when the government rations medical care.

Elderly Americans are turning out in droves to fight ObamaCare, and President Obama is arguing back that they have nothing to worry about. Allow us to referee. While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense. Once health care is a "free good" that government pays for, demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics.

Mr. Obama's reply is that private insurance companies already ration, by deciding which treatments are covered and which aren't. However, there's an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government. An Atlantic Ocean, in fact. Virtually every European government with "universal" health care restricts access in one way or another to control costs, and it isn't pretty.

The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care. If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it. Even France— which has a mix of public and private medicine— has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the U.S. "rations" by ability to pay (though in the end no one is denied actual care). This is true of every good or service in a free economy and a world of finite resources but infinite wants. Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices. The problem is that governments ration through brute force— either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation— and usually all three.

A lot of talk has centered on what Sarah Palin inelegantly called "death panels." Of course rationing to save the federal fisc will be subtler than a bureaucratic decision to "pull the plug on grandma," as Mr. Obama put it. But Mrs. Palin has also exposed a basic truth. A substantial portion of Medicare spending is incurred in the last six months of life.

From the point of view of politicians with a limited budget, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?

In Britain, the NHS decides, and under its QALYs metric it generally won't pay more than $22,000 for treatments to extend a life six months. "Money for the NHS isn't limitless," as one NHS official recently put it in response to American criticism, "so we need to make sure the money we have goes on things which offer more than the care we'll have to forgo to pay for them."

Before he got defensive, Mr. Obama was open about this political calculation. He often invokes the experience of his own grandmother, musing whether it was wise for her to receive a hip replacement after a terminal cancer diagnosis. In an April interview with the New York Times, he wondered whether this represented a "sustainable model" for society. He seems to believe these medical issues are all justifiably political questions that government or some panel of philosopher kings can and should decide. No wonder so many seniors rebel at such judgments that they know they could do little to influence, much less change.

Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life's cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonoscopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare's holes —and Medicare is still growing by 11% this year.

The political and fiscal pressure to further ration Medicare would increase exponentially if government is paying for most everyone's care. The better way to slow the growth of Medicare is to give seniors more control over their own health care and the incentives to spend wisely, by offering competitive insurance plans. But this would mean less control for government, not more.

It's striking that even the AARP—which is run by liberals who favor national health care— has been backing away from support for Mr. Obama's version. The AARP leadership's Democratic sympathies will probably prevail in the end, perhaps after some price-control sweeteners are added for prescription drugs. But AARP is out of touch with its own members, who have figured out that their own health and lives are at stake in this debate over ObamaCare. They know that when medical discretion clashes with limited government budgets, medicine loses.


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