Many elderly British patients forced to live in agony after NHS refuses to pay for painkilling injections

It takes a socialist to have a heart of stone. But after Stalin and Co., should we be surprised? Leftists talk the talk but they don't walk the walk where compassion is concerned

Tens of thousands with chronic back pain will be forced to live in agony after a decision to slash the number of painkilling injections issued on the NHS, doctors have warned. The Government's drug rationing watchdog says "therapeutic" injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known. Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy. [QUACK MEDICINE! I can't believe it]

Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment. The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

But the British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery. Dr Christopher Wells, a leading specialist in pain relief medicine and the founder of the NHS' first specialist pain clinic, said it was "entirely unacceptable" that conventional treatments used by thousands of patients would be stopped. "I don't mind whether some people want to try acupuncture, or osteopathy. What concerns me is that to pay for these treatments, specialist clinics which offer vital services are going to be forced to close, leaving patients in significant pain, with nowhere to go,"

The NICE guidelines admit that evidence was limited for many back pain treatments, including those it recommended. Where scientific proof was lacking, advice was instead taken from its expert group. But specialists are furious that while the group included practitioners of alternative therapies, there was no one with expertise in conventional pain relief medicine to argue against a decision to significantly restrict its use.

Dr Jonathan Richardson, a consultant pain specialist from Bradford Hospitals Trust, is among more than 50 medics who have written to NICE urging the body to reconsider its decision, which was taken in May. He said: "The consequences of the NICE decision will be devastating for thousands of patients. It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

One in three people are estimated to suffer from lower back pain every year, while one in 15 consult their GP about it. Specialists say therapeutic injections using steroids to reduce inflammation and other injections which can deaden nerve endings, can provide months or even years of respite from pain. Experts said that if funding was stopped for the injections, many clinics would also struggle to offer other vital services, such as pain management programmes and psychotherapy which is used to manage chronic pain.

Anger among medics has reached such levels that Dr Paul Watson, a physiotherapist who helped draft the guidelines, was last week forced to resign as President of the British Pain Society. Doctors said he had failed to represent their views when the guidelines were drawn up and refused to support the letter by more than 50 of the group's members which called for the guidelines to be withdrawn.

In response, NICE chairman Professor Sir Michael Rawlins expressed outrage over the vote that forced Dr Watson from his position, describing the actions of the society as "shameful". He accused pain specialists of refusing to accept that there was insufficient scientific evidence to support their practices. A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.

Iris Watkins, 80 from Appleton, in Cheshire said her life had been "transformed" by the use of therapeutic injections every two years. The pensioner began to suffer back pain in her 70s. Four years ago, despite physiotherapy treatment and the use of medication, she had reached a stage where she could barely walk. "It was horrendous, I was spending hours lying on the sofa, or in bed, I couldn't spend a whole evening out. I was referred to a specialist, who decided to give me a set of injections. The difference was tremendous". Within days, she was able to return to her old life, gardening, caring for her husband Herbert, and enjoying social occasions.

"I just felt fabulous – almost immediately, there was not a twinge. I only had an injection every two years, but it really has transformed my life; if I couldn't have them I would be in despair".

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The gradual erosion of "free" doctor visits in Australia. Co-pays now common

When Australia's Medicare was set up, it covered all Australians and offered doctors 85% of the normal cost of a visit if the doctor charged the government instead of the patient. That was called "bulk billing" and was widely accepted by GPs -- so most Australians thenceforth could see their doctor for free.

The amount the government reimburses has however not kept pace with rising costs generally so fewer and fewer doctors are now willing or able to see a patient for free and "bulk bill" the government for the cost. It varies from State to State, with high-cost States like NSW having few "bulk billers" and low cost States like South Australia having more. So what started out as free medical care for all has slowly ebbed away and led back to a "patient pays" system, with patients paying part of the cost of a visit and the government paying the rest.

Because of their efficiencies, large health centres have been able to give "free" care long after other practitioners had abandoned it but now they too are starting to throw in the towel, even in South Australia. See below

AUSTRALIA'S largest medical centre operator has scrapped bulk-billing for most of its South Australian patients - charging $30 an appointment for the same service it provided freelast week. The Australian Medical Association yesterday warned the number of free doctors was dwindling because Medicare rebates were seen to be too low for medical centres to remain viable. Primary Health Care, which owns 87 medical centres across Australia, including five in SA, is charging $30 an appointment for most patients in selected medical centres. In Adelaide, the fee is being charged for anyone over 16 without a concession card at Marion Domain and Primary Old Port Rd Medical and Dental Centre, Royal Park – both among the city's busiest medical clinics. It is believed Norwood Village Medical and Dental Centre also will be introducing the fee, which is not refundable by Medicare.

Primary managing director Edmund Bateman would not return calls to The Advertiser yesterday and it was not known if the move had been rolled out nationally. A flyer given to patients at Marion Domain Medical and Dental Centre yesterday says there have been "increased demands on general practitioners with greater documentation required, greater demand for care, greater and increased Medicare audits and greater direction of GP practices". "The co-payment of $30 will provide a net bulk bill fee to your GP that is a discount to the common fee charged for private billed patients in most areas," the flyer says. "Such a co-payment is justified due to the inadequate Medicare rebate. "However, due to the current economic circumstances, the practice has determined to continue bulk billing concession card holders [the elderly and the unemployed] for as long as possible."

AMA state president Dr Andrew Lavender said he was not surprised by the decision to scrap bulk-billing and he knew of several small medical centre operators who also had decided to charge for appointments. "The main problem is that Medicare rebates have not kept pace with the cost of providing medical services," he said. "The Medical Benefits Schedule was established over 20 years ago and since then has never kept pace with either average weekly earnings or the cost of medical services, and the other problem is that there is an increasing burden of red tape and administrative costs and it's no longer sustainable to continue charging at bulk-billing rates for the majority of medical services.

"I am aware that many of the smaller practices have stopped bulk-billing, but we would expect that more of the large corporate practices will cease bulk-billing as well because it is just not sustainable, really, to maintain the service. It is a business and they have obviously substantial business costs."

Medicare pays $33.55 an appointment, but the AMA is calling for this to be "substantially increased". If a practitioner agrees to bulk-bill, patients assign their right to a benefit to the practitioner as full payment for the medical service and the practitioner cannot make any additional charge for the service.

Dr Lavender said the move to stop bulk-billing would put more pressure on hospital emergency departments. "It will mean that some people will choose to attend at emergency. That will certainly put an increased load but it is hard to anticipate exactly how much," he said.

The State Government recently launched an advertising campaign to encourage people to use GP clinics for non-urgent medical assistance during the busy winter period to free up emergency clinics. Health Minister John Hill said it was disappointing some clinics were moving away from bulk-billing. "There is a marketplace, though, and people should also shop around when they can, as the majority of clinics do bulk bill," he said.

Further pressure on the public health system could come from people dropping private health cover in the wake of the Federal Government lifting the level of income on which the Medicare Levy Surcharge is applied – the impact of which is not expected until later this year. For the 2008-09 financial year, the Medicare Levy Surcharge on those without private health cover was raised from $50,000 to $70,000 for singles and from $100,000 to $140,000 for couples/families. This means more people will escape the 1 per cent surcharge and so may consider dropping their private cover.

Federal Health Minister Nicola Roxon yesterday supplied statistics showing SA had the second-highest rate of bulk-bill doctors in the country, with 79 per cent of doctors offering the free service. One Marion Domain patient, who did not want to be named, said he was given no warning about the fee. "I think $30 is a bit rude," he said. "I will not be going back to the clinic." Another patient, Jamie Milosevic, 21, of Sheidow Park, said the extra fee was ridiculous. "Heaps of people had to actually leave the line and go and pull money out, which is stupid," he said.

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Code Blue! How Canada care nearly killed my kid

When the Code-Blue alarm sounded over the hospital's loudspeaker system, my husband and I knew it sounded for our daughter. It was 11 p.m. The hallways of the British Columbia hospital were dark. Only one emergency operating theatre was in use. She was in it. The skeletal staff came running. Resuscitation carts were rushed toward the theatre. My own heart nearly stopped, because she is my heart.

To follow Dr. David Gratzer's plainspoken definition (the good doctor is a Canada-care whistleblower), Code Blue is "the term used when a patient's heart stops and hospital staff must leap into action to save him." My then 12-year-old had stopped breathing on the operating table and was being revived.

Earlier that day she had broken her arm sliding down an embankment with friends. She arrived home, coat draped awkwardly over her disfigured limb, and stood in the doorway sheepishly. Sheepish because she feared I'd be angry. You see, she had fibbed about her whereabouts and was supposed to be studying.

Sheepish, but heroic, as we would soon discover. "Oh those bones, oh those bones," goes the old song. My familiarity with the structure of the human arm until then extended to, "the finger bone is connected to the hand bone, and the hand bone is connected to the arm bone, and the arm bone is connected to the shoulder bone, Oh mercy how they scare!"

A subsequent X-ray of Nicky's arm many hours on would reveal that nothing much was connected any longer. Hers was not just any old fracture. The humerus and the ulna were completely severed. The free-floating bones were pushing out against the skin. Yet the child never so much as whimpered.

We rushed her to the hospital where we imagined she'd get care right away. Recent immigrants to Canada, this was our first encounter with the single-payer health care system. Back in the "old country," South Africa, we had benefited from a thriving, profitable, private sector in medicine, where relatively unrestricted entry into the profession, and the prospects of a lucrative, prestigious career, attracted the country's crème de la crème, and ensured a steady supply of graduates from excellent medical schools. (These once venerated institutions have since succumbed to the malignant effects of affirmative action that privileges the majority population. Consequently, South Africa's medical schools are no longer internationally recognized.)

The old-fashioned family physician had pride of place in this market and still made house calls. Emergency calls were answered by an "on call" partner in a practice, and not an answering machine. If you had no insurance, you'd contract directly with your medic, and pay him off, little by little, if necessary. Commensurate with job satisfaction, voluntarism was high among the doctors I patronized. Once a month, my daughter's pediatrician, bless him, would venture into the "bush" to treat underprivileged children, gratis. Another specialist repaired cleft palates, also for free.

These superb practitioners had done stints in Britain's government-run National Health Service. Obama would call them racists, but, as they told it, the NHS was staffed mainly by graduates of Pakistan's medical schools. Oxford and Cambridge-bound students were less likely to be enticed by the prospects of capped physician fees and squalid working conditions.

My daughter was born in a private, spiffy, state-of-the-art South African clinic, entirely within the financial reach of a middle-class young family. Now she was writhing in excruciating pain, on a hard bench, in full view of her unforgiving caretakers, in the dilapidated corridors of a state-run Canadian hospital. In retrospect, the admissions process was devoid of any manner of medical prioritizing. A woman who complained of a migraine was being interviewed at length ahead of us. She took her time, as did her interviewer. A few sullen sorts were being checked out for mild sniffles as we waited. And waited.

It was abundantly clear that the service, perceived as free by the freeloading public, was being overused. Yet separating urgent from trivial cases did not seem to form part of the protocol. This was compounded by the cruel indifference of the gatekeepers – the receptionists and emergency nurses.

So we sat and we sat. Every now and then I'd rise to plead for a palliative for my agonized child and her detached limb. Cold stares and stern admonitions were all I got. Two hours into the wait, my daughter finally began sobbing quietly. Still, the staff stared. When we were eventually summoned, a bureaucrat began filling in a lengthy questionnaire. I realized where she was going with her probes. Before the medical abuse would cease, child abuse had to be ruled out. The woman was investigating us for breaking our daughter's arm!

Next in store was a protracted stretch on a gurney, unattended. Another eternity passed before the mangled arm was X-rayed with great difficulty. A tired looking young surgeon explained the severity of the fracture. This was not a case for a cast. Nicky would require surgery sometime that night. When, he could not say. An inept nurse began poking the child's arm for a vein. I swooned at the sight of the punctured, bleeding little appendage. My husband kept vigil as I recovered outdoors. After another nurse was called in, a morphine IV was finally inserted. It stayed in until she was operated on – hours later.

A cursory investigation into why Nicky coded that night was conducted. The findings were, conveniently, inconclusive. The custodians of Canada care had tried to convince me that my daughter had reacted to a compound in the chemical cocktail that was the anesthetic.

A decade on, the same precious person required wisdom teeth extraction, this time in the United States. She had forgotten how close she had once come to dying, but the thought of another such procedure panicked her mother. Nicky's American oral and maxillofacial surgeon, however, had no qualms whatsoever about putting her under in his well-appointed rooms. (Yes, we paid him out of pocket; ever heard of saving for a procedure instead of going on holiday?) For after hearing all the facts of the case, he was in a position to explain what had happened 10 years back.

It took a free American practitioner, in private practice, to deconstruct for me what had transpired on that fateful day. The subpar care Nicky had received entailed the ongoing administration of morphine. Morphine, especially in a young child, depresses the respiratory system. Administered following hours on morphine, the general anesthetic acted cumulatively to stop her breathing.

Why is this episode typical of a day in the life of a patient interned in a state-run health care system? As one wag warned: "Power will intoxicate the best hearts, as wine the strongest heads. No man is wise enough, nor good enough to be trusted with unlimited power." (Except for Obama, naturally.) The license to exercise near-unlimited power goes hand-in-glove with an indifferent, cruel and invasive bureaucracy.

In the U.S., an overly litigious society has led to the practice of defensive medicine. But in the "public option's" sphere of influence, responsibility is collectivized. The culprits of a Code Blue or the odd slip of the scalpel have no out-of-pocket payments to fear. Had I sued the hospital, the comatose Canadian taxpayer would have been forced to pony up for the malpracticing parties.

In defense of the medics who ministered to Nicky let me say this: Most were good. All were hopelessly locked into a professional gulag in which wages are tied to a negotiated deal with labor, rather than – as is the case in a competitive market – to the individual physician's performance.

For his considerable skill, the surgeon who pinned Nicky's shattered bones together is rewarded with an increased workload, but no extra pay. Medical men and women like him must watch as mediocre practitioners are elevated beyond their capabilities, and as underperforming hospitals are "fixed" with infusions of funds. For such are the perverse, inverse incentives in all government departments – failure is rewarded with more resources. Coupled with capped fees and overflowing waiting rooms, these medical conscripts must contend with antiquated equipment and obsolete drugs.

Doctors are all corralled into this one and only "company." There is no other option, public or private. Should their instinct for freedom get the better of them, they must defect to America. And soon that option will die, too.

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Distortions rife in health care debate

The points below are generally reasonable but show little awareness of how rationing (most usually via long waiting lists) is endemic in ALL socialized medicine systems

Confusing claims and outright distortions have animated the national debate over changes in the health care system. Opponents of proposals by President Barack Obama and congressional Democrats falsely claim that government agents will force elderly people to discuss end-of-life wishes. Obama has played down the possibility that a health care overhaul would cause large numbers of people to change doctors and insurers. To complicate matters, there is no clear-cut "Obama plan" or "Democratic plan." Obama has listed several goals, but he has drawn few lines in the sand.

The Senate is considering two bills that differ significantly. The House is waiting for yet another bill approved in committee. A look at some claims being made about health care proposals:

CLAIM: The House bill "may start us down a treacherous path toward government-encouraged euthanasia," House Republican Leader John Boehner of Ohio said July 23. Former New York Lt. Gov. Betsy McCaughey said in a July 17 article: "One troubling provision of the House bill compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care."

THE FACTS: The bill would require Medicare to pay for advance directive consultations with health care professionals. But it would not require anyone to use the benefit. Advance directives lay out a patient's wishes for life-extending measures under various scenarios involving terminal illness, severe brain damage and situations. Patients and their families would consult with health professionals, not government agents, if they used the proposed benefit.

CLAIM: Health care revisions would lead to government-funded abortions. Tony Perkins of the Family Research Council says in a video, "Unless Congress states otherwise, under a government takeover of health care, taxpayers will be forced to fund abortions for the first time in over three decades."

THE FACTS: The proposed bills would not undo the Hyde Amendment, which bars paying for abortions through Medicaid, the government insurance program for the poor. But a health care overhaul could create a government-run insurance program, or insurance "exchanges," that would not involve Medicaid and whose abortion guidelines are not yet clear. Obama recently told CBS that the nation should continue a tradition of "not financing abortions as part of government-funded health care."

The House Energy and Commerce Committee amended the House bill Thursday to state that health insurance plans have the option of covering abortion, but no public money can be used to fund abortions. The bill says health plans in a new purchasing exchange would not be required to cover abortion but that each region of the country should have at least one plan that does. Congressional action this fall will determine whether such language is in the final bill.

CLAIM: Americans won't have to change doctors or insurance companies. "If you like your plan and you like your doctor, you won't have to do a thing," Obama said on June 23. "You keep your plan; you keep your doctor."

THE FACTS: The proposed legislation would not require people to drop their doctor or insurer. But some tax provisions, depending on how they are written, might make it cheaper for some employers to pay a fee to end their health coverage. Their workers presumably would move to a public insurance plan that might not include their current doctors.

CLAIM: The Democrats' plans will lead to rationing, or the government determining which medical procedures a patient can have. "Expanding government health programs will hasten the day that government rations medical care to seniors," conservative writer Michael Cannon said in the Washington Times.

THE FACTS: Millions of Americans already face rationing, as insurance companies rule on procedures they will cover. Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions.

Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them. He recently told a forum: "We don't want to ration by dictating to somebody, 'OK, you know what? We don't think that this senior should get a hip replacement.' What we do want to be able to do is to provide information to that senior and to her doctor about, you know, this is the thing that is going to be most helpful to you in dealing with your condition."

CLAIM: Overhauling health care will not expand the federal deficit over the long term. Obama has pledged that "health insurance reform will not add to our deficit over the next decade, and I mean it."

THE FACTS: Obama's pledge does not apply to proposed spending of about $245 billion over the next decade to increase Medicare fees for doctors. The White House says the extra payment, designed to prevent a scheduled cut of about 21 percent in doctor fees, already was part of the administration's policy.

Beyond that, the nonpartisan Congressional Budget Office said the House bill lacks mechanisms to bring health care costs under control. In response, the White House and Democratic lawmakers are talking about creating a powerful new board to root out waste in government health programs. But it's unclear how that would work. Budget experts also warn of accounting gimmicks that can mask true burdens on the deficit. The bipartisan Committee for a Responsible Federal Budget says they include back-loading the heaviest costs at the end of the 10-year period and beyond.

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