Saturday, September 26, 2009

Australia: Another government hospital doesn't give a damn

WHEN the family of Emilia Chatterjee complained to Gosford Hospital that she had contracted an infection after being left in urine-soaked clothes, the hospital apologised to the 84-year-old and said the issue had been addressed. The only problem was that Mrs Chatterjee was dead.

In a shocking bungle that heaped insult upon injury, the hospital acknowledged that staff had not cleaned rooms as they should have, nor listened to the requests of her daughters, who were forced to maintain a round-the-clock vigil on their mother to ensure she was looked after.

The family said nurses told them that the urine she was left to lie in had given her an infection - one that took her life on August 28, seven weeks after she entered hospital.

Yet when the Central Coast Health Service wrote three weeks later to say the issues had been addressed it was clearly under the impression that the great-grandmother was still alive. "The Nurse Unit Manager has asked that I extend her apologies to you and Mrs Chatterjee for any distress caused as a result of the actions of nursing staff," CCHS divisional manager Andrew Roberts wrote.

Mrs Chatterjee's daughter Giorgina Neilson said the family was horrified at the conditions her mother was in. "The hygienic condition of the hospital was totally unacceptable. We were horrified," she said. "She wasn't being fed, she wasn't being cleaned regularly . . . The hospital did acknowledge, some of the nurses did acknowledge to my sister that it was because she lay in the urine that she got the infection."

Yesterday the State Government was again forced into a grovelling apology. "Central Coast Health general manager Matt Hanrahan extends his sincere apologies on behalf of the health service for the distress experienced by the family of Mrs Chatterjee," it said in a statement. "Mr Hanrahan said that the failure to acknowledge the death of Mrs Chatterjee in correspondence with the family related to concerns regarding her care was regrettable."

The bungle was also a baptism of fire for new Health Minister Carmel Tebbutt, who yesterday ordered a full departmental investigation.


Snowe to Reid: Whats the Rush?

Harry Reid is once again threatening to invoke reconciliation, whereby only 51 instead of 60 votes would be needed to pass the government-run health care proposal, ObamaCare. Apparently, the democratic system is not working fast enough for Reid’s taste. This time, Reid has threatened to eliminate the filibuster should Republicans halt consideration of the bill in committee. “If we can’t work this out to do something within the committee structure, then we’ll be forced to do reconciliation,” he said, calling the tactic a “last resort.”

“Railroading” might be a better term. However, the haste that Senate Democrats want to move on Senator Max Baucus’ public-private insurance “co-ops” proposal —which would provide taxpayer-subsidized health care to 26 million— has Olympia Snowe scratching her head.

As the Senate Finance Committee prepared to vote on a measure that would have required the language of the bill to be posted online prior to a committee vote (which would have given the Congressional Budget Office (CBO) time to properly estimate the cost of the bill) she actually got angry at her Democrat colleagues who refused.

Said Snowe with no small amount of displeasure, "I truly do not understand the skepticism about this request, the reluctance and the reticence. This is about doing our job. If it takes two more weeks, it takes two more weeks. We're talking about trillions of dollars in the final analysis. What is the rush? Is there something happening in two weeks?"

She might justifiably have added the word “bums”—as in, “What’s the bum’s rush?”

According to the CBO, a reliable cost estimate of the bill will not be quantifiable without the final proposed language, as opposed to the conceptual language the committee normally works with. Nonetheless, in a party line vote of 13-10, the committee agreed to only give the CBO the conceptual language, which would likely throw cost estimates off, according to the CBO.

The icing on the cake is Harry Reid’s thuggish threats to Senate Republicans to invoke reconciliation if they do not vote the legislation out of committee—despite the fact that neither they nor Reid has any idea about how much it will actually cost.

In recent weeks, Reid has threatened to use reconciliation repeatedly. At one point, Reid spokesman Jim Manley said, "The White House and the Senate Democratic leadership still prefer a bipartisan bill. However, patience is not unlimited, and we are determined to get something done this year by any legislative means necessary."

Senator Minority Leader Mitch McConnell predicted a public backlash if the bum’s rush tactic were used. He said, “Let me say…budget reconciliation has never been used to structure one-sixth of the American economy. If that option were chosen, there would be a severe, negative, and I think appropriate reaction from the American people… If you thought the American people were upset in August, you haven’t seen how upset they will be if this device is chosen.”

McConnell is not off-track. Some 56 percent of Americans currently oppose Democrats’ health care proposal, according to Rasmussen Reports. If Democrats now choose to eliminate the time-honored filibuster to nationalize the health care system, the consequences will be dire, both for Democrats, and for the country.

The filibuster has been used as a means of giving the minority party in the Senate a voice. It has been an effective tool for slowing down debate and allowing cooler heads to prevail for more than 150 years. Without it, a majority party could rule things like a mob. Which is what Reid apparently intends to do.

Senate Republicans need to answer in kind. They should make a threat of their own to Harry Reid: If he invokes reconciliation on ObamaCare, they will shut down and boycott the Senate altogether. Then the Senate will not work as fast as the Obama-Reid Cabal wants. In fact, it will not work at all. And the nation can heave a great sigh of relief.


Health plan would push millions out of Medicare program

President Obama's repeated pledge that senior citizens would not lose benefits under his proposed cuts to Medicare has been officially contradicted by an independent congressional analyst whose dire prediction could put the latest Senate health proposal in jeopardy.

The $856 billion health care reform bill now being drafted in the Senate Finance Committee would be paid for in part by slashing $125 billion from the Medicare Advantage program, which is used by about 9 million people, or nearly 20 percent of all Medicare recipients.

The cuts would come from the additional benefits Medicare Advantage enrollees receive, Congressional Budget Office Director Doug Elmendorf told the committee, and would amount to reducing those benefits by "a little more than half."

Under Elmendorf's estimates, Medicare Advantage enrollees would receive about $42 monthly in additional benefits in 2019 under the current health care proposal, not the more than $84 in benefits they would get without the cuts.

As a result, Elmendorf said, about 20 percent of Medicare Advantage users, approximately 2.7 million, would drop out of the program and would instead use standard Medicare.

Medicare Advantage refers to the various private health care options available through the government-run Medicare system. Often, Medicare Advantage plans include prescription drug coverage and other benefits. Generally, Medicare Advantage plans feature more benefits and lower co-pays than standard Medicare coverage, but include limitations on which doctors and hospitals a patient can visit. Insurers have warned that premiums may go up for seniors enrolled in Medicare Advantage under President Obama's health care reform proposal. The president has promised seniors will continue to receive the same level of coverage after reform is passed.

"Because the competitive bidding process would reduce the benefits that would be made available, fewer would choose Medicare Advantage and more would choose fee-for-service," which is standard Medicare, Elmendorf said.

One Democrat, Sen. Bill Nelson, of Florida, will offer an amendment to protect Medicare Advantage benefits, and at least one other Senate Democrat may be prepared to vote against the bill if the cuts go through. That could put passage in jeopardy, because no Republicans on the panel are likely to back the plan.

"I have real doubts that Congress ultimately will take as large a cut out of Medicare Advantage," said Joseph Antos, a health care scholar at the free-market American Enterprise Institute. "You are going to take 20 percent of the Medicare population, who are probably more active voters than the average Medicare beneficiary, and tell them that you can't have what you had last year. President Obama is telling you you can't keep what you want."

But without making drastic cuts to Medicare, Democrats are left without enough money to fund the massive reform plan.

"If they don't make the cuts, where are they going to get the $120 billion?" said Bob Laszewski, president of Health Care Policy and Strategy Associates. "There is pretty good agreement about what the benefits of health insurance should be, but where there really isn't agreement is how they are going to pay for it."


Doubling Down on a Flawed Insurance Model

Obama's plan takes the problems of the current system—mandates, runaway spending and more—and makes them worse

"What this plan will do is make the insurance you have work better for you. . . . And here's what you need to know, I will not sign a plan that adds one dime to our deficits—either now or in the future. Period."

So spoke President Barack Obama in his address to Congress earlier this month, for the first time laying out more specific goals for health-care reform. To persuade the American people to support his health reform agenda, the president has made two simple promises. First, his plan will benefit everyone who already has health insurance. Second, his plan will not add to the nation's yawning budget deficit. Both claims are essentially false, and examining them offers economic lessons for reform.

The administration's plan will impose mandates that employers provide coverage, mandates that individuals obtain coverage, and mandates about the form this coverage will have to take. These will remove the freedom to choose one's health-insurance plan, because government, in its effort to correct perceived inequities, will dictate which health-care services must be covered and which health-care providers must be used.

The proposed unprecedented intrusion of government into private markets will have adverse effects on people with insurance in both the short and the long run.

The mandates will lead to large increases in the cost of health insurance for everyone. Research studies have shown that as people become insured, especially under a health plan that offers broad coverage and low copayments, they consume more health-care services. The best estimates indicate that each newly insured person will approximately double his or her health spending.

With 30 million to 40 million newly insured persons under the administration's plan, aggregate health-care demand will increase significantly. But when demand expands prices increase. We estimate that the higher demand will increase health insurance premiums for the typical family plan by about 10%. Because an employer-sponsored family insurance plan cost $12,680 in 2008, this translates into an increase of about $1,200 in the typical annual premium.

The mandates will also have adverse additional longer-run consequences. According to provisions in both House and Senate bills, mandated plans must have low copayments and provide coverage of health-care services that is at least equal in scope to a typical, current employer-sponsored plan. But these are the very flaws that are responsible for high and rising health-care costs, flaws that stem directly from the misguided tax exclusion for and the extensive state regulation of health insurance. By locking in these flaws, the mandates will inhibit precisely the innovation needed to reform U.S. health care. Ultimately, as government seeks to rein in costs, it will curtail access to health-care services by erecting barriers between patient and health-care provider.

The current House and Senate bills will also break the president's second promise—not to add to the deficit. In part because the health insurance that the administration's plan forces people to buy is expensive, the plan proposes to give individuals large financial subsidies to partially offset the cost. The entitlement-based subsidy, combined with the proposed Medicaid expansion, would add between $700 billon and $1.2 trillion to federal spending over the next decade, according to the Congressional Budget Office. The new entitlements would come on top of existing federal health-care entitlements that the government has been neither able to control nor finance.

A portion of the additional spending is to be financed by savings from the existing federal health-care programs. But, thus far, the alleged savings come mainly from cutting future Medicare payment rates. If history is any guide, the savings won't materialize.

For the past 25 years, Congress has repeatedly "cut" payment rates. Yet Medicare's expenditures have continued to outstrip its dedicated revenues. New taxes have been required but revenues still can't keep up with expenses. Recall that in the early 1990s Congress removed the cap on Medicare's taxable wage base. Today, the Medicare Board of Trustees projects that the Hospital Insurance Trust Fund will be bankrupt in eight years.

More important, cutting payment rates is not reform. Ultimately, such price controls will lower the quality of health care and reduce the supply of health services, just as price controls have in every market where they've been tried. Congress's near-exclusive reliance on such cuts is revealing. It is a clear demonstration that the federal government has no idea how to reform its current insolvent health-care programs, much less how to properly design a new one.

Reform will be partly financed by higher taxes. The House bill proposes to raise the highest personal income tax rate by 5.4 percentage points. This is on top of the Obama administration's plan to raise the top rate by another 4.6 percentage points next year. The combined 10-percentage-point increase raises the top income tax rate to 45%—an economic growth-destroying level not seen since the early 1980s. Sen. Max Baucus (D., Mont.) proposes, instead, to tax some health insurance premiums.

In neither bill do higher taxes finance the proposed additional spending. Should the Medicare savings fail to materialize, as we believe they will, the spending in either bill will add more than $100 billion per year in perpetuity to the already soaring national debt.

Returning to President Obama's address: "We did not come to fear the future. We came here to shape it." But shaping needs a well-thought-out plan. To move forward, the country must begin to have two separate debates. The first debate centers on how to improve current health insurance arrangements in order to rein in the epidemic of health spending that too often fails to provide good value for money.

The second debate should center on additional steps to improve access to health care for those who cannot afford it. However, this debate must be separated from the issue of insurance coverage. Many currently insured Americans, no doubt, would be willing to pay some additional amount if extending health insurance coverage actually improved the health of the uninsured.

The hard reality is that there exists little evidence that it does. Helen Levy and David Meltzer, in a 2008 review of research in the Annual Review of Public Health, summarize the overwhelming conclusion of academic research by concluding: "The central question of how health insurance affects health, for whom it matters, and how much, remains largely unanswered at the level of detail needed to inform policy decisions." We must experiment with alternatives, such as further expansions of community health clinics, special assistance for the chronically ill, and other programs that might not supply traditional services but could have a big impact on people's health.

Comprehensive, low-deductible, low-copayment insurance has brought us to where we are today. The administration's plan to expand and lock-in this flawed paradigm will ultimately defeat the goal of making health services more affordable for everyone. Fortunately, there are other options, many of which have appeared on these pages. These include policies that encourage more cost-conscious health-care choices, greater competition among health insurers, and reduce the practice of defensive medicine.

President Obama claims to support these ideas, but the plan he outlined is not consistent with these claims, and neither is the Senate Finance Committee bill. The American people should ask for a second opinion.


Bad Medicine: ObamaCare is hazardous to your health


President Obama addressed Congress two weeks ago on the issue of health care, and on the same day an Associated Press GfK poll showed that the proportion of Americans who strongly approve of the way he is doing his job has fallen from 41% in December to 24% now. And the percentage of people who strongly disapprove of his performance has risen from 6% to 35%.

Those serious declines no doubt have to do with many issues--economic decline, the massive spending increases (enacted and proposed) of $6.5 trillion over the next decade, the coming massive tax increases that are presidential and congressional priorities, and currently most important, the proposed governmental takeover of health care. On that matter, more than 1.3 million people have signed and sent to Congress the Salem Radio Network's Free Our Health Care Now! petition to make sure individuals, not the national government, make their health care decisions. (Disclosure: The petition incorporated information form the National Center for Policy Analysis, of which I am chairman.)

But the Democratic congressional leadership, led by Sen. Max Baucus of Montana, has now offered a bureaucratic, government-intrusive health care proposal. The details change daily as the bill works its way through the Finance Committee, which Mr. Baucus chairs, for there are more than 500 proposed amendments being considered. But the bill would start off by imposing annual fees of $6.7 billion on health insurance companies, $4 billion on medical device producers, $2.3 billion on drug manufacturers and $750 million on clinical laboratories, all of which would surely be passed on to consumers in higher prices. The insurance companies' $6.7 billion fees alone would come to some 60% of the industry's after tax earnings.

And then American families who do not have health insurance--the people the Democrats claim they're trying to help--would be assessed finds of between $750 to $1,900 a year. All this reflects Congress's simple objective: government rather than individual control of our health care.

But America's health care is not doing badly. Indeed a National Center for Policy Analysis study from last March shows how much better we are doing than countries like Canada, Britain, and other European nations that have government health care control:

* Breast-cancer mortality is 52% higher in Germany and 88% higher in Britain than in the U.S.

* Prostate-cancer mortality is 457% higher in Norway and 604% higher in Britain than in the U.S.

* Eighty-nine percent of middle-aged women in the U.S. have had a mammogram, compared with 72% in Canada.

* Fifty-four percent of men in the U.S. have had a prostate-specific antigen test, compared with 16% of Canadian men.

As for the availability of health care, another study shows that 74% of those in the U.S. meet for scheduled doctors appointments within four weeks, while only 42% of British and 40% of Canadians do. Only 10% of Americans wait longer than two months, while 33% of Brits and 42% of Canadians wait that long.

On average, doctors in a survey say neurosurgery should be performed within 5.8 weeks, but in Canada it takes about 31 weeks. And orthopedic surgery should be within 11 weeks, but in Canada it takes 37 weeks. So it is pretty clear that government health-insurance monopoly is dangerously inefficient.

The government-operated Baucus plan would impose big costs on Americans, in terms of both money and freedom..

First there is the original proposal of a 35%--since raised to 40%--excise tax on companies that offer health-care plans that cost more than $8,000 for individuals or $21,000 for families, just to make sure that government can control costs and health care plan contents.

The individuals' cost of the required Baucus health care plans are very high, As The Wall Street Journal pointed out the other day, for a family of four making $42,000 the "government would subsidize 80% of their premium and pay $1,500 to offset cost-sharing," but the family would "still pay $6,000 a year--or 14.3% of their total income." As family incomes slowly rise, so would their health care costs--to 17% or 18% of income. In committee, the subsidies will likely be increased, but the individual's cost will still be too high.

The plan would cut some $500 billion from Medicare and Medicaid, including the excellent Medicare Advantage plan that gives 10 million senior citizens private health-care options. Giving choices to seniors is simply an anathema to government-control believers.

The federal government would also likely follow the lead of states and impose a list of benefits that must be included, even if all patients don't need them. There are now about 2,100 state-based mandates, for such services as acupuncture, wigs, massage therapy and in vitro fertilization.

Finally, Mr. Obama also believes in community rating, a requirement (already existing, in one form or another, in 11 states) that limits the differences in what companies can charge people for their coverage, regardless of their age or medical condition. That means younger, healthy people would pay much more than their care would cost--yet they would pay big fines if they don't take this bad bargain.

So what is a better solution? First, allow everyone to purchase health insurance across state lines (difficult under current law, as you must buy your insurance in your own state), so that they can get the best possible policies at the best possible prices.

Second, individuals should get the same tax break that companies get when they supply health insurance for their employees. All policy payments should be tax deductible, either to the company or the individual.

Third, health insurance should be portable. Companies should help their employees own their own insurance so that it travels with them from job to job, state to state, and is under their control.

Fourth, Congress should enact tort reform so that doctors can do what is best for their patients instead of practicing costly legal defensive medicine.

And finally, let people purchase insurance that meets their needs, rather than requiring intrusive, one-size-fits-all federal government mandates.


Senate considers aiming low on health care

As a deadline to pass a health care bill gets closer with no end in sight to the discord in Congress, some lawmakers want to scrap the proposals that are now on the table and try to pass a much smaller bill. "People feel that it may be very hard to get such a large bill done this year," said Sen. Joe Lieberman, I-Conn., after a closed-door meeting with Senate Democrats.

Lieberman said many Democrats appear "open" to the idea of trying to pass a far less ambitious legislation than the $900 billion plan on the table in the Senate Finance Committee, where lawmakers have lined up more than 500 amendments in an attempt to reshape the bill. "We've never adopted a reform package this large in one legislative act," Lieberman said. "We ought to begin this year putting parts of reform in and then make it better and better as time goes on. More than one senator suggested that as a possibility."

With just weeks remaining on the legislative calendar, both the House and Senate may ultimately have little choice but to take up a smaller bill. In the House, Speaker Nancy Pelosi must merge three similar, $1 trillion bills into one piece of legislation that that can garner the 217 votes needed. But she has no plans of bringing it to the floor yet, which would require twisting the arms of her skittish Democratic moderates and freshmen who have problems with the bill. Instead, Pelosi will wait and see if the Senate can pass a bill and then try to pass House legislation around the same time, a leadership aide said.

But Pelosi may have to wait a while for the Senate. Even after the Senate Finance Committee gets through its giant stack of amendments, Majority Leader Harry Reid, D-Nev., will have to find a way to combine the bill with a much more liberal and partisan health care proposal passed earlier this summer by another committee, and that final product must win the support of all 60 Democratic votes (Massachusetts is likely to soon appoint a Democratic replacement for the late Sen. Edward Kennedy), or alternatively pick support among a few Republicans.

Some Democrats are beginning to think it may be an impossible task. "I suggested that earlier this year we ought to take up something incrementally, because of the challenge," Sen. Ben Nelson, D-Neb., said. Nelson and other Democrats agree that Congress has to pass some kind of health care reform this year, even if it is a much smaller plan. Nelson suggests first passing a bill aimed a bringing down the cost of health care, which many Democrats in the closed-door meeting on Tuesday said is the biggest priority. If a bill is whittled into something smaller, the end product would focus on medical costs.

Reid repeated a warning that he may use a procedural move to pass a health care bill with just 51 votes, which would require breaking up the bill. He cited the need to bring down health care costs as the reason for the urgency. "Too many people waited too long for Congress to rein in skyrocketing costs, and we have to do something about it," Reid said. "That's what the debate's all about."


1 comment:

Anonymous said...

The problem at its simplest is explained in the free trade magazine 'General Surgery News' ("The Cacophony of Health Reform Debate" is online but only for subscribers). This is a great source since not only do their full page ads show huge puss filled wounds ("Wound Wont Heal?", "Abdomen Wont Close?", etc.), they regularly feature articles about insurance hassles and the death of general practitioners and how surgeons are becoming rare due to red tape.

They spell out a massive amount of waste that indeed centers on the uninsured. Hospitals do NOT turn them down as long as they show up for emergency services. So they WAIT until any often easily treated problem turns into a serious emergency with complications galore. And they bluntly point out that the uninsured are poor and that poor people are the sickest members of the nation.

In other words, there really IS a massive and growing problem due to this generating a viscous cycle over time. Also, the population is aging demographically.

So *somehow* what is needed, and here I'm extrapolating since they do not directly bash Obamacare in their latest issue, is PREVENTIVE medicine for the poor.

This may sound too obvious? It wasn't to me, and I follow this stuff online like crazy and have done medical research. Understanding the dynamics of the most complicated industry in the world besides perhaps Wall Street may eventually lead to simple conclusions, but the are not obvious ones to a layperson. It's like people who find it obvious that looming tariffs caused the panic that set off The Depression. Before reading about it, I would have asked, "What tariffs?"

Another solution is to turn people away to die at emergency wards, like perhaps is done in countries where medical tourism is popular and costs are a fraction of those in the US. The articles in this magazine indicate a VERY strong ethic at work so this will not happen in the US. If it did though, the problem would have been solved long ago, I imagine. They point out that hospitals were traditionally charitable organizations rather than commercial outfits.