Sunday, September 06, 2009

The NHS gets a bad bill of health

The British government could make the NHS more efficient by contracting out the management of its care, says Simon Heffer

Since McKinsey and Co, the consultancy company, is not a registered charity, I presume it cost the taxpayer a substantial amount for the firm to conduct an efficiency review into the National Health Service. Having commissioned the report, the Department of Health took one look at its main finding – that 10 per cent of NHS staff should go in order to achieve efficiency savings – and rejected it. If you seek an example of how superbly the Government spends money, this is a magnificent one.

Any fool knows that the NHS is overmanned: perhaps not with doctors and nurses, but certainly with bureaucrats and support staff. Even the fools who run the Department of Health must have realised that if they asked McKinsey to do this job, it would find there were too many people on the payroll. To order this review and then to reject it immediately is completely obtuse.

Having read some of the findings of the report, even I would not agree with all of them. I doubt it is sensible, with our ageing population, to pursue a goal of fewer doctors and nurses. But it has long been apparent that the NHS is an organisation that exists as much for the benefit of many of those who work in it, as for those it purports to treat. It is also apparent that, despite numerous reforms since it began in 1948, it is shaped by an immediate post-war ideology that has about as much relevance today as Bile Beans and Craven "A"s. No private-sector health concern would begin to think of running itself as the NHS does: it would be bankrupt within weeks. But then no private-sector health concern has as its mission in life the provision of jobs for Mr Brown's client state.

Labour rejected McKinsey's plans because it deemed them politically unworkable. It is not prepared to have a mature conversation with the British people about how their right to a health service free at point of use would not be affected by a desire to secure better value, in an economy that is cruising towards bankruptcy. Sadly, the Tory party doesn't want to have this conversation, either. Feeling morally blackmailed by a climate in which public spending, irrespective of the value obtained from it, is a good thing, it too has dismissed McKinsey, though with the caveat of saying (quite rightly) that there are bureaucratic jobs that can be lost.

Given the expense of the NHS – more than £100 billion a year, or about a seventh of total public spending – cowardice about how to reform it is not an option. It is derelict of anyone who seriously wishes to govern this country to say that we can go on in the same bloated, welfarist way that we have pursued since 1948. For a failure to get costs under control will, sooner rather than later, ensure that those same vulnerable people the NHS is supposed to help are at risk of having very little decent care at all.

The bold move for a government to take would be to contract out the management of the NHS. Hospitals, then possibly even whole health authorities, should be franchised out to the private sector, to break the culture of jobbery and self-serving trade unionism that has handicapped the development of the NHS. The service would still be free at point of use: but it would be delivered more efficiently. As McKinsey found, some hospitals are abominably wasteful. The rescue of the whole NHS should start with them.

Of course, all our politicians can carry on claiming that value doesn't matter, and believing that there is a bottomless pit of money to run our health-care service. In the suffering this will inflict on patients in the long term, it reveals an utter unfitness to govern.


Distortions -- or Truths?

by Pat Buchanan

We should have "an honest debate" on health care, said Barack Obama in his Aug. 22 radio address, "not one dominated by willful misrepresentations and outright distortions." Among the "phony claims" made against the House bill, says the president, are that it provides funding for abortions, guarantees coverage for illegal aliens, contains "death panels" and represents a federal takeover of the health care system. Is Obama right? Are critics misleading and frightening folks with falsehoods about Obamacare?

Well, let us inspect each of those "phony claims." Does the House bill fund abortions? No. However, while the House Energy and Commerce Committee at first voted to exclude abortions from "essential" services, to the howls of NOW, Chairman Henry Waxman conducted a second vote, to drop the anti-abortion amendment. That vote carried. In short, funding for abortions remains an open question. And whether Obama agrees to drop it to assure passage, he supports the Freedom of Choice Act that would, opponents insist, overturn every state and federal restriction, including the Hyde Amendment, which forbids federal funding. Obama has already used his authority to lift the Reagan administration prohibition against using foreign aid funds to procure abortions abroad.

Obama is a pro-abortion absolutist. And if abortion-funding is not in the final health care bill, does anyone doubt that Democrats will move swiftly to incorporate it in future legislation?

As for illegal aliens, Obama is right again. They are not covered in any of the five bills. All their children are automatic citizens and are covered, however. And no illegal alien who comes to an emergency room can be denied care. And there is no eligibility verification screening provided for in any of the bills to sort out and exclude illegal aliens. Obama said in Mexico City he is determined to put our 12 million to 20 million illegal aliens on a "path to citizenship." That would make them legal immigrants. And legal immigrants are covered.

Moreover, a high percentage of all immigrants, legal and illegal, are poor, uneducated, unskilled and unable to find the kind of jobs that carry health insurance. We have some 40 million immigrants today, with another 100 million expected by 2050. Any national health insurance system put in place today is going to be swamped if we do not close the borders and halt immigration. Obama and the Democrats, who are almost all pro-abortion and pro-amnesty, are assuring us their health care bill will not advance these goals to which they are committed by ideology. This is disingenuous at best.

What about the "death panels." No, they are not in the bill. Nor is there any doctor's right to perform euthanasia or mercy-killing. Obama's resolve to cut health care costs, at the same time he repeatedly reminds us that half of all such costs are incurred in the last six months of life, however, points straight to rationed care for the elderly ill, where drugs, procedures and operations necessary to life are going to be curtailed or cut off. There is no other way to get there.

And if government bureaucrats are making those decisions, can they not fairly be called death panels, especially if the folks for whom they are deciding are suffering from such diseases as senility and Alzheimer's? How do you curtail or cut care for the elderly sick and terminally ill without advancing the date of their deaths? Sarah Palin may have been factually incorrect, but her instincts about what is coming were dead-on.

What of Obama's dismissal as "phony" the claim that the "public option" for health insurance must lead to a government takeover? But did not Barney Frank say the government option is the best way to a single-payer system -- that is, a government monopoly? Barack says he wants competition. But in the past, he, too, has spoken of favoring a single-payer system and he, too, has said a public option is the first step on a 10- or 20-year march to single-payer.

Because Obama has ceased talking of a single-payer system and it is not in the bill does not mean that a public option will not put us on the road to government control. Indeed, does anyone believe Barack has any objections to government-run universal health care? Does anyone think that a government-run insurance program, with access to tax revenues and the ability to undercut all competition, will not crowd out private insurance and take us to where Barney and Barack want to go?

Both Barney and Barack are pro-abortion and pro-amnesty. Both have spoken favorably of a single-payer system where Uncle Sam shoulders aside the insurance companies that Nancy Pelosi calls the "villains" in the health care system.

As a Fabian socialist, however, Obama will accept a small victory, if the road leads toward ultimate triumph and the alternative is a big defeat. Thus, what the center-right needs to do is administer to this Fabian socialist a decisive defeat in a big battle -- like this one we are in.


How Obama Blew Health Care Reform On A Bet The Republicans Were Hollow Men

The Obama administration may have blown its chance to reform health care in the United States by cynically cutting deals with special interests and ignoring public sentiment, according to an explosive Wall Street Journal story today.

It's a profound piece of myth busting by the Journal. According to the story Obama likes to tell, he is engaged in a struggle against special interests to remake the health care system in a way that will benefit the American people. But there aren't really any special interests opposing him. The drug companies, the health care providers, the health insurers all signed on to Obama's plan long ago. They are actively lobbying for it.

The Obama administration "expended great effort to line up the support of health-care insurers, pharmaceutical makers and care providers, believing that by keeping them around the table, they could win over Republicans and stop the kind of industry-led attacks that helped sink the Clinton plan," writes the Journal team.

It was supposed to be a simple formula. Win over the health care industry shepherd, and the Republican will follow like sheep. But it didn't work.

What seems to have gone wrong can be described as a failure of the imagination: Obama's administration just never believed Republicans would stand up for their limited government principles if that meant opposing business interests. They were apparently assuming that Republicans and conservatives could be won over by winning over "business interests," as if free market and anti-government positions were just rhetorical cover for policy making at the behest of business.

There was plenty of evidence for this during the Bush administration, when the Republicans seemed to throw every principal overboard to serve special interests. (Well, every principal except "Do Not Speak Ill Of George Bush.") But, at least as long as they are in opposition, the Republicans now seem willing to buck the siren call of business interests supporting Obama's plan in favor of resistance to big government. Time may tell whether this is pure partisanship or a post-Bush return to principled conservatism.

But, in any case, the Obama administration's assumption that brining business to the table would win over the GOP opposition seems to have played a key role is putting the plan to reform health care in jeopardy.


Pulling the Trigger on ObamaCare

As bipartisan negotiations in the Senate have failed to trick Republicans into supporting a vigorous government-run takeover of the entire health care system, Barack Obama and congressional Democrats are making a last ditch effort to sway at least one Republican member: Olympia Snowe of Maine.

Reports CNN Politics, "For the past months, Snowe has been pushing the idea of a safety net plan, or 'trigger,' for a public health care option as part of a key compromise. A source familiar with her negotiations with Obama said that's one of the things they're talking about…The idea would give insurance companies a defined period to make changes in order to help cover more people and drive down long-term costs. But if those changes failed to occur within the defined period, a trigger would provide for creating a public option to force change on the insurance companies."

Concern over a government-run medical system has galvanized citizens nationwide in opposition to let their voices be heard in town halls. And they've left the members of Congress ducking for cover. The political damage has been so extensive that Barack Obama is preparing an address to a joint session of Congress on Wednesday to in yet another attempt to sell his latest scheme for ObamaCare.

According to FOX News, White House aides have said that Obama "will deliver the message that Democrats are willing to go it alone if it cannot get Republicans behind it." The joke is that he does not actually need a single Republican vote to pass what he wants if his own party would just rally behind him.

The true trouble that ObamaCare faces is that Democrats believe that they are on a political Titanic —and vulnerable members in both chambers are stampeding to get to the lifeboats.

The reason Democrats want Snowe —or somebody like her— is so they can parade her around as the token Republican brokering a grand compromise, thus providing what they believe is political cover. And so, now they are ready to give Snowe what she has been asking for: a delayed implementation of the government takeover of the health care system in exchange for selling out her own party.

And if Olympia falls for the Snowe-job, she will do so knowing full well that her sell-out is a charade. After all, House Speaker Nancy Pelosi has already played the socialist hand. "If they want no public option, but a trigger, you can be sure that the trigger will bring on a very robust public option," said Pelosi, knowing full well that she gets to define and control the mechanism, tied to the escalating costs of providing life-saving treatments.

And of course, government controls that, too. It currently mandates minimal levels of coverage to be provided at the state level. It prohibits insurance to be purchased across state lines. It thus allows regional, corporatist monopolies to operate with impunity that in turn pay handsomely via political protection money to elected officials keep the status quo.

In the legislation now before Congress, even if the so-called public "option" were put on a trigger tied to costs, the bill would still force employers to provide coverage and individuals to buy coverage or else pay a tax. It would establish a whole new body of regulations that would force insurance companies that would eventually, inevitably bankrupt private insurance.

As reported by the Heritage Foundation, the legislation establishes "a single minimum coverage standard that will eventually apply to nearly all health plans and establishes a new 'Health Benefits Advisory Committee' within HHS to make detailed recommendations, which the secretary of HHS would then impose through regulation." Thus, by simply upping what must be minimally covered under private health plans, costs would skyrocket, and the deadly trigger on ObamaCare would be pulled.

They can call it whatever they want. A delayed public "option." A compromise. A trigger. But, Barack Obama, Nancy Pelosi, and Harry Reid are determined to get what they want. And whether now, sooner, or later, they are determined to force through a bill that inevitably results in socialized medicine.

Olympia Snowe can go along with it, too, if she wants. But she must realize that, really, she'll only be pulling the trigger on the American people. On freedom of choice. And on quality health care that provides for the young and protects the old.


Health care reform means more power for the IRS

There's been a lot of discussion about the new and powerful federal agencies that would be created by the passage of a national health care bill. The Health Choices Administration, the Health Benefits Advisory Committee, the Health Insurance Exchange — there are dozens in all.

But if the plan envisioned by President Barack Obama and Congressional Democrats is enacted, the primary federal bureaucracy responsible for implementing and enforcing national health care will be an old and familiar one: the Internal Revenue Service. Under the Democrats' health care proposals, the already powerful — and already feared — IRS would wield even more power and extend its reach even farther into the lives of ordinary Americans, and the presidentially-appointed head of the new health care bureaucracy would have access to confidential IRS information about millions of individual taxpayers.

In short, health care reform, as currently envisioned by Democratic leaders, would be built on the foundation of an expanded and more intrusive IRS.

Under the various proposals now on the table, the IRS would become the main agency for determining who has an "acceptable" health insurance plan; for finding and punishing those who don't have such a plan; for subsidizing individual health insurance costs through the issuance of a tax credits; and for enforcing the rules on those who attempt to opt out, abuse, or game the system. A substantial portion of H.R. 3200, the House health care bill, is devoted to amending the Internal Revenue Code of 1986 in order to give the IRS the authority to perform these new duties.

The Democrats' plan would require all Americans to have "acceptable" insurance coverage (the legislation includes long and complex definitions of "acceptable") and would designate the IRS as the agency charged with enforcing that requirement. On your yearly 1040 tax return, you would be required to attest that you have "acceptable" coverage. Of course, you might be lying, or simply confused about whether or not you are covered, so the IRS would need a way to check your claim for accuracy. Under current plans, insurers would be required to submit to the IRS something like the 1099 form in which taxpayers report outside income. The IRS would then check the information it receives from the insurers against what you have submitted on your tax form.

If it all matches up, you're fine. If it doesn't, you will hear from the IRS. And if you don't have "acceptable" coverage, you will be subject to substantial fines — fines that will be administered by the IRS.

Under some versions of health reform now circulating on Capitol Hill, the IRS would also be intimately involved in how you pay for insurance. Everyone would be required to buy coverage. The millions of Americans who can't afford it would receive a subsidy to pay for it. Under the version of the plan currently under negotiation in the Senate Finance Committee, that subsidy would come through the IRS in the form of a refundable tax credit. Under the House plan, the subsidy would come directly from the Health Choices Administration.

In either scenario, the IRS would be the key to making the system work. Before you could receive any subsidy, whether through the IRS or not, the Health Choices Administration would have to determine whether you are eligible for it. To do so, the bills under consideration would give the Health Choices Commissioner the authority to demand sensitive, confidential information from the IRS about individual taxpayers. The IRS would have to provide it.

Under current law, it is a felony for a government official to release taxpayer information in all but the most limited of circumstances. One such exception is for law enforcement; the IRS is allowed to give taxpayer information to prosecutors in criminal cases. The information can also, in some instances, be released to the Social Security Administration and the Veterans' Administration for the determination of benefits. The health care bills would change the Internal Revenue Code to permit the IRS to give similar information to the vast, new health care bureaucracy.

That means the personal tax information of millions of Americans would enter the system whether they want it to or not. "There's a mandate to buy insurance," says one Republican House aide. "You have to buy it. You have millions of people who can't buy it without a subsidy, so they will have no choice but to accept the subsidy in order to buy insurance, and then the Health Choices Commissioner will have access to their tax records."

"How many hands would this information go through?" asks a GOP source in the Senate. "What are the quality controls? This increases the risk of misusing this information."

Some versions of the bill even permit the release of confidential taxpayer information for decidedly less pressing reasons. In H.R. 3200, the IRS would be required to provide taxpayer information to the Social Security Administration for the purpose of helping Social Security officials find qualifying seniors who can then be encouraged to enroll in the prescription drug program. "There is no precedent for using taxpayer information for the purpose of identifying people to go out and advertise to them," says the House expert.

So far, there has been little substantive public debate about the integral role of the IRS in nearly every aspect of the various national health care proposals. But people who are closely involved with the process are deeply concerned about what they view as a massive, and in some senses unprecedented, expansion of the Internal Revenue Service.

First, they wonder whether the IRS can handle the new demands. "There is a sense at the IRS that their purpose is to collect revenue and not to implement all sorts of other programs," says a second Senate GOP aide. "Also, the IRS isn't necessarily great at doing what it does already. How is it going to determine whether 300 million people have health insurance?"

Second, they are concerned about anticipated abuse of the system. "You're going to have lots of fraud," says the House source. "People claiming lots of affordability credits or refundable tax credits. The IRS is not going to have the resources and expertise to police this stuff."

Finally, there is a third concern, more fundamental than questions of whether the IRS can handle the job: Should the IRS be involved in health care enforcement in the first place? As seen in the town halls across the country in August, many Americans are concerned about the coercive nature of the proposed national health care system. Handing the IRS the power to monitor every American's place in the system worries them even more.

Backers of the Democratic bills are betting that the handouts involved — giving people money to buy health insurance — will outweigh concerns about privacy and coercive government. Perhaps. But before Congress makes any decision on national health care, voters should know just what it will involve.


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