Monday, September 14, 2009

Yet another futile directive from the British health bureaucracy

Hospitals to be told to make patients happy. How is that going to happen given the abysmal and chaotic standard of care that is routinely provided? They are trying to run before they can walk

HOSPITALS that fail to keep their patients happy will lose money under new plans to improve the NHS. Having acknowledged that the health service is “good but not great”, Andy Burnham, the health secretary, wants hospital budgets to be linked with patient satisfaction.

The next phase of NHS reform will focus on improving patients’ “experience”, shifting the focus from basic medical care to the “extras” that help determine how happy patients are with their treatment. Ministers want hospitals to devote far more attention to issues such as the bedside manner of doctors and nurses; the warmth of welcome from receptionists; the quality of food and the cleanliness and attractiveness of wards. It will be the first time hospital budgets are affected by the “softer” aspects of patient care — as Burnham describes them.

The policy could be introduced as early as next financial year, (shortly before the likely election date) when hospital tariffs are reviewed, and is designed to end what Burnham describes as the “like it or lump it” culture in the NHS. “Sometimes hospitals are missing the point. How you are spoken to, how you are dealt with, whether you are treated in a friendly way — these things can be as important as your medical care,” said Burnham.

This new emphasis on providing “quality” care is similar to that in America, where private healthcare companies such as Premier Inc offer rewards to medical centres rated highly by their patients. It comes as Labour faces intense pressure from the Conservatives over the state of the NHS. David Cameron has sought to present the Tories as “the party of the NHS”, although many in his shadow cabinet, and backbenchers, have private healthcare.

Burnham’s assessment of the health service as “good, but not universally good” and “not yet great” marks a change of tone for the government, which previously emphasised its huge investment in the NHS, rather than acknowledging its ongoing shortcomings. Burnham’s qualified praise for the health service reflects an acknowledgment by Labour strategists that ministers need to do more than simply highlight achievements, and must set out their vision for the next stage of reform.

Burnham said that the NHS had been transformed from “poor or failing” over the past decade, but still needed to change. “Now that waiting times have come down, the NHS can start worrying about quality. We want to change the ‘get what you are given’ culture the service has bred. The NHS needs a system that pays hospitals more money when patients are pleased by their experience.”

While hospitals are already paid on results, the tariff is based on treatment and the success of operations, not on whether patients are satisfied with the way in which they were cared for. Linking payment to patient satisfaction would be a major shift in the way hospital budgets operate.

In an interview with The Sunday Times, Burnham said it was about “measuring what was truly important ... all of the softer things that contribute to the patient experience, not just hard and fast data.”

Officials have yet to determine how much hospitals would stand to gain or lose according to patient satisfaction, but Whitehall sources said “significant” sums would be involved, the new policy being at the heart of Labour’s vision for service improvement. Under a pilot scheme launching next spring in NHS Northwest, hospitals will be able to earn a premium of up to 4% of their budgets if patients are happy.

Following record investment in the health service, waiting times for operations and appointments with specialists have fallen dramatically, with waits of six months or more virtually eradicated. The catalogue of targets set by Whitehall to achieve the changes drew heavy criticism from clinicians, who claimed the pressure to “tick boxes” distorted clinical priorities. The government argues that the targets were vital and effective when the NHS was failing.

Burnham said that the target regime had now “served its purpose” and a different approach was needed to make patients happier with the way they are treated. He acknowledged that the NHS was still not as efficient as it could be, saying: “Clearly there’s a challenge there.”


What 'right' to health care?

by Jeff Jacoby

DURING SENATOR EDWARD KENNEDY'S FUNERAL in Boston's Mission Church last month, his 12-year-old grandson offered an intercessory prayer: "For what my grandpa called the cause of his life," Max Allen said, "that every American will have decent quality health care as a fundamental right and not a privilege, we pray to the Lord."

Opinions differed on whether a funeral was the right place to importune the Almighty for universal health care. But that He is the source of fundamental rights is in fact a core American belief. The Declaration of Independence pronounces it a self-evident truth that human beings "are endowed by their Creator with certain unalienable Rights" – rights that include life, liberty, and the pursuit of happiness. Health care isn't on that list. Should it be?

A great deal depends on the answer, for the Declaration's very next sentence affirms that the purpose of government is to "secure" those rights against infringement. If access to health care is deemed a fundamental right, then the government must be obliged to guarantee that access to every citizen. Medical treatment would have to be available on an equal basis to anyone seeking it, regardless of age or physical condition or ability to pay. Washington could no more entrust the provision of health care to private markets than it does freedom of religion: Your religious liberty, after all, is not a commodity you must purchase – it is yours by right, no matter where you live or how much you are worth. Should the same be true of health care?

Ted Kennedy was hardly alone in saying so. When Barack Obama was asked during one of the 2008 presidential debates whether health care is a right, a privilege, or a responsibility, he answered promptly: "I think it should be a right for every American." The 2008 Democratic National Platform avows in its opening paragraph that "affordable health care is a basic right." When the Harvard Community Health Plan commissioned a survey on the subject some years back, 90 percent of respondents said that everyone had the right to "the best possible health care -- as good as a millionaire."

It is not hard to understand the urgent passion with which so many people approach the issue of health care. And it would take a remarkably cold heart to be indifferent to the desperation of those who need medical help but cannot afford it. But rights do not spring from passion or need. Wanting something does not entitle you to it -- not if someone else must provide or produce that something. The rights delineated in the Declaration of Independence and the Constitution are negative rights only -- they protect our autonomy, allowing us to peacefully live life and pursue happiness, neither coercing others nor being coerced by them.

My right to free speech or to own property does not give me a claim on anyone else's time or labor or resources. But if I have a "right" to health care, someone else must be compelled to provide or pay for that care. Compulsion comes in different forms -- higher taxes, lower fees, insurance mandates, health-care rationing, intrusive regulations -- but the bottom line is the same: a universal right to health care would leave society less free.

It may sound noble to declare that health care is a fundamental human right and not a mere commodity to be left to the vagaries of the market. Of course, the same thing could be said about food or clothing -- also essential to human welfare -- yet not even Ted Kennedy would have suggested that Washington nationalize US food production or overhaul the clothing industry. It is precisely because food and clothing are seen as commodities, because we do leave their availability to the market, that they can be had in such abundance and diversity.

To be sure, some people will always need help. No decent person or society ignores the cries of the sick or hungry or poor. Happily, there is no better system for achieving the widest possible access to health care -- or any other good or service -- than the one that requires the least degree of political interference: the normal interplay of supply, demand, and competition. Health care is too important to be left to the marketplace? No, it is too important not to be.


AARP’s ObamaCare Ad Raises Serious Questions

Two weeks after an AARP health care town hall in Dallas went “South,” news outlets reported 60,000 membership cancellations. Hoping to stem their losses, spokespersons for the organization — which purports to represent the interests of American seniors — were quoted during the days that followed as saying the group does not back “everything” in President Barack Obama’s so-called health care reform package (a.k.a., “ObamaCare”). One would hardly know it by looking at the group’s online advertising.

In search of news related to today’s Tea Party activities in Washington, D.C., I stumbled across the ABC News web site and noticed the AARP banner advertisement above near the top of the page. The text of the banner ad: “Health Care Reform Will Be A Government Takeover”, was soon stamped with the word, “FALSE”.

When I clicked to open the ad, the image below appeared, revealing more about the AARP’s stance on ObamaCare: “Health care reform isn’t socialized medicine. You’ll still be able to choose your own doctor and insurance plan.”

Apparently not wanting to lose any more members, it appears AARP is following the same path as President Obama. In other words, the group is lying in open forums and, in places frequented primarily by liberals (i.e., the ABC News web site), they show their true colors. As a result, I’m forced to echo the words that appeared in a recent headline at Human Events: “Who Does the AARP Represent in Health Care Debate?”

SOURCE (See the original for graphics)

Democrats stifle Republican health care plans

Rep. Tom Price, the Georgia Republican who heads the House GOP Study Committee, came to President Obama's speech Wednesday night itching to make a point. Price, who also happens to be an orthopedic surgeon, has often heard the president accuse Republicans of criticizing Democratic health care proposals while having no plans of their own. He expected Obama to do the same Wednesday night.

"We knew the president would at some point say something like, 'and the other side has no ideas,' " Price says. So Price and his Republican colleagues brought with them copies of the more than 30 health care reform bills they have proposed in the House this year.

Obama didn't directly accuse Republicans of not having a plan. But he did say he would welcome "serious" health care proposals. "My door is always open," Obama said. That's when Price held up the sheaf of papers he was carrying -- a copy of H.R. 3400, the Empowering Patients First Act, which Price and the Republican Study Committee proposed in July. Other GOP lawmakers held up their own bills. Some raised a list of all the health care bills -- there are more than 30 -- proposed by members of the Study Committee.

Why use the props? "To say in a quiet and respectful way, 'Here are our ideas,' " Price says. "To say to the president, 'You're not being honest with the American people when you say that there haven't been ideas put forward, and that you've listened to them, because you haven't.' "

The small Republican protest got a bit of coverage, although it was overshadowed by the hubbub over GOP Rep. Joe Wilson's "You lie!" outburst during the president's speech. But the larger problem remains. Republicans have authored a number of health care bills -- serious legislation addressing portability, pre-existing conditions, cost and other issues that most trouble American consumers -- and hardly anyone has noticed.

Republicans don't really blame Nancy Pelosi. The speaker is as partisan a Democrat as they come, and no one is surprised that she has used her power to stifle Republican efforts. But they do blame the Obama administration. "The White House, in spite of saying they look forward to meeting with anybody who wants to solve these challenges, has rebuffed us at every turn," Price says.

They also blame the media. Somewhere in this extended health care debate, Republicans believe, reporters might have noticed that there are real, substantive GOP proposals out there. So far, though, it hasn't happened. A search of the LexisNexis database of newspapers, magazines, television programs and major blogs finds about 3,000 mentions of the major House Democratic bill, H.R. 3200, in the past six months. (Those are just the stories that refer to the bill by its House number; there have been thousands more stories referring generally to the Democratic legislation.) A similar search found 60 mentions of H.R. 3400, the Price bill.

Another Republican bill, H.R. 2520, the Patients' Choice Act, by Wisconsin Rep. Paul Ryan, received 12 mentions in the same time period. And two other bills, H.R. 3217 and H.R. 3218, the Health Care Choice Act and the Improving Health Care for All Americans Act, by Rep. John Shadegg, together received 20 mentions.

The virtual embargo on reporting Republican legislation has allowed Democrats and their allies in the media to keep up the "Republicans have no plan" attack. Just hours after the president's speech, for example, the Democratic National Committee released a new commercial claiming that Republicans "refuse to offer a plan" to reform the health care system. "It's frustrating," Price says. But Republicans believe that in the end, the public won't buy the administration's line. "The American people are smarter than that," Price says. "They know there are alternatives out there. That's what August was all about."


Health care faces some big legislative bottlenecks

The fierce national debate over health care is entering a new phase, with advocates on all sides focused on a few legislative bottlenecks that will determine the ultimate overhaul of the $2.5 trillion medical care system.

President Barack Obama's prime-time address to Congress on Wednesday reassured some nervous Democratic lawmakers, and he aligned himself more closely with certain proposals. While Obama's words seemed to halt and possibly reverse the momentum that conservative groups had gained in August, they did not resolve all the concerns of centrist Democrats who will play pivotal roles, especially in the Senate.

Obama's speech "was a game-changer when it came to the message," said Sen. Ben Nelson, D-Neb., one of the moderates. "But it's not an automatic change on the legislative side."

Some version of a health care overhaul must squeeze through five key gates this fall if a final package is to become law by year's end. Advocates would be shocked if the Democratic-controlled Congress failed to pass some version. At a minimum, they say, it would bar insurers from dropping customers who become sick and require them to cover people already with medical conditions. But Obama and most congressional Democrats want more:

_granting subsidies to help low-income people buy health insurance;

_requiring nearly all U.S. citizens to have insurance and requiring large employers to contribute;

_creating greater competition for private insurers, possibly through a government-run option;

_imposing more efficiency in Medicare and other programs, where experts say too much money and effort are wasted.

Obama is pressing the case with a rally Saturday in Minneapolis, an appearance Sunday on CBS' "60 Minutes" and trips in the week ahead to New York, Ohio, Pennsylvania and Maryland. But the health care issue is mainly in Congress' lap. Knotty issues include whether to establish a government-run insurance plan and how to control costs.

Perhaps the easiest early hurdle will be in the House. But even there, divisions between liberal and conservative Democrats worry leaders, and Republican opposition appears absolute. Three House committees have approved portions of a far-reaching health care bill, but it will be changed before it reaches the full House.

In essence, Obama encouraged House leaders to tweak their bill when he embraced several Senate proposals absent from the House version. He also set a 10-year spending target of $900 billion, which may prove hard to meet.

Conservative Democrats may try to remove the government-run insurance option, which is dear to liberals. Still, many lawmakers expect the public option to stay in the House bill.

Things are more complicated in the Senate, where procedural rules make it much harder for the majority party to impose its will. Obama's remarks revitalized efforts by Senate Finance Committee negotiators to shape a compromise bill that can attract at least one Republican's support.

The first Senate showdown is expected in about two weeks, when that committee debates and votes on the bill. Liberals may try to add a government-run insurance option, similar to the House's. More likely to survive are nonprofit insurance cooperatives, designed to compete with private industry and give consumers more choices.

The committee-approved bill will be merged with a second committee's version and sent to the full Senate, the third legislative choke point. Lawmakers expect emotional debate and numerous bids to amend the measure. To avoid a bill-killing filibuster by Republicans, supporters must assemble 60 votes in the 100-seat chamber. With Sen. Edward M. Kennedy's death, Democrats hold 59 seats. Their best hope for a GOP crossover is Sen. Olympia Snowe of Maine, one of the Finance Committee negotiators. But Snowe may be loath to be the only Republican supporter and the crucial 60th vote. "I'm not going to speculate" on the possibility, she said Friday. "That is very dangerous territory."

If Snowe balks, the ultimate Senate bill may need a lower price tag or other changes to attract a few other Republicans, such as Ohio's George Voinovich, who is retiring. Liberals would chafe at such concessions.

Senate Democrats could try a contentious tactic, called "budget reconciliation," to pass portions of the health care package with simple majorities that are not subject to filibusters. Some liberal groups urge this strategy. Senate insiders consider it unlikely.

With Congress on track to pass substantially different bills, a yet-to-be-appointed House-Senate conference committee will meld them into one. This small group, dominated by Democrats, will wield extraordinary power, including the right to add provisions that neither the House nor Senate passed. Some lawmakers think the panel could try to split the difference on the public insurance question. A possible compromise would be to replace the House's public option and the Senate's cooperatives with a "trigger" or "fallback" public plan, which would take effect only if private insurers fail to meet targets for providing affordable policies. Snowe backs such a plan, and some lawmakers think it must be included in the bill at some point to win her vote.

In the fifth hurdle for the legislation to clear, the conference committee would send its reconciled bill to the House and Senate for a final yes-or-no vote, with no amendments allowed. House liberals might be furious over various concessions, but Democrats think they would hold their noses and pass the bill.

In the Senate, opponents could try one last filibuster. If so, the bill's backers would need at least one GOP vote, as before. And they would need all, or virtually all, of the Senate Democrats to agree to let the bill reach the floor, even if some plan to vote against it on final passage, which requires only a simple majority. House and Senate Democrats might find plenty to complain about in the final bill produced by the conference committee, said Richard Kirsch of the liberal Health Care for America Now. But they will feel tremendous pressure to vote for a long-sought health care overhaul, flaws and all.


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