Monday, October 12, 2009

Daughter saves mother, 80, left by NHS doctors to starve

"Death panels" are already a reality in socialist Britain

AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened. Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding. Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days. Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding. Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients. Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed. “It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered. [Despite all attempts to kill them, in other words]


Doctors say EU working week is killing patients

SENIOR doctors say NHS patients are dying as a result of new European Union rules that impose a 48-hour week on hospital staff. The Royal College of Surgeons said, in a hard-hitting report, that lives were being lost because patients had to be switched between up to four doctors every 24 hours, instead of being cared for by the same team round the clock.

Junior doctors used to work 80-hour weeks, staying on call at all times and sleeping in the hospital. Surgeons said this guaranteed continuity of treatment. In August, EU rules were introduced limiting their working week to 48 hours. John Black, president of the college, said that, as a result, no doctor was monitoring patients for long enough to detect changes in their condition and vital medical details were being mislaid in a chain of “Chinese whispers”. The surgeons claim that the rapid changes in shifts mean that nobody is taking personal responsibility for patients. One surgeon who responded to the survey said: “No rapport is built with the patient and no responsibility is assumed by the junior for the patient care. An unmitigated disaster.”

The college has compiled a dossier from ward reports by surgeons, laying out the scale of the problem. This weekend the college released details to The Sunday Times of a series of “avoidable deaths” that it claims were caused by the way in which the new limits on the working week have been implemented since August.

— In one case a patient died of a rupture in her bowel because information about an obstruction had not been passed on from one junior doctor to the next when they changed shifts;

— A patient died of a brain haemorrhage following surgery that should not have been carried out. Information about the patient’s medical condition had become confused in handovers between three specialist registrars — doctors at the grade below consultant level

— A patient died of cancer after requests for tests were not passed on. An x-ray had detected an abnormality in the patient’s liver but no doctor took responsibility for chasing up the tests, and the patient was discharged from hospital. The college concedes the patient might have died even if the tests had been done.

The college also cited a series of other, non-fatal, errors that it had discovered by surveying 900 surgeons. They reported that a patient wrongly underwent surgery for a broken bone because instructions from a consultant were not passed to surgeons on the next shifts.

Another patient missed an emergency operation for a hernia because her case was not handed to the next shift. The patient then became “lost” in the hospital and was not seen by doctors on ward rounds for three days.

More than half of consultant surgeons and 44% of surgeons of all grades believe the 48-hour week has been achieved at the expense of patient safety, the survey showed. Black insists the deaths are an inevitable part of patients being looked after by a string of doctors working shifts, rather than because of poor communication by medics. “We now have a clear message from the front line that patient care is being made significantly less safe. “Multiple handovers are inherently unsafe. Every handover is an accident waiting to happen,” he said.

The college is lobbying the government to introduce an opt-out to the rules for surgeons to allow them to work up to 65 hours a week. The surgeons’ leaders say the government could introduce legislation that would allow this if it had the political will.

The Department of Health defended the EU rules. A spokesman said: “Hospitals which have been working a 48-hour week for over two years have produced evidence that shows the change has decreased hospital mortality. There is no evidence of harm being caused to patients.” [So the bureaucrat knows better than the doctors. Typical socialism]


The Stressed German Model

It took the Germans 125 years to figure out that their health-care system doesn't work. What if the Obama health-care proposal turned out to be the biggest public-policy mistake in 125 years?

Yesterday, these columns discussed the Congressional Budget Office's efforts to push the square peg of the Obama plan through the round hole of affordability. Meanwhile in Germany, often cited by American liberals as the "model" of a well-run health-care plan, the political debate is running in the opposite direction. Chancellor Angela Merkel's new coalition partner, the Free Democratic Party, is pressing her to claw back the state's participation in a system that now insures nine of 10 Germans.

Germany's health-care system was brought to life in 1883 by Otto von Bismarck and became the model for virtually every such state-directed national insurance plan since. Alas, the German system is starting to come apart at the financial seams. Germany's system relies on a handful of state-supported health insurers. This week they informed the government that the system was on the brink of a financial shortfall equal to nearly $11 billion.

Pointedly, the insurers made clear that cutbacks alone won't solve the problem. They said the government would have to consider raising premiums on the insured or, you guessed it, raise taxes. Currently, German workers pay a fixed-rate premium into the insurance scheme; that rate is now set at 14.9% of gross pay.

Chancellor Merkel, something of a political acrobat, was previously allied in coalition with leftist Social Democrats. She's now resisting calls from the Free Democrats to get off the state-pulled health-care train. The FDP's spokesman on health, Daniel Bahr, wants a "shift in direction away from state-run medicine." Why? Because "the current financial figures have showed us that the health-care fund doesn't work."

With Congress inching ever closer to passing a greater federal presence in providing health insurance under ObamaCare, let's hope it doesn't take the U.S. until the year 2134 to figure out it isn't working.


Politico Outs the Secret Plan to Pass ObamaCare

Politico (again) breaks a major story this morning with its outing of the Dem secret plan that Brian Darling of the Heritage Foundation has been warning of for more than ten days:
a former House and Senate leadership aide sent an email sketching out another route to passage. Instead of introducing a Senate bill, Majority Leader Reid could insert the merged health care reform language into a revenue raising House bill already languishing in conference committee. The Senate would pass it and send it to the House whereupon passage, it would go straight to the president’s desk – completely bypassing conference. Do not pass go, do not collect $200.

By cutting out conference, this single-bullet scenario eliminates weeks of expected wrangling and would make it possible to pass a bill by the Thanksgiving target so many Democrats are aiming for. Many insiders agree that a conference committee would make that goal next to impossible.

The Democrats are raping the Congressional process to pass ObamaCare:

i) create a Vapor Bill without legislative language to hide the legislative language from the American people and other Senators until the bill is already on the Senate floor;

ii) get a Vapor Score on a Vapor Bill — even though the Congressional Budget Office says they cannot provide an accurate score without the legislative language — which CBO did not get because it does not exist;

iii) move to the motion to proceed on a House bill that is not the health care bill, but is the AIG bonus bill, then gut it and amend it with the first-time-ever-seen health reform legislative language;

iv) add the public option AFTER ending a filibuster with 60 votes; and,

v) skip a House-Senate conference and have the President sign the bill.

This is why the Founding Fathers warned of the tyranny of the majority.

The U.S. Congress, under the Democrats, is being run like a banana republic where the dictator violates any and all fair processes with little regard for public opinion — that is, until the 2010 elections, where, if the Dems carry out these outrageous and flagrant flaunting follies they will have their heads handed to them.

All of these flags-on-the-play violations to pass a bill that Zogby finds 60% of the American people oppose? Or if you prefer the Pew Poll version, only 34% of Americans support it.

Really, the Dems need to take a breath, and seriously consider their politically irrational and lemming-like behavior.


Healthcare reform for the “party of no”

The basic axiom of free-market economics is that government regulations mess up a market, which leads to misdistributions, which leads to more cries for government regulation. You couldn't find a better example than the current health insurance "crisis." This week Congress is poised to take a problematic situation and make it much worse. There are indeed 45 million people who are uninsured in this country. Some of them (like my 23-year-old son) don't want to spend $100 a month for what seems like a useless precaution but others are in dire need of insurance coverage and can't get it. The basic reason is that, instead of allowing a free market to operate, we've done the following:

a) Allowed the states a free hand in regulating insurance, and

b) Shrunk the market by allowing 62 percent of the market to secure its coverage as employer-based "health benefits."

The result is that only 6 percent of the non-elderly population actually buys insurance directly from insurance companies and these tend to be a perversely self-selected group who are too sick to work or can't get a good job. As a result, the insurance companies can't create large risk-pools and have to charge everybody a high rate.

Understanding all this requires a little analysis, of which Democrats seem to be incapable, and so the easiest thing is to blame it on "greed." Thou and I are certainly not greedy, nor are our favorite politicians greedy, but someone out there is greedy -- the insurance companies! -- and therefore their greed must be countered by the government, mainly by getting the government into the insurance business.

I take my text from a 95-page report "Premiums Soaring in Consolidated Health Insurance Market -- Lack of Competition Hurts Rural State, Small Business," issued last May by Health Care For America Now!, a Washington lobbying organization sponsored by the AFL-CIO, Move On, the AFSCME, the teachers' unions, the Children's Defense Fund, La Raza, ACORN and a lot of other groups, the names of which are probably familiar. The report described an alarming situation:
Commercial health insurance premiums have risen four times faster than wages and have more than doubled in the last nine years. Shrinking competition among health insurance companies is a major cause of these spiraling costs. In the past 13 years more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets.

In 21 states, the top two insurance vendors control more than 70 percent of the market, while in nine states that portion has been captured by a single provider. In Alabama, for instance, Blue Cross/Blue Shield controls 83 percent of the market. In Rhode Island, Blue Cross/Blue Shield and UnitedHealth together own 95 percent. As the report notes, "The U.S. Justice Department considers a market 'highly concentrated' if one company holds more than a 42 percent share of that market, a level that is common in…more than 30…states."
Americans are paying for this unchecked private insurance industry consolidation in the form of higher health premiums and a growing number of uninsured people. Meanwhile, insurance company profits and compensation for the industry's top executives are surging…

The report quotes David Balto, former policy director of the Bureau of Competition at the Federal Trade Commission and now a fellow at the Center for American Progress:
Antitrust enforcement against anti-competitive mergers and exclusionary conduct is essential to a competitive marketplace. This unprecedented level of concentration and the lack of antitrust enforcement pose serious policy and health care concerns.

Then it turns to President Barack Obama for a summary:
"The consequence of lax [antitrust] enforcement for consumers is clear," then-Senator Barack Obama said is a September 2007 address to the American Antitrust Institute. "The number of insurers has fallen by just under 20 percent since 2000. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed." [brackets in original]

Health Care for America Now!'s solution to the problem is, of course, the "public option":
In several recent reports, leading experts on the American health care system have detailed how the injection of a robust new public health insurance plan as a competitor for private plans would expand choice for individuals and business and drive competition on price and quality in local markets across the country.

In other words, let's get the government in the insurance business.

A very dramatic and convincing case, no? Senator Charles Schumer, who was present at the release of the report, pulled no punches:
This is the starkest evidence yet that the private health care insurance market is in bad need of some healthy competition. A public health insurance option is critical to ensure the greatest amount of choice possible for consumers.

The Health Care Now! report has been the centerpiece of Democratic efforts since then.

So, what's wrong with this picture?

Well, let's try this for starters. Since 1945, the entire insurance industry has been governed by McCarran-Ferguson Act, in which Congress ceded its right to regulate insurance as "interstate commerce" and instead gave pre-emptive authority to the states. The first thing McCarran-Ferguson did was exempt the insurance industry from federal antitrust law. Antitrust does not apply to insurance. This is not the decision of the big, bad insurance companies. It is the will of Congress. Yet nobody -- least of all liberal Democrats in Congress -- seems to be aware of this.

Why was insurance exempted from antitrust laws? It's a long story. Until 1944 the states had routinely regulated insurance companies. The federal government stayed out of the picture on the polite fiction that insurance was not "commerce." Then in United States vs. South-Eastern Underwriters Association, the U.S. Supreme Court decided that the "business of insurance" was indeed commerce and that Congress could regulate. It left open the door, however, that Congress could delegate its powers to the states.

McCarran-Ferguson did just that. It exempted the industry from federal antitrust laws, except in cases where boycott, coercion or intimidation were involved. It also said that state regulations would not be pre-empted by federal law. States were free to license and regulate as they saw fit.

What happened as a result was what happens in all such instances. The regulations became an oligopolistic conspiracy between the regulators and the principal players in the field. Those who secured licenses quickly argued that no new competitors were necessary. More often than not, the regulator agreed. I have a brother-in-law in insurance who, after a series of grain silo explosions in the Midwest in the 1980s, tried for two years to persuade various Midwestern states to allow him to sell insurance backed by European reinsurers. The state insurance commissions told him, "No thanks, we're doing just fine." The same thing happens over and over with health insurance. Blue Cross-Blue Shield, which is run by doctors and hospitals on a nonprofit basis and always has strong local ties, is consistently able to persuade state commissions to grant it a near-monopoly. That is why, of the 25 states dominated by one provider, Blue Cross/Blue Shield controls 15 of them.

All this has become even more acute over the last decade as insurance commissions in some states -- particularly the smaller and more rural ones -- have decided the best way to deal with rising medical costs is to allow consolidation of the market into larger entities. "The idea is that the bigger insurance companies will be able to drive better bargains with doctors and hospitals," said a spokesperson at the National Association of State Insurance Commissioners. But these insurance giants have also found it easier to raise their prices to consumers, which is what Health Care Now! is complaining about.

So what we have is not the big health insurers versus the public. What we have is government versus government. The states have overregulated insurance, erecting barriers to entry and even encouraging consolidation on the theory that all this will help consumers. And when it has the opposite effect, the federal government decides insurance companies are the problem and they have to be supplanted by a federal entity.

There is a much more direct route to beneficial competition -- and it should be the agenda for the "Party of No."

a) Repeal McCarran-Ferguson or settle for its equivalent, Senator Jon Kyl's proposal to allow companies to sell insurance across state lines.

b) Override state mandates that force insurance companies to include coverage for things people don't want.

c) Expand Health Savings Accounts (HSO's), which already cover 8 million people and are rising.

d) Set up high-risk pools for people with serious conditions, as is done at the state level with auto insurance. Provide these people with small subsidies for basic coverage.

The result would be that, instead of today's oligopolized insurance market, a thousand Willie Lomans would start trudging door-to-door trying to sell people health insurance at prices they could afford. Congress could just sit back and watch -- until it found something else it can try to mess up. How about energy?


Paying the Health Tax in Massachusetts

Be warned: Even people with good insurance will risk fines if mandatory insurance becomes the national law

My husband retired from IBM about a decade ago, and as we aren't old enough for Medicare we still buy our health insurance through the company. But IBM, with its typical courtesy, informed us recently that we will be fined by the state. Why? Because Massachusetts requires every resident to have health insurance, and this year, without informing us directly, the state had changed the rules in a way that made our bare-bones policy no longer acceptable. Unless we ponied up for a pricier policy we neither need nor want —or enrolled in a government-sponsored insurance plan— we would have to pay $1,000 each year to the state.

My husband's response was muted; I was shaking mad. We hadn't imposed our health-care costs on anyone else, yet we were being fined ("taxed" was the word the letter used).

We've spent much of our lives putting away what money we could for retirement. We always intended to be self-sufficient. We've paid off the mortgage on our home, don't carry credit-card debt, and have savings in case of an emergency. We also have a regular monthly income of about $3,000, which includes an IBM pension. My husband, 61, earns a little money on the side, sometimes working as an electronics consultant on renewable energy projects. I'm 58 and make some money writing science books. We are not wealthy, but we aren't a risk of becoming a burden on society either. How did we become outlaws?

The turning point was three years ago, when then-Republican Gov. Mitt Romney pushed through the state legislature a health-care plan that he promised would provide universal coverage while lifting from the middle-class the burden of having to pay for those who do not have insurance. His argument was that the uninsured drove up the cost of health care for everyone by seeking care at emergency rooms and then skipping out on their medical bills. Hospitals make up for those unpaid bills by charging everyone else more than they otherwise would.

The central plank of the Romney plan was a mandate that required everyone to buy health insurance or pay a fine for posing a risk to society by walking around without coverage. There would be subsidies for those who couldn't afford insurance, and residents would be required to buy a minimum amount of health insurance, on the grounds that they might buy a policy that doesn't cover the cost of their care and end up skipping out on their medical bills. "We insist that everybody who drives a car has insurance, and cars are a lot less expensive than people," Mr. Romney told the Boston Globe in 2006.

Mr. Romney and Sen. Ted Kennedy publicly promised that the middle class —that is, people like us— would not be taxed and that our health-care costs would actually decrease if the plan became law.

My husband and I weren't convinced. It all seemed inane, but we are neither politically or socially conservative and figured the plan wouldn't affect us much. Besides, who could be against a plan that covers more people for less money?

For the first two years of the mandate, our IBM health insurance was seen as acceptable in the eyes of the state. This year the rules changed. The state requires that health plans cap out-of-pocket expenses for individuals (not including monthly premiums) at $2,000 a year. Our plan's cap is $2,500.

Ten years ago, we had excellent coverage through a more gold-plated plan. But we found that it was no longer worth paying the premiums and scaled back to a more modest policy. Today, we pay about $300 a month for catastrophic care. If we went with the next step up in plans offered to us by IBM, our monthly premium would increase to $800. We simply don't need to pay that kind of money for the amount of health care we actually consume.

Nonetheless, we now owe the state an extra $1,000. Ironically, that's about the extra amount we would pay out-of-pocket under our current plan if both of us actually fell ill in the same year.

We could choose a state-sponsored plan. It would mean paying more than what we pay now, but less than what IBM's next step up would cost. But we don't want to. IBM seems like a rock of stability compared to the state of Massachusetts. It's apparent that state health-care policies can change at the whim of politicians in Boston, and we might not be able to adjust to the new rules. The way we figure it, if we sign up for a state-subsidized plan we will be at the mercy of the state.

So we are sticking with our plan and paying the tax. But what bothers me most is that a similar health-care mandate is being proposed in Washington, and some of the same promises that were made here are being made again—such as that the mandate will never hit middle-class folks with a new tax. When asked about the mandate, Maine Republican Sen. Olympia Snowe said recently, according to the New York Times, "It surprises me that we would have these high-level penalties on average Americans."

Well, I don't find it surprising. The mandate in Massachusetts was sold as something that wouldn't penalize people like my husband and me. But those political promises were only good for as long as it took to get the mandate enacted into law.


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