Tuesday, October 27, 2009

Incredible stupidity from the Australian medical bureaucracy

Yet another boneheaded and useless attempt at computerization. Britain has spent 12.5 BILLION pounds on their system and it still is not working. Let's hope the Australian authorities stop their nonsense long before that point

A FEDERAL scheme to provide thousands of GPs with communications encryption technology so they can send sensitive health information securely over the internet risks turning into an expensive white elephant because hardly any other health workers can decode the messages. A revamp of federal government incentive payments in August meant GPs must be signed up for the secure communications method known as "public key infrastructure" in order to remain eligible for grants worth up to $50,000 per practice each year.

The idea of the system is that it allows doctors to send sensitive patient data, including referrals and test results, to each other without risk of the information being seen by other people.

But Mukesh Haikerwal, one of the 10 commissioners who wrote the recent National Health and Hospitals Reform Commission report, says the scheme is turning into a "superhighway to nowhere" because hardly any hospitals, specialists or allied health workers have the technology, and they have been given little incentive to adopt it.

"If everybody was connected, it would be a very useful thing to be doing," said Dr Haikerwal, a former Australian Medical Association president who is also a vocal advocate for greater use of information technology in health care. "But it's not (currently useful) -- either you stop the rollout, or you enable everyone to be part of the system. Ninety-eight per cent of us (GPs) are able to send stuff securely, but none are able to receive it in a secure electronic form, and none are able to send us stuff back."

Once GPs have signed up to the scheme, the federal Health Department sends them chip cards that encode a GP's identity, and the readers used to verify the card information and activate the system once a password is entered. Mini chip cards that fit into a USB key that plugs into the GP's computer are also being sent out. The federal Health Department estimates 10,000 GPs are likely to apply for the technology, and says 9000 have done so already.

Medicare sends the necessary equipment free to those who apply, but a Medicare Australia spokesman said the cost of this was commercial-in-confidence. Dr Haikerwal estimated that the cost of extending the technology to specialists could be $7000 to $10,000 a practice for the hardware, software and training, although not all of this would be expected to come from taxpayers.

Dr Haikerwal's concerns were backed by Royal Australian College of General Practitioners president Chris Mitchell, who said there was no point in having a secure messaging system "that allows you just to communicate with yourself".

Stephen Johnston, head of national infrastructure services for the federal government's National E-Health Transition Authority, said the "whole health system has to be connected". "GPs are just one part of the story," Mr Johnston said. "But it won't happen overnight." A spokesman for the Health Department said take-up of the technology was "progressing" and predicted others would come on board steadily.


No health care measure can alter the fact that medical resources are limited

If you've been following the health care debate over the last couple of years, you may have heard the grim tale of Nataline Sarkisyan. Just 17 years old, afflicted with leukemia, she needed a liver transplant, but the insurance company Cigna refused to cover the surgery. After being picketed by nurses and the family, the insurer relented, but too late: She died that same day.

When he ran for president, John Edwards used the girl's experience as proof of the need for reform. Her parents went to Cigna headquarters to charge the company with killing their daughter to make money. Lately, a liberal group called Americans United for Change has used her in a TV spot to dramatize its claim that "if insurance companies win, we lose."

Her case is an excellent illustration of what is wrong with our approach to health care -- but not how Cigna's critics mean. The insurer declined to pay for the transplant because, it said, "the treatment would be unproven and ineffective -- and therefore experimental and not covered."

Nataline's surgeons disagreed, estimating she had a 65 percent chance of surviving six months with a new liver. But Dr. Goran Klintmalm, head of the Baylor Regional Transplant Institute in Dallas, told The Los Angeles Times the surgery was "very high-risk" and "on the margins." Even on the best prognosis, she stood a one-in-three chance of dying -- after undergoing a very expensive operation and taking a liver that might otherwise have gone to someone with a better chance of survival.

Maybe Cigna was mistaken. Maybe not. The problem is that the critics seem to imagine that once we crack down on insurance companies or go to a single-payer government health insurance plan, future patients like Nataline will get anything their doctors recommend.

They won't. No matter how we "reform" health insurance, there will still be close calls, where it's not clear that a costly procedure will actually do any good. There will have to be someone, either in government or in the private sector, to decide which operations and treatments should be covered and which should not. And there will be patients who will die after being refused.

Health care "reform" won't eliminate such incidents and may produce more of them. Despite all those greedy private health insurers -- or maybe because of them -- Americans get far more liver transplants per capita than the residents of Canada, France or Britain.

But liberals are not the only people who fantasize that our health care resources are unlimited. Republicans have accused the Obama administration of plotting to set up "death panels" to ration care for seniors. Former Lt. Gov. Betsy McCaughey of New York called the House Democratic health care bill "a vicious assault on elderly people" that will "cut your life short." Republican National Committee Chairman Michael Steele has taken the same tack. After the administration proposed modest reductions in the growth of spending on Medicare, he did an impersonation of John Edwards.

"We want to make sure that we are not cutting the Medicare program," Steele said. "Anytime you get a body of individuals that go beyond me and my doctor who are going to make decisions about what kind of health care I get, that's rationing of health care." But as long as someone else has to pay for those decisions, someone other than doctors and patients is going to make decisions about what treatments are worth the cost.

As it happens, Washington is not about to get stingy with seniors. The cost constraints in the health care bills moving through Congress would trim total projected Medicare outlays by only 3 to 5 percent over the next decade. A cut of 5 percent in 2019 spending, however, would leave it 80 percent higher than this year.

Ten years from now, even with such "cuts," seniors will have more and better medical options than today. Yet Republicans act as though everyone over 65 will be herded onto an iceberg and pushed out to sea.

What left and right have in common is the delusion that when it comes to medicine, nothing succeeds like excess. But no health care measure can alter the fact that our resources are not unlimited. We may not want to hear it, but no matter what kind of insurance system you have, sometimes someone has to say "no."


End of Life Care Should Not End Life

The subject of how best to honor and care for those facing death due to terminal illness or old age has always been controversial. As talk of "death panels" and "rationing" stirs debate over the government's proper role in health care, two new studies funded by the National Institutes of Health are lending new weight to the argument that, when it comes to providing end-of-life care for the elderly and terminally ill, sometimes less is better. The studies, featured in the New England Journal of Medicine, document how certain medical therapies implemented in the final months of a patient's life often cause emotional and physical stress and pain, effectively negating any positive benefits associated with such treatments.

However, those worried that a government takeover of health care will result in health care rationing in keeping with Dr. Ezekiel Emanuel's "complete lives" theory view these studies with alarm-and for good reason. In a culture where "quality of life" is increasingly viewed as the predominant justification for abortion, assisted suicide, and even infanticide , there is a legitimate concern that these kinds of studies will be used by the government to advance policies that endanger society's most vulnerable members.

The pivotal question is not whether difficult end-of-life decisions must sometimes be made, or whether-as the NIH studies indicate-sometimes the best decision is to forego heroic measures in favor of simply keeping a patient comfortable in his or her final days. The traditions of hospice and palliative care, for example, both work to keep dying individuals in a state of dignity and comfort without resorting to extraordinary, and ultimately futile, measures. The question is who should make these decisions.

Government-run health care has ominous implications because it supplants individual doctor-patient relationships with generalized protocols crafted by bureaucrats who have no way of accounting for the particular needs of the human beings affected by them. These protocols are often drafted with cost-cutting goals and resource management in mind-not the criteria most want at the top of the list when it comes to life and death medical care.

At many hospitals and nursing homes in the United Kingdom, for example, elderly patients deemed close to death are placed in a "care pathway" designed to ease the dying process and conserve medical resources. Once it is determined that a patient is near death, life sustaining fluids and medicines are withdrawn and the patient is placed under heavy sedation. As bioethicist Wesley J. Smith describes it, "the Pathway misuses the legitimate treatment of palliative sedation, and mutates it in some cases into a method of causing death, known as terminal sedation. This means that sedation is sometimes administered, not because the individual patient actually needs the procedure, but because he or she has been reduced to a category member, and that's how members of the category are treated." When this kind of one-size-fits-all approach is employed, casualties are inevitable. One man has already lost his life due to the misapplication of England's bureaucratic approach to end-of-life care.

At the other end of life's spectrum, last month a woman in England was forced to watch her premature infant struggle to survive without medical care for hours before finally dying on the delivery room table. The reason? Doctors told the new mother that "national regulations" prevented them from providing medical care because the baby was born two days too early to qualify for life-saving measures. In Canada, the government recently decided to end funding for a medication that adds an additional nine months to the lives of colon cancer patients. Why? "Clinical" evidence suggested that the additional months of life were not worth the cost of the medication.

In each of these situations, end-of-life decisions were made without the input of, and sometimes against the explicit wishes of, the individuals involved. These treatments are not being employed as one option among many-they are being imposed uniformly as a matter of policy.

Few would deny that some measure of reform is needed in the healthcare arena. Our country is on the threshold of a veritable Senior Tsunami; an enormous age wave is coming. As America increasingly becomes a mass geriatric society, large numbers of the elderly will soon need acute and long term care. Yet, even as the demand for medical care is increasing, Medicare funds are in short supply, and something's got to give .

But if our leaders in Washington are unable or unwilling to come up with a uniquely American solution to this problem, and if the looming healthcare crisis continues to be exploited by leaders on the Left simply as a means to a greater ideological end , there is good reason to fear that the cold comfort of England's "care pathway" approach to end-of-life care may be coming soon to a hospital near you.


Obama Taxes Pacemakers, Heart Valves

The more fiscal details of the health care bills emerge, the more appalling they seem. The Senate Finance Committee bill includes a broad provision taxing all manner of medical devices. This tax includes such frivolous luxuries as pacemakers, stents, artificial heart valves, defibrillators, automated wheelchairs, mechanized artificial limbs, replacement hips and knees, surgical gurneys, laparoscopic equipment and the like. President Obama is planning to reduce the cost of medical care by taxing it!

The most recent Gallup Poll reflected that 49 percent of respondents said they believed that the Obamacare plan will increase their health care costs. Only about 20 percent said it would lower them. It is taxes like these that substantiate this kind of concern.

The origins of this new medical device tax are troubling, as well. The medical device industry had its day at the White House, as did the insurance industry, the drug makers, the nurses and the doctors. In turn, each group heard the White House request that they come up with voluntary cuts in their health care costs and support Obama's proposed changes in return for assurances that Congress would not impose deeper cuts (or, in the case of the doctors, that it would actually rescind cuts already scheduled under current statutes).

But, unlike all these other groups, the medical device industry refused the deal. This posture enraged the tyrants in the White House, who vowed to punish the industry with cuts imposed by Congress. The result was a decision by the revenue-hungry Senate Finance Committee to extract billions in funds from the industry.

The legislation does not work like a sales or excise tax. Rather, it follows the model of the punitive tobacco settlement imposed on cigarette companies in the '90s. It assesses an industry-wide payment that firms must make in proportion to their market share. It bars them from passing along the cost of the assessment by charging more for certain basic products, but allows them to raise the price of others to raise the funds for the fee.

So, the result will be that virtually every piece of advanced surgical equipment will be subject to a price increase to meet the levy from Washington. No matter that these devices often make the difference between life and death and that, in effect, taxing them raises the cost of vital treatments. The vengeful White House will have its pound of flesh from the medical device industry for daring to be independent and refusing to knuckle down to administration pressure.

This tax, imposed in a spirit of haughty arrogance, falls on totally inappropriate objects. Valves, prosthetic limbs, pacemakers, hearing aids and such are essential therapies that make life longer, better and less painful. To tax them makes no sense -- except in the world of sharp elbows and interest group politics that grips this take-no-prisoners and show-no-mercy White House.


House health care bill exceeds $1 trillion

Health care legislation taking shape in the House carries a price tag of at least $1 trillion over a decade, significantly higher than the target President Barack Obama has set, congressional officials said Friday as they struggled to finish work on the measure for a vote early next month.

Democrats have touted an unreleased Congressional Budget Office estimate of $871 billion in recent days, a total that numerous officials acknowledge understates the bill's true cost by $150 billion or more. That figure excludes several items designed to improve benefits for Medicare and Medicaid recipients and providers, as well as public health programs and more, they added.

The officials who disclosed the details did so on condition of anonymity, saying they were not authorized to discuss them publicly.

Some moderate Democrats have expressed reluctance to support a bill as high as $1 trillion. Last month, Obama said in a nationally televised address before a joint session of Congress that he preferred a package with a price tag of around $900 billion.

Obama also said he would not sign a bill that raised deficits, and the CBO estimates the emerging House bill meets that objective. Officials said the measure would reduce deficits by at least $50 billion over 10 years and perhaps as much as $120 billion.

Democrats also said the bill would slow the rate of growth of the giant Medicare program from 6.6 percent annually to 5.3 percent.

"The bill will be paid for over 10 years. It will reduce costs but also will not add a dime to the deficit" in future years, House Speaker Nancy Pelosi, D-Calif., said at a news conference.

Still, Obama's speech provoked enough concern among House Democrats that senior presidential aides were called to a meeting in the Capitol to explain precisely what the president had in mind when he set the $900 billion target.

The figure of $871 billion "is a coverage number. I think the White House has made that very clear. It is a number about coverage," Pelosi said recently when asked about the size of the measure.

Linda Douglass, a spokeswoman for the White House, said, "The speaker is working on a plan that meets with the president's price tag of around $900 billion for health insurance reform and will not add a dime to the deficit."

House Democrats took steps to fulfill another of Obama's goals during the day, announcing their legislation would completely close a gap in Medicare prescription drug coverage within a decade, five years faster than originally contemplated.

In addition, Pelosi said, "as of Jan. 1, 2010, our legislation will give a 50 percent discount for brand-name drugs to recipients in the donut hole and it will reduce the size of the donut hole by $500."

After months of delay, Democrats in the House and Senate are aiming for votes next month on legislation to fulfill Obama's goal of expanding coverage to millions who lack it, banning insurance industry practices such as denying coverage for pre-existing conditions and slowing the growth in health care spending nationally. The House bill will also lift the insurance industry's exemption from federal anti-trust laws, a provision under consideration in Senate negotiations as well.

With time growing short, Pelosi and Senate Majority Leader Harry Reid are struggling independently with the most controversial of all issues involved with health care, proposals for a government-run insurance option to compete with private industry.

In the House, Democrats have tentatively concluded they cannot win passage of the provisions favored by most liberals, one calling for a nationwide government-run plan with payments to doctors and hospitals linked to rates paid by Medicare. It was unclear what fall-back plan was under consideration, but the internal disagreement cast doubt on plans to publicly unveil legislation early next week.

Across the Capitol, Reid, D-Nev., assessed support for a nationwide government-run insurance option that would allow states to opt out of the system. While the plan evidently enjoys a clear majority, it is uncertain whether it can command the 60 votes needed to overcome a threatened Republican filibuster.

Democrats hold 60 votes in the Senate, but one, Sen. Ben Nelson, D-Neb., has spoken out strongly against a so-called public option. A few other members of the rank and file have been non-committal.

One, Sen. Mary Landrieu, D-La., met with Reid during the day and later issued a statement saying she was encouraged that a compromise might be possible. She also added pointedly that she had told Reid about "the unique challenges Louisiana is facing in terms of Medicaid and the special concerns I have about teaching hospitals," a possible signal that easing home-state concerns could influence her vote on the larger, national question of a government-run insurance option.

Also opposed is Sen. Olympia Snowe of Maine, the only Republican this year who has voted for a Democratic-drafted health care bill in committee. As an alternative, she favors allowing the government to step in only if there is insufficient competition in the private insurance industry.

Nor was it clear whether Democrats would be able to enlist additional Republicans. Sen. George Voinovich, R-Ohio, frequently mentioned by Democrats as a potential convert, said in an interview, "We can't afford the health care system that we have right now. And if we can't afford the one we have right now, how are we going to afford another one that's going to cost more money."

For Reid, the question of a government-run option is one of a many thorny issues to be settled before he can bring health care legislation to the Senate floor. He and senior committee chairmen have been meeting with top White House aides in recent days to produce a bill, and hopes of largely wrapping up the work by the end of the week went unfulfilled.


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