Thursday, October 22, 2009

Mother-of-two dies after NHS surgeon punctures heart during back operation

Another poorly trained Indian doctor by the sound of it

A 51-year-old finance assistant, Christie Burgess, bled to death after a surgeon punctured her heart three times during a routine back operation. Miss Burgess had been sent to Salford Royal Hospital for emergency surgery on a prolapsed disc but during the operation, Tarek Jallul, a temporary surgeon, pierced her heart.

The blunder wasn't spotted until Mrs Burgess, from Macclesfield, Cheshire, became seriously ill. Although a specialist heart surgeon from the Manchester Royal Infirmary tried to correct the damage she died a few hours later.

Her partner, Kevin Jones, 58, has been awarded an undisclosed settlement from the NHS trust after a three-year legal battle. [There had to be a battle??? Insult added to injury!]

But Mr Jones says the hospital have never apologised for the mother-of-three's death or fully explained what went wrong. He said: "I'm really, really angry. It would help me dramatically if I could get to the bottom of it and get some answers. "It would give me some kind of closure on Christine's death." Janet Lamb, her sister said: "She was the best sister anyone could ask for." ""She should be here to enjoy her grandchildren."

The hospital said it "deeply regretted" Mrs Burgess's death and there is now a specialist heart surgeon constantly on call.

Mrs Burgess, a financial assistant for a chemical company Ciba, had suffered back problems but was the told the operation in May 2006 was a simple procedure. It's understood locum consultant Mr Jallul, who was employed by the hospital on a temporary contract, now works overseas. The General Medical Council launched an investigation he was given a formal warning.

In a statement, the hospital said: "We deeply regret the death of Mrs Burgess. "Legal proceedings commenced earlier this year and both parties have agreed an-out of-court resolution."


Competition and Health Insurance

Contrary to Democratic rhetoric, repealing the insurance industry's antitrust exemption won't reduce prices or profits

During his weekly radio address last Saturday, President Obama attacked health insurers for allegedly making excessive profits and paying excessive bonuses, for spreading "bogus" misinformation about the impact of Democrats' reform agenda on the cost of health insurance, and for "figuring out how to avoid covering people." He opined that health insurers are "earning these profits and bonuses while enjoying a privileged exemption from our antitrust laws, a matter that Congress is rightfully reviewing."

Mr. Obama's comments followed hearings by the Senate Judiciary Committee last week. In an unusual move, Majority Leader Harry Reid testified as a witness, alleging that "exempting health insurance companies [from antitrust] has had a negative effect on the American people" and that "there is no reason why insurance companies should be allowed to form monopolies and dictate health choices."

Such populist rhetoric might exert additional pressure on insurers to fall (back) into line behind the Democratic reform agenda. But there is no evidence that their antitrust exemption has contributed to higher health insurance costs, premiums or profits, or, as implied by Sen. Reid, of "health insurance monopolies . . . making health-care decisions for patients."

The legislative basis for the insurance antitrust exemption is the 1945 McCarran-Ferguson Act, which also codified state insurance regulation as national policy. This statute exempts the "business of insurance" from federal antitrust law provided that the activities are (1) regulated by state law and (2) do not involve boycott, coercion or intimidation. Its passage followed a 1944 Supreme Court ruling that insurance was interstate commerce and therefore subject to federal antitrust law—a ruling that cast doubt on states' exclusive regulatory role, and the legality of then typical agreements among property and casualty insurers to use rates developed jointly by state or regional insurance rating organizations.

Most states responded to McCarran-Ferguson by enacting or modifying laws giving regulators authority over property/casualty insurance rates, including those developed by rating organizations. The next several decades saw a steady erosion of the role of collective pricing systems in conjunction with increased price competition, less price regulation, and a significant narrowing of the antitrust exemption's scope by the courts.

The traditional debate about the antitrust exemption involved property/casualty insurance and medical malpractice liability coverage. Subject to state regulation or prohibition, property/casualty rating organizations collect and analyze loss costs and disseminate projections of future losses. And insurers, subject to state law, can incorporate these forecasts in their ratemaking.

In principle, this system helps produce more accurate rates, thus improving financial stability. More important, it reduces entry barriers for small insurers or insurers entering new markets. Small property/casualty insurers are particularly strong supporters of the antitrust exemption, which allows the sharing of loss projections.

None of this is germane to health insurance, where insurers do not jointly develop forecasts of future medical costs for use in pricing. The antitrust exemption also does not prevent review and challenge of mergers of health insurers by the Department of Justice, which, for example, challenged the 2005 merger of UnitedHealth Group and PacifiCare, and obtained a consent decree requiring the divestiture of certain portions of PacifiCare's commercial health business.

Mergers and acquisitions of health insurers also are generally subject to approval by state regulators. Earlier this year, Pennsylvania Insurance Commissioner Joel Ario derailed a proposed merger between the state's two largest health insurers, Highmark and Independence Blue Cross.

Repealing the antitrust exemption for health insurers would not significantly increase competition, and it would not make health-insurance coverage either less expensive or more available. There is no evidence that the exemption has increased health insurers' prices or profits or contributed to higher market concentration.

Repealing the antitrust exemption would also not lower the cost of malpractice insurance, or prevent future malpractice insurance crises, such as those that occurred in the mid-1970s, mid-1980s, and earlier this decade. It would instead tend to reduce rate accuracy and undermine competition in already fragile malpractice markets.

In other words, the insurance industry's antitrust exemption is inconsequential to the health-care reform debate. It just distracts attention from important issues and further demonizes private health insurance.

Rhetoric about monopoly notwithstanding, Congress's reform proposals are not designed to increase competition in private health insurance. The House bill proposes a government-run insurer. The Senate Finance Committee proposes creation of quasi-public cooperatives. Both bills (and the Senate HELP bill) include restrictions on health insurance underwriting, pricing, profitability and policy design that would essentially turn private health insurers into regulated public utilities.

If the goal were to promote robust concentration in private health insurance, Congress would focus on reducing impediments to competition. It could do so by allowing consumers to buy insurance across state lines at terms that do not require them to subsidize other buyers or to buy coverage for state-mandated benefits they are unwilling to pay for. Congress could also eliminate tax and regulatory rules that favor employment-based coverage over individual coverage.

In short, the rationale for repealing the insurance antitrust exemption is—to borrow a word used by Mr. Obama in his radio address—bogus.


When the government controls medical care …

… patients are an expense or liability to be gotten rid of rather than a source of profit who must be served.

Much of the problems with government supplied health care can be traced to this truth concerning incentives. A hospital is not paid more if they treat people well. They don’t lose money if they do a poor job. They face no liability; any judgment the government permits to be levied against them is made up by taxes looted from the productive classes.

And, the goal of a medical care provider is to please his pay-masters rather than the patients he treats; and all to frequently when the interests of patients and the government clash, the patients will lose out.

This phenomenon is quite evident in the sad case of British Corporal Matthew Millington of the Queen’s Royal Lancers who died at the age of 31 from lung cancer, after receiving – in a transplant – the cancerous lungs of a smoker who averaged 30 – 50 cigarettes a day.

Why would a hospital implant the lungs of a person who smokes so many cigarettes a day into a patient? Was it the result of an inexperienced surgical team making a ghastly mistake? No. The surgery was performed by Papworth Hospital in England, which is the main transplant hospital in the United Kingdom, whose spokesmen claim that in fact everything was done properly!
A spokeswoman for Papworth, the UK’s leading cardiothoracic hospital, said that it was not unusual to use smokers’ lungs, adding that all organs are “screened rigorously” before a transplant. “We have a strong record of high quality outcomes and this is an extremely rare case.”

In the past year there were 146 lung transplants in the UK, and 84 people died while waiting on the transplant list, she added. “If we had a policy saying we did not use the lungs of those who smoked, then the number of lung transplants would have been significantly lower.”

Let us ignore the fact that the supply of organs is kept low by the superstitiously premised laws outlawing people from selling their own organs. Let us pass over the laughably implausible claim that transplanting smokers’ lungs results in acceptably good outcomes.

Let us, instead, focus on the question of how the hospital handled the case of Corporal Millington of the Queen’s Lancers and compare it to how a hospital that saw him as a customer would have treated him.

Often the detractors of free markets accuse it of being a dehumanizing system of cut-throat competition. What they do not realize is that when two people engage in trade, they are cooperating. The competition is between actors striving to be the best cooperators with prospective trading partners. In a free market, the providers of health care services would be competing to see which one of them could better care for a prospective customer.

Thus, in a free market, Corporal Millington would have contracted with the hospital that sought to cooperate with him most effectively. He would have chosen a hospital that committed to satisfy his need for undiseased, functional lungs at an affordable price. In a free market, the availability of disease-free lungs would have been much higher; people would be far more likely to sign up to supply their organs for transplant if their heirs or estate would be paid a fair market price for them, and the hospital would not have to worry about waiting lists.

However, had the new lungs developed cancer (and let’s not forget occasionally non-smokers get lung-cancer too), the hospital would have had a strong incentive to make it right, either out of a sense of obligation or out of fear of retribution; In a free market, there are two incentives to keep unscrupulous people treating their customers well. The first is, of course, the fear of lawsuits. the second, though, is their greed for future profits and their fear of losing these future profits should they ever develop a bad reputation. The latter can particularly devastating. The McDonald-Douglas Aircraft Company, for example, was nearly driven into bankruptcy by the perception that the DC-10 was an unsafe aircraft. To this day, the Massengill corporation has never returned to the drug-making business after the debacle of 1938. The yellow press would love nothing better to go after a hospital for transplanting diseased organs into a patient; the readership and viewership of such pieces would bring in a tidy sum in advertising dollars.

Thus the hospital, if nothing else to avoid the collapse of their business after a widespread accusation of incompetence/malpractice, would face a huge opportunity cost if they forewent transplanting in a new, second set of lungs.

But, unfortunately for Corporal Millington, he wasn’t the customer of Papworth. Rather, some officials of the NHS were. The desire of the actual customers (NHS) were to keep costs down by a) cutting corners on the type of lungs transplanted into patients, b) concerning themselves with patient outcomes in the aggregate, and reducing seemingly unnecessary, redundant duplication of services by centralizing transplants as much as possible.

Thus they faced no economic loss for allowing him to die of cancer. There was no profit to saving him; in fact, saving him would have been an expense. They didn’t have to cooperate with Corporal Millington and so they didn’t.


When you make a (health care) deal with the devil, you’re the junior partner

Recent events have shown lobbyists across the health care sector the truth of Dick Armey’s axiom that “if you make a deal with the devil, you are the junior partner.”

In July, the pharmaceutical industry cut a “deal” with the White House in which the Administration promised the industry that health care “reform” won’t cost them too much (less than $80 billion), in return for the industry’s agreement to spend $150 million on ads promoting Obamacare. “Big Pharma’s” behavior was an understandable reaction to the Washington reality, especially in this Administration, that if you’re not at the table, you’re on the menu. But the effect was to put on the menu every American who takes medicine.

Within a month, however, the drug industry had already received their first stab in the back, from a House bill that would allow the government to negotiate drug prices – something the “agreement” had seemed to specifically preclude. The NY Times reported in August:

“We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal,’ ” Billy Tauzin, the former Republican House member from Louisiana who now leads the pharmaceutical trade group, said Wednesday. “Who is ever going to go into a deal with the White House again if they don’t keep their word? You are just going to duke it out instead.”

Indeed. Who is ever going to go into a deal with the White House again? How about the American Medical Association? The health insurance industry, the American Medical Association (which represents fewer than 30% of American physicians but misleadingly acts as if it truly represents “the nation’s doctors”), and various hospital groups have, until the Baucus almost-bill, tried to “work with” the Administration to tailor “reform” so that it would benefit them, regardless of how much it would cost everyone else.

The AMA thought they had a deal that any reform would be gentle on Medicare reimbursement rates for doctors. Indeed, the House bill seemed to promise a slight increase in those rates, at least for primary care physicians. No such luck once they saw what Baucus got passed. The Baucus measure includes massive cuts to Medicare payments and subsidies (which will never actually happen, just as required cuts have not happened each year since 2003). The story is the same for hospital groups which decided to support Obamacare early on, with the starry-eyed naivety of someone who has never dealt with a Chicago politician.

So another “agreement” bites the dust. Can you picture Rahm Emanuel sitting down with the industry lobbyists, crossing his fingers behind his back as he shakes hands over his “understanding” with drug makers, doctors, or hospital administrators?

And just in the past few days, we have the results of the latest Democrat betrayal. The PriceWaterhouseCoopers report which shows that the Baucus almost-bill will substantially raise health insurance premiums was commissioned by America’s Health Insurance Plans (“AHIP”), an industry lobbying organization. While the report is good ammunition against what will be a disastrously expensive government destruction of our health care system, those of us who oppose Obamacare in all its forms must not simply assume that AHIP is an ally.

Like the other medical industry groups who couldn’t resist the temptation to try to influence a government hell-bent on controlling everything, the health insurance industry sided with Obamacare, if somewhat more cautiously than the drug makers did. They even revived “Harry and Louise” who have suddenly switched sides from when the very same insurers used those very same characters to great effect to defeat Hillarycare.

The health insurers thought that government would force millions of young, healthy people (i.e. extremely profitable people to sell health insurance to) into their arms like so many herring being caught up in a giant net. That didn’t happen either in the Baucus bill, and the penalties being proposed for not having insurance are too low for the industry to believe they will effectively force people into insurance they don’t want or can’t afford. Apparently the insurers missed the fact that government is made up of politicians who can ill afford to alienate every young healthy voter in America.

In other words, AHIP released the PWC report not because they thought the Baucus bill was bad for medicine or for Americans, but because it wasn’t sufficiently coercive and because they thought they had a deal. And they did…Chicago style. Yes, the PWC information is useful for those who oppose Obamacare, that does not mean we should confuse AHIP with a friend of economic liberty or even a friend of the best possible health care system. If it were up to them, everyone would be forced to buy their product whether it was wanted or not, and at almost any price.

Really, who can blame them? If Obamalosireidcus is going to force insurance companies to take people with pre-existing conditions without charging them more and limit how much more the companies can charge old people versus young people (even though old people have much greater risk of expensive health problems), the insurance companies see two possible outcomes: Premiums rising well beyond what makes sense for the average healthy young or almost-young person to spend, leading to further “adverse selection”, i.e. healthy people dropping coverage, and continuing in a rising premium death spiral for health insurance. Or the government forcing young healthy people into the “pool” to “spread the risk”, forcing them to subsidize health care for old or sick people…with premiums still rising, just not quite as fast. Of course the health insurance industry wants an “individual mandate!”

Imagine how much auto insurance would cost if people were allowed to buy it just after getting into an accident. That’s what Obama wants to do with health care. Effectively, he wants to force people who don’t drive to buy expensive car insurance and subsidize the losses that the insurers will take by paying claims for accidents which happened before the accident-causing driver was even insured. It is economically and politically unsustainable, not least because it’s bad for both young adults and old adults, all of whom happen to have the right to vote.

Indeed, Obamacare is only good for two groups: the very small minority of chronically sick people who can’t currently get health insurance (but do we need to destroy the whole system to help them find an answer?), and (particularly if there is a public option) unions who hope to dump their health care costs on government, leaving them free to take the money they had saved for their members’ and retirees’ medical bills and spend it on getting Democrats elected. Any wonder why Democrats are so desperate to get this passed, given the rapid shift in the political tide against them in the past few months?

With this Administration, even the unions can’t be sure they have a deal – luckily for the rest of us. That said, when it comes to Armey’s axiom, in a deal between the Obama Administration and Big Labor, it’s hard to know who is the junior partner.


“Gifted hands” surgeon rips into Obamacare

As the Senate Finance Committee completed its work on a bill that would greatly expand the government’s role in health care – requiring nearly everyone to buy insurance, and designing that insurance through subsidies and mandates – President Obama is trying to rally doctors to his side. At an event last week at the Rose Garden, phalanxed by doctors wearing their white coats (as well as some that White House staffers had handed out), Obama declared, “nobody has more credibility with the American people on this issue than you do.”

Yet one of the nation’s top surgeons, with credibility and acclaim the world over for the pioneering surgeries he has and his personal story of overcoming hardship, recently ripped the dominant health care legislation before Congress in a critique similar to that of conservatives and libertarians. Benjamin Carson, director of pediatric neurosurgery at the Johns Hopkins Medical Institutions in Baltimore, Md., and recipient of numerous awards including the Presidential Medal of Freedom, criticized in a recent interview the approach of the current bills for their mandate, creation of a “public option,” and lack of malpractice liability reform.

“My biggest problem is I feel it’s going in the wrong direction,” Carson told reporters at TV station WLOS in Asheville, N.C. (Video here.)“It’s giving us more government and less autonomy. And I think we should be going in exactly the opposite direction. We should be having more autonomy and less government. And that is the kind of thing that brings the prices down.”

Considered one of the best neurosurgeons in the world, Carson gained acclaim in the ’80s and ‘90s for his pioneering operations separating conjoined twins joined at the head and other procedures that have saved children from epilepsy and brain cancer. But Carson is also celebrated for his personal story of overcoming poverty and prejudice. An African-American, Carson grew up in a single-parent home Detroit ghetto, but his mother pushed him and his brother to achieve excellence. He is the author of the popular autobiography “Gifted Hands: The Ben Carson Story,” which was made into a TV movie this year with Cuba Gooding Jr. portraying Carson. And he does much philanthropic work through charities such as his “Carson Scholars” fund.

Over the past few years, Carson has been writing and speaking more about public policy, including health care reform. He has railed against excessive litigation, pointing out how much malpractice insurance and other forms of “defensive medicine” to protect against lawsuits add to medical costs. In the interview with WLOS, Carson insisted that tort reform must go “hand in hand” as part of any true health care reform.

“We have to bring a rational approach to medical litigation,” he said. “We’re the only nation in the world that really has this problem. Why is it that everybody else has been able to solve this problem but us? Simple. Special interest groups like the trial lawyers’ association. They don’t want a solution.”

Carson also blasted proposals backed by Obama and most Democrats that would create a government-backed “public option,” saying it would inevitably lead to a “single payer” system like that of Canada, in which the government as the sole insurer would end up calling all the shots for patients. He pointed to how the Canadian government itself crowded out private insurance. “What happened to the private insurance companies in Canada? Just like that, they were gone, because they couldn’t compete with it (the government). Now, why would it be any different here? That’s one of the things that disappoints me about the lack of honesty … We can’t really debate when there’s all this subterfuge.”

Carson said that despite the problems with American health care, Canada and European countries were not models to emulate in their health insurance financing systems. “All we have to do is go to other places and see what’s going on. See how long people have to wait. Very, very long waiting periods. Why do you think so many people from Canada come here when they have a problem? I know a young man in England who has a problem with his knee. He needs an operation, and the waiting list is so long. … These are the kind of things that people in this country are not used to. But more importantly, it’s something that we don’t have to get used to. We can fix this without going to that kind of system that causes those kinds of long waits.”

As his main “fix”, Carson proposes a system of patient empowerment in which “individuals and families can own their own insurance; it doesn’t have to be through their employer.” Not all of Carson’s ideas expressed in the interview were free-market, though. He did propose that the government set insurance rates, and cover patients’ catastrophic costs above $250,000.

Above all, Carson was adamant that there transparency and deliberation, rather than a rush to force through a health care bill that no one had read. In fact, he proposed bringing health care to a national vote of the American people “I would say we should have a national referendum on it. People should be able to vote. That would really work, because now, people would have to explain it. They would have to know what was in it. When we do these big sweeping national things and just sort of jam them through and nobody even knows what’s in it, that’s not democracy. At some point, someone has lost their ideal of what democracy is.”

Carson’s colleagues at Hopkins – ranked by U.S. News and World Report for 19 years as the nation’s best overall hospital and lauded for the millions it spends on charity care for the poor –have also voiced concerns about the direction that health care legislation is going. Citing the cuts to hospitals to pay for the goal of universal coverage – cuts of more than $150 billion in Medicare and Medicaid payments to hospitals, according to the Congressional Budget office “preliminary analysis” of the Max Baucus’ Senate Finance Committee bill – the Hopkins officials have been warning about severe stress on Hopkins and other hospitals that Hopkins and other hospitals would face.

At a Sept. 18 “town meeting” on the campus of the main hospital in Baltimore, Md., Johns Hopkins Institutions Director of Federal Relations Beth Felder was blunt about the cuts in reimbursements. “That is going to come out of hospitals and health systems,” she said. “I think that’s not a good thing for us.” Similarly, Johns Hopkins Medicine health system CEO Edward Miller told C-Span on Sept. 16 that cuts in the reimbursement rates for Medicare and Medicaid, “There are going to be less physicians that will care for these patients.”


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