Monday, October 19, 2009

Some British pigs are more equal than others

3,000 NHS staff get private care

THE National Health Service has spent £1.5m paying for hundreds of its staff to have private health treatment so they can leapfrog their own waiting lists. More than 3,000 staff, including doctors and nurses, have gone private at the taxpayers’ expense in the past three years because the queues at the clinics and hospitals where they work are too long.

Figures released under the Freedom of Information act show that NHS administrative staff, paramedics and ambulance drivers have also been given free private healthcare. This has covered physiotherapy, osteopathy, psychiatric care and counselling — all widely available on the NHS.

“It simply isn’t fair to have one service for staff and another for everyone else,” said Norman Lamb, the Liberal Democrat health spokesman, who obtained the figures. “If the NHS has to circumvent their own waiting lists the system isn’t working well enough. It’s an admission by the NHS that their own system isn’t able to respond to the mass of people desperate to get back to work.”

The number of health service employees sent to private healthcare facilities has more than doubled in the past three years. In 2006-7, 708 staff working for NHS trusts received private treatment at a cost of £279,000. Last year it increased to 1,641 at a cost of £828,413.

The health department defended the practice and said sending doctors, nurses and other key staff for private treatment helped to get them back to work. “If trusts want to get their staff back to work more quickly they can’t jump NHS waiting lists, so going private is an option,” said the spokesman. “There is evidence that early intervention in tackling sickness absence enables staff to return to work more quickly. “Other benefits include: reducing the risk of chronic illness that could result in ill health retirement, cost-saving on temporary staff and having a positive impact on staff health and wellbeing and, in turn, patient satisfaction.”

The East Midlands ambulance service recently set up a contract with a private occupational healthcare specialist worth £300,000 a year. It has sent its staff to the specialist for vaccines, health screening and to deal with needle injuries and blood tests.

Other big spenders include the south east coast ambulance service, which has sent more than 800 staff for physiotherapy, osteopathy and counselling at a cost of more than £279,000 over three years.

Humber mental health trust has spent more than £47,000 on private counselling, even though it specialises in offering this service along with psychiatric help. A spokeswoman said staff would feel awkward being counselled by NHS colleagues. “An appropriate and professional counselling and therapeutic service has to be free from any other existing pressures in respect of relationships and therefore cannot always be provided by an organisation,” she said. “Staff may also be referred externally due to peak of demand to meet the need in a timely manner.”

West Suffolk hospital has spent £56,000 over the past three years on private treatment for staff but said it would no longer do so.


British death panels "need more training"

Doctors and nurses need more training in how to care for people who are dying, Mike Richards, the Government's cancer tsar, has said, following concerns over the controversial 'death pathway' scheme

Prof Mike Richards, who was involved in the introduction of the Liverpool Care Pathway, said it was "essential" that medical staff were skilled in deciding who should be put on the scheme for those at the end of their lives. It follows concerns that patients with terminal illnesses are being made to die prematurely because they are incorrectly placed on the pathway, which can mean the withdrawal of food and fluids.

However, in an interview with The Daily Telegraph, Prof Richards said the Liverpool Care Pathway, worked well in the majority of cases. Prof Richards said: "The Liverpool Care Pathway is very valuable but its success depends on the skills and experience of staff who deliver it. It is therefore absolutely essential that every member of team delivering the pathway receives training."

In a letter to the Daily Telegraph last month, a collection of palliative care experts warned that patients may be wrongly diagnosed as dying and that putting them on the pathway became a self fulfilling prophesy. Since then families have come forward with concerns about the treatment of their dying relatives, sparking a debate about end of life care in hospitals.

Prof Richards warned that as the population ages and plans to help more people die at home are implemented, a wider range of clinicians will have to care for the dying. He said: "There are 1.3 million people working in the NHS and almost all of them have roles in end of life care. This includes GPs, hospital doctors, community and hospital nurses, physiotherapists and others. We need to increase the number of staff receiving training and a proportion of the funding for the end of life care strategy is dedicated for this.

"We train all clinicians in resuscitation though relatively few will use this skill in any one year. I would like to see a similar approach so that all staff are trained in end of life care. "Since the end of life care strategy was published 15 months ago we have succeeded in making training staff a priority for hospitals across the country but we need push this further so that we reach all staff groups." Prof Richards said e-learning modules were being developed to allow hundreds of thousands of staff to be trained in end of life care.

Meanwhile Marie Curie Cancer Care, which drew up the Liverpool Care Pathway, to help hospital staff provide the kind of end of life care that is provided in hospices, has called for mandatory training for all staff who use it. An audit showed in one in four cases family members were not told when their relative was placed on the Liverpool Care Pathway. The data also showed 84 per cent of nurses who use the pathway have received training. Thomas Hughes-Hallet, chief executive of the charity said: "We will be pressuring the NHS to ensure that the training does take place. We want 100 per cent of staff using the pathway to be trained. There is an issue around training, we can always get better." Mr Hughes-Hallett said the charity had never received a complaint about the LCP and it is now seen as a world-leading scheme which has been adopted in 17 other countries.

As part of the end of life strategy, surveys will be carried out among bereaved relatives of patients who have died to find out what they thought of the care family members received. The surveys which will begin next year will enable the Department of Health to compare the experiences of relatives of patients who died on the Liverpool Care Pathway with those who were not.


Insurance mandates: Kiss Your Money and Freedom Goodbye

Talk about personal responsibility is cheap. Legislating personal responsibility isn't. Take the movement to require everyone to purchase government-approved health insurance.

If at first this seems like a reasonable requirement necessary to reduce cost shifting by those who do not pay their own fare, then step back and think again. The damage caused by such a mandate is far greater than the problem it purports to solve.

Passing a law won't magically make everyone insured any more than laws against speeding cause everyone to drive carefully - and shaving a few MPH off your speed is a much milder behavior modification than involuntarily spending thousands of your hard-earned dollars on government's wish list rather than your own.

Many states, including Colorado, require drivers to have automobile insurance; yet the number of uninsured drivers is estimated at 14 percent nationally and 16 percent in Colorado.

Analyzing the newest health "reform" bill by Sen. Max Baucus (D-Mont.), the Congressional Budget Office found that its individual purchase mandate would still leave 25 million uninsured - out of some 30 million that CBO says are currently uninsured on any given day.

From a practical standpoint, the requirement to purchase health insurance will start badly and grow even worse. That's because the choice of what kind of insurance to purchase will no longer belong to consumers but to politicians and bureaucrats, relentlessly pressured by lobbyists to add to every conceivable screening or procedure in the nanny-state's wish list to your mandatory policy.

Politicians who resist that pressure and defend your right to choose your own level of coverage will be smeared at election time by dishonest advertisements accusing them of opposing mammograms and maternity care.

Requiring health insurance to pay for preventive screenings is like mandating that auto insurance must pay for oil changes and new tires. Only in health care do we forget that insurance was designed to pay for unforeseen catastrophes, not for predictable events for which we should plan and budget.

These are the types of mandates that turn a practical, affordable policy into an unaffordable one. In Massachusetts, which implemented an individual mandate in 2007, the average family insurance policy now costs $13,788 a year - the most expensive in the nation.

But, true to form, liberals in Congress seem incapable of learning from others' mistakes.

Worse still, the Senate bill's $829 billion cost estimate doesn't attempt to account for the total cost to Americans - only for the cost to government. Factor in the cost to businesses and families of buying government-approved health insurance and the total cost soars to $2 trillion, says Michael Cannon, health policy director at Cato Institute.

If Congress can order us to use our own money to buy goods or services that we might not otherwise purchase, what's to stop it from ordering us to drive hybrid vehicles, install solar panels on our homes, or eat our vegetables?

So let's say someone who still holds to the old-fashioned notion that America is "a free country" decides to spend her own money as she darn well pleases and buys health insurance that doesn't meet government's criteria. Then what?

According to a memo from the Joint Committee on Taxation, such independence would result in a $1,900 income tax penalty from the IRS. Refusal to pay the penalty would subject the taxpayer to a misdemeanor criminal charge carrying a fine of $25,000 and up to one year in jail.

What is so wrong with American health care that justifies this type of authoritarian government? And what does it say about Democrats who would jail those who spend their own money however they choose?

Contrary to President Obama's oft-repeated disinformation, health care spending had nothing to do with the implosion of the financial markets. In fact, the biggest problems in health care and the most expensive problems in government emanate from government health care programs. Medicare, for example, is nearly bankrupt and carries a long-term deficit of $89 trillion.

Only in Washington is it conventional wisdom that the cure for big government's errors is to make them bigger.


Does Medicaid offer a glimpse into the future of American medicine?

Last week, my wife, a pediatrician, gave a patient a prescription for compounded Tamiflu -- that is, the preparation of a children's dose of the anti-viral drug by breaking down adult-dose capsules and turning them into a liquid suspension. The Swine flu scare has made children's Tamiflu scarce, so compounding is often the only way of getting the drug for kids. Before handing the patient the prescription, my wife's office checked with the insurer to make sure it would pay for compounded Tamiflu. Reassured that the drug was covered, the patient went to get the drug compounded at the only pharmacy in the area that will do the job (Wal-Mart, if you're interested).

Of course, when the pharmacy went to put the prescription through, the insurer refused to pay. Twice. Oh, no, not another health insurance company horror story! Well, yes it is -- but with a twist. You see, the insurer was AHCCCS -- Arizona's implementation of Medicaid -- a government program that may provide us all with a peek at the future of American medicine.

The problem was cleared up quickly enough once my wife heard about it. She set her staff to work calling the AHCCCS offices and demanding approval of the prescription. The government employees were all apologies and soon authorized compensation for the patient, who had already paid out of pocket.

But that's the way it always is. My wife and her staff play a frequent game of "guess what AHCCCS will pay for today" that has turned them into constant phone pals with bureaucrats down in Phoenix. The AHCCCS people are almost always polite and usually concede the point. But this happens over and over again.

Tamiflu wasn't approved for use at all just a few weeks ago, even after the CDC recommended the drug for treating Swine flu. Sure enough, my wife (and other doctors, I'm sure) got on the horn and AHCCCS added Tamiflu to the formulary -- the list of drugs for which it would pay.

Yes, she does this from time to time with the private insurers too -- they're no saints, and occasional arm-twisting is required. But not with such regularity as with AHCCCS, and not to the extent that it seems a system is at work.

If there is a system, it's not a system for refusing care and treatment. It's a system for making it a little more difficult to get things paid for -- unless somebody with savvy runs interference. But most physicians' offices don't provide this kind of value-added advocacy service. It's expensive to have staffers on the phone arguing with Medicaid bureaucrats, none of whom can be fingered as a specific villain in any given case. And without savvy advocates, medications and treatments don't get approved. Not incidentally, I'm sure, such how-did-that-happen refusals to pay for even pre-approved care, spread out across the entire system, must represent a fairly substantial cost saving.

This shouldn't come as a surprise. Medicaid is, after all, a political health-care system, rather than a commercial one. It doesn't just charge for services and raise rates as needed; it's given a certain budget to work with, and somehow it has to jam all the demands upon its resources within the limits of that budget. That's not easy.

In countries where politically run health-care systems are the norm, the cost-control measures are more overt. The Los Angeles Times recently published an article about the budget strains to which the government-run health-care system is subject in British Columbia, and the accommodations it has made in response.
Provincial officials recently announced a $360-million shortfall in the $15.7-billion healthcare budget for the fiscal year that ends in March.

The shortage will mean fewer surgeries and longer waits.

The Vancouver Island Health Authority has said it would reduce the number of non-emergency MRIs by 20%; non-emergency patients now are being booked for scans in March.

Vancouver Coastal Health, which serves a quarter of the province's population, said it would eliminate 450 elective surgeries, about 30% of the schedule, during the four weeks of the 2010 Winter Olympics. And in the rapidly growing suburbs east of Vancouver, the Fraser Health Authority plans to close its spending gap by, among other things, holding the number of MRIs to last year's total, ending $550,000 in service programs for senior citizens and reducing elective surgeries by about 14%.

How do you control costs in a politically run health-care system? You announce "this much care and no more." Ironically, that leaves one woman described in the article crossing the border and paying out-of-pocket for hip surgery in the U.S. to escape a year-and-a-half long waiting list, and has spurred the establishment of technically illegal private surgery centers in the province at a time when many Americans are touting the advantages of government-run systems like Canadian Medicare.

And like Arizona's AHCCCS.

Americans aren't yet ready to face the hard choices that are made by politically run health care systems. That's why we get one unexplained denial after another instead of hard limits on care as a matter of policy. But, when Americans wise up to the fact that state-run medicine has a hard-nosed attitude toward cost control, they're likely to discover that doctors like my wife can't always fix the problem.


Crooked Democrat advertising

The Democratic National Committee has agreed to pull a TV ad featuring former Senate Majority Leader Bob Dole, R-Kan., following objections Dole conveyed to the White House that the ad twists his support for a bipartisan compromise for health care reform legislation into something else entirely.

The ad, which was set to launch Monday, features Dole and other Republican former officials advocating in general terms for health care reform. Dole is quoted saying, "I want this to pass. ... We've got to do something," and the ad attempts to contrast that attitude with that of current GOP congressional leaders, which the DNC describes as "siding with the insurance companies and just saying no to insurance reform."

"I wish they hadn't done it," Dole said of the DNC ad in a phone interview with ABC News on Sunday afternoon, saying that the ad's depiction of current GOP leaders "is just not my view." He found it a bit ironic that "all I've been doing is urging bipartisanship" and that was used for partisan purposes.

"The ad doesn't reflect what I was trying to do," he said. "I just didn't think it was fair when I've tried to be helpful in encouraging a bipartisan solution for the DNC to run an ad that I interpreted and I know others did as a backhanded comment about Republicans."

Dole also objected to any impression that the ad suggested he endorsed any specific legislation when he's tried to keep what he's supporting "pretty generic." Dole conveyed as much to White House chief of staff Rahm Emanuel yesterday, who told the DNC to pull the ad.

"We have great respect for Sen. Dole and his commitment to reform," a DNC spokesman told ABC News. "As soon as Sen. Dole's concerns were communicated to us we immediately agreed to pull the ad."

President Obama cited the support Dole and other Republican former officials have expressed for health care reform in his weekly address Saturday, though some of those Republicans -- former Senate Majority Leader Bill Frist, R-Tenn., for example -- have expressed misgivings about specific Democratic legislative proposals.

Dole told ABC News, "My whole message is you can't score unless you're in the game. I still believe a compromise is there. No one I know is flatly against health care reform." The 1996 GOP presidential nominee said that there's "still plenty of time to get a bipartisan result. And that's really going to start when bill gets to the floor" of the Senate and "amendments are offered." "I was up there a long time and I learned it's never over 'til it's over," Dole said. "I'm an optimist. I guess that's my problem."

Rejecting the arguments of some Democrats that the current crop of Republicans isn't as inclined to compromise as he was, Dole said, "there's a lot of good men and women in Congress from both parties. And come crunch time they will think long and hard -- depending on what's in it -- before they vote no."

"I'll take some of the blame for the Clinton failure," Dole said, referring to former President Bill Clinton's failure to pass comprehensive health care reform legislation in 1994.

The World War II veteran said he doesn't think a failed bill can be used the same way to hurt Democrats in 2010 as it was in 1994. "It's a different time," he said, "and the whole issue has become much more important. It's going to be drag on the economy if we don't figure out some long term way to fix it."

Working with other former Senate majority leaders former Sens. Tom Daschle, D-S.D., Howard Baker, R-Tenn., and George Mitchell, D-Maine -- before Mitchell resigned to serve as President Obama's special envoy to the Middle East -- Dole and others at the Bipartisan Policy Center have not only issued statements urging compromise, in June they suggested a framework for bipartisan health care called “Crossing Our Lines: Working Together to Reform the U.S. Health System.”

"Some of the recommendations we made are in the Baucus bill," Dole said, referring to the bill being offered in the Senate Finance Committee by Sen. Max Baucus, D-Mont. "I agreed on mandates which I don't really like. Daschle, for example, yielded on the public option, something that he strongly believes in. We understood and I think members of Congress ought to understand, there aren't any easy votes on this issue. Trying to avoid any political risk at all is going to be difficult."

Dole said if he were President Obama, he'd "want some of the other party on board for a couple reasons. It gives the president some protection if it's bipartisan. Secondly, the American people will feel better about it if both parties are involved."

He suggested the president add tort reform measures to the legislation which "would bring some more Republicans around."


Bipartisan Facade Can't Hide Health Plan's Flaws

If the Democrats' health care package is so great, why are President Obama and Dem congressional leaders so hungry to share the credit for its passage with a Republican?

It's not as if D.C. Dems are opposed to hogging the glory when a federal program is popular. So why did Obama feel the need to announce after the Senate Finance Committee passed a health care measure with the support of Sen. Olympia Snowe, R-Maine, that the measure "enjoys the support of people from both parties" -- when this one bill enjoyed the support of one lone-wolf Republican?

Obama doesn't need Snowe's vote to pass a measure if he can draw the support of the Senate's 58 Democrats and two left-leaning independents. Snowe's vote was hardly pivotal, considering that the committee approved the measure by a 14-9 vote. Democrats hold a comfortable majority -- 256 members out of 435 -- in the House. So why are Obama and company so desperate to win over a token Republican or two?

Is it the idea that if ObamaCare fails, they want voters to blame the GOP? Or does the president want to be able to share the blame if a bill passes and inevitably fails to deliver as promised? No one knows what the final health care reform bill will look like, but plenty of reasons remain for voters to be skeptical. Until those who claim the mantle of reform acknowledge the cost of all the things they want to give families, they have too many incentives to over-promise and too few incentives to tell people they can't get something for nothing.

In Washington's standard hide-the-tax fashion, the Senate Finance Committee legislation would impose an excise tax on "Cadillac" employer-funded health care plans -- a 40 percent levy on premiums in excess of $8,000 per individual or $21,000 per family. So they're taxing a service to make it cheaper. Big labor is opposed because "Cadillac" policies can be very working class. But some on the left support this scheme, in the belief that taxing health care will control costs by providing employers with incentives to offer less-generous health coverage.

If this plan passes, workers will have to pay higher premiums and/or taxes for what they already have. That's more cost shifting than cost savings.

The worst suspicions of the plan's critics thus have been confirmed. Under ObamaCare, those who have health care will be paying more -- fair enough -- but for less health care -- which is not so fair.

As for proposed limits on what insurers can charge based on age or gender -- again, these schemes don't control costs; they shift costs. And cost shifting is the practice that has led to runaway health care spending in America.

With all the freebies thrown into versions of the package -- with millions of additional people covered, no denials for pre-existing conditions, free checkups and preventive procedures -- ObamaCare can only increase the nation's health care tab.

"When history calls," Snowe said to explain her vote, "history calls." Maybe, but history can be like the Delphic oracle: It doesn't always tell you what you think you hear. The more Washington pads the guaranteed benefits package, the less incentive Americans will have to look for savings in their own health care. Snowe and the Democrats may believe that their plans will cut health care costs, but history suggests that these paper savings will not materialize.


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