Monday, November 09, 2009

British Government targets increase superbug risks, say NHS infection chiefs

Deadly superbugs have increased despite a crackdown on the best-known infections such as MRSA, a parliamentary report will warn this week. While rates of MRSA and Clostridium difficile are falling, after scandals over major outbreaks, other potentially fatal infections which receive less attention appear to be soaring, the Commons public accounts committee will say.

Around 300,000 infections are diagnosed in English hospitals every year – but many more potentially fatal bugs may be going undetected, because of a lack of surveillance, research has found. A voluntary scheme charting all bloodstream infections found numbers increased by 30 per cent between 2003 and 2007, in what the committee's chairman Edward Leigh described as a "rising tide" of infections threatening all hospital patients. The report is expected to show increasing numbers of cases of E-coli, linked to surgical site infections and urinary tract problems, and in cases of the bacterial infection Klebsiella.

The Sunday Telegraph has established that the NHS' most senior doctors and scientists responsible for infection control believe their efforts are being hindered by Government waiting targets. An anonymous survey of 170 NHS directors of infection control found that 59 per cent had experienced a clash between their efforts to block the spread of disease and rules which say new patients must be found a bed within four hours.

Infection experts say NHS managers are so fearful of missing the four hour target for Accident and Emergency patients to be admitted to a ward, that infected patients are being shunted around overcrowded hospitals, hastening the spread of disease, in a rush to clear space for new arrivals.

The four hour target has already been implicated in a series of NHS hospital scandals, in which hundreds died, but, on each occasion, ministers have insisted that poor management, rather than the target, was to blame. In total, 100 of 170 directors at England's hospital trusts reported difficulties as a result of the four hour target, in research carried out for the National Audit Office.

A Department of Health spokesman said MRSA bloodstream infections had fallen by 74 per cent since 2003/04 and C. difficile infections by 35 per cent between 2007/08 and 2008/009.


Barack Obama's healthcare reform bill passes first hurdle

The US House of Representatives approved the broadest overhaul of US health care in four decades overnight, handing President Barack Obama a hard-fought victory that energised his top domestic priority. Heeding Mr Obama's appeal to "answer the call of history," lawmakers capped 12 hours of bitter debate with a 220-215 vote for a 10-year, $US1 trillion-dollar plan to extend health coverage to some 36 million Americans who lack it now. "Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people," Mr Obama said in a statement shortly after the vote.

One Republican supported the measure, but most criticized its $US1 trillion price tag, new taxes on the wealthy and what they said was excessive government interference in the private health sector.

The battle over Mr Obama's top domestic priority now moves to the US Senate, where work on its own version has stalled for weeks as Senate Democratic leader Harry Reid searches for an approach that can win the 60 votes he needs. Any differences between the Senate and House bills ultimately will have to be reconciled, and a final bill passed again by both before going to Mr Obama for his signature.

The overhaul would spark the biggest changes in the $2.5 trillion US healthcare system, which accounts for one sixth of the US economy, since the creation of the Medicare government health program for the elderly in 1965.

The vote followed days of heavy lobbying of undecided Democrats by Mr Obama, his top aides and House leaders, and a deal designed to mollify about 40 moderate Democrats who are foes of abortion rights. Democrats could afford to lose 40 of their 258 House members and still pass the bill. In the end, 39 Democrats sided with Republicans against the bill.

The landmark vote was a huge step for Mr Obama, who has staked much of his political capital on the healthcare battle. A loss in the House would have ended the fight, impaired the rest of his legislative agenda and left Democrats vulnerable to big losses in next year's congressional elections. Mr Obama said he was "absolutely confident" that the Senate would pass its own bill, stressing: "I look forward to signing comprehensive health insurance reform into law by the end of the year."



As the suicidal Democratic congressmen proceed to rubber-stamp the Obama healthcare reform despite the drubbing their party took in the '09 elections, the president trotted out the endorsements of the AMA and the AARP to stimulate support. But these -- and the other endorsements -- his package has received are all bought and paid for. Here are the deals:

* The American Medical Association (AMA) was facing a 21 percent cut in physicians' reimbursements under the current law. Obama promised to kill the cut if they backed his bill. The cuts are the fruit of a law requiring annual 5-6 percent reductions in doctor reimbursements for treating Medicare patients. Bravely, each year Congress has rolled the cuts over, suspending them but not repealing them. So each year, the accumulated cuts threaten doctors. By now, they have risen to 21 percent. With this blackmail leverage, Obama compelled the AMA to support his bill...or else!

* The AARP got a financial windfall in return for its support of the healthcare bill. Over the past decade, the AARP has morphed from an advocacy group to an insurance company (through its subsidiary company). It is one of the main suppliers of Medi-gap insurance, a high-cost, privately purchased coverage that picks up where Medicare leaves off. But President Bush-43 passed the Medicare Advantage program, which offered a subsidized, lower-cost alternative to Medi-gap. Under Medicare Advantage, the elderly get all the extra coverage they need plus coordinated, well-managed care, usually by the same physician. So more than 10 million seniors went with Medicare Advantage, cutting into AARP Medi-gap revenues.

Presto! Obama solved their problem. He eliminates subsidies for Medicare Advantage. The elderly will have to pay more for coverage under Medigap, but the AARP -- which supposedly represents them -- will make more money. (If this galls you, join the American Seniors Association, the alternative group; contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it .)

* The drug industry backed ObamaCare and, in return, got a 10-year limit of $80 billion on cuts in prescription drug costs. (A drop in the bucket of their almost $3 trillion projected cost over the next decade.) They also got administration assurances that it will continue to bar lower-cost Canadian drugs from coming into the U.S. All it had to do was put its formidable advertising budget at the disposal of the administration.

* Insurance companies got access to 40 million potential new customers. But when the Senate Finance Committee lowered the fine that would be imposed on those who don't buy insurance from $3,500 to $1,500, the insurance companies jumped ship and now oppose the bill, albeit for the worst of motives.

The only industry that refused to knuckle under was the medical device makers. They stood for principle and wouldn't go along with Obama's blackmail. So the Senate Finance Committee retaliated by imposing a tax on medical devices such as automated wheelchairs, pacemakers, arterial stents, prosthetic limbs, artificial knees and hips and other necessary accoutrements of healthcare.

So these endorsements are not freely given, but bought and paid for by an administration that is intent on passing its program at any cost.


What the Pelosi Health-Care Bill Really Says

Here are some important passages in the 2,000 page legislation. What the government will require you to do:

• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.

Eviscerating Medicare:

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

Questionable Priorities:

While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.

• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."

These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.


Here We Go Again: Rostenkowski, Health Care and the Original Town-Hall Protest

Back in 1989, the Democrat House, led by Ways and Means Chairman Dan Rostenkowski, passed the ‘Catastrophic Health Care Act.’ The Act promised to expand coverage and benefits, financed by a surcharge on senior’s existing Medicare benefits. Passage of the Act sparked on outcry from seniors. CBSNews goes back into the archives to find footage of one of the protests.

The report forgets to mention that Congress quickly repealed the Catastrophic Act in response to the voter backlash. Something current Members of Congress might want to keep in mind.

The problem for today’s Democrats is that the PelosiCare bill they are being pressured to support has a lot more to anger seniors than just a modest surcharge. Between the cuts to Medicare and numerous higher taxes, more people will lose under this bill than gain. That’s very dangerous politics. Again, if a small surcharge, in exchange for more benefits, was enough to spark protests that rattled on Old Bull like Rostenkowski, imagine the backlash when seniors realize they will lose lots of benefits in exchange for…nothing. Rostenkowski was genuinely surprised by the protests. After Tuesday’s elections results, however, Democrats can’t say they weren’t warned.

Below is a list of the cuts to Medicare contained within PelosiCare:

* $170 billion in cuts to Medicare Advantage (MA) which currently provides benefits to more than 11 million seniors.

o The Congressional Budget Office (CBO) predicts these cuts “could lead many plans to limit the benefits they offer, raise their premiums, or withdraw from the program.”

o CBO also predicts 3 million seniors will lose the plan they currently have and the non-partisan Medicare Payment Advisory Commission (MedPAC) predicts these cuts will result in 1 in 5 seniors no longer having access to an MA plan;

* $143.6 billion in across-the-board cuts by instituting a new, permanent “productivity adjustment” to reimbursement rates for all hospitals, Ambulatory Surgery Centers (ASCs), skilled nursing facilities (SNFs), hospice, clinical laboratories, and durable medical equipment (DME);

* $56.7 billion in cuts to home health agencies by freezing payment rates in 2010, applying the productivity adjustment, and other reimbursement changes;

* $42.3 billion in cuts to the Medicare prescription drug program (Part D) by imposing government price-controls for drugs. As a result, CBO predicts seniors’ premiums will increase by at least 20%;

* $23.9 billion in additional cuts to SNFs by freezing their payment rates in 2010;

* $14.3 billion in provider reimbursement cuts by reallocating Medicare funding nationally;

* $10.3 billion in additional cuts to hospitals by slashing reimbursements designed to cover uncompensated care;

* $9.3 billion in yet further cuts to hospitals that have a high rate of readmitted patients;

* $8.2 billion in undisclosed cuts determined by the new, unelected “Center for Medicare Innovation;”

* $5.3 billion in cuts to inpatient rehabilitation facilities cuts by freezing payment rates in 2010;

* $3 billion in reimbursement cuts to providers who use imaging equipment (MRI, CT scans, etc);

* $1 billion cut to physician-owned hospitals, effectively legislating these hospitals out of existence. In some communities, physician-owned hospitals are the only hospital in the community.

* $800 million in additional DME cuts (power wheelchairs); and

* Plus, $14.5 billion in additional miscellaneous cuts to the Medicare program.


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