Wednesday, November 04, 2009

Daughter of British Alzheimer's patient defies NHS gagging order to speak out

Secrecy and censorship is the prime refuge of Leftists

A daughter has spoken out in defiance of a gagging order that was imposed after she won a £30,000 refund for care unfairly denied to her mother, an Alzheimer's patient. Pauline Hardinges was given the payout after she fought a year-long battle with Cornwall and Isles of Scilly Primary Care Trust for them to pay for her mother's 24-hour care. But when she went to collect the money she was asked to sign a confidentiality agreement, which she was told was routine in such cases.

Mrs Hardinges said she signed the agreement but has chosen to break the gagging order to publicise the fact that relatives of other dementia families could be eligible for refunds of private care costs.

The 65-year-old, from Looe, Cornwall, said: "When I took the matter up with the primary care trust I was told it was to stop me speaking to the media. I was appalled – I wanted everyone suffering from this horrendous disease, or looking after someone with it, to know they can claim for every penny of nursing care from the Government." She added: "There was no way I was going to keep my mouth shut, so I told my neighbour and he claimed for £130,000 for his dad's care – and got the lot."

Mrs Hardinges' mother, Dorothy, was diagnosed with Alzheimer's in 2000 at the age of 86. Her care needs were assessed but the trust ruled that she was only entitled to "social", rather than medical care. This meant that when her condition deteriorated Mrs Hardinges had to place her mother in a private care home. It was not until 2007 that Mrs Hardinges found out a retrospective review could be conducted into the way her mother's care needs were assessed. The review found that her mother should have been given round-the-clock care by the NHS and so she was entitled to be refunded all costs of care she had incurred.

"The NHS were dreadful and kept putting up obstacles – but in 2008, after a year-long battle, they finally told me my mother should have been fully funded from the beginning" added Mrs Hardinges. "They'd hidden the fact government money was available. To cheat sick and elderly people is outrageous." Pauline added: "When I was refunded the £30,000 I signed the confidentiality contract under duress. "But I couldn't have lived with myself by not speaking out. Even if one family gets help as a result of reading my story it will have been worth it."

Cornwall and Isles of Scilly Primary Care Trust defended the gagging order. An official said: "This standard clause has been in place for some years."

But Neil Hunt, of the Alzheimer's Society, said: "It is a very complex and confusing system and most of the time people are not aware of what type of care their relatives are entitled to. "Thousands of families face astronomical care bills. We want a more transparent and fair system that doesn't penalise people with dementia."

A Department of Health spokeswoman said: "We are currently consulting with the public on the future of care services. Under the proposals, a National Care Service would be created, making care for older and disabled people simpler, fairer and more affordable for everyone. Under the National Care Service, everyone will get at least some care for free.”

Mrs Hardinges added: "When I signed, I wrote "under duress" underneath. It was only later when I thought about all the people who might not have the wherewithal to do the same that I thought I would go public. "I was paying for medical care I believed she was entitled to, so I stopped – and was threatened with court." Mrs Hardinges said she turned to the NHS when she ended up in hospital with stress after giving up a restaurant job to care for her mother.


Harry's Shell Game

After months of work by Senate Committees, Senate Majority Leader Harry Reid stepped up to the microphone and pronounced that in his opinion “the best way to move forward is to include a public option with the opt-out provision for states.” Though there is little understanding of how an opt-out provision would work, it resurrected the seemingly dead government plan that, if enacted, will eventually destroy the private insurance market.

The inclusion of a public option in the Senate bill immediately resulted in Maine Senator Olympia Snowe, the only Republican who was lending a “bipartisan fig leaf” to any of the Democrat’s health care plans, withdrawing her support. Liberal Democrat Chuck Shumer lauded Senator Reid who, he said, “showed just how deep his commitment is” to the public option.

Reid knows that without the illusion of a bipartisan plan, he is likely to lose several middle of the road Democrats, especially those who must face the voters next year. Senator Joe Lieberman signaled weeks ago his concern that Obama was trying to do too much too fast in a weak economy and has now said he is likely to join a Republican fillibuster.

The likelihood of Reid getting the needed sixty votes to pass a bill out of the Senate with a public option, with or without the new gimmick of a “state opt- out” remains murky at best. So what is his motivation?

The Senate leader is facing a very difficult re-election campaign with polls showing him running behind Republican contenders. His liberal base demands a public option. The opt- out provision may be a meaningless gimmick but it allows Reid to appear strong with Democrat activist groups back home and perhaps gives cover to worried Democrats.

No one knows the language of the Senate bill, but it is certain that the public option will draw the greatest attention and debate. Even if Reid can’t get the votes for what will become, in reality, a government health care system, he will be credited by his leftist supporters in the Senate, as well as back home for having given it his best. He can then offer up Senator Snowe’s trigger, regain “bipartisan support”, and attract nervous Democrats.

All the while, with the media focusing on the fight over “public option”, “opt-out”, and “trigger” provisions, other equally destructive parts of the bill will be overshadowed.

As Harry’s shell game is played in Congress, voters need to keep an eye on the ball. The problems with this “reform” go far beyond the issue of a public option. With or without the public option, it will be at minimum a trillion dollar proposal with a new “Health Choices” Commissioner dictating health insurance plans.

With or without a public option, it forces everyone to buy a government dictated health insurance plan, imposes new job-killing taxes on employers, slashes Medicare for seniors, underpays doctors and hospitals, limits the deductibility of medical expenses on income taxes, imposes billions in new fees on manufacturers of life saving medical devices, creates taxpayer subsidies for abortion and illegal aliens, and leaves millions uninsured.

Harry’s shell game is about his tough re-election prospects in Nevada. Many think he is misreading his state. Unless the people of Nevada really want this new dependency on government, they are about to bury him in “you are fired” pink slips for attempting to destroy the finest health care system in the world.


Memo: It's officially safe to criticize Barack Obama

There's a lot of buzz on Capitol Hill about a new health care memo, by strategist/communicator Frank Luntz, which is filled with advice for opponents of the Democrats' reform legislation. The memo analyzes the public's concerns that national health care will result in lower quality care at higher cost, with an out-of-control deficit to boot, and Luntz recommends language to help critics make the case against the legislation more effectively. For example, he suggests opponents would be better off avoiding the phrase public option; calling it the government option is better.

The new memo updates a similar analysis Luntz wrote last May. Some of the advice is familiar. But one striking difference between the two documents is in the treatment of Barack Obama. Last May, Luntz advised politicians to stay away -- far away -- from criticizing the president. "Your political opponents are the Democrats in Congress and the bureaucrats in Washington, not President Obama," Luntz wrote. "Every time we test language that criticized the president by name, the response was negative -- even among Republicans." He continued: "If you make this debate about Republicans vs. Obama, you lose. But if you make it about Americans vs. politicians, you win." Therefore, the advice was to go after Washington bureaucrats and government health care, but never Obama.

That was then. Now, things are different. "In the spring, we counseled strongly that you should avoid direct confrontation with President Obama," Luntz writes in the new memo. "That has changed." The "thrill is gone" from Obama's relationship with the American people, Luntz writes, and it's now OK to go after the president's proposals with the president's name attached. "There is no change in support for the plan if it is called 'Barack Obama's plan' instead of the plan of 'Democrats in Congress,'" Luntz says. "So long as the attack is grounded in policy and NOT personage, you can talk about opposing 'President Obama's plan.'"

That said, Luntz still doesn't advise doing it. "While you no longer shoot yourself in the foot by criticizing the president, you would do much better to criticize Congress -- which has disapproval ratings that will clearly sink some re-election hopes," Luntz writes. While many Republicans insist on calling health care reform "Obamacare," Luntz says they would do better by attacking "Washington."

To many readers, Luntz's advice might seem more than a little late; obviously there is a lot of criticism of Obama in the public conversation. But Luntz's memo, based on extensive research and testing of political language, will mean something for the more cautious and timid Republican lawmakers on Capitol Hill. It will assure them that not only can they go after the worst Democratic policy proposals, but they can tie them to Obama without fear of backlash from their own voters. Obama's personal popularity rating, which hit 78 percent in a Gallup poll last January, has now fallen to 56 percent. Among politically-crucial independents, it has fallen from 75 percent in January to 52 percent today. Numbers like that mean Obama's intimidation factor has disappeared. Luntz's memo gives health-care opponents a road map for taking advantage of that fact.


Dems health care “reform”: The more you know, the less you like

I’d like to bring your attention to a few interesting articles from recent days which argue strongly against the Democrats’ so-called “reform” of our health care system, particularly if you are not very old or sick:

First, from Tyler Cowen in the New York Times, his article explaining “How an Insurance Mandate Could Leave Many Worse Off." Not only would the proposal force people to buy something they don’t want (more on this below), but the structure of the subsidy package would actually create a disincentive for people to earn more money.

Second, as reported in the Wall Street Journal, WellPoint, one of the nation’s largest health care insurers, has done a series of studies on the likely effect of the Democrats’ plans on health insurance premiums in the 14 states in which they operate. (You can access all 14 reports HERE.) The results are not pretty (for the Democrats)....

In other words, in order to fund a small theoretical decrease in the cost of insurance for the elderly and sick, young healthy people are going to see their health insurance costs explode. And keep in mind that the Democrats’ plans include massive custs to Medicare funding, so the scenario for the “older” segment is far worse than even this analysis appears.

The WellPoint studies are very detailed, showing each component of the cost increases, such as the impact of guaranteed issue, limiting the age discount, and new taxes on health insurers, medical devices, and pharmaceuticals.

With the subsidies built into Democrats plans, people below 200% or 300% of the poverty line may avoid some of the true cost increase, but only by shoving that increase off to the rest of society.

In other words, the Democrats’ plans are, not surprisingly, a massive transfer of wealth system from the young and relatively young who earn a decent living to the old and poor. It has nothing whatsoever to do with controlling health care costs and will in fact make recent years’ health care inflation look like a walk in the park.

And third, the Washington Times again brings up the issue of whether the proposed reforms, particularly a federal mandate requiring people to buy something, are constitutional. While it’s obvious (to me) that the Founders and anyone who understands the Constitution would say such a mandate is clearly unconstitutional, I think a Supreme Court case on the issue would end up 5-4 or 6-3 one way or another.

A particularly interesting aspect of the case would be that even the insane and destructive overbroad interpretation of the commerce clause has always been based on interstate commerce, because “regulating” (i.e. to make regular, not to make all kinds of regulations about, using the language of the time) commerce between the states was the purpose of the language. However, health insurance is explicitly not interstate commerce; insurers are prohibited from selling policies approved in one state across a border into another state. Indeed, making health insurance interstate is one of the most important true reforms we need to make.

The Democrats are losing the public debate over health care reform, despite what their pawns in the media would like you to belive. However, they still have enormous majorities in both houses of Congress and enormous debts to the unions who fund their campaigns. Therefore, it is certainly possible that legislation may pass (probably with fewer GOP votes than you could count on one hand…between both the House and the Senate). If it does, it will spell electoral disaster for the Democrats in 2010. And, reversing the order of impact (i.e. legislation on elections), the election results in New Jersey, New York, and Virginia next week could cause “moderate” Democrats in moderate districts to rethink any possible support for Obamalosireidcus-care.

More Here

Medicare rationing for kidney dialysis

A new proposal to put the government between you and your doctor

A new proposal from Medicare has been published in the Federal Registry and it provides a window on how medical care will be delivered in the future under a government-run system. Medicare is proposing to provide a fixed budget for the medical care of dialysis patients and the details of the plan guarantee that patients will have a private company intervening in physician decisions whether to provide expensive but highly beneficial drug therapies.

The end stage kidney disease program, better known as kidney dialysis, is the one aspect of Medicare that applies to persons less than 65 years old. This quirk in the system began in the 1960s in order to help fund the expensive dialysis programs that were feasible but enormously costly on a per treatment basis. These are life-saving treatments and could not possibly be affordable to most patients. Over the years, the program has grown larger and larger because more and more patients were found to benefit from the treatment. The cost per treatment is actually about 64% of the costs 20 years ago, factored for inflation, as tremendous efficiencies have been introduced. But the program has grown to now cost 6.4% of Medicare's total budget or some $23 billion in 2006. This is because over 350,000 patients receive dialysis treatments in the United States.

One way that the system has been able to keep per treatment costs low has been the entry and domination of the industry by large, for profit, public companies like Fresenius Healthcare and Da Vita Healthcare, that can provide the capital and the integration of services to be profitable under a highly constrained cost structure. Kidney specialists are not employed by these companies but supervise care for the patient and are paid directly by Medicare for their services.

But costs continue to rise because of rising numbers of patients receiving dialysis treatments and Medicare has now decided that since drug therapy is a rising source of costs for the dialysis program, a prepayment for drug treatment will be included in a "bundled" payment for dialysis services. The "bundle" of money will go to the for-profit dialysis provider and the company will have to buy and then dispense the medications prescribed by the independent physicians. These key medications will no longer be reimbursed under Medicare's Drug Plan, the so-called "Part D". So if the physician prescribes expensive medications compared to less costly but less effective ones, the company could and probably would lose money.

This is clearly an example of Medicare creating a system that potentially interferes with a physician's best judgment and looks to the possibility of rationing more costly medications. Dialysis unit administrators will have a strong incentive to restrain physicians prescribing the more expensive medications that will likely provide a long term benefit for patients. The particular medicines that will be most affected are those that help improve bone function over the long term in dialysis patients but have little obvious short term effects. It will take years to sort out the impact of this approach.

It is true that hospitals must pay for expensive medications required by hospitalized patients and hospitals try to influence physician utilization of these expensive medications. But hospitals use physician committees to modify utilization in an appropriate fashion. The dialysis providers in a community dialysis unit do not have the resources of a hospital to organize committees of physicians to oversee utilization. Patients in dialysis units will have no inkling whether their medication regimens are based on the best care available or on the bottom line profits of a commercial enterprise. Both the companies and the physicians are being put in a bind by the government plan.

The new approach is open to public comment at this time but this is clearly the new face of rationing. Restrict payments through providing a fixed budget for care. Welcome to the British National Health Service.


The Democrats are sucking the d*cks of the trial lawyers

Those of us who are not true believers in expanded government are certain of the following:

If the 1,990-page House Health Care Bill becomes law, the average American will receive worse health care, American physicians will decline in status and income, American medical innovation will dramatically slow down and pharmaceutical discoveries will decline in number and quality. And, of course, the economy of the United States will deteriorate, perhaps permanently.

However, we are also certain that there is one American group that will thrive -- trial lawyers. The very existence of a 1,990-page law guarantees years of, if not more or less permanent, lawsuits. And the law actually specifies that states that do not limit attorneys' fees in cases of medical malpractice shall be financially rewarded. What we are seeing here, therefore, is something unprecedented in our history: Many trial lawyers will earn as much as most physicians, and fewer and fewer physicians will earn as much as successful trial lawyers.

Nothing better illustrates the reorientation -- indeed, the transformation -- of values that will take place if the Democrats' health care legislation is passed. Thanks to trial lawyer/Democratic influence, for decades, we have been moving in the direction of litigation-based society. But with a Democratic health care bill, the movement will accelerate exponentially.

Much of our money, our innovation, our creativity and our ingenuity will gravitate from medicine to law.

Young people who wish to make a good living -- and even talk themselves into believing that they are also doing good for society -- will opt for trial law over medicine. As far back as memory goes for living Americans, a young person who wished to do well, as well as do good in life, would likely choose medicine as a profession if he were bright enough and willing to put in the great number of hours necessary.

In the last generation, many of the brightest chose finance -- as it turned out, another often unproductive and often destructive arena -- to make a lot of money while believing that they, too, were doing a lot of good for society.

With the financial professions in trouble and in some disrepute, and medicine being financially and socially devalued -- doctors are increasingly called "health care providers" (along with nurses, physician's assistants, lab technicians, etc.; they're all the same) -- law, especially trial law, will be seen as offering the most opportunities for making a great deal of money.

No rational person argues that society doesn't need law or lawyers, or that all lawyers, even trial lawyers, do no good. That is certainly not what is being argued here.

But it does say something about a society when those who sue physicians and hospitals make as much or more money than those who heal disease. It says something about a society when it glorifies and rewards those who litigate while it demonizes and punishes those who produce the drugs and devices that keep its citizens alive and well.

This is part of the upside-down world the left is bequeathing to us and our children in the name of health care "reform."


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