Thursday, November 12, 2009

Socialized medicine in Japan

Fourteen Hospitals Turn Away Critically-Injured Elderly Man

Rescue workers in Japan called fourteen hospitals before finding one that would take an elderly bicyclist who collided with a motorcycle. The accident, which occurred at 10:15 pm in the Japanese city of Itami, left the 69-year-old bicyclist, who was not identified, in critical condition with back and head injuries. Paramedics arrived on the scene five minutes after the crash and administered first aid. Yet, for about an hour, they were unsuccessful at locating a hospital to treat the man.

Helpless, the elderly man waited in the ambulance at the accident scene as hospital after hospital rejected treating him, citing unavailable beds, staff shortages and a lack of equipment and specialists. All told, fourteen hospitals in the neighboring prefectures - i.e., governing districts - of Hyogo and Osaka refused his entry.

"There were four other emergency calls in the same time frame of that night," explained Mitsuhisa Ikemoto, the fire department spokesman. "[A]s a result, we were unable to find a hospital."

It took a second round of calls for rescue workers to find a hospital. Finally, at 11:30 that night - 75 minutes after the accident - they took him to a hospital in Itami, which had initially declined to accept him. Unfortunately, it soon became apparent that the hospital's resources that night were unsatisfactory.

At the time of his arrival at the hospital, the elderly man was already in critical condition from the accident and post-accident delay. When his condition suddenly deteriorated, hospital staff scrambled "to transfer him for better treatment," according to the Associated Press.

Two hospitals rejected that transfer request. By the time a third hospital agreed to take the man, his condition was too poor to permit him to be moved. He died of hemorrhagic shock at about 1:15 the next morning.

The Associated Press reported that the man "initially showed stable vital signs," and, attributing the assessment to Ikemoto, reported the man "might have survived if a hospital accepted him more quickly." Ikemoto was quoted saying, "I wish hospitals are more willing to take patients..."

Rescue workers also had trouble finding a hospital to treat a 29-year-old motorcyclist who also had been involved in the crash. Despite the motorcyclists' severe injuries, the first two hospitals contacted refused to admit him. The third try succeeded, and the man was taken to a university hospital in Hyogo. Fortunately, two weeks after the accident, he was recovering.

The frustrating, and in one case, tragic experiences of the two accident victims initially denied medical care are not unique in Japan's universal health insurance system.

According to a government survey conducted by the country's Fire and Disaster Management Agency, Japanese hospitals denied admission to some 14,387 emergency patients in 2007. All 14,000-plus patients identified on paramedics' reports were rejected at least three times. Moreover, at least 3.5 percent of these victims had serious conditions, which the survey defined as requiring more than three weeks of hospitalization.


Zogby: Obama Job Approval on Healthcare Legislation Sits At 39%

President's Approval Still Double That of Both Congressional Democrats and Congressional Republicans

As the United States Senate prepares to vote on its version of the healthcare bill, likely voters show a strong dissatisfaction with both major political parties. President Obama has the highest job performance rating with regard to healthcare reform legislation of the five politicians and parties tested, a paltry 39% approval.

President Obama still holds a healthy positive approval on the issue of healthcare among his base - 74% positive among Liberals and 73% positive among Democrats. The President's performance on healthcare is also rated positively by half of all Moderates (50%), though 47% rate his performance as negative.

Congressional Republicans and Democrats fare much worse, even among their own base of supporters, with each group receiving a positive rating from fewer than one-in-five likely voters. Only one-in-three Conservatives (34%) rate Congressional Republicans performance as "excellent" or "good," while two-in-three Conservatives (65%) rate the performance "fair" or "poor." Congressional Democrats receive similar ratings from Liberals (38% positive, 59% negative).

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Narrowly passed House health care bill lacks broad support

The narrow margin that carried the Nancy Pelosi/Barack Obama health care bill to victory in the House late Saturday should inform the Senate as it finalizes its own plan. The bill passed 220-215 with one Republican siding with the majority and 39 mostly moderate and conservative Democrats joining opponents. This is an economy busting bill devised and passed by liberal Democrats who largely ignored appeals for moderation.

A measure that will impact every American and greatly rework the nation's health care system should not be rammed through in such a divisive way. The Senate's task is to scale back the expense and scope of the bill to something more palatable to the broadest number while favoring less disruptive, incremental change at a time when the economy can ill afford higher taxes and deeper deficits.

Concerns and questions about the bill were waved away by the House majority. But they must be forthrightly dealt with by the Senate. Above all else is the cost. Democrats estimate the cost at $1.2 trillion over the next decade, but have worked feverishly to repress credible, contrary estimates that the true expense will be $2 trillion or more. The plan will levy taxes for 10 years to pay for six years of benefits, suggesting that in the second decade the annual costs will explode.

Democrats say the health care package will not increase the deficit because it contains offsetting cost cuts. To believe that, Americans would have to forget everything they know about how the federal government operates and its inability to manage its current health care programs -- Medicare and Medicaid -- with anything resembling fiscal responsibility.

Part of the supposed savings will come by trimming $500 billion from Medicare, a reckless move considering that the program is already hurtling toward insolvency.

The House bill makes a mockery of President Barack Obama's promise that those who currently have health insurance they're satisfied with will not be forced to change. By setting up a government panel to mandate coverage levels, it will strip employees and employers of the right to negotiate their plans that suit their own needs. It also mandates that employers cover 72.5 percent of employee insurance or pay an 8 percent fine. Many employers will find the fine less expensive than the mandated policies and dump their employees into government sponsored plans.

It returns an HMO-style management system for determining what procedures and treatments are covered, what fees are paid and who can provide care. Americans have unpleasant memories of how such a system worked in the 1980s, and have no reason to think government can execute it any better.

The bill reaches well beyond the stated goals of providing everyone access to affordable health care and controlling the soaring costs of insurance. It diverts billions of dollars into ill-defined community health programs that are bound to become a major pay-off to Democratic interests. It also contains a series of gratuitous racial preference requirements.

The House bill has the real potential of raising taxes on businesses and consumers alike, killing jobs in a fragile economy and establishing a massive new bureaucracy with an insatiable appetite for tax dollars.

It's a mess. Surely the Senate can do better. It ought to start by acknowledging the House bill is too expensive, too radically changes health care and promises to bring a deep and bitter divide to the nation.


Democrats Raise Alarms Over Health Bill Costs

Article below from the NY Slimes. Interesting that even they acknowledge problems

Mr. Obama has made cost containment a centerpiece of his health reform agenda, and in May he stood up at the White House with industry groups who pledged voluntary efforts to trim the growth of health care spending by 1.5 percent, or $2 trillion, over the next decade. But health economists say it is impossible to know whether the bills, including one passed by the House on Saturday night, would meet that goal, and many are skeptical that they even come close.

Experts — including some who have consulted closely with the White House, like Dr. Denis A. Cortese, chief executive of the Mayo Clinic — say the measures take only baby steps toward revamping the current fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed. Some senators are also dissatisfied. “My assessment at this point,” said Senator Ron Wyden, Democrat of Oregon and a member of the Finance Committee, “is that the legislation is heavy on health and light on reform.”

There are a variety of ideas for attacking cost increases more aggressively, including setting Medicare reimbursement rates for doctors and hospitals more rigorously and discouraging workers and employers from buying expensive health insurance policies that mask the true costs of treatment.

Among other innovations being considered is a cost-cutting method known as bundling, in which health providers receive a lump sum to care for a patient with a particular medical condition, say, diabetes or heart disease. The House bill calls for the administration to develop a plan for bundling, while the Senate Finance Committee version of the bill gives it until 2013 to create a pilot program.

Some experts would like to see such changes adopted more quickly, and senators of both parties say they will press for more aggressive cost-cutting measures when the bill comes up for debate. But drastic changes in the health care reimbursement system could cost the White House the support of doctors and hospital groups, who have signed onto the legislation and are lobbying hard to keep the current fee-for-service system from being phased out too quickly.

The debate underscores a fundamental tension inside the White House between cost-containment idealists and pragmatists.

The first group includes officials like Peter R. Orszag, the budget director, and Dr. Ezekiel J. Emanuel, the medical ethicist whose brother Rahm is the chief of staff. The second includes Rahm Emanuel and Nancy-Ann DeParle, the director of the Office of Health Reform, who must contend with the realities of getting legislation passed. “Let’s be honest,” Rahm Emanuel said in a recent interview. “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.” He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”

Mr. Orszag would not be interviewed. But in an e-mail message sent through a spokesman, he said the current legislation “lays the foundation” for cost-cutting over the long-term, adding: “Will more need to be done in the future? Absolutely.”

Senator Susan Collins, the Maine Republican whose vote the administration is courting, convened a news conference on Monday with Senator Lamar Alexander of Tennessee, a member of the Republican leadership, to spotlight her concerns over cost containment. Ms. Collins said she had been meeting with a group of moderate Democrats who shared her views. “I don’t believe we need more pilot projects to show us that health care delivery reforms are necessary,” she said in an interview. She added, “I think people are much more upset over the cost of care than the administration is acknowledging.”

Both the House and the Senate are proposing cost-saving measures. The House bill projects $440 billion in Medicare savings over 10 years; the Senate Finance Committee bill projects about $420 billion. White House officials say there will be additional, substantial savings in the private sector, as well. But how much is not clear.

Still, it is one thing to wring savings out of a bloated system, quite another to change the way that system does business. Experts agree that the Senate Finance bill does more to put systemic changes in place. That is because the bill includes two measures that health economists favor: a tax on high-value “Cadillac” health plans, and an independent commission that would make binding recommendations on how to cut Medicare costs.

House Democrats strongly oppose the Cadillac tax, which would hurt, among other people, union workers with generous benefit plans. But Ms. DeParle said in an interview that she sensed fresh interest in the House in adopting the Medicare commission idea. “There is a lot of support for cost containment,” she said.

Dr. Cortese, of the Mayo Clinic, said the bills could do more to reward quality care over quantity. He said he had met with Mr. Orszag and others at the White House and had proposed legislative language that would give Medicare three years to begin rewarding hospitals that are delivering better care at lower cost. “Our position has been focusing on paying for value,” he said, adding, “My take is there are people in the White House who understand exactly what I’m saying.”

Yet a deal the White House made with the hospital industry could make it difficult to cut costs too deeply. The White House and the Senate Finance Committee chairman, Max Baucus of Montana, agreed to limit hospitals’ payment reductions to $155 billion over 10 years. Those savings will come almost exclusively from “an agreement to squeeze the prices a little bit across the board, rather than reforming the way payments work,” said Mark McClellan, who ran Medicare under President George W. Bush.


Employer taxes may spook Senate on health care

As the Senate prepares to vote on its version of health care legislation, one of the most contentious issues will be a provision requiring employers to provide insurance coverage. With the jobless rate at 10.2 percent and expected to climb, penalties for employers who don't offer insurance benefits will make it difficult for moderate Senate Democrats to support the plan.

While most big companies provide workers with health insurance, many smaller employers do not, and they would end up having to come up with the money to either buy coverage or pay a penalty. "There is no question it will result in job loss and it will encourage employers not to hire employees," said John Goodman, president of the conservative National Center for Policy Analysis.

In the Senate, Democratic leaders are considering a $750-per-worker tax on companies that employ more than 50 people but don't offer benefits.

The House bill passed narrowly on Saturday night requires employers to pay a tax of 8 percent of total payroll if they do not provide health care coverage that meets federal standards. The House bill requires companies to pay 72.5 percent of a single worker's health care premiums and 65 percent of a family's coverage. Goodman called the proposal "a huge tax on labor," especially if it is coupled with the 2.5 percent income tax that would be levied on an individual who went without coverage under the House bill.

The House bill would also assess a graduated payroll tax beginning at 2 percent for companies earning $500,000 annually and rising to 6 percent for those making between $670,000 and $750,000 per year. "There are plenty of employers earning more than $500,000 annually," said Amanda Austin, director of federal public policy for the National Federation of Independent Businesses. "That, in our estimation, is right around a 15- to 17-employee firm."

Companies are so fearful of a looming tax and mandate coupled with the tough economy, Austin said, that many have stopped hiring. If the an employer mandate become law, she said, many companies will shed jobs. "The workers who are going to get cut are the low-wage workers," Austin said. "Or the employer will cut them down to part time, or won't expand the business. Or, he'll keep his full-time workers, and nobody gets raises."

Henry Aaron, a health care expert at the liberal Brookings Institution, said employer mandates play a critical role in reforming health care by providing an incentive for companies to maintain employee health care coverage. Without such penalties and taxes, Aaron said, companies would be tempted to boot workers into the new government plan. "There are going to be gainers and losers, but on balance, there is no reason to expect that these costs over the long haul are going to put a big dent in profits," Aaron said. "They are most likely to put a big dent on future wage increases that workers enjoy."


Kennedy's disability plan could snag health bill

An insurance plan championed by Sen. Edward M. Kennedy that would help elderly or disabled people avoid nursing homes ironically adds yet another sticking point to the comprehensive health care reform plans for which the Massachusetts Democrat fought through much of his career. The Community Living Services and Support (CLASS) Act is designed to help those who need assistance with basic daily tasks pay for in-home assistance. But moderate Democrats and Republicans worry about the plan's impact on the deficit and the potential for saddling the federal government with the responsibility of another insurance program.

Sen. Kent Conrad, North Dakota Democrat and chairman of the Budget Committee, has called the act a Ponzi scheme.

Under the proposal in the House-passed version of the overhaul, the CLASS Act fund would collect monthly premiums, estimated to be $65 in 2011, from the wages of all working Americans, unless they elect to opt out - a technique used to help drive participation. Once they pay premiums for five years, participants would be eligible for cash benefits to help them buy in-home care, if they can no longer care for themselves. Participants would qualify if they could no longer do two of life's basic tasks on their own, such as eating, showering and dressing.

Mr. Kennedy first proposed the act years ago and later included it in the comprehensive reform bill that his Senate health committee passed a month before he died in August. "We must pass the CLASS Act and create a long-term care infrastructure in this country that will support every American's choice to live at home and be part of their community," he said in November 2006. "Every older or disabled American has this right, and it's our job in Congress to provide them with the support they need to make this a reality."

But budget hawks warn that cost estimates for the program by the Congressional Budget Office (CBO), Congress' nonpartisan budget-keeper, don't look far enough into the future, when they expect benefit requests will far outweigh revenue. "While the goals of the CLASS Act are laudable - finding a way to provide long-term care insurance to individuals - the effects of including this legislation in the merged Senate bill would not be fiscally responsible for several reasons," several senators wrote late last month in a letter to Senate Majority Leader Harry Reid, Nevada Democrat, asking him to keep the act out of the bill he sends to the Senate floor.

"Nearly all the savings result from the fact that the initial payout of benefits wouldn't begin until 2016, even though the program begins collecting premiums in 2011," wrote the group, which includes Mr. Conrad and Democratic Sens. Mary L. Landrieu of Louisiana, Evan Bayh of Indiana, Blanche Lincoln of Arkansas, Ben Nelson of Nebraska and Mark Warner of Virginia, as well as Connecticut independent Joe Lieberman.

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