Thursday, November 26, 2009

Third of new mothers left alone after birth by over-stretched midwives in Britain

More than one in three mothers are left alone and worried during labour or shortly after giving birth, a poll shows today. Almost a third received no free antenatal classes on the NHS, while a quarter had very little help with breastfeeding despite it being a Government priority.

Critics say the Health Service is struggling to cope with a massive shortage of midwives because officials failed to foresee huge rises in birth rates.

Sushma Cherion, 37, said she was left alone in a delivery room for two hours after giving birth for the first time. Mrs Cherion, of Hemel Hempstead, Hertfordshire, gave birth to Leia-Rose, who is now two, at King George Goodmayes Hospital in Essex. The software test engineer, who is married to Gilles, 39, said: 'When I was transferred to a ward, I was not seen by a midwife until eight hours later. 'There were no midwives on the ward and I was not greeted by anyone. I was a first-time mum and did not know that I was supposed to wake up and feed my baby.

'There was no guidance from midwives about breastfeeding. 'I wanted my soiled sheets changed but I couldn't and started crying, so I ended up changing them myself.'

The Royal College of Midwives says there is a shortage of at least 5,000 midwives. It commissioned the survey of more than 3,500 women visiting the Netmums website, which found that 35 per cent of new mothers say they were left alone during labour or just after, at a time when they felt worried.

Sally Russell, of, said: 'This survey's results should demonstrate to the Government just how stretched maternity services are. 'Some mums have told us that the lack of postnatal care has led them to suffer with postnatal depression, which can have dramatic impacts on the whole family.'


Socialist Britain too poor to afford cancer research?

If they fired just one percent of their bureaucrats, they would have a mint to spend on research

Research into cancer and dementia will come under threat from government plans to fund social care, experts warned last night. Andy Burnham, the Health Secretary, told The Times that millions of pounds would be “reprioritised” from health research and development to pay the costs of the Social Care Bill, published today. Money will also be diverted from public health campaigns such as those on swine flu, sexually transmitted diseases and obesity.

The Bill, a key plank of Gordon Brown’s pre-election legislative agenda, has been condemned by Labour peers, scientists and health campaigners. It would guarantee free care at home or other support for up to 400,000 elderly and disabled people from next October, at a cost of £670 million a year.

Mr Burnham, disclosing for the first time how he planned to pay for the proposal, said that £60 million would be diverted from the health service’s research and development (R&D) budget and £50 million from public health promotions. Cutting spending on management consultants in the NHS would provide £60 million.

Further funds will be sought as part of a “major productivity drive”, he said. The NHS is expected to make up to £20 billion in efficiency savings over the next four years. Hospitals could see their income tied to levels of patient satisfaction on matters such as the quality of maternity care.

Scientists warned of the consequences of cutting research budgets, which help to support the clinical trials of new medicines. Nick Dusic, director of the Campaign for Science and Engineering, said: “This is extremely disturbing as the NHS budget was supposed to be ringfenced to protect long-term investment into the health needs of this country. In any department any raid on the R&D budget is supposed to be discussed first with the Government’s Chief Scientific Adviser. If they’ve breached this process it’s an extremely worrying development that needs to be looked into.”

Health ministers are expected to be interrogated in detail about which elements of the R&D budget should be cut to pay for social care as part of a continuing inquiry by the Lords Science and Technology Committee. Lord Warner of Brockley, the Labour peer and former Health Minister who last week described the social care proposals as “totally misjudged”, said: “I will be looking at the Bill very carefully to see if my worst fears are confirmed and whether the figures really do add up.”

Mr Burnham defended the Bill from claims that it amounted to “an admiral firing an Exocet into his own flagship”. He denied that any cuts would affect patient care or compromise major research projects. “I’m not saying [the Social Care Bill] is perfect, but in the interim it makes the system a bit fairer now,” he said.

Asked to account for the reallocation of funds, he said: “It’s always a question of priorities. I’m not cutting into vital projects. I’m moving stuff out of lower-priority, backroom spend towards direct public benefit. All I want to say is we are being tough about that. I’m interested in really squeezing so that we get as much benefit directly to the public as quickly as we can. “I’ve got to be ruthless about that and I will be ruthless about that. We will spell it out when the Bill comes to Parliament.” He added: “I don’t think anyone can accuse us of underfunding R&D.”

The NHS research budget for 2010-11 is more than £1 billion. It funds a multitude of projects ranging from the diagnosis of brain tumours in children to reasons why patients’ immune systems are lowered after kidney transplants. Academics and research scientists expressed concern that funding to find cures for conditions such as cancer or Alzheimer’s disease could be hampered in the case of longer-term cuts to training and research.

Peter Dangerfield, co-chair of the BMA medical academic staff committee, said that budget cuts were already becoming commonplace in medical schools and that in some cases research and teaching posts were not being filled as staff retired. “There are worries and concerns here,” he said. “Research, training and education budgets are usually the among the first to go when the health service is asked to make savings. We do fear that patients could suffer quite a hard hit in the long term, missing the benefits of new medicines and expertise.”

Harpal Kumar, chief executive of Cancer Research UK, said: “The NHS research and development budget funds vital infrastructure that supports cancer clinical trials. These trials have been instrumental in driving the improvements in cancer outcomes we have seen over the past 20 or 30 years. We would be very concerned to see cuts that affected these budgets given that they are an integral part of improving health outcomes for patients. This government investment ultimately benefits everyone.”

Andrew Lansley, the Shadow Health Secretary, said that Labour’s sums did not add up. “The amount of money they are cutting from the NHS budget doesn’t even begin to cover what they claim the cost of the policy will be, which most experts agree is already a gross underestimate.

Anna Dixon, director of policy at the King’s Fund, said: “Ministers should think hard about the likely impact of reducing budgets for research and development at a time when we are asking the NHS to step up and find projects and solutions to make efficiency savings. The suggestions in the Social Care Bill are rather short-term and what we need is a more substantial and long-term solution to social care funding that will be accessible to everyone who needs it.”

Norman Lamb, the Liberal Democrat health spokesman said: “The Government’s plans are so vague as to be incredible. It’s fantasy politics and the full costing of this has to be revealed.”


Senate healthcare bill: The five paragraphs you must read

Buried in the Senate's 2,074-page health reform bill are provisions that undermine your health freedom and privacy

"There is no such thing as a little freedom," said Walter Cronkite. "Either you are all free, or you are not free."

Whether you're for or against federal efforts to help people buy health insurance, you should know that the reform bill before the Senate would mandate a healthcare system that is definitely "not free."

What most of us know about the Democratic bill is that it requires nearly all Americans to have health insurance. What most of us don't know is that it requires us to buy a minimum level of insurance approved by the federal government, and forces health plans and providers to share our personal health information with the federal government and other entities.

If this bill becomes law, we could each be assigned a national beneficiary ID number or card (possibly an electronic device). And our personal health information will flow electronically to the US secretary of Health and Human Services (HHS) – and many others – without our consent.

Sound farfetched? Buried in the Senate bill's 2,074 pages are provisions that actually permit and foster such things. Freedom and privacy are often lost in the fine print – which is why we've been studying the Senate bill since it was released Nov. 19 to help uncover the facts. Here are five highly invasive provisions Americans should know:

1. Mandatory insurance

Bill text: "Sec. 1501. Requirement to Maintain Minimum Essential Coverage.... An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month."

Translation: Uncle Sam will now serve as your national insurance agent and force you to buy "minimum essential coverage" – or else you'll have to pay an annual fine. However, what Congress considers "minimum essential coverage" and "essential health benefits requirements" includes comprehensive coverage that many neither need nor want. Plus, those who prefer to carry catastrophic-only coverage won't have a free range of options for such coverage.

Bottom line: In a free society, the government should not force citizens to buy any product nor should the government mandate citizens' level of health-insurance coverage. Rather than imposing penalties to coerce people into government-sanctioned health insurance, Congress should offer incentives to help those who wish to buy insurance but find it unaffordable.

Congress could allow everyone to deduct the full cost of health insurance (and provide tax credits for those with no tax liability), while offering assistance to those who can't afford insurance and subsidize high-risk pools for those with preexisting conditions.

Helping those in need is a much better way to reform our nation's healthcare system than overhauling the entire system and putting Big Brother in charge of deciding what is acceptable coverage for nearly every American.

2. Electronic data exchanges

Bill text: "Sec. 1104. Administrative Simplification…. (h) Compliance. – (1) Health Plan Certification. – (A) Eligibility for a Health Plan, Health Claim Status, Electronic Funds Transfers, Health Care Payment and Remittance Advice. – Not later than December 31, 2013, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards (as described under paragraph (7) of section 1171) and associated operating rules (as described under paragraph (9) of such section) for electronic funds transfers, eligibility for a health plan, health claim status, and health care payment and remittance advice, respectively."

Translation: Requiring everyone to buy federally sanctioned health insurance, and then forcing qualified plans to comply with Administrative Simplification requirements, provides the government and health industry with power they would not be able to exercise in a free market.

Administrative Simplification rules are a product of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. They lay the foundation for a nationally linked database of personal health information. A federal "Nationwide Health Information Network" (NHIN) is well under way in the United States, without assurances that individuals will control their personal health data.

Bottom line: Americans should be able to contract privately with the insurance companies of their choice. Patients should be able to decide whether to have electronic or paper medical records, and not have the government require electronic records, which are then included in a nationally linked database.

3. Real-time health and financial data

Bill text: "Sec. 1104. Administrative Simplification…. (4) Requirements for Financial and Administrative Transactions. – (A) In General. – The standards and associated operating rules adopted by the Secretary shall – (i) to the extent feasible and appropriate, enable determination of an individual's eligibility and financial responsibility for specific services prior to or at the point of care.... (i) Eligibility for a Health Plan and Health Claims Status. – The set of operating rules for eligibility for a health plan and health claim status transactions shall be adopted not later than July 1, 2011, in a manner ensuring that such operating rules are effective not later than January 1, 2013, and may allow for the use of a machine readable identification card."

Translation: Administrative Simplification rules are being expanded to gather real-time financial and health data on individuals through a tracking ID, possibly a "machine readable" ID card (electronic device).

Bottom line: Moving forward with real-time data collection without an ethical patient consent provision means everyone loses their health-privacy rights. Congress needs to enact strong patient consent provisions for all health data, especially data collected "real-time."

4. Health data network

Bill text: "Sec. 6301. Patient-Centered Outcomes Research.… (f) Building Data for Research. – The Secretary shall provide for the coordination of relevant Federal health programs to build data capacity for comparative clinical effectiveness research, including the development and use of clinical registries and health outcomes research data networks, in order to develop and maintain a comprehensive, interoperable data network to collect, link, and analyze data on outcomes and effectiveness from multiple sources, including electronic health records."

Translation: Your personal health information may soon be studied by government scientists. Washington is creating a new research center that plans to use patients' electronic health records for conducting research and creating disease registries. The data network is comprehensive and includes use of electronic health records.

Bottom line: Federal funds should not be used to collect data electronically and conduct research on patients' personal health information without their consent.

5. Personal health information

Bill text: "Sec. 6301. Patient-Centered Outcomes Research…. (B) Use of Data. – The [Patient-Centered Outcomes Research] Institute shall only use data provided to the Institute under subparagraph (A) in accordance with laws and regulations governing the release and use of such data, including applicable confidentiality and privacy standards."

Translation: Think your health privacy is protected? It's not. This language refers to "applicable confidentiality and privacy standards," but HIPAA's so-called privacy law permits individuals' personal health information to be exchanged – for many broad purposes – without patients' consent (See 45 CFR Subtitle A, Subpart E – Privacy of Individually Identifiable Health Information; section 164.502(a)(1)(ii) "Permitted uses and disclosures").

Bottom line: Trust is a must for ensuring quality healthcare. Thus, as stated above, Congress needs to pass a strong, ethical patient consent law that ensures patients have control over the flow of their personal health information. What about the consent of the governed?

All told, the national mandatory health-insurance bill puts the federal government in charge of individuals' insurance choices and data privacy. This philosophy of governing is the opposite of America's founding principle: consent of the governed. Without health freedom and privacy rights, Congress is opening the door for many wrongs to be committed – all in the name of covering the uninsured.


Medicare Cuts Oxygen under new rules‏

First Mammograms and now oxygen

New Medicare rules designed to reduce waste and fraud in medical-equipment reimbursements are driving some home-oxygen suppliers out of business and leaving patients scrambling to find new providers. The new payment rules, effective Jan. 1, affect the more than one million people who rely on Medicare to pay for oxygen services, which relieve the symptoms of conditions such as emphysema and chronic obstructive pulmonary disease.

"It's totally penny-wise and pound-foolish," says Barbara Renzullo, a nurse and case manager at Massachusetts General Hospital in Boston. Some patients, unable to find a new supplier because their reimbursement rate has fallen so far, "wind up in the hospital."

Under the new rules, Medicare pays suppliers at the prevailing rate —an average of $200 a month, paid 80% by Medicare, 20% by patients—for the first three years after a patient begins coverage. Suppliers are then required to continue providing oxygen services to patients for an additional two years, but at a sharply reduced payment rate. After that, patients are entitled to receive new equipment, and Medicare will resume paying suppliers at the higher rate.

The changes are part of broader efforts by Congress and the Centers for Medicare and Medicaid Services, or CMS, which oversees the federal insurance programs, to address waste and fraud in reimbursements for so-called durable medical equipment, which includes things like home-oxygen machines, wheelchairs and walkers. CMS says it expects to save about $220 million in the fiscal year that began last month. The agency says it had been paying too much for oxygen equipment, and that payments for the first three years should cover service costs for the two-year gap.

Suppliers say those calculations don't account for how much it actually costs to provide services, such as delivering oxygen tanks. Some are balking at accepting new patients who are near or have already reached the three-year limit on full payments. The companies would have to provide oxygen services for the next two years while getting minimal payments for follow-up visits and other services.

Ms. Renzullo, at Massachusetts General, said she has seen patients forgo using oxygen when their suppliers closed and no other company would take them. In January, one terminally ill patient wanted to move to Virginia to live with her daughter, Ms. Renzullo says. But the patient had reached the three-year oxygen payment cap, and no supplier in Virginia would accept her. The patient spent extra days in the hospital while Ms. Renzullo tried to sort out the situation. Ultimately, a Massachusetts supplier mailed an oxygen concentrator to Virginia.

Some smaller, independent oxygen providers, which account for much of the industry's business, say they are being driven out by separate Medicare rules that took effect Oct. 1 and require durable medical-equipment suppliers to be accredited and to post a surety bond.

The changes are supported by many in the industry, but some small suppliers say they can't afford them. It costs $2,500 to $3,500 for a company to go through an accreditation survey, says Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers. But a supplier may spend tens of thousands of dollars to comply with the stringent requirements.

Respiratory therapist Bob Sherman is job hunting after his company, Family Pharmacy and Valley Medical Supply in Stevensville, Mont., decided to exit the durable medical-equipment business. The costs for accreditation and a surety bond, coupled with lower reimbursements, cut too far into profits, he says.

A CMS spokesman said the agency has heard of one supplier filing for bankruptcy recently, but is unsure whether it was caused by the new rules. He also said the amount paid to suppliers to maintain equipment was increased last month.


Obamacare: Big State Tax Hikes

Anxious to avoid raising taxes too much to pay for their health care proposals, the Obama administration and its congressional allies hit on a great new idea: Make the states raise their taxes to fund the program, instead.

Both the House and the Senate bills require that states cover a larger percentage of their people under Medicaid -- a joint state and federally funded program. The idea was to force states to raise their taxes to cover a big part of the health care bill for treating poor people. Since the Feds can simply charge any increase in spending to their already overdrawn bank account, but the states have to balance their budgets, the increased state spending for Medicaid will cause sharp increases in state taxes. And the governors will get the blame, not Obama and not the Congress.

The House bill requires states to give Medicaid to those whose incomes are less than 150 percent of the poverty level, while the Senate will settle for only 125 percent. For most states, this is a hefty increase.

In some states, like New York, where Medicaid covers everyone making 150 percent of the poverty level already, there will not be any extra required spending. But not so in California, which only covers 100 percent of the poverty level. Were the House bill to pass, the already fiscally beleaguered state would have to increase its Medicaid spending on poor people by 50 percent, at least an extra $2 billion a year and perhaps more.

In many Southern states, the Medicaid program only covers a portion of those living below the poverty level. For these states, the requirement to cover all those in poverty and then 50 percent more will cause enormous increases in taxes. In Arkansas and Louisiana, where swing-Senators Pryor, Lincoln and Landrieu come from, the cost could exceed $1 billion for each state each year.

Unfunded mandates for state spending imposed from on high in Washington have always rankled governors. The senators and congressmen in Washington get the credit for spreading largesse, but the governors in the states get the blame for the taxes that are needed to pay for it. Since Democrats currently control the vast majority of governorships, this process of making their own party members take the rap for raising taxes is politically self-destructive in the extreme. But Obama is so desperate to pass his health care legislation that he doesn't care what havoc in his party he reaps in the process.

The question now is whether the governors of the 50 states, particularly the Democrats, are going to sit idly by and let their budgets be destroyed by the health care bill.

When the Republicans in Congress insisted on tacking big cuts in aid to legal immigrant benefits for disability and other areas onto the welfare reform bill, it was the Republican governors who forced them to repeal the pernicious cuts the very next year. They did not want to have to raise taxes to make up for the withdrawal of federal funding.

Now, the Democratic governors face the same situation. If Obamacare passes with its expansion of Medicaid benefits -- but with no federal funding of the extra spending -- it is these Democrats and their legislatures that will have to bite the bullet and pass new taxes to pay for it.

Since states are already facing mammoth financial problems as a result of dwindling revenues and swelling expenditures in the recession, these additional burdens could be politically fatal. Unless Democratic governors want to avoid the fate of one of their late brethren, former Gov. Jon Corzine of New Jersey, whose political career was ended in a blaze of new taxes, they might want to call their buddies in Congress and ask them to lay off the unfunded mandates, particularly during this recession.


A budget-buster in the making

The article below is by respected journalist, David S. Broder, writing in a Left-leaning paper

It's simply not true that America is ambivalent about everything when it comes to the Obama health plan. The day after the Congressional Budget Office (CBO) gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results. This poll may not be as famous as some others, but I know the care and professionalism of the people who run it, and one question was particularly interesting to me.

It read: "President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?"

The answer: Less than one-fifth of the voters -- 19 percent of the sample -- think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely. That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.

I have been writing for months that the acid test for this effort lies less in the publicized fight over the public option or the issue of abortion coverage than in the plausibility of its claim to be fiscally responsible. This is obviously turning out to be the case. While the CBO said that both the House-passed bill and the one Reid has drafted meet Obama's test by being budget-neutral, every expert I have talked to says that the public has it right. These bills, as they stand, are budget-busters.

Here, for example, is what Robert Bixby, the executive director of the Concord Coalition, a bipartisan group of budget watchdogs, told me: "The Senate bill is better than the House version, but there's not much reform in this bill. As of now, it's basically a big entitlement expansion, plus tax increases."

Here's another expert, Maya MacGuineas, the president of the bipartisan Committee for a Responsible Federal Budget: "While this bill does a better job than the House version at reducing the deficit and controlling costs, it still doesn't do enough. Given the political system's aversion to tax increases and spending cuts, I worry about what the final bill will look like."

These are nonpartisan sources, but Republican budget experts such as former CBO director Douglas Holtz-Eakin amplify the point with specific examples and biting language. Holtz-Eakin cites a long list of Democratic-sponsored "budget gimmicks" that made it possible for the CBO to estimate that Reid's bill would reduce federal deficits by $130 billion by 2019.

Perhaps the biggest of those maneuvers was Reid's decision to postpone the start of subsidies to help the uninsured buy policies from mid-2013 to January 2014 -- long after taxes and fees levied by the bill would have begun.

Even with that change, there is plenty in the CBO report to suggest that the promised budget savings may not materialize. If you read deep enough, you will find that under the Senate bill, "federal outlays for health care would increase during the 2010-2019 period" -- not decline. The gross increase would be almost $1 trillion -- $848 billion, to be exact, mainly to subsidize the uninsured. The net increase would be $160 billion.

But this depends on two big gambles. Will future Congresses actually impose the assumed $420 billion in cuts to Medicare, Medicaid and other federal health programs? They never have. And will this Congress enact the excise tax on high-premium insurance policies (the so-called Cadillac plans) in Reid's bill? Obama has never endorsed them, and House Democrats -- reacting to union pressure -- turned them down in favor of a surtax on millionaires' income.

The challenge to Congress -- and to Obama -- remains the same: Make the promised savings real, and don't pass along unfunded programs to our children and grandchildren.


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