Wednesday, December 30, 2009

British hospital food campaigns 'have failed'

Lots of patients come out of British hospitals with malnutrition but more than £50 million spent on bids to improve hospital food has been wasted, according to a recent report

Researchers said 17 separate government initiatives since 2000 had resulted in no discernable improvement in the quality of meals served to patients and a change in the law was needed. Alex Jackson, from the Good Food for our Money campaign which published the report, said the initiatives had been a missed opportunity. He said: "The Government has led us into an expensive ground hog day to improve hospital food and seems incapable of learning from past mistakes.

"One billion meals are served by public sector institutions every year, paid for by taxpayers' money. This huge amount of food provides a unique opportunity to improve health and encourage more sustainable farming. Yet the Government has failed to seize this opportunity, and continues to spend our money on issuing weak voluntary schemes and yet more 'guidance' to public sector caterers, who are given no incentive to take action."

The authors of the report, called A Decade of Hospital Food Failure, want to see the introduction of legal standards guaranteeing the quality of the food and its environmental benefits.

Among the schemes criticised was the £40 million Better Hospital Food Initiative which was launched in 2001, headed by former Masterchef host Loyd Grossman, before being scrapped five years later. It set a target for all hospitals to introduce at least three new meals from its menu, but figures from the Hospital Caterers Association found after five years a quarter of NHS trusts had failed to introduce a single dish.

The report also quoted researchers from Bournemouth University who tested the quality of food in hospitals earlier this year and found patients were often left "undernourished and hungry" and would be better fed in prison.

The Good Food for our Money campaign is organised by Sustain, a charity that campaigns for better food, whose members include Christian Aid, Friends of the Earth and the Wholesome Food Association.


Bungling NHS fraud busters

NHS fraud investigations cost three times more than they recover

A fraud squad dedicated to detecting those cheating the National Health Service has cost three times as much money as it recovered, new figures have revealed. Over the last three years, the budget of the NHS Counter Fraud unit was £32.4 million, while the squad recovered £10.1 million. The figures, contained in a Parliamentary written answer obtained by the Liberal Democrats, also show that fewer than 200 convictions were secured.

Norman Lamb, the party’s health spokesman, said that the unit was failing to deliver value for money. He added: “Tackling fraud and ensuring that every penny spent by the NHS can be accounted for is a vital task. There must be serious question marks over whether this unit is working effectively. “It is clear from these figures that the current approach isn’t working.

The NHS needs to work more closely with the police to tackle fraud at a local level and ensure that every penny possible goes to frontline services. “These figures raise serious questions about whether a dedicated NHS Counter Fraud Unit is the best way to tackle this complex issue. We need an urgent review of how fraud is investigated.”

Fraud is estimated to cost the NHS £115 million a year.


Surprise: NYT Discovers Spending Money on Frail Elderly Not Always Useless

After a year of front-page stories pushing not so subtly for reductions in “costly” end of life care for the old and “frail” (as a precursor for the kind of universal health care the editors favor) reporter Reed Abelson looked at the other side of the debate in a December 23 front-page piece from Los Angeles, an entry in the paper’s new “Months to Live“ series: “U.C.L.A. Medical Center at Heart of End-of-Life Debate.”
The Ronald Reagan U.C.L.A. Medical Center, one of the nation’s most highly regarded academic hospitals, has earned a reputation as a place where doctors will go to virtually any length and expense to try to save a patient’s life.

“If you come into this hospital, we’re not going to let you die,” said Dr. David T. Feinberg, the hospital system’s chief executive.

Yet that ethos has made the medical center a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.

That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive.

Take the case of Salah Putrus, who at age 71 had a long history of heart failure. After repeated visits to his local hospital near Burbank, Calif., Mr. Putrus was referred to U.C.L.A. this year to be evaluated for a heart transplant. Some other medical centers might have considered Mr. Putrus too old for the surgery. But U.C.L.A.’s attitude was “let’s see what we can do for him,” said his physician there, Dr. Tamara Horwich.

Indeed, Mr. Putrus recalled, Dr. Horwich and her colleagues “did every test.” They changed his medicines to reduce the amount of water he was retaining. They even removed some teeth that could be a potential source of infection. His condition improved so much that more than six months later, Mr. Putrus has remained out of the hospital and is no longer considered in active need of a transplant.

One certainly doesn't see admissions like this in the Times very often:
Indeed, U.C.L.A. and five other big California medical centers recently published their own research results with a striking conclusion: for heart failure patients, the hospitals that spend the most seem to save the most lives


Obamacare: Less Healthcare For More People

Over the Christmas holiday lull, I saw one commenter support Obamacare on the purely utilitarian grounds that the government should do that which benefits the most people. I almost spit out my eggnog. Obamacare will actually harm most people to benefit the minority by reducing the level of medical care we now receive so that the minority can get greater access. I am not saying that is wrong–protecting minorities is usually a very worthy endeavor. But that statement just wasn’t true. For better or worse, the point of Obamacare is to provide less health care for more people, not better health care or more affordable health care.

None other than the liberal columnist Bob Herbert sees it and complains that union members will be hurt by that agenda in today’s New York Times. He writes against taxing so-called “Cadillac” insurance policies–most of which are enjoyed by union members, and reveals an important truth. From his column:
The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care. Which is exactly what the tax is designed to do.

Precisely. And that “cost cutting” agenda is the law’s primarily thrust–which is why the expensive for whom to care will find themselves rationed out.

Moreover, since another primary purpose of the bill is to grant the government greater power over all our lives to promote the cultural agendas of the Left, Obamacare exacerbates the cuts to come by expanding the meaning of health care to encompass non medical things, like paying counselors visit the homes of families with small children. When the health care financing system pays for non health care services, it will mean, by definition, there will be less money to pay for the delivery of true medicine.


Why the Personal Mandate to Buy Health Insurance Is Unprecedented and Unconstitutional

Some excerpts from an extensive legal analysis of the interstate commerce clause and the Supreme Court's most expansive precedents

Executive Summary

A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States. An individual mandate would have two features that, in combination, would make it unique. First, it would impose a duty on individuals as members of society. Second, it would require people to purchase a specific service that would be heavily regulated by the federal government.[1]

This statement from a 1994 Congressional Budget Office Memorandum remains true today. Yet, all of the leading House and Senate health-care reform bills being debated in Congress require Americans to either secure or purchase health insurance with a particular threshold of coverage, estimated by CBO to cost up to $15,000 per year for a typical family.[2] This personal mandate to enter into a contract with a private health insurance company is enforced through civil and criminal tax penalties in section 501 of the House bill[3] and with a freestanding mandate and equally questionable civil tax penalties in sections 501 and 513 of the pending Senate bill.[4]

The purpose of this compulsory contract, coupled with the arbitrary price ratios and controls, is to require many people to buy artificially high-priced policies to subsidize coverage for others as well as an industry saddled with other government costs and regulations. Congress lawfully could enact a general tax to pay for these subsidies or it could create a tax credit for those who buy health insurance, but that would require Congress to "pay for" or budget for the subsidies in a conventional manner. The sponsors of the current bills are attempting, through the personal mandate, to keep the transfers entirely off budget or--through the gimmick of unconstitutional taxes or penalties they dub "shared responsibility payments"--make these transfers appear to be revenue-enhancing.

This "personal responsibility" provision of the legislation, more accurately known as the "individual mandate" because it commands all individuals to enter into a contractual relationship with a private insurance company, takes congressional power and control to a striking new level. Its defenders have struggled to justify the mandate by analogizing it to existing federal laws and court decisions, but their efforts do not withstand serious scrutiny. An individual mandate to enter into a contract with or buy a particular product from a private party, with tax penalties to enforce it, is unprecedented-- not just in scope but in kind--and unconstitutional as a matter of first principles and under any reasonable reading of judicial precedents.

Congress has a responsibility, pursuant to the oath of all Senators and Representatives, to determine the constitutionality of its own actions independently of how the Supreme Court has previously ruled or may rule in the future. But it is very unlikely that the Court would extend current constitutional doctrines, or devise new ones, to uphold this new and unprecedented claim of federal power.

Constitutional Overview

In reaction to states that were enacting trade barriers and violating the rights of their citizens, those who drafted and ratified the U.S. Constitution were determined both to constrain the powers of states and, at the same time, limit the power of Congress. They designed an ingenious system of checks and balances that divides state and federal authority in the hope of preventing any one government from exerting too much control over a free people.[5] To that end, the Constitution creates a national government with a legislature of limited and enumerated powers. Article I allocates to Congress "[a]ll legislative powers herein granted,"[6] which means that some legislative powers remain beyond Congress's reach. The Constitution's Necessary and Proper Clause similarly grants Congress the power "[t]o make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof."[7]

The Supreme Court recognized and affirmed this fundamental principle from the earliest days of the republic, as Chief Justice Marshall famously observed: "The powers of the legislature are defined and limited; and that those limits may not be mistaken, or forgotten, the constitution is written."[8] And in his canonical opinion interpreting the Necessary and Proper Clause, Chief Justice Marshall insisted that "should Congress, under the pretext of executing its powers, pass laws for the accomplishment of objects not entrusted to the [national] government; it would become the painful duty of this tribunal, should a case requiring such a decision come before it, to say that such an act was not the law of the land."[9]

Nowhere in the Constitution is Congress given the power to mandate that an individual enter into a contract with a private party or purchase a good or service and, as this paper will explain, no decision or present doctrine of the Supreme Court justifies such a claim of power. Therefore, because this claim of power by Congress would literally be without precedent, it could only be upheld if the Supreme Court is willing to create a new constitutional doctrine. This memorandum explains why the two powers cited by supporters of this bill--the power of Congress to regulate interstate commerce and the power of Congress to tax--do not justify an individual mandate, even under the most expansive readings given these powers by the Supreme Court. In particular, this paper addresses four topics that have not yet been given adequate consideration by Congress and most, if not all, of the commentators:

First, most arguments, either favoring or opposing the individual mandate, do not discuss the Supreme Court's "class of activities" test, which it has applied in every relevant Commerce Clause case. This paper addresses this oversight and argues that, despite the broad congressional power to regulate interstate commerce, the individual mandate provision fails this test and is unlikely to survive the Court's review.

Second, this paper addresses the common, but mistaken, suggestion that a universal federal mandate to obtain health insurance is no different than a state requiring its licensed automobile drivers to have liability insurance for their injuries to others.

Third, this paper analyzes claims arising under the Taxing Clause. A preliminary review raises serious questions about the constitutionality of using the taxing power in this manner.

And finally, this paper explains why it is highly unlikely that the Supreme Court would break new constitutional ground to save this unpopular personal mandate.....


In theory, the proposed mandate for individuals to purchase health insurance could be severed from the rest of the 2,000-plus-page "reform" bill. The legislation's key sponsors, however, have made it clear that the mandate is an integral, indeed "essential," part of the bill.[54] After all, the revenues paid by conscripted citizens to the insurance companies are needed to compensate for the increased costs imposed upon these companies and the health care industry by the myriad regulations of this bill.

The very reason why an unpopular health insurance mandate has been included in these bills shows why, if it is held unconstitutional, the remainder of the scheme will prove politically and economically disastrous. Members need only recall how the Supreme Court's decision in Buckley v. Valeo--which invalidated caps on campaign spending as unconstitutional, while leaving the rest of the scheme intact--has created 30 plus years of incoherent and pernicious regulations of campaign financing and the need for repeated "reforms." Only this time, the public is aligned against a scheme that will require repeated unpopular votes, especially to raise taxes to compensate for the absence of the health insurance mandate.

These political considerations are beyond the scope of this paper, and the expertise of its authors. But Senators and Representatives need to know that, despite what they have been told, the health insurance mandate is highly vulnerable to challenge because it is, in truth, unconstitutional. And political considerations aside, each legislator owes a duty to uphold the Constitution.

Much more here

No comments: