Saturday, December 19, 2009

Patients 'still suffering at crisis hit British hospital'

Patients are still suffering unnecessarily at a hospital criticised six months ago for poor standards that contributed to hundreds of deaths, according to a new report. At least one patient has died because of similar problems since, the review suggests. Health watchdogs also found that Stafford Hospital, run by Mid-Staffordshire NHS Trust, was still suffering staff shortages.

In March a damning investigation found that up to 1,200 people had died because of the poor standards of care at the hospital. Regulators found overstretched nurses who turned off vital pieces of equipment because they did not know how to use them and reception staff expected to judge the seriousness of the conditions of patients arriving at A&E.

The latest report, by the Care Quality Commission, found that improvements were being made but that the changes needed to happen faster. In one case the commission found that a “serious untoward incident” on an ward where concerns had been raised about staffing levels led to a patient’s death. The hospital closed the 12-bed Clinical Decision Unit (CDU) soon after the death.

But the CQC warned that there were still staff shortages across the hospital. Relying heavily on bank or agency nurses could also have a negative impact on patient care, the report states.

Too many patients are still being sent unnecessarily to casualty when they could be dealt with in other parts of the hospital, inspectors also found. In one case a patient with heart failure who was already in the outpatients department was sent to A&E instead of straight to see a specialist when he developed breathlessness.

The report also found that patients were being seen by senior doctors sooner but that there were still problems contacting consultants during night shifts.

Andrea Gordon, regional director for CQC in the West Midlands, said: "On CQC's six month follow up review we found that while some progress had been made against the trust's action plan, more still needs to be done. "Permanent staffing levels remain a concern and this must improve. “Although there had been some change, there was still a shortfall in permanent nursing staff and the trust was still using bank and agency staff to supplement numbers. “We are aware that the trust is working to address these issues but there is still some way to go.”

Antony Sumara, the chief executive of Mid-Staffordshire Trust, said: “We know that there is more to do and that this needs to be delivered more quickly. Staff at our hospitals are as committed as I am, to making changes for the benefit of our patients.”

Last month the CQC warned that hundreds of patients had died needlessly at another hospital, Basildon University Hospital, because of poor care.

Katherine Murphy, director of the Patients Association, said: "This is a Trust under unbelievable levels of pressure to improve and it still can't get the basics right every time or ensure it has enough staff. "That should be worrying for all of us. "The local community don't want improvement over a few months or 6 months or a year, they want it straight away. "They are the ones that suffer if things aren't put right."


Lawyers growing rich on NHS negligence

It would be a lot cheaper for them to do their job properly in the first place but that doesn't enter a bureaucratic mind. It's not their money that they are wasting

The number of negligence cases being brought against the NHS is rising at 11 per cent a year. Lawyers representing patients in clinical negligence claims frequently take more money from the NHS than their clients receive in damages. The rise of no-win, no-fee actions against the health service has been blamed for a sharp increase in the proportion of payouts ending up in the pockets of the claimants’ lawyers.

Law firms representing patients made more than £100 million last year from successful claims concluded against the NHS. Their costs, at rates of up to £400 an hour, were more than double those for lawyers representing the health service. “Success” fees charged by lawyers working on a no-win, no-fee basis — which cover their risk of losing some cases — can double the cost, according to the NHS Litigation Authority (NHSLA).

Figures released by the authority, which handles all clinical negligence claims, show that legal fees accounted for almost half the £312 million damages claims closed last year. Patients’ legal costs exceeded the damages that they received in more than one in five cases. According to the authority, the number of cases being brought against the health service is rising at 11 per cent annually, with more than 6,700 cases expected for this financial year.

The cost to the NHS is accelerating at a similar rate. The authority’s annual report says that payouts, including both completed cases and continuing payments, will pass £800 million this year — a 60 per cent rise on five years ago. When settlements relating to staff injuries are included, the total is even higher.

A review of civil litigation costs, which is due to report next month, is expected to address the way no-win, no-fee costs can spiral. Submissions to the review, seen by The Times, describe how this problem has grown in recent years because of success fees and insurance premiums taken out by lawyers to protect against losing the case. Since 2000, both have been recoverable from the NHS.

Christine Tomkins, chief executive of the Medical Defence Union, which provides medico-legal support to health professionals, said that analysis of their cases had shown that the average damages was just under £10,000. Claimant costs, including legal fees, success fees and insurance premiums, had been calculated at an average of more than £20,000.

Dr Tomkins said that cases and costs should be more closely managed, with a cap on fees, adding that the no-win, no-fee cases were being “cherry-picked because they were winnable”. She said: “There needs to be much closer attention to costs being accrued by claimants’ solicitors. We are often not aware of a case until we are contacted and we immediately think: ‘We must settle.’ But we can then discover that there have already been weeks of costs accrued.”

Among contested claims highlighted in the NHSLA annual report was the case of six male cancer patients who had banked semen samples with a hospital trust for possible future use. The samples thawed and became unviable. In another case a child born with congenital rubella syndrome, “due to admitted NHS negligence”, is receiving care costing £130,000 a year.

The Conservatives, who identified some of the disparities in legal costs and damages, said that there were cases where lawyers were getting ten times as much as patients. They calculated that over the past five years, almost £700 million in NHS funds has been spent on fees to lawyers dealing with clinical negligence claims. Mark Simmonds, the Conservative health spokesman, said: “Taxpayers will be rightly angry that hundreds of millions of pounds of their money is being paid out for mistakes in the NHS and that in many cases lawyers get their hands on more of the compensation money than the patients.”

Stephen Walker, chief executive of the NHSLA, described the claimant costs as “seriously disproportionate”. He said: “These law firms are not doing anything dishonest or illegal, they are just playing the system.”

A Department of Health spokesman said that litigation costs were a concern across government and were the reason for the current review, adding: “The vast majority of the millions of people treated by the NHS every year experience good quality, safe and effective care. However, if patients do not receive the treatment they should and mistakes are made, it is right that they are compensated and have access to legal representation.”


Less Health Care for More Money

by Ann Coulter

The New York Times' Nicholas Kristof recently wrote a column about John Brodniak of Oregon, who developed a cavernous hemangioma, causing him great pain as blood leaks into his brain. According to Kristof, Brodniak can't get medical help because we don't have universal health care. Senators who vote against ObamaCare, Kristof said, are morally equivalent to someone who would walk past a man "writhing in pain on the sidewalk."

In another article in the Times, William Yardley wrote about Melvin Tsosies -- also of Oregon -- who ended up with $200,000 in medical bills after having a heart attack. As of March 2008, Yardley reported, Tsosies was waiting to find out if he would win the Oregon lottery for health insurance. But with 600,000 uninsured state residents and a "universal" health care program with only enough money to pay for about 24,000 of them, Tsosies is more likely to win a Powerball lottery.

How can this be happening? Oregon already has "universal health care"! (Probably just a coincidence, but isn't Oregon also the only state with physician-assisted suicide?)

Once again forgetting about the existence of the Internet, the Times neglects to mention its own erstwhile enthusiasm for Oregon's universal health care plan, introduced back in 1990. Back then, the Times published an editorial titled "Oregon's Brave Medical Experiment," hailing this technocratic monstrosity as an example of "hardheaded compassion" designed to make "health coverage available to many more families." Ron Wyden -- then a congressman from Oregon, now a U.S. senator at the forefront of pushing "universal health care" onto the nation -- said: "This is a strong dramatic step toward universal access of health care." He predicted, "[T]his is going to be copied everywhere."

No wonder Wyden is such an ardent proponent of national health care -- it will force states that didn't adopt these idiotic universal health care schemes to bail out the ones that did.

Liberals cite medical horror stories from the very states they once cheered for enacting universal health care in order to argue for a national health care plan that will wreck the entire nation's medical care the same way liberal states already wrecked their own medical care. Only Democrats could propose fixing one Bernie Madoff-style scam with an even bigger Bernie Madoff-style scam. Maybe when national universal health care fails, we'll be able to go international. Then interplanetary -- then interstellar! Why should I pay for my gall bladder surgery when some Venusian could?

Eighty-five percent of Americans are happy with their health care, but Democrats have a plan to make it worse for more money. As a bonus, national health care will add trillions of dollars to the national debt, and your insurance rates will skyrocket.

Democrats are being utterly disingenuous to say that you won't have to leave your current plan under national health care. Maybe, but it won't be your choice: Your employer will be making that decision for you. Recall that one of the big selling points of national health care is that it is supposed to reduce costs for American businesses. The only way national health care will make American companies "more competitive" is if they dump their employees into the public health care system. It's so weird! We expected X number of people to show up for health care and instead 75X showed up! Yeah, just like every other government program in the history of the world.

Ten years from now, we'll be talking about cost overruns of $6 trillion -- but by then, national health care will be an untouchable "third rail" of politics, just as Medicare is now. (Ironically, injuries sustained from actually touching the third rail won't be covered under ObamaCare.)

As with Medicare, voters will be terrified to go back to even the wisp of a free market system we have now, afraid that they'll never be able to get health insurance without the government providing it. Having been dragged unwillingly into the government plan, how will a 58-year-old be able to leave the public system and get insurance on the free market?

Speaking of which, how many of you are planning to retire on your Social Security benefits? Just you there, with the shopping cart full of cans?

The only solution will be for the government to keep running up gigantic deficits and raising taxes on "the rich," which, in turn, will stifle job creation and economic growth in a phenomenon known to economists as "the Carter years."

In addition to forcing Americans into dealing with surly government workers in order to obtain medical care, sooner or later, there's no free lunch. (And if government X-rays are anything like the photos the DMV takes for your license, count me out. I don't want my lungs looking like they had a bad hair day.)

Even if national health care puts the screws to doctors and pharmaceutical companies by reimbursing them below cost -- so all future doctors will soon resemble DMV employees and no new drugs will ever be invented -- the government is still going to have to cut services and pay for the system with massive tax hikes. Which is exactly what happened with Oregon's "Brave Medical Experiment."


New regulations will destroy the insurance market

It has been shown that the so-called "public option" for low-premium health insurance is sure to significantly crowd out, and perhaps even eliminate, the private provision of health insurance. Thanks to Senator Joseph Lieberman's courageous stand, it appears that the public option will not be a part of any bill that passes the Senate. Unfortunately, HR 3962 includes regulations that will destroy the ability of private firms to provide marketable insurance, with or without a public option.

To understand the devastation that will be wrought by this bill, one must understand how health insurance functions on a free market to transfer individuals' financial risk to large "risk pools" with less variation across time. Consumers who are risk averse pay "premiums" to insurers each month for the removal of that risk, and in turn insurers assign their clients to different pools according to their risk of large claims.

An Already-Regulated Industry

Insurance companies have already been strictly limited in their ability to assign individuals to different risk pools and charge them varying premiums. By forcing high-risk and low-risk groups into the same pool, existing regulations increase premiums for low-risk consumers and decrease premiums for high-risk consumers. This is nothing more than a coerced subsidy to the less healthy, and it drives low-risk consumers away from purchasing health insurance. This is why the majority of the uninsured are not poor and dying, but in fact healthy young people who are at almost no risk of unanticipated healthcare costs.

To cope with their inability to partition along risk levels, profit-seeking insurance companies must cut costs by excluding the highest-risk patients from insurance. In a free market, these individuals would be offered insurance at a higher premium aligned with their high risk of major claims. In human terms, this leads to the exclusion of people with preexisting conditions and those with significant claims on past insurance plans. Once again, we see how leftist economic policy harms the very class of society that its supporters desire to help.

Obamacare is a Welfare Program

Not oblivious to the exclusion of these unfortunate citizens, on page 95 of the bill, House Democrats have proposed to completely outlaw the exclusion of any customer on any of the following grounds: "health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, disability, or source of injury (including conditions arising out of acts of domestic violence) or any similar factors."

Thus, it will become illegal to refuse to insure any consumer on any grounds, including evidence of insurability. In addition to being unable to exclude future enrollees, insurers will be prevented by page 29 from legally dropping any consumers from their plans on any grounds other than "clear and convincing evidence of fraud."

The effect on the structure of insurance is obvious; this new law will turn health insurance into a legally-enforced entitlement program, and the new entitlement will be used by those who are too costly to be insured under the current restrictions on risk-pool partitioning. Again, it is important to remember that these patients would have the option to buy insurance on a free market, but that their plans would carry premiums that actually reflect their personal health risk.

While risk-pool separation is considerably limited by national and state regulations, the little separation that is allowed would still be able to mitigate the heavy costs of forcing insurers to cover literally every customer who wishes to buy insurance. While the high-risk individuals would not pay as much in premiums as they would on a free market, insurance companies would still be able to use slightly lower premiums to attract low-risk customers.

However, this inequality in premiums is offensive to politicians hell-bent on equality. Therefore, in the very next page of the bill, House Democrats propose to outlaw all variations in premiums except according to geographical area, age group, and whether the plan in question covers an individual or a family.

These provisions will be catastrophic to the insurance market. The bill only allows for premium variation across age by a ratio of two to one between the highest and lowest premiums. In real terms, elderly patients who cost several times as much to insure can only be charged twice as much as 20-somethings who often go entire years without claims. That this is a subsidy for the elderly hardly needs to be explicitly stated.

The bill leaves the determination of the maximum difference between individual and family plans at the discretion of the "health choices" commissioner, who is likely to find himself bombarded with visits and letters from family-centered lobbying organizations seeking subsidized health insurance paid for by singles and nonparents. This rent seeking will inevitably end up in subsidies handed out according to political objectives, whether the goal is to attract more young, single voters or more parents of children.

Turning any transaction into a subsidy both induces the subsidized class to enter the transaction and induces the subsidizing class to attempt to avoid it. In this case, it means that an even greater number of young and healthy individuals (and, most likely, nonparents) will drop their increasingly expensive insurance plans and attempt to prepare for healthcare risks on their own. This terrible result of coercive price-fixing decreases the benefit of the subsidy to high-risk consumers and decreases the ability of the insurance companies to control and reduce average payouts.

Democrats are aware of this effect of their policy, and have legislated accordingly. Pages 296–300 amend federal tax law to create a new tax on all citizens who fail to purchase health insurance. Depriving these individuals of the ability to opt out of the new, undifferentiated insurance pool is an atrocious affront to individual choice, and requires the threat of imprisonment. This new tax will help achieve the statistical goal of universal coverage, but it will do so at an incredible cost to the income and liberty of the relatively young and healthy, most of whom, ironically, voted for Obama and Democratic congressional candidates.

Soaring Costs

Not only will high-risk individuals who are now forced out of the market by regulation be legally entitled to purchase the bill's minimum standard of coverage, but both these excluded consumers and those who are now in high-risk pools will have financial incentives to buy higher levels of insurance. Facing new, subsidized prices, high-risk individuals will purchase plans with lower deductibles. Paying for a higher percentage of the price of more claims will massively increase the cost of insuring the new general pool of clients.

One of the only remaining ways for insurers to cut their costs, then, is to limit the amount that individuals are able to receive in claims. Indeed, insurance companies already use lifetime claims limits to cope with risk-partition laws and deliver lower-price packages to low-risk consumers. Predictably, page 50 of the House bill prohibits insurance companies from imposing any such limits on lifetime benefits.

Outlawing lifetime limits guarantees that all consumers will have the incentive to undergo drastically more treatments in their lifetimes, because the bill ensures that they will not be moved into a higher premium group until they enter a different age group or move to a different area. For the already-subsidized elderly, this creates incentives to undergo many more life-extending treatments in the final year of their lives. Such treatments are several times more expensive than general care for other elderly patients.

Astute readers will correctly object that while the Democrats' healthcare proposal will drastically increase the costs facing every insurance provider, the bill also requires all individuals to buy the minimum package of insurance, or to enroll in the public option. Especially because in the current discussion we are ignoring the effects of the public option, it is possible to argue that if there were no public option this bill would actually be a boon to private insurers, who are virtually guaranteed that every American will buy their plans. To survive this bill, then, insurance companies will simply increase the premiums of the packages that are forced onto every citizen.

This would indeed be true, were it not for further regulations effectively barring premium increases. Page 31 of the bill would require insurance companies to "submit a justification" for any projected future increase in premiums for any group to the secretary of Health and Human Services as well as state-level authorities.

The secretary of HHS and the state "health czars" would then annually review and approve or deny any increase in premiums. In various sections of the bill, the health choices commissioner is given power to determine the cost-accounting and other ratings methods that will determine whether a price increase is "justified" in the eyes of the DHHS Secretary.

Public officials operating under a Congressional mandate to achieve universal coverage are hardly likely to approve price increases, even though that means slowly bankrupting private insurers. Even if they are not made to "compete with" and be strangled by a public option that consumers have already funded with their tax dollars, private insurers will be absolutely ruined by restrictions on their ability to control and separate costs and to increase prices to account for their ever-rising costs.


While a public option would certainly hasten the death of the private-insurance market in America, it is not a necessary means to that end. By destroying the economic structure of insurance, House Resolution 3962 would convert an already-overregulated industry into a pseudo-private welfare program. Even without a public option, insurance companies would be kept from controlling costs or adjusting their prices. The inevitable result will be the complete dissolution of the private health-insurance market.


A Return to Slavery One Progressive Step at a Time

Let’s just call it what it is, as one of my favorite economists Walter E. Williams writes in a recent Town Hall column: “There is absolutely no moral case, much less constitutional case, for Congress forcibly using one American to serve the purposes of another American, a practice that differs only in degree from slavery, which we all should find morally offensive.”

If you strip the health-care debate of it’s sugar coated political buzz words such as mandate and public option, aren’t we really talking about just another case where the government has decided to force you to labor for the benefit of someone else? At the rate we are going, how long will it be before you’ll be spending more of your time working for others rather than yourself. Isn’t that so very altruistic of you!

If the Health Care Police (HCP), I assume they would be the ones in charge of enforcing the governments health care mandate, knocked on your door every other Monday morning and forced your college educated 22 year old daughter to work all day picking up trash on the side of the highway you’d be horrified. You’d want some answers! What dastardly criminal act could she have committed to deserve such a punishment, keeping her out of work all day and thereby depriving her of 10% of her income?

They don’t do that in America, you say. Well, not quite yet anyway, but they will soon if the Democrats have their way with health care. She will be forced by the government to spend an equivalent amount of her earnings to purchase something she had decided not to. Is this not also a practice that differs only in degrees?

As a parent, wouldn’t you want to talk to the prosecutor to know what crime your daughter had committed that merited a fine that was upwards of 10% of her income? Shouldn’t there be some kind of a trial to find her guilty before punishment is meted out, even if it is only a show trial like the one KSM is entitled to? Won’t you be mortified to learn she has committed the most heinous of acts imaginable in our new Progressive Society? That’s right she is guilty of working for an employer who does not provide health insurance, and has failed to purchase a government approved insurance policy on her own. Oh, the shame of it!

Your representatives in Congress are spinning a yarn that goes like this: legions of hospitalized young adults without medical insurance are the cause of the explosion in health insurance premiums. This in an attempt to justify a morally bankrupt and unconstitutional taking of private property. Their remedy? Mandate (a pretty word that means to force) that all citizens must buy health insurance. That’s what they would like you to believe, but that is not what the facts tell us.

The fact is that they are bullying healthy young people into to subsidizing health care premiums for those in poor health who have medical insurance, those with preexisting conditions who have been denied health insurance coverage and those who are not financially able to purchase health insurance. The Progressive bullies in Congress always pick on the politically weak in society, in this case it happens to be young people, it’s not like they are reliable voters anyway, and their perennial favorites, “The Rich” who will pay the freight to provide an insurance subsidy for the politically favored classes.

Will health insurance reform really be the rallying cry Progressives use to justify re-instituting a modern day version of Slavery in America?


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