Monday, December 21, 2009

Thousands of British patients 'could be denied lung cancer drug by Nice'

Thousands of patients could be denied a lung cancer medication after the Government’s drugs rationing body decided it was too expensive for the NHS. The drug, called Alimta or pemetrexed, has already been passed for use in the health service as a first line treatment. But in draft guidance the National Institute for Health and Clinical Excellence (Nice) said that the evidence was that the drug was too costly to use a maintenance therapy, to try to prolong the time that patients stay in remission. The drug prolongs life for an average of around five months, but costs around £51,000 annually.

Nice said that it was “disappointed” to have to turn down the drug, which could be used by an estimated 2,000 patients a year. But it said that the information it had been given about the drug’s effectiveness and benefits by its manufacturers did not justify its use. Dr Carole Longson, from Nice, said: “We are disappointed not to have been able to recommend the drug as a maintenance treatment as well. “The committee felt that there were many uncertainties in the data and analysis provided by the manufacturer. “These uncertainties led the committee to conclude that, on current evidence, the cost of the drug related to the benefits it brings means that pemetrexed would not be a good use of NHS money. “The next step in the NICE process is for the manufacturer to consider the Committee’s comments and respond to its concerns.” The organisation is not expected to make a final decision about the use of the drug until next year.

Lilly, the pharmaceutical company which makes the drug, said that it was hopeful that it could change the decision and said that they were pleased that Nice had already accepted that the drug was an end of life medication, to which the body is required to look upon more favourably than other drugs. A spokesman for Lilly said: “We are pleased that within this preliminary guidance, NICE has found that Alimta fits within the end of life criteria. “We believe that the cost of Alimta related to its benefits is a good use of NHS resources and we look forward to participating in the ongoing NICE appraisal process during the consultation phase and providing additional information to further demonstrate the significant benefit that Alimta brings to patients."


Doctors as cleaners? Only in Britain

Doctors and nurses at one of the country's top children's hospitals have been asked to help clean wards in their free time, according to the British Medical Association. Staff, including consultants and managers at Alder Hey Children's Hospital in Liverpool, were reportedly asked to do the work outside normal working hours. It is thought the suggestion was made to ensure the hospital impressed inspectors from the Care Quality Commission (CQC) who visited Alder Hey. They had previously criticised the hospital's hygiene standards in April.

Unions criticised the move and said cleanliness should be sufficiently resourced without seeking volunteers. Dr Jaswinder Bamrah, of the British Medical Association, said: "Doctors and nurses have been asked to volunteer to clean the hospital and I just do not think it is right. "They are over-using a highly skilled workforce to do what they are not trained to do. "They need to look at the issue of who is paid to do the cleaning and sort it out. "This step takes doctors and nurses away from patient care - the time spent cleaning would be better spent providing care for patients.

"This has been an ongoing problem for Alder Hey and it is very important to make sure the hospital is cleaned properly by those paid to do it - otherwise all sorts of problems car arise, like MRSA or C difficile spreading."

Paul Summers, Unison's regional organiser, said although it was a voluntary request some employees felt pressure to comply. "It was not compulsory but I have heard some people did feel bullied into helping out," he said. "I understand some staff were offered time in lieu if they did volunteer, but this isn't really the point. "There should be enough cleaning staff employed to do this job. "It raises questions about cleaning standards and about current cleaning staff levels."

Louise Shepherd, chief executive at Alder Hey Children's NHS Foundation Trust said CQC inspectors were impressed by the way staff rallied round after the unannounced visit. She said: "We believe, along with all our staff, that maintaining high standards of cleanliness in a healthcare environment is everyone's responsibility and have very much welcomed those many staff who have volunteered from every service and department to support this initiative. "Throughout this campaign, our patients have remained our top priority and we are confident that patient care has at no time been compromised. Indeed, we have received huge support from our parents and families for this initiative.

"We would also like to reiterate that this campaign was categorically not a response to inadequate levels of resources available. Indeed, Alder Hey has increased resources put in to hygiene yet again during the last year and the entire Organisation is committed to ensuring cleanliness remains a top priority at all times.

"Finally, we were delighted to receive glowing feedback about the high standards of cleanliness and hygiene achieved across the trust from the Care Quality Commission Inspection Team who visited our trust unannounced yesterday. "They were particularly complimentary about the initiative undertaken by staff and felt it was an exemplary demonstration of the passion and commitment they have to maintaining the highest standards of care and keeping our children safe at all times."


Barack Obama's health reform set to pass Senate after abortion deal

President Barack Obama's goal of health care reform received a key boost when Senate Democrat leaders said they had secured the key 60th vote needed to pass legislation. The Senate bill is now expected to be put to a vote before Christmas, despite Republican delaying tactics. Democrats from the Senate and the House of Representatives will then still have to hammer out major differences between their two versions of health reform before a final bill can be delivered to Mr Obama.

The president has made health reform his domestic policy priority and White House aides welcomed reports that there were now 60 supporters for a compromise deal in the Senate. Mr Obama devoted his weekend radio and Internet address to the issue he campaigned on in 2008. "Now - for the first time - there is a clear majority in the Senate that's willing to stand up to the insurance lobby and embrace lasting health insurance reforms that have eluded us for generations," he said.

The breakthrough came when Sen Ben Nelson, a socially conservative Democrat, told his party colleagues that he was willing to accept new wording that restricted federal funding for abortion. It also emerged that he had secured extra federal funding for health programmes in his home state of Nebraska after days of negotiations. His support appeared to give Senate leader Harry Reid the 60 votes required in the 100-seat chamber to overcome the threat of a Republican filibuster.

He was confident that his party's liberal wing would back the legislation, despite the absence of a government-run insurance scheme and other concessions made to Mr Nelson and Joe Lieberman, an Independent whose support the Democrats required. Mr Nelson made clear that he would vote against a final bill if the more liberal provisions in the House version are incorporated into the final merged legislation.

But for now, Democrats were celebrating the likely passage of a bill that will extend cover to 31 million uninsured Americans and restrict the scope for insurance companies to turn down patients for pre-existing conditions or hike their fees.

The legislation was being read in full on the floor of the Senate on Saturday at the insistence of Republican leaders. A first procedural vote is expected for the highly unusual time of 1am on Monday, paving the way for a full vote by Christmas Eve. Republicans accused their counterparts of trying to force through a bad bill with unprecedented voting times in the days before Christmas.

"This bill is a legislative train wreck of historic proportions," Senate Republican leader Mitch McConnell of Kentucky said. He said it includes cuts to the federal Medicare health care programme for the elderly, home health care and hospices as well as "massive tax increases" at a time of double-digit unemployment.


Reid 2.0: It’s Still a Budget Buster

The Obama White House and its congressional allies have tried all year to push their various bills through to passage by truncating the time between introduction and a decisive vote to the bare minimum. They figure the only way to get something passed is to minimize public review and scrutiny of whatever their latest idea is to engineer American health care from Washington, D.C.

To date, that tactic hasn’t worked out so well. In July, House Democrats tried to unveil a bill on the 14th for a planned vote on the 31st. A firestorm erupted, however, pushing back the vote into November. In the Senate, meanwhile, a series of self-imposed deadlines have been missed as Democratic pronouncements of inevitability have bumped up against the reality of steadfast and growing public opposition.

Nonetheless, Senate Majority Leader Harry Reid is running the same play again today, and very possibly with different results. He unveiled the latest version of his reform legislation this morning, filled to the brim with outrageous payoffs to buy the votes of holdout Senators. Virtually no one else has seen the bill before today, much less had a chance to give it the scrutiny it deserves. And certainly the public has not had a chance to weigh in. No matter. Senator Reid has simultaneously set in motion the procedures necessary to force a vote on his new health-care plan in a matter of hours, not weeks.

And yet, despite the unprecedented effort to short-circuit public review and input, it is likely that this latest version of the Reid plan will be just as unpopular as the previous one, and for many of the same basic reasons.

According to the Congressional Budget Office (CBO), the amended Reid plan would reduce the federal budget deficit by $132 billion over the period 2010 to 2019, but that is a mirage.

For starters, as CBO notes, the bill presumes that Medicare fees for physician services will get cut by more than 20 percent in 2011, and then stay at the reduced level indefinitely. There is strong bipartisan opposition to such cuts. Fixing that problem alone will cost more than $200 billion over a decade, pushing the Reid plan from the black and into a deep red.

Then there are the numerous budget gimmicks and implausible spending reductions. The plan’s taxes and spending cuts kick in right away, while the entitlement expansion doesn’t start in earnest until 2014, and even then the real spending doesn’t begin until 2015. According to CBO, from 2010 to 2014, the bill would cut the federal budget deficit by $124 billion. From that point on, it’s essentially deficit neutral — but that’s only because of unrealistic assumptions about tax and Medicare savings provisions. By 2019, the entitlement expansions to cover more people with insurance will cost nearly $200 billion per year, and grow every year thereafter at a rate of 8 percent. CBO says that, on paper, the tax increases and Medicare cuts will more than keep up, but, in reality, they won’t. The so-called tax on high cost insurance plans applies to policies with premiums exceeding certain thresholds (for instance, $23,000 for family coverage). But those thresholds would be indexed at rates that are less than health-care inflation — forever. And so, over time, more and more plans, and their enrollees, would bump up against it until virtually the entire U.S. population is enrolled in insurance that is considered “high cost.”

Similarly, the Medicare cuts assume that hospitals, nursing homes, home health agencies and others can survive with a permanent annual cut in their payment rates for presumed productivity gains. Medicare’s chief actuary has already signaled that this reduction could push one in five hospitals into insolvency, thus forcing them out of the Medicare program.

What’s more, the benefit promises are sure to expand well beyond what CBO has assumed. There are 127 million people living in households with incomes between 100 and 400 percent of the federal poverty line, but CBO assumes that only 18 million of them will get the new subsidized insurance under the Reid plan by 2015 because of rules that make most workers ineligible for assistance. But, if enacted, employers would find ways to push more workers into subsidized arrangements, and Congress would loosen the rules to make more people eligible. Costs would grow much faster than CBO currently projects. In addition, the Reid plan continues to include a new entitlement program for long-term care that every actuary who has looked at it says is a financial disaster waiting to happen. If passed, it would only be a matter of time before another federal bailout would be necessary.

It is now plain as day that the Reid plan has evolved into nothing more than a massive entitlement expansion, which subsidizes more people into an unreformed system with soaring costs. Several Senate Democrats claim to be strong fiscal conservatives. Their votes on the Reid legislation will provide conclusive evidence whether that’s true or not.


ObamaCare: Does It Cover 'Stupidity'?

Americans overwhelmingly like their health care and their health insurance. While Americans reject ObamaCare, the President and Congress insist on driving it through. Most Americans, up to 85 percent, already have health insurance and are satisfied with it. Lacking health insurance is different from lacking health care -- which, by law, emergency rooms must supply. Millions go without health insurance by choice and not due to lack of resources. Deduct from the number without insurance those who have access to it via entitlement programs, those temporarily without it while between jobs, those here illegally and those who could go on their parents' insurance plans by paying affordable amounts -- and you're down to 10 million to 15 million people without health insurance for longer than a year. This represents 5 percent of Americans.

To address this, the President and the Democrats are this close to a complete government takeover of health care. And a takeover it is. Assuming some kind of plan reaches the President's desk, it will -- at minimum -- force all Americans to purchase health insurance or pay fines or worse. It will force nearly all employers to provide health insurance or pay fines. It will tell health insurers that they must accept applicants with pre-existing illnesses and restrict their ability to "discriminate" based on factors like sex and age.

Incredibly, the President and Congress tell us that our economic recovery hinges on "health care reform" and that they can achieve it -- providing millions of people with health insurance estimated to cost a trillion dollars in the first decade -- while simultaneously reducing the deficit. The plan anticipates cutting hundreds of billions from the popular Medicare programs, whose beneficiaries vote in numbers greater than any other age group. Doctors and hospitals already complain that Medicare reimbursements fall short of costs, let alone profits. Good luck with that.

"Health care reform" achieves its deficit-reducing magic by collecting taxes in the early years -- building up money -- while paying out very little. Only after the first four years does money go out. It also forces states to pick up part of the tab. So, voila, it actually reduces the deficit -- at least in the first decade.

Then what? The Congressional Budget Office -- in cost estimates full of caveats, conditions and on-the-one-hands -- says that it could/might/may reduce the deficit in the second and third decades, too. Again, this assumes continued cuts in doctor and hospital reimbursements.

Despite the White House photo op of docs in their white frocks, most physicians oppose ObamaCare. They resent further government supervision and control over their practice. A poll commissioned by Investor's Business Daily found that 65 percent "oppose" ObamaCare and that 45 percent would consider taking early retirement or leaving their practice if the bill went through. Given the broad opposition -- most Americans, most doctors and seniors in fear of cuts in Medicare -- why do it?

First, the Democrats -- now in control of all three branches of government -- have convinced themselves that they face a political price if they fail. ObamaCare supporters, based on bogus assumptions and inflated numbers, argue that many, if not most, bankruptcy filings are due to health care bills. If, as President Obama asserts, "reforming" health care and economic prosperity go hand in hand, how can they abandon it?

Second, while a large majority of Republicans and most independents oppose these "reforms," Democrats overwhelming support them. They consider health care and health insurance a right -- never mind the Constitution or the price tag -- and think "the rich" should bear the costs. Congresspersons fear an electorate upset at a failure "to deliver" a victory over the evil, money-grubbing insurance companies.

Third, many believe in good faith that this is the "right thing to do." This breathtakingly ignores the mountain of evidence that government command-and-control health care reduces quality, reduces innovation and inevitably leads to rationing. The president of the Canadian Medical Association says Canada's system -- a single-payer kind, favored by President Obama -- is "imploding." She calls for more competition.

Critics of America's health care system say that citizens in other countries enjoy longer life expectancies. But after adjusting for homicides, increased infant mortality due to teen pregnancies and low birth weights, obesity and other behavioral factors, the discrepancy disappears. Compare American medical outcomes against those of other countries. Our system produces the world's best results for cancer patients who go into medical care at the same time similarly situated patients enter their countries' care. Our pharmaceutical companies lead the world in coming up with new life-extending and -enhancing drugs, a record at risk given new controls and taxes under the guise of "reform."

When the ObamaCare bill comes due -- when the deficit explodes and the costs are "controlled" through government-directed rationing -- supporters, including President Obama, will long have departed Washington, leaving others to deal with the mess. In the meantime, bend over and cough. Or else.


Can the US Constitution force Americans to have medical insurance?

One of the proposals in the restructuring of medical insurance in the USA is to force all adults to buy medical insurance. This calls for an analysis of the moral and legal basis for such force.

By natural moral law, as expressed by the universal ethic (, each human being is a self-owner, with the single moral obligation to avoid harming others. The absence of insurance does not harm others. A person without insurance in effect becomes self-insured. If he requires medical services, he has a moral obligation to pay for them. There is generally also a legal obligation to pay for such services.

Thus an uninsured person who obtains emergency medical services can properly be required to pay for the services. If does not have the funds at the time, he should be required to pay the debt in the future. If he is poor and penniless, he is most likely receiving or eligible for assistance. It is therefore not only morally wrong to force people to obtain insurance, but also there is no sound financial reason to force everyone to have medical coverage.

Now let’s consider whether the U.S. Constitution authorizes Congress to force Americans to have medical insurance. The question was posed to the Speaker of the U.S. House of Representatives, and she refused to answer it. Presumably she believes that this is not a serious question because of the belief that the U.S. Constitution authorizes Congress to apply force on U.S. citizens without any restriction.

In other words, in the view of many such welfare-statists, there is no restriction on the use of force by the U.S. government on U.S. citizens and residents. Regarding the rights and liberties of Americans, they may as well tear up the Constitution and just put in a note, “anything goes.”

Tyrants who are in favor of making U.S. citizens slaves of the government argue that drivers are required to obtain liability insurance, and thus the same applies to medical insurance. But the federal government does not require drivers’ insurance within the states. The states do so because drivers travel on governmental roads, and as the agent providing the road, the state may enact rules of the road, and a driver agrees to the rules when he obtains a license. But no license is required just to be a human being.

The view that general welfare or interstate commerce authorize the U.S. federal government to use any force whatsoever on U.S. citizens is contrary to legal logic. The Constitution states that Congress only has the powers specifically allocated to it by the Constitution. The Tenth Amendment makes it clear that all other powers are left to the states. The Ninth Amendment recognizes that there are moral and common-law rights that exist prior to and apart from the U.S. Constitution, and that such rights shall not be denied by Congress, thus making natural moral rights also Constitutional rights.

A principle of legal logic is that the authorization of power in one section of a constitution does not cancel out constraints of power in other sections. Thus the authorization to levy legislation for commerce among the states does not void free speech or the security of property. Commerce may be regulated only within the constraints specified by the other sections.

In 1994, the Congressional Budget Office issued a memorandum titled, “The Budgetary Treatment of an Individual Mandate to Buy Health Insurance.” It stated, “The imposition of an individual mandate, or a combination of an individual and an employer mandate, 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.”

If the requirement to buy insurance becomes law, it will be brought to the Supreme Court, which will then have to decide whether to shred what remains of the spirit of the Constitution, limited government. Congressional personae may anticipate this and do a clever run-around. They may provide funds to the states on the condition that the states make insurance mandatory. Or, Congress could just levy a tax that would pay for universal coverage.

In effect, the requirement to pay for medical insurance is a tax. But it is a tax on personhood rather than on a privilege or an activity or on property. Such a direct tax is Unconstitutional unless it is apportioned according to state population. If some folks are getting angry about the coming medical legislation, it is because such mandates are what is destroying the spirit of American liberty. Moreover, forcing Americans to buy insurance shifts more power from consumers to the very insurance firms that are being blamed for coverage that is both expensive and deficient. Consumer sovereignty is the power to not buy, and that will be lost.


Another Creative Way To Pretend A Public Mandate Is Constitutional

This one's from Sen. Blanche Lincoln (D-Ark.). The Constitution “charges Congress with the health and well-being of the people," according to Lincoln.

Unfortunately, as CNS News points out, "the words 'health' and 'well-being' do not appear anywhere in the Constitution."

Congress' own Budget Office has determined that the U.S. has never required Americans to buy any good or service. But the Supreme Court still might rule the mandate to purchase insurance as constitutional. National Journal's Stuart Taylor Jr. explains why: "It's true that the proposed mandate, like much else that congress has done since the New Deal, would extend federal powers far beyond anything envisioned by the Framers. The commerce clause, in particular, was not intended to allow Congress to regulate activities that were neither interstate nor commercial. But the need to govern an ever-more interconnected nation, in which once-local activities such as health care have become critical components of the national economy, has spawned a long line of precedents expanding the commerce power, especially since the justices began upholding New Deal programs in 1937.

As Taylor points out, whether those precedents are justified is an entirely separate matter.


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