Thursday, January 28, 2010

British centrist party calls for tighter rules on foreign doctors

The Liberal Democrats have launched new proposals to tighten rules on the employment of foreign doctors after the death of a 70-year-old man treated by a doctor from Germany. Norman Lamb, the party's health spokesman, called for a series of reforms including a national language and competency test for every doctor wishing to work in Britain.

The demand comes after David Gray, from Manea, Cambridgeshire, died after he was given more than 10 times the recommended daily dose of diamorphine by Daniel Ubani, a locum doctor from Germany. Dr Ubani, 67, had been on his first shift working for an out-of-hours medical service when the overdose was administered on February 16, 2008, an inquest into Mr Gray's death has heard.

The Liberal Democrats said the reforms should include making sure that a suspension in one country is effective across the European Economic Area - covering the European Union, Iceland, Liechtenstein and Norway.

There should also be a criminal offence created for a primary care trust to allow a doctor to operate without ensuring compliance with regulations, the Liberal Democrats said. Mr Lamb said: "The tragic death of David Gray raises serious concerns about the safety of out-of-hours care in this country. "We cannot allow a situation to continue where we are reliant on tired, overworked foreign doctors to cover out-of-hours care.

"Patients' lives are being put at risk because standards across Europe are not uniformly good and foreign doctors can practice in the NHS without a test of competence and language. "Ministers have known for some time that the safeguards in place were not adequate but they have completely failed to take action. "These proposals will ensure that every doctor working in this country can speak English, is familiar with our health service and is well trained."

The General Medical Council (GMC) currently applies a test for English language proficiency and clinical skills to doctors from outside the European Economic Area before granting registration to work in the UK. But it cannot apply the same set of tests to doctors from within the EEA - a situation described as "profoundly unsatisfactory" by Niall Dickson, chief executive of the GMC.


It still won’t work

In the wake of Scott Brown's astounding win last week in Massachusetts, President Obama has been backpedaling faster than Darrelle Revis on health-care reform, telling reporters that Congress should "move quickly to coalesce around" parts of the health-care bill that both parties can agree on, "core elements" such as insurance reform. That might be more popular politically, but it still won't work.

Take one "core element": prohibiting insurers from turning down customers with "pre-existing conditions" or charging more to customers who become sick. A bill to simply ban such practices might attract support from such GOP moderates as Maine's Olympia Snowe and Susan Collins. But the "reform" would wind up pushing millions of people off the insurance rolls — and New York state provides the proof.

The term "pre-existing condition" simply means people who are already sick. But if you can wait to buy insurance after you get sick, who'd ever buy insurance while they're healthy?

Requiring insurers to charge the same premiums to the sick and the healthy compounds the problem: Premiums would fall for older and sicker customers — but rise for the young and the healthy. Knowing that they could always buy a policy after falling ill, many young people would drop out of the insurance market. (Indeed, these "young invincibles" already make up the largest part of the uninsured.)

New York provides an object lesson: It enacted precisely these "reforms" in 1993. The next year, roughly 500,000 people canceled their insurance, according to a study by the actuarial firm of Milliman & Robertson.

With the young and healthy dropping out of the insurance pool, premiums will have to rise to cover the now-sicker insured population. That, in turn, will encourage more healthy people to drop out, raising premiums still further — and so on, in what's known as the "adverse-selection death spiral." The only solution would be to mandate that everyone buy insurance. But, as the last year's debate has shown, that creates all sorts of problems:

* To mandate that people buy insurance, the government has to define what insurance is. (I'm pretty sure my policy with the $1 million deductible won't qualify.) This opens the door to all manner of special interests demanding to be part of the required benefits. People would be unable to keep their current plans, but would have to buy new, probably more expensive, policies that met government specifications.

* If the government is going to force people to buy insurance, it'll have to subsidize insurance for those who can't afford it. Covering those costs means new or higher taxes for someone. And subsidies without cost controls will break the bank (as they're doing now in Massachusetts) — so the government will have to impose price controls or restrictions on care.

Before you know it, "mini-me" ObamaCare has morphed back into the full-blown version.

Democrats have boxed themselves into a corner. The public has rejected their plans for a government takeover of the health-care system — but giving up would mean admitting that they just wasted a year on a bill that didn't even pass. They'll be tempted to try to pass something — anything.

Alas, "anything" so far doesn't include the type of free-market reforms that could actually solve some of these problems. For example, if Democrats really wanted to deal with the problem of pre-existing conditions, they'd support expanded state high-risk pools. Better yet, they'd offer the same tax break to people who buy their own insurance as we give to employer-provided insurance. Moving to personal, portable insurance means that people who lose their jobs would no longer automatically lose their insurance — so pre-existing conditions would be far less of an issue.

And, if Democrats want to create an incentive for the young and healthy to buy insurance, they could eliminate costly mandated benefits that makes insurance a poor deal for the young.

But Democrats seem determined to prolong the agony — trying to force through some version of their top-down, command and control, government-directed approach no matter how often Americans say "No!" We can only hope that sooner or later they'll get the message — and start over with something that will actually work.


Why ObamaCare Isn't Flying

This is the sound of President Obama's health-care reform bill crashing to earth: Senate Majority Leader Harry Reid on Tuesday: "We're not on health care now. We talked a lot about it in the past." Democratic Sen. Dianne Feinstein: "It's a time out."

The bill's advocates can't believe this is happening. They elected a popular and charismatic Democratic president. With him came a filibuster-proof congressional majority. Done deal. Write the bill, vote it into everlasting life, and burn votive candles to Franklin Roosevelt's unfinished national entitlement legacy.

After seven nonstop months ObamaCare is failing, just as ClintonCare failed after a year's effort in 1994. It's clear there is something inherently wrong in what the Democrats have been trying to do here. What is it? The answer lies in the often-repeated phrase that they are trying to reform "16% of the American economy." Why would anyone think it possible in 2010—as politics, economics or mere practical feasibility—to reorder 16% of a $14 trillion economy of 300 million people living in 50 separate states whose geography is 16 times larger than France?

The Obama reformers are driven by the idea that their bill would fulfill a dream running back 70 years to 1939, when FDR failed to win passage of a universal health-care bill. But this isn't 1939. It's not even 1994. American health care, whatever its defects, is today unimaginably complex. What the Democrats are trying to do isn't just difficult. It's impossible.

According to data compiled by Hoover's business research from the U.S. Census, the health-care industry consists of 340,650 separate establishments employing 5,508,926 people. I leave it to a mathematician to calculate the number of possible economic relationships this would produce every day, much less annually . We have 512,000 physicians and surgeons, 2.2 million registered nurses and a galaxy of different jobs orbiting around them. Some 36% of these are in individual physicians' offices.

One of the jewels of this collection of professionals, which the politicians say is "failing" us, is the U.S. medical-device industry. It has come a long way since the days of "The Clinic of Dr. Gross" in Thomas Eakins's famous painting. There are 8,616 separate medical-device companies in the U.S., employing 359,065 people. Within the device industry, its two largest categories are electronic and precision equipment and surgical appliances. These are the wizards of American medicine.

The president says the special interests oppose his bill. But to pay for the bill, Congress would levy a $2 billion annual tax on the medical-device industry, which ardently opposes the legislation. Let's pick a state. How about suddenly famous Massachusetts. The Massachusetts Medical Device Industry Council lists more than 220 companies as primary members. They have weird names like Aeris, ExtruMed, Bioxcell and WunderThink. Yet the Democrats are agog that Massachusetts voted Scott Brown into the Senate.

Harvard Medical School Dean Jeffrey Flier said of the health-care bill in these pages recently that "our capacity to innovate and develop new therapies would suffer most of all." And that's the high-minded criticism of the bill. Down at the level of simple retail politics what you see are tens of thousands of separate health and medical interests that understandably are in motion because of this bill's determination to change everything in American health care.

The president and his health-care advisers are giving philosopher kings a bad name. Only people who have reduced American health care to rows and columns of data in academic studies would think it possible to remake this incredibly sophisticated organism as easily as rebooting a spreadsheet. You can't do it.

Meanwhile, press reports this week also noted that Mr. Obama's "comprehensive climate bill" is being down-sized to something that can pass Congress. Same problem.

Barack Obama is 48 years old, a "young" president. But in a sense, he is an old 48-year-old. The House leadership, the committee chairmen leading his agenda, are old guys from the 1960s and '70s. The so-called progressive Democrats who make up his core base are essentially a labor movement stuck in a one-size-fits everything industrial model from the 1930s.

It is a revealing irony that the other big story this week is the phenomenal steady success of Apple's iPhone, the result of a basic platform opening itself to a zillion application companies. Probably 90% of those tiny app firms voted for Barack Obama, whose idea of how the world actually works could not be less like their own.

Senate Minority Leader Mitch McConnell's suggestion that Mr. Obama start over is better advice than he knows. Refashioning America's terrific health-care industry from basic platforms might even be exciting. That won't happen. The Democrats will ride their, and Mr. Obama's, 70-year-old national-entitlement dream straight to November, and over the cliff.


Can we have “universal” medical care without coercion?

The recent loss of what supposedly was a “secure” U.S. Senate seat by Democrats in Massachusetts has triggered a firestorm of speculation about the future of the Democrats’ “health care” bill. For the current legislative season, so-called ObamaCare looks to be dead or at least dormant.

“Politically dead” is a temporal term, however, and there is no doubt that President Obama and his congressional allies are going to formulate an alternative strategy and then try once again to ram “universal care” through the legislative process. In this piece, I don’t deal with the politics of universal care, but rather with the larger collectivist and coercive reasoning that accompanies its implementation.

Ever since the Progressive Era, Americans have been told that there is a difference between “good government” and “bad government.” “Good government” provides all sorts of services that poor people cannot afford, such as medical care, transportation, housing, education, and even food. (“Bad government” arrests, imprisons, and generally acts like an occupier.)

Obviously, “universal care” falls under the “good government” label, and when conservatives or libertarians complain about “government on our backs,” the “Progressives” are quick to reply that government “gives” us all sorts of goodies that we never would have unless there were intervention by the State. While this sounds good, I remind readers that government provides nothing without coercion, so when someone speaks of “good government,” that person really is claiming there is “good coercion.”

What comprises “good coercion”? It is the application of force that supposedly serves a “greater public good,” the “greater good” being medical insurance for those who did not have insurance before. Clearly, a philosophical issue is before us. Should government force someone not only to pay for health insurance for someone else (through taxation), but also to purchase a government-approved health insurance policy for himself?

Advocates of such coercive measures are quick to accuse private enterprise of being “exploitative and oppressive.” (Listen to a speech by Ralph Nader or read the latest issue of The Nation or the editorial page of the New York Times.) Something does not quite make sense, however.

No one has forced me to purchase the vast amount of things that I own and use. Instead, I choose to purchase them, and that includes health insurance. (I would prefer that the health system not be dominated at all by third-party payments, so I could purchase insurance for potential catastrophic events, but nonetheless I do purchase my insurance voluntarily.)

Contrast what I just have described to the purchase of government-produced goods. As a taxpayer I am forced to pay (on pain of arrest and imprisonment) for products that other people use, from roads (which, at least, I use myself), public schools, Social Security and Medicare, and, of course, “national defense.” It does not matter if I wish to use those products or support them; I have no choice but to help pay for them.

Thus it is with “universal” medical care. The plan is for the government to force everyone to purchase an “insurance plan” and pay for others to purchase such plans as well. No one is permitted to opt out (unless one is part of an old-order Amish sect).

Proponents of such a policy claim that unless everyone is forced to participate, the system will not provide “equal care,” and therein is the lynchpin of the whole system. From taxation of “Cadillac” plans to forcing everyone, regardless of health, to purchase policies, the government is attempting to enforce an egalitarianism that is in the best interests of no one but the political classes.

There is no way that the plan can make everyone better off. Instead, like so many other tax-and-spend schemes, it seeks to make some people better off by making a lot of other people worse off, and such a plan can be put into place only with brute force. It is a truism in economics that people won’t deliberately and knowingly make themselves worse off. The political classes know it, and perhaps maybe others are beginning to understand.


Speech therapy

The Left-leaning writer below is not buying the Democrat excuses for failure

"Communications failure" is the phrase being used by the White House and assorted commentators to explain the collapse of health care reform and other parts of President Obama's agenda. According to this reasoning, Obama hasn't pursued the wrong goals. He has simply failed to articulate them. And tonight's State of the Union could somehow change that.

There are two problems with this theory. First, it's not as if the administration has failed to articulate its message. Second, even if it has, it's unlikely the State of the Union will make a difference.

Obama himself seems to subscribe to the notion that no one is listening. "What I haven't always been successful at doing is breaking through the noise and speaking directly to the American people in a way that during the campaign you could do," Obama told ABC's George Stephanopoulos after Republican Scott Brown's win in Massachusetts last week. Spokesman Robert Gibbs, meanwhile, argued on Tuesday that the administration was out-communicated by its opponents. Health care reform "became a caricature of its component parts," Gibbs said.

In one sense Gibbs is right: Ever since the inauguration, and especially since the health care debate began in earnest in the fall, the Obama administration has done nothing but communicate. Between the town halls, the weekly presidential addresses on YouTube, the prime-time speech on health care to a joint session of Congress, and the constant hawking of the administration's line on cable news—all of which drew charges that Obama was "overexposed"—it's hard to say that the White House hasn't done enough talking. Yet certain memes—"death panels," anyone?—took hold despite the administration's efforts.

So "communications failure" seems too pat an explanation for the collapse of the administration's plans for health care reform. It's an easy political fall-back. When something doesn't go your way, it's not because of a flaw in the policy. It's not because you failed to organize your supporters. It's because you failed to articulate your goals and why they're important. In the spectrum of political failings, it's the least blameworthy, since it leaves open the possibility that people just don't get it.

There are more plausible—and just as easy!—explanations. One of the best is that the administration has simply been battered by a series of unfortunate events. If Ted Kennedy had not died when he did, there would be no talk right now of a "communications failure." Same if Martha Coakley had run a better campaign. Or if Senate Democrats had not spent so long trying to court Republican votes that never materialized. If these events hadn't played out the way they did, we'd be talking about Obama's patience, Rahm Emanuel's diplomacy, and the White House's shrewd communications strategy.

What must be frustrating to the administration is that its talking points are hardly unique. Most independent experts, including the Congressional Budget Office, say that both the House and Senate versions of health care reform would reduce the deficit. The White House has repeated this numerous times. Yet 68 percent of Americans believe it would increase the deficit. The CBO says that reform would be fully paid for, be it through taxes on the wealthy or a tax on so-called "Cadillac" plans. Obama mentions this often. Yet more than 75 percent of Americans think it would lead to higher taxes for the middle class. Perhaps the most telling contradiction is that while many Americans believe that reform would improve care, costs, and access for the country as a whole, they think it would hurt them personally—a logical conundrum, if not an impossibility. The White House may be suffering from a communications failure, but it's not for lack of talking.

An alternate theory, of course, is that Americans hear quite well what Obama is saying, thank you—they just don't believe him. If that's the case, then he may need more than a single speech to turn sentiment around.


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