Thursday, January 07, 2010

British government dithering over use of private health services

The government is to be investigated after Andy Burnham, Health Secretary, said the NHS should be the first option when health care contracts are awarded. Mr Burnham said the NHS should be the 'preferred provider' of health care with private companies seen a second choice if the health service cannot meet requirements. It was designed to boost the NHS in the face of growing criticism that the health service was facing creeping privatisation.

But the statement appeared to row back on earlier pledges that the NHS and private sector would compete on an equal footing to provide health care services. Voluntary organisations and charities objected to the change in stance and a joint complaint was submitted last month to the NHS's Co-operation and Competition Panel.

It has agreed to look into the complaint brought by NHS Partners Network, representing private companies that providers treatment to NHS patients and Acevo, the Association of Chief Executives of Voluntary Organisations.

One primary care trust blocked bids from voluntary and private organisations for a contract to provide community health services after Mr Burnham's 'preferred provider' statement in September saying only NHS organisations could bid. This was unfair, it has been claimed.

Peter Kyle, the deputy chair of ACEVO, said: "Although this is a complaint against one PCT, it is the first instance of a PCT implementing Andy Burnham's 'preferred provider' policy, so can therefore be interpreted as a complaint against the secretary of state's position."


NHS plans to use cheaper drugs

This is perfectly reasonable when the generic and the branded drug are identical but that is not always so. There is the additional concern that doctors may be encouraged to prescribe ONLY those drugs with a generic equivalent

The NHS is to increase its use of cheap, generic drugs in a bid to save more than £20 million a year. But patients' groups have expressed concern that the plan could put people with life-threatening medical conditions at risk.

Ministers insist that doctors should prescribe fewer expensive, branded medications to reduce the NHS drugs’ bill, which topped £10 billion in 2007, 10 per cent of the overall budget. Already around 83 per cent of drugs prescribed are off-patent, meaning they can be manufactured and sold at a cheaper rate. But ministers estimate that that figure could rise to 88 per cent of all drugs.

Under proposals being considered certain conditions or drugs could be made exempt from the plans.

Experts have warned that most generic drugs are slightly different from their branded counterparts and that the changes could prove fatal to people with serious health conditions such as epilepsy, asthma or those who have had an organ transplant.

Ministers estimate that even just switching half of those drugs for which a generic version exists could save £20.5 million a year. But official estimates show that the scheme could cost £4.5 million a year to run, on the top of £9 million in start-up costs.

Norman Lamb, the Liberal Democrat Health spokesman, said: "There are legitimate reasons to make savings in the NHS and to increase the use of generic drugs. "However, the bottom line is patient safety is paramount. People's health must not be put at risk, and there is a danger that these plans could do that."

Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: “We are pleased to see that the government has listened to our concerns and that their 'preferred option' currently excludes anti-epileptic drugs from automatic generic substitution. "However, we will be campaigning strongly to ensure that there is public consultation over any future changes to the proposed list of drugs that can be substituted to safeguard people with epilepsy."


The bureaucratization of medicine

I had a little chat with a postal worker on why they aren't delivering mail to the apartment building that I just moved into. I also spoke to the representative of the building owner on why she can't get the post office to deliver mail to the building.

An iron law (if not THE iron law) of bureaucracy is that the so-called workers in the system will make the least effort necessary in order to collect their paychecks. The ideal situation of course is that the bureaucrat should do no work at all in order to collect their pay. Thus it should be no surprise to us that a new generation of Islamic suicide bombers are penetrating security checkpoints manned by the employees of a Federal agency.

In the private sector a serious failure of that magnitude would result in the firing of the employee who failed to do his job and possible criminal prosecution. In the Federal sector a lazy bum is protected by the civil service apparatus. And God help you if you try to discipline an affirmative action diversity hireling.

The Left, in what they imagine to be their infinite wisdom, is now pushing for placing the entire field of medicine in the hands of people who have no stake in the outcome of medical treatments. Whether you, or the most precious members of your family, live or die is simply irrelevant to them as long as they collect their paychecks and pensions. There is no shortage of horror stories coming out of nations where the state provides universal health care.

Innocent people will die needlessly when the state takes over the field of medicine. The nice term for this is murder.


Obamacare’s Three Major Hurdles

The ability to achieve victory largely comes down to one’s determination to win, versus another’s willingness to accept defeat. United States history is replete with examples of Americans overcoming far greater odds than those currently faced by the opponents of Obamacare. In fact, it’s not clear that Obamacare opponents face long odds at all, or even that they face odds longer than those faced by Obamacare supporters, despite the latter’s grossly premature declarations of victory.

The Democrats are determined to expand the federal government’s portfolio beyond the Post Office, Amtrak, and General Motors, by adding the entire health-care industry to its holdings. But before they can subject what will soon be one-fifth of our economy to the federal government’s command-and-control model, Democrats must clear three major obstacles. And they have to do so without losing even three of the 220 votes that Obamacare received in the House or even one of the 60 votes it received in the Senate. In short, they have essentially no margin for error. The Democrats’ three major hurdles are as follows:

(1) The “public option.” The House has previously insisted upon it; the Senate can’t pass it. Early indications are that the House will ignore the calls of Howard Dean and others and will quietly and meekly acquiesce to the Obama administration’s lobbying and coercing. But this could change, and even the slightest dissent within the House Democratic flock could kill the bill.

(2) Abortion. Obamacare supporters conveniently seem to be forgetting that Obamacare wouldn’t have passed the House without the Stupak Amendment’s prohibition on taxpayer funding of insurance plans that cover abortions. Senate Democrats, who are more universally committed to public funding of abortion than Democrats in the House, rejected that approach.

There is no real middle ground between these two positions. One side or the other will have to cave. The very pro-abortion Obama administration will push hard to make the House members give ground. President Obama and Rahm Emanuel are more than happy to sacrifice several handfuls of anti-abortion Democrats in swing districts. But it’s not remotely certain that those members will be willing to sacrifice themselves. True, most of them will be pleased that the “public option” will have been jettisoned, but that won’t go very far in helping them to explain an abortion flip-flop to their constituents. This is a serious hurdle, and it will almost certainly result either in the defeat of many Democratic members or of Obamacare itself.

(3) Public opinion. Poll after poll has shown that, both in terms of sheer numbers and intensity of sentiment, Americans don’t want Obamacare. The Democrats must therefore hope to clear the first two hurdles and pass this unpopular legislation, and then be rewarded by voters with a return trip to Congress and the White House so that they can implement it in 2013 or later. To say the least, that’s a tall order.

And public opinion is likely to continue to move further against them, the more that Americans realize how much Obamacare would politicize medicine. The exemption of the longshoreman’s union from the excise tax on “Cadillac plans,” the survival of full Medicare Advantage benefits in Florida but nowhere else, and the loophole that says that Nebraska wouldn’t have to continue paying into Medicaid while the other 49 states would, are all quite glaring examples of how a shift from private to federal control would politicize health care in an ugly and unseemly way.

Any one these three hurdles can fatally trip up Obamacare. So, at this point, the only thing that would ensure Obamacare’s victory is if its opponents quit running the race. On some level, Obamacare supporters know this, which is why they are already declaring victory and trying to demoralize an opposition that they think lacks resolve. But if Obamacare opponents are determined to match its supporters’ will to win, and if they are determined to run this race for as long as it takes, the smart money is on one of these three hurdles taking Obamacare down.


37 House Dems Could Abandon Obamacare

In November, House Speaker Nancy Pelosi (D., Calif.) lassoed 219 other Democrats and eked out a narrow passage for Obamacare in her chamber. With the Senate’s health-care bill heading back to the House, that number could dwindle. Rep. Eric Cantor (R., Va.), the House minority whip, released a memo this morning that points to 37 House Democrats who may be looking to jump ship.

Cantor tells NRO that the upcoming retirements of Sens. Chris Dodd (D., Conn.) and Byron Dorgan (D., N.D.) and Gov. Bill Ritter (D., Co.) can be attributed partly to the American people’s growing frustration with the Democrats’ handling of the health-care debate. “The Democrats had decided to avoid an open debate,” says Cantor. “That strikes the wrong tone with the public, and people are wondering what they are hiding and who may be rewarded behind closed doors. From the ‘Cornhusker Kickback’ to the ‘Louisiana Purchase,’ it has been a reprehensible practice to watch.”

With the GOP gaining momentum, Cantor tells us that he has “a very plausible formula to stop this bill.” All Republicans need is “three Democrats to change their vote to a ‘no,’ and that’s a real possiblity,” he says, since “many Democrats” feel that the Senate legislation “falls way short” on issues like Medicare cuts, budget costs, and abortion. Here are some choice snippets from Cantor’s memo:
"Millions of Americans have made clear their opposition to the Democrat take-over of our nation's health care system. Together with my Whip Team, I have identified 37 Democrats who — we believe — can be persuaded to vote against a final health care agreement. Because each of these 37 Democrats voted for the House bill, we only need to turn 3 votes to prevent a final agreement from passing. . . .

"If we can convince enough of these 37 Members (along with the 39 Democrats who already voted no) to reconsider and switch their position on the bill, I know that we can defeat this government take-over of our health care before it becomes law. . . .

"Democrat Leaders are telling the press and pundits that the hardest part of the process toward enacting their government take-over of our nation's health care system is past them, but long-time students of the legislative process know better."

For conservatives, it’s good to see Cantor working hard to build a case for both GOP and Democratic opposition to Obamacare. Although he’s the House GOP whip, and the memo was sent out as fodder for the Right, you can be sure that House Democrats in pro-life districts (such as Dahlkemper, Donnelly, Kaptur, and Oberstar) or in districts with many Medicare Advantage enrollees (such as Space, Moore, Kagen, and Maffei) will be taking close notice.


Obama backs high-end health plan tax

President Barack Obama signaled to House Democratic leaders Wednesday that they'll have to drop their opposition to taxing high-end health insurance plans to pay for health coverage for millions of uninsured Americans. In a meeting at the White House, Obama expressed his preference for the insurance tax contained in the Senate's health overhaul bill, but largely opposed by House Democrats and organized labor, Democratic aides said. The aides spoke on condition of anonymity because the meeting was private.

House Democrats want to raise income taxes on high-income individuals instead and are reluctant to abandon that approach, while recognizing that they will likely have to bend on that and other issues so that Senate Majority Leader Harry Reid, D-Nev., can maintain his fragile 60-vote majority support for the bill.

House Speaker Nancy Pelosi and four committee chairmen met with the president Wednesday as they scrambled to resolve differences between sweeping bills passed by the House and Senate. The aim is to finalize legislation revamping the nation's health care system in time for Obama's State of the Union address early next month. Despite the dispute over the payment approach, Pelosi, D-Calif., emerged from the meeting expressing optimism. "We've had a very intense couple of days," Pelosi said. "After our leadership meeting this morning, our staff engaged with the Senate and the administration staff to review the legislation, suggest legislative language. I think we're very close to reconciliation."

Congressional staff members stayed at the White House into the evening to continue work, and a conference call of the full House Democratic caucus was scheduled for Thursday. Obama is taking a more direct role than ever, convening Oval Office meetings Tuesday and Wednesday of House Democratic leaders.

The House and Senate bills are alike in many ways. Both impose first-time requirements for almost all Americans to purchase health insurance, providing subsidies for lower- and middle-income people to help them do so, though the subsidies in the House bill are more generous. Both establish new marketplaces called exchanges where people can go to shop for and compare health insurance plans. Both would ban unpopular insurance company practices including denying coverage to people with pre-existing health conditions.

Differences include whom to tax, how many people to cover, how to restrict taxpayer funding for abortion and whether illegal immigrants should be allowed to buy coverage in the new markets with their own money. The House bill covers about 36 million uninsured Americans over 10 years, costing more than $1 trillion, while the cheaper Senate bill covers about 31 million.

House Democrats are steeling themselves to abandon establishment of a new government insurance plan opposed by moderates in the Senate, but in return hope to get the Senate to rescind insurers' antitrust exemption, make subsidies more affordable and agree to establishment of national rather than state health insurance exchanges, among other things. Obama has signaled his support for the House position on the subsidies and other areas, aides said.

The difference in how the bills are paid for is emerging as among the toughest disputes. The House wants to increase income taxes on individuals making more than $500,000 and couples over $1 million, which would raise $460 billion over 10 years to pay for the bill. The Senate wants to tax insurance companies on plans valued at over $8,500 for individuals and $23,000 for couples, raising $150 billion. Most analysts say the insurance tax would be passed on to consumers, and organized labor is strongly opposed, as are House Democrats, some of whom contend that the tax would violate Obama's campaign pledge not to tax the middle class.

"We did in our house bill something that protects middle class Americans from having to pay more for health insurance," Rep. Xavier Becerra, D-Calif., a member of the House leadership, said Wednesday. "So far we want to stay to that principle." House members "have been very clear on that issue and working with the president to stick to what he said when he was campaigning for president, we're trying to make sure this does not affect middle class Americans," Becerra said.

Obama has defended the tax as a way to drive down health costs. "I'm on record as saying that taxing Cadillac plans that don't make people healthier but just take more money out of their pockets because they're paying more for insurance than they need to, that's actually a good idea, and that helps bend the cost curve," the president said in an interview with National Public Radio just before Christmas. "That helps to reduce the cost of health care over the long term. I think that's a smart thing to do."

In the end the House likely will have to accept the insurance plan tax at some level - say starting with plans valued at $25,000 or more, with carve-outs for certain union professions - but it might not happen without a fight. A provision in the Senate bill to increase the Medicare payroll tax on high-earners could provide some middle ground, although that measure would raise only $87 billion over a decade.


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