Patients in England and Wales denied powerful drug available in Scotland

Patients in England and Wales are being denied a powerful new arthritis drug on the NHS despite a decision by Scottish health authorities to provide it to sufferers for free. The Government’s drugs rationing body, the National Institute for Health and Clinical Excellence (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra. Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.

But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC). The move will reopen accusations of medical ‘apartheid’ within Britain. It follows an outcry after patients in Scotland were given access to expensive cancer drugs denied on the NHS in England and Wales.

Roactemra has been described as a “life changing” drug because it can be taken after other medications have failed, a common problem in the treatment of rheumatoid arthritis. Patients groups last night said that denying the medication to tens of thousands of patients with the crippling condition in one part of the country was “cruel”. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “I have heard patients stories that would make you weep. “People are virtually suicidal because they have nowhere else to go and yet they know that there are other drugs out there that they could have access to but cannot because of Nice.” She added that it was “ludicrous” that the drug would be available in Scotland “and yet two miles on over the border you can’t get it.”

The drug - the first new arthritis treatment for a decade - is already used in most other European countries, including France and Germany. It offers another option for patients for whom other treatments have failed or no longer work and is used in combination with a standard anti-inflammatory drug, called methotrexate. Currently many rheumatoid arthritis patients receive methotrexate as a first-line treatment to ease their symptoms. In later years they are offered another class of drugs, called anti-TNFs, together with methotrexate, but even combined the effects of the drugs can wear off.

In combination Roactemra has been found to improve the rates of remission of the illness sixfold in comparison with just methotrexate alone.

The SMC - set up in the aftermath of devolution to make decisions about drugs north of the border - has agreed that the drug can be used for patients suffering from moderate to severe forms of the disease for whom other medications no longer work.

Prof John Isaacs, from Newcastle University, said: “This is fantastic news for people in Scotland who suffer from this disabling, lifelong disease. “However, it also highlights the disparities in accessing treatments between Scotland and the rest of the UK. “Because Roactemra works in a completely different way to the existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working, providing an extremely important option for these individuals.” ...

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They’d rather not talk about it

Obama and Coakley afraid to make the Mass. Senate race a referendum on Obamacare

President Obama and Senate Democrats have pledged to make the 2010 midterm elections a referendum on Obamacare. "If Republicans want to campaign against what we have done by standing up for the status quo and for insurance companies over American families and businesses, that is a fight I want to have," Obama said Thursday. But during Sunday's rally for Democratic Senate candidate Martha Coakley at Northeastern University--Obama's first campaign appearance of 2010--he tried to keep the spotlight off of the health care legislation that Massachusetts voters could kill on Tuesday.

Obama mentioned "Wall Street" five times while talking about his proposal to tax banks. He mentioned taxes more than a dozen times. But when it came to health care, the president could muster only a few oblique references to health care reform in general. Talking about the letters he reads from average citizens, Obama said, "Sometimes it's young children who are writing: ... Mr. President, can you help, my brother is sick and we don't have health insurance."

Obama also said that Ted Kennedy waged a "personal battle" for "seniors who are living on fixed incomes, for families struggling to get health coverage for their children, for students who dream of a college education." Health care reform, which Kennedy called "the cause of my life," is just one issue on a laundry list of others--no mention that Kennedy's legislation hangs in the balance on Tuesday.

"Understand what's at stake here, Massachusetts," Obama said toward the end of his speech before talking about abstract ideas of progress rather than a concrete legislative agenda. "It's whether we're going forward or backwards. It's whether we're going to have a future where everybody gets a shot in this society or just the privileged few. If you were fired up in the last election, I need you more fired up in this election."

Coakley too didn't mention the health care legislation in Congress. At one point, she told a story about a couple named "Jim and Karen," who had health care and insurance problems, and said: "They know I will go to Washington and fight for them." But she couldn't bring herself to say, I'm going to go vote for a health care bill to fix these problems.

The reason for this shiftiness is obvious: Massachusetts voters oppose Obamacare. In fact, they oppose "President Obama's health care plan" 48% to 40%, according to the new PPP poll. Those polling numbers also explain why Brown is so confident in attacking the health care bill head on.

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Hoping It Won’t Be Needed, Democrats Ponder a Backup Plan on Health Care Bill



With the Massachusetts special election for United States Senate increasingly unpredictable, Democrats in Washington are contemplating a fall-back plan to advance far-reaching health care legislation, even if a Republican victory on Tuesday deprives Senate Democrats of the crucial 60th vote they need to overcome filibusters.

For the moment, at least, the preferred Plan B would be to try to persuade House Democrats to approve the health care bill that the Senate adopted on Christmas Eve, obviating the need for an additional Senate vote and sending the measure directly to President Obama for his signature, administration officials and Congressional aides said on Sunday.

House Democrats have expressed complaints about the Senate legislation, and Congressional leaders and top White House officials, including Mr. Obama, worked last week to negotiate various compromises. Over all, however, the bills are similar, if not identical, on a vast majority of issues. For supporters of the health care overhaul, the complaints with the Senate bill may seem minor compared with the prospect of outright defeat of the legislation, the president’s top domestic initiative, and the thought of Republicans’ using a health care failure to clobber Democrats in this fall’s midterm elections.

Aides said that the Democrats could move forward with the Senate-passed bill and then push through a raft of changes during the upcoming federal budget process.

If rank-and-file House Democrats balk, party leaders have other options. They could try to pass a revised health care bill in the Senate before the new Massachusetts senator is sworn in. Or they could try to use a procedural tactic known as budget reconciliation that would require only 51 votes. But there is little appeal in those choices. Rushing a bill through the Senate would prompt howls from Republicans and accusations of foul play. And budget reconciliation would most likely require scaling back the scope of the health care changes.

From a political and public relations standpoint, officials said it seemed better for House Democrats to step forward and make the case that approving the Senate bill would be better than having no health care bill.

A House Democratic aide said the House view of the Senate bill had not changed. “We are working toward a compromise bill,” the aide said.

The Republican Senate leader, Mitch McConnell of Kentucky, appearing on “Fox News Sunday,” warned that health care would be a political weapon under any circumstances. “I think the politics are toxic for the Democrats either way,” Mr. McConnell said.

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Health Care Reform Loads the Deck Against Specialists

Scarcely does a week roll by without a human interest story appearing somewhere in the news about a child with an unusual and rare ailment being flown to the United States to see a medical specialist. Often the story features a prominent person or even a government official of his or her particular homeland making a medical pilgrimage here to take advantage of medical expertise that can be found nowhere else.

Our free market health care system furnishes an environment within which medical specialists can flourish. It rewards their unique and rare levels of skill and expertise handsomely via the law of supply and demand. As these sorts of highly qualified specialists are in short supply relative to the demand for their services, those services when performed reap high monetary rewards.

Unfortunately, not everyone esteems these specialized services. And, hence, they have come up with other ways of setting the value of a medical service or procedure besides those of the free market.

Medicare (and Medicaid) has for years used such an alternative method and, shocking though it may be to some, critics charge that this method is nothing more than a revival of the old “Labor Theory of Value” championed most notably by Karl Marx. In fact, a Harvard team in the 1980s set out to study and discern the “value” of a physician’s “work” and subsequently created a fee schedule based on this theory, which has governed Medicare payments to physicians since January 1, 1992.

Quite simply, the centralized planners of Medicare — as Robert Emmet Moffit puts it in his insightful Heritage Foundation study “Back to the Future” — wished to use Medicare not only to provide health services to the elderly, but also as “a powerful engine of income redistribution and social justice among American physicians.”

They developed their “relative value scale” as a means of leveling the compensation playing field between what they deemed to be overvalued and overpriced surgeons and other specialists and allegedly undervalued and underpriced general and family practitioners.

A prime feature of the Labor Theory of Value is that it values a product or service according to the amount of labor that went into it, independent of market forces. Accordingly, Medicare and Medicaid’s relative value scale pays for a procedure based on how hard it is—i.e., based on the amount of labor that went into it—not based on the level of skill and knowledge needed to perform it.

So less highly skilled procedures performed by primary care physicians or general practitioners, if deemed to require the same amount of work as more intricate services that can only be competently performed by highly skilled specialists, will—in theory—be rewarded with equivalent compensation by the relative value scale. Note how this decidedly goes against trends in the free market which value rarer, more highly skilled work by specialists over the simple hard work of family physicians.

What is the relevance of this for current health care “reform” legislation? In an early white paper giving the essentials of what became the Senate health care bill; its architects remarked that they spent much time focusing on Medicare “because of its unique ability to lead the way for system-wide changes.” Their conclusion: “Increasing the supply of primary care practitioners and redefining their role in the health system — by using Federal reimbursement systems and other means to improve the value placed on their work — is a necessary step toward meaningful reform.”

Given that proposals in the Senate version of the bill are likely to be given preference in any final compromise version of the legislation, it is wise that we take this claim to heart as showing the direction in which the Democrats would like the health care system in the coming years. It is a direction that does not bode well for medical specialists – nor for their patients, few of whom, one assumes will travel from afar to seek highly specialized treatment from government-spawned general practitioners.

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Obamacare: Death to "The Right to Work"

Barack Obama has now handed Big Labor the ultimate prize in its decades-long push to force workers into unwanted unions: the power to bludgeon employees with government taxes.

That is real purpose behind the backroom deal conjured up between the president and the union bosses late last week. They want to require non-union workers to foot the bill for a massive 40% excise tax increase on health care benefits. Union workers need not pay. And the only way union workers can escape the onerous tax is to meekly cave in to union demands.

Obama and the union bosses call it a “Cadillac Tax.” A “Right to Work Death Tax” would be more accurate – because its ultimate goal is to gut the 22 state Right to Work laws and turn those sovereign states into union serfdoms.

Now, all that is standing between the union bosses and the targeted workers are the 44 U.S. Senators and 167 members of the House from states protected by the highly popular Right to Work laws. Thirteen of those Senators and 73 of those House members are Democrats.

For them, it is a time for choosing: they can either side with Barack Obama and the union bosses, or they can stand up for the right of their constituents to continue working free of union coercion. It is one or the other. They can’t have it both ways.

If they vote for the Obama government health care takeover with the “Right to Work Death Tax” included, they will have betrayed the trust of more than 90 percent of their constituents who have chosen to remain independent. They will have condemned their states to the same union thuggery that has destroyed the economies of non-Right to Work states throughout the once prosperous Northeast. And they will have consigned the industries within their states to the same fate as America’s now-defunct auto industry.

If, on the other hand, they stand up for workers rights – if they say a resounding “No!” to the Obama-union boss attempt to force their workers to pay thousands of dollars more for benefits union employees get free – they will have put the people of their state before party dictates. And they will have earned the lasting gratitude of tens of millions of workers who want only to work free of government oppression and union coercion.

It seems like an easy choice – for those who put principle before politics. And, so, this paper echoes the words of the prophet Joshua to say, “Choose ye this day whom ye shall serve.”

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