Sunday, January 03, 2010

Two patients ill with suspected legionnaire's disease at scandal-hit British hospital

And the only result seems to be bureaucratic platitudes

Two patients at a hospital severely criticised for its high mortality rates and poor hygiene standards are feared to have contracted life-threatening legionnaire's disease. Both are receiving urgent treatment after falling ill at Basildon University Hospital in Essex and tests are being conducted to confirm their condition.

It comes just days after the hospital announced that a spot-check by health watchdog the Care Quality Commission confirmed it had improved cleanliness standards on its wards. The CQC visit took place a month after it criticised Basildon and Thurrock University Hospitals Foundation Trust for filthy wards, blood-spattered curtains in A&E, inadequate care, and a death rate that was 30 per cent higher than the national average. The trust has had previous problems with legionella. In 2004, it was fined for failing to control it after a patient fell ill. Weeks later, tests showed the bacteria were still present.

The disease, which causes lung infections and pneumonia, brings symptoms of muscle ache, tiredness, headaches, dry cough and fever. It is found in water systems such as showers and spas and can be lethal for those who are already ill because their immune systems are weakened.

Basildon hospital is the largest in the county with 777 beds. The two patients were in two separate areas of the hospital - one is critically ill and the other is said to be comfortable and stable. A spokesman said the hospital had stepped up its already rigorous treatment of its water system to kill the bacteria and was looking for the source of the suspected outbreak. She insisted patients and their families should not be concerned.

"It is our normal clinical practice to test patients with a suspicious respiratory infection for legionella, because we are aware of the risk of the presence of legionella bacteria in the hospital’s water system. This means that anyone diagnosed with legionnaire's disease is identified quickly and treated with the appropriate medication promptly," the spokesman said.

Barbara Stuttle, Acting chief executive of NHS South West Essex, said Basildon hospital had considerably improved its record of keeping legionella at bay since 2004. "Legionella bacterium is widely distributed in the environment and over the past few years Basildon University Hospital has demonstrated commitment and determination in managing and controlling it in the hospital," she said. "Our own commissioned review of the hospital's practices in June 2009 – carried out by an independent expert – found that Basildon University Hospital was thorough and rigorous in its management of the control of Legionella."

But Katherine Murphy from the Patients' Association said the suspected outbreak showed there was still complacency about patient safety and called for the chief executive Alan Whittle, who has until now escaped sanction for the string of problems on his watch, and his board to be held to account. "Until someone is held to account for the continued failings at this hospital, patients lives will continue to be at risk," she said. "It is astonishing that the so-called improvements that we were reassured had been undertaken have been so ineffective. For the hospital to suggest it is not to blame or that people should not be concerned is ridiculous."

She also questioned the validity of the CQC's spot-check. "The fact that there has been a recent spot-check which found that the trust was meeting the minimum standard for infection control raises serious questions about the CQC's methods and judgement," she said.

A CQC spokesman said the hospital would deal with the problem along with the Health Protection Agency but it would "keep a very close eye" on how it is handled. "Infections will happen in hospitals – it is all about how they are being managed and prevented," she said. "A spot check is not going to prevent this from happening but we will be watching very closely to see how it's being managed and that they are doing everything they should be."

The agent that causes legionnaires' is a bacterium called legionella pneumophilia and is generally killed using heat and chlorine treatment of the water system. It can affect people of all ages, but it mainly hits those over 50 and more men than women.


Senate Obamacare bill depends upon Enron accounting for 'savings'

Senate Majority Leader Harry Reid proudly declares that the Senate health reform bill "saves money and saves Medicare," reducing the budget deficit by $132 billion over 10 years, while extending Medicare's solvency.

In fact, only by double-counting savings from Social Security and Medicare does the Nevada Democrat's plan reduce government borrowing. Without this dubious accounting, the Reid Senate bill increases the non-Social Security/Medicare deficit by almost $250 billion. A surprisingly frank new Congressional Budget Office analysis calls foul on this off-the-books borrowing.

The accounting mischief begins with Social Security. The Reid Senate plan imposes a 40 percent excise tax on so-called "Cadillac" health plans with premiums above $8,500 for singles and $23,000 for families.

But most insurers are smart enough to avoid this tax. Instead, insurers will reduce health premiums below the taxable levels, while increasing co-pays and deductible. Since health premiums are non-taxable, reducing premiums would increase employees' taxable wages, boosting Social Security revenues by $52 billion over 10 years.

Of course, when workers pay more Social Security taxes today, they're owed higher benefits at retirement. But the Reid Senate health bill spends the extra Social Security revenues today, meaning we won't have the cash to pay those larger Social Security benefit bills when they come due.

It's not just balanced-budget purists who condemn this double bookkeeping. Reid himself does -- or at least he used to. In 1990, he asked, "Are we as a country violating a trust by spending Social Security trust fund monies for some purpose other than for which they were intended? The obvious answer is yes." As a lawyer, Reid assured us, someone doing this outside of government would be prosecuted.

It's a good thing Reid is not back in the private sector, since his Senate health care reform bill's accounting abuse of Medicare goes even further. The Reid Senate plan includes $438 billion in cuts to Medicare Advantage plans, hospitals and fee-for-service payments.

The cash savings from these Medicare reductions, like the new Social Security taxes, cover other costs in the health plan, like expanding Medicaid and subsidizing private health insurance premiums.

But more than $300 billion of these cuts are also credited to the Hospital Insurance trust fund. These new federal IOUs extend the fund's life by several years, allowing Democrats to claim the Reid Senate bill helps rather than guts Medicare.

But a Dec. 23 CBO analysis directly undercuts Reid's claims. Under the Senate health bill, CBO writes, "the majority of the HI trust fund savings would be used to pay for other spending ... and would not enhance the ability of the government to redeem the bonds credited to the trust fund to pay for future Medicare benefits."

This is the very definition of a "raid" on the trust fund -- Medicare gives us cash, which we spend, while we give Medicare a series of IOUs backed only by Washington's willingness to raise taxes in the future.

As the Obama administration's own budget documents acknowledge, these trust fund "balances are available for future benefit payments ... only in a bookkeeping sense." There's no real cash there, particularly so when Social Security and Medicare revenues are raised for the very purpose of spending on them on other things.

"The key point," the CBO memo says about the Reid Senate health bill, "is that the savings to the HI trust fund ... would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. ... To describe the full amount of HI trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government's fiscal position."

Medicare's chief actuary Rick Foster similarly said in December that Medicare cuts "cannot be simultaneously used to finance other federal outlays and to extend the trust fund, despite the appearance of this result from the respective accounting conventions." Reid once railed against these dubious accounting conventions, but now embraces them.

In total, the Reid Senate health bill borrows more than $350 billion from Social Security and Medicare. But this borrowing is "off the books," meaning it's not generally reported as part of the government's debt.

This bookkeeping allows Democrats to devote around one-third of the $350 billion bill to reducing the budget deficit, thereby claiming a mantle of fiscal responsibility, while spending the majority on expanded coverage for non-retirees.

The national debt measured in total -- meaning debt held by the public plus debt to Social Security and Medicare -- will unambiguously rise under the Senate bill.

This "off balance sheet borrowing" resembles Wall Street financial scandals, yet without such practices the truth of the Senate health bill would be made clear: It borrows far more than it saves and it weakens the nation's fiscal position at a time when it is already under threat. Dodgy accounting is hardly the only sin in Reid's Senate health plan, but it hides a multitude of other ones.


ObamaCare: Should Republicans Have Negotiated on Health Care Bill?

Writing for Forbes, Bruce Bartlett puts forth an interesting hypothesis that healthcare legislation could have been made better (hopefully he meant to write “less destructive”) if the GOP had been willing to compromise with Democrats: "Democrats desperately wanted a bipartisan bill and would have given a lot to get a few Republicans on board. This undoubtedly would have led to enactment of a better health bill than the one we are likely to get. But Republicans never put forward an alternative health proposal. Instead, they took the position that our current health system is perfect just as it is".

Bruce makes several compelling points in the article, especially when he notes that it will be virtually impossible to repeal a bad bill after 2010 or 2012, but there are good reasons to disagree with his analysis. First, he is wrong in stating that Republicans were united against any compromise. Several GOP senators spent months trying to negotiate something less objectionable, but those discussions were futile. Also, I’m not sure it’s correct to assert Republicans took a the-current-system-is-perfect position.

They may not have offered a full alternative (they did have a few good reforms such as allowing the purchase of insurance across state lines), but their main message was that the Democrats were going to make the current system worse. Strikes me as a perfectly reasonable position, one that I imagine Bruce shares. But let’s further explore Bruce’s core hypothesis: Would compromise have generated a better bill? It’s possible, to be sure, but there are also several reasons why that approach may have backfired:

1. It’s not clear a policy of compromise would have produced a less-objectionable bill. Would Senate Democrats have made more concessions to Grassley and Snowe rather than Lieberman and Nelson (much less whether the “concessions” would have been good policy)? And even if Reid made some significant (and positive) concessions, is there any reason to think those reforms would have survived a conference committee with the House? Yet the compromising Republicans probably would have felt invested in the process and obliged to support the final bill – even if the conference committee produced something worse than the original Senate Democrat proposal.

2. A take-no-prisoners strategy may be high risk, but it can produce high rewards. In the early 1990s, the Republicans took a no-compromise position when fighting Bill Clinton’s health plan (aka, Hillarycare), and that strategy was ultimately successful. We still don’t know the final result of this battle (much less how events would have transpired with a different strategy), but if the long-term goal is to minimize government expansion, a no-compromise approach is perfectly reasonable.

3. A principled opposition to government-run healthcare will help win other fights. The Democrats ultimately may win the healthcare battle, but the leadership will have been forced to spend lots of time and energy, and also use up lots of political chits. Does anyone now think they can pass a “climate change” bill? The answer, almost certainly, is no.

4. A principled approach can be good politics, which can eventually lead to good policy. Democrats wanted a few Republicans on board in part to help give them political cover. The aura of bipartisanship would have given Democrats a good talking point for the 2010 elections (”my opponent is being unreasonable since even X Republicans also supported the legislation”). That fig leaf does not exist now, which makes it more likely that Democrats will pay a heavy price during the mid-term elections. It is impossible to know whether 2010 will be a 1994-style rout, or whether the newly-elected Republicans will quickly morph into Bush-style big-government conservatives (who often do more damage to liberty than Democrats), but at least there is a reasonable likelihood of more pro-liberty lawmakers.

When all is said and done, Bruce’s strategy is not necessarily wrong, but it does guarantee defeat. Government gets bigger and freedom diminishes. For reasons of principle and practicality, Republicans should do the right thing.


First stop the ObamaCare disaster, then talk real reform

By Tom Skoch, editor of The Morning Journal of Ohio

AFTER my column last Sunday about the immediate need to stop ObamaCare from becoming law and destroying America's health care system, I got a letter from the chairman of the Democratic Party in Lorain. It basically said Obama and the Democrats' version of health reform isn't perfect, but it's better than the status quo, and then it asked, "Tell us what a 'good' bill would look like." The letter went on to say, "I have some solutions, but for now let's just try to identify and agree on the problems with the current system then see if we can agree on solutions."

The writer named four general problems with the current health system, as he sees it, but excused himself from specifying the solutions he claims to have. That's like holding one's cards out of sight, while insisting that we critics of ObamaCare show our cards. Well, we have some solutions in our cards too, but this is no time to be distracted into playing cards.

Let's just focus on stopping ObamaCare, since that is the immediate threat to our well-being. If you see a thief running off with a woman's purse, you yell, "Stop, thief" in response to the immediate crisis. Later, you can discuss potential reforms of the criminal justice system to prevent purse-snatching. But the only thing you absolutely must do right at the moment is yell, "Stop, thief" and marshal the good people who will grab the thief and end the crisis. In rushing to pass ObamaCare, the Democratic leaders would steal our personal and national well-being for generations to come. Stop, thief.

Good alternative health reform proposals that are not costly, stifling and damaging like ObamaCare have been put forth already, but they can't get past the Democratic leadership which controls what Congress acts on and when. Unlike ObamaCare, such alternatives would improve health care without trillions more being spent atop our already dangerously huge national debt, without raising premiums and cutting back care, without job-killing taxes and costly non-funded federal mandates on Ohio's health system and without the legion of new federal bureaucrats we will have to pay to run ObamaCare and to determine what medical treatment we get, or don't. The alternatives would not force taxpayers to fund abortion against their will as ObamaCare would.

Details on good alternatives to ObamaCare can be found at

But all of that can be discussed in greater detail after the arrogant, brazen ramming of ObamaCare through Congress is stopped. Now is the time to hear the outcry of the majority of citizens who are against ObamaCare and who rebel at having it shoved down their throats. As the physician's oath says, "First, do no harm." First, refuse to be bullied into accepting massive changes for the worse in health care.

Do not be distracted from recognizing the dangers to the United States in the Democrats' health reform bills. Do not be distracted from stopping ObamaCare first. Then let's take our time doing health reform right, in a bipartisan fashion, and in the best interests of America's long-term health.


1 comment:

Rusty Shackleford said...