Wednesday, March 10, 2010

Four big obstacles remain for Obamacare

House Democratic leaders concede they do not have enough support to pass President Obama's health care package, but the party is hopeful it will come up with the 216 votes needed to pass the bill before the March 18 deadline set by the White House. But first they will have to clear a number of hurdles standing in the way of passage.

1. The Senate -- Looming large in the minds of nearly every House member are the 290 or so House bills the Senate has ignored since January 2009. Many House Democrats are refusing to pass the Senate's health care legislation without a guarantee that the Senate will take up a corrections bill using an exhaustive and potentially politically damaging parliamentary tactic that would require just 51 votes to pass it in their chamber. "There are too many deficiencies in the Senate bill for us to just go on faith," Rep. Anthony Weiner, D-N.Y., said.

2. Pro-life Democrats -- Up to a dozen Democrats, led by Rep. Bart Stupak, D-Mich., stand ready to vote against the Senate bill because of its effect on federal funding of abortion. While House Speaker Nancy Pelosi, D-Calif., has insisted the bill does not expend taxpayer money on the procedure, Stupak and others point to provisions in the Senate bill like one that would provide funding for elective abortions by private health insurance plans that receive federal dollars. Stupak told The Examiner that Pelosi is working around the pro-life Democrats, trying to find other former "no" votes to make up the deficit, but Democratic strategist Peter Fenn said the leadership will have to find a way to win the votes of at least some pro-life Democrats. "If you lose the Stupak crowd, you are going to be in trouble," Fenn said.

3. Fiscal moderates -- As Pelosi goes fishing for new "yes" votes among the 39 Democrats who voted against the House health care bill, she may have hard time reeling anyone in. That's because the vast majority of these lawmakers represent red districts. Seven of them won their last election by less than 5 percentage points and 14 are vulnerable freshmen. Many of these members dislike the bill's $1 trillion cost and size. "My top concern is cost containment and delivery system reform," Rep. Jason Altmire, D-Pa., who voted against the House health care bill, told The Examiner. "I'm going to do what's right by my constituents and right by my district."

4. House liberals -- While it is expected that many of the 80 or so of the most liberal members of the Democratic caucus will vote for the Senate bill because it's better than nothing, don't rule out the possibility that at least a few of them will defect and vote down the bill because it does not include a government-run public option that was part of the House-passed version. Upon resigning from the House on Monday over sexual harassment charges, freshman Rep. Eric Massa, D-N.Y., said Democratic leaders were forcing him out because he planned to vote against the Senate bill because it did not create a European-style, single-payer system of health care delivery. "I suspect that most will fall in line and vote for it, but there may be some holdouts that we don't know about," said Merrill Matthews, director of the Council for Affordable Health Insurance, a research and advocacy organization.


Obama: Time to debate health care over

President Obama on Monday tore into private health insurers for recent rate hikes, taking a more aggressive rhetorical turn as he pushes for final congressional passage of his top domestic priority. Obama repeated his assertion that the plan under consideration includes the best Democratic and Republican ideas. The time for debate has ended, he argued. Congress "owes the American people a final up or down vote on health care. It's time to make a decision," he told an enthusiastic crowd at Arcadia University near Philadelphia. "Stand with me and fight with me. ... Let's seize reform. It's within our grasp."

The administration is ramping up its health care push in the coming weeks. The White House has called for legislation to be on the president's desk at the end of March before the congressional Easter vacation. Two Democratic leadership aides told CNN last week that House Speaker Nancy Pelosi, D-California, is aiming to have the House of Representatives pass the Senate's health care bill by March 17.

A separate package of changes designed in part to make the overall measure more palatable to House liberals then would be approved by both chambers through a legislative maneuver known as reconciliation. Bills passed under reconciliation require a Senate majority of 51 votes. Democrats lost their filibuster-proof, 60-seat Senate supermajority with the January election of Sen. Scott Brown, R-Massachusetts.

Obama opened his remarks Monday by targeting Anthem Blue Cross in California for recently boosting its rates by almost 40 percent. A diabetic Philadelphia-area woman introduced the president. Her insurer reportedly told her in January that her rates would more than double. "The price of health care is one of the most punishing costs for families, businesses and our government," Obama said. "The insurance companies continue to ration health care. ... That's the status quo in America, and it's a status quo that's unsustainable."

Insurance companies, the president argued, have made a calculation. He cited a recent Goldman Sachs conference call in which an insurance broker told investors that insurers are willing to lose some customers through premium hikes because of an overall lack of competition in the industry. "They will keep doing this for as long as they can get away with it," Obama said. "How much higher do premiums have to rise until we do something about it? How many more Americans have to lose their health insurance? How many more businesses have to drop coverage?"

Obama dismissed GOP criticism that his nearly $1 trillion proposal fails to control spiraling medical costs. "You had 10 years," Obama said in reference to GOP control of Congress. "What were you doing?" He also brushed aside warnings by political observers that health care reform may lead to major Democratic losses in midterm elections. Washington is "obsessed with the sport of politics," he said. "We have debated health care in Washington for more than a year. ... When's the right time? If not now, when? If not us, who?"

Meanwhile, the Senate's top Republican made it clear Sunday his party won't relax any of its efforts to halt the reform package. "What the American people would like us to do is not make this gargantuan mistake," Senate Minority Leader Mitch McConnell, R-Kentucky, told ABC's "This Week."

If the bill does go through, avoiding a GOP filibuster by using the reconciliation tactic in the Senate, the battle moves to its next stage. "Every election this fall will be a referendum on this bill," McConnell said.

Obama said Monday he's not inclined to take "advice about what's good for Democrats" from McConnell. But "the issue here is not the politics of it," he asserted, saying Congress and the president were sent to Washington to "solve the big challenges."


Liberals want to suspend self-government for Obamacare

President Obama is demanding a final vote on Obamacare before the members of the House and Senate return home for the Easter recess, which begins March 29. Whatever your views on the merits of the variety of health care reform proposals that collectively have been debated over the course of the past 15 months, you should be offended and repulsed by this schedule. Why? Because there is no bill to look at and debate; no text to read; no budget estimate to examine for its assumptions and calculations.

This is a massive proposed law, thousands of pages long, with extraordinarily dense language. The president has promised even more new provisions touching on such important subjects as tort reform and Medicare taxes, provisions that have never seen the light of day or been debated in any committee. His whole pitch is "Trust me," and the American people clearly do not, but still he pushes for a rapid conclusion to the debate.

This is not how free people govern themselves, and there can be no rhetorical cover for this attempted diktat. There is no urgency for a program the benefits of which do not begin to arrive in great measure for many years. There is no conceivable argument for voting in essence "sight unseen" except that the bill cannot withstand scrutiny, so scrutiny must be avoided.

Time and time again we have seen how the legislative process tosses up unseen and unread provisions that shock and appall. Most recently in the law to reauthorize the Patriot Act, there appeared out of nowhere a provision that would have criminalized various interrogation procedures. The "McDermott Amendment" was stopped, but not for lack of trying.

There will be no end to the fine print in Obamacare 4.0. The outrages of the "Cornhusker Kickback" and the "Louisiana Purchase" will have plenty of cousins in the newest proposals pushed by the president. With enough time, they can be discovered, and public opinion can be brought to bear to force them out.

Once into law, however, the worst provisions of Obamacare, passed in darkness and with undue speed, will require enormous effort to repeal and supermajorities if the president wields his veto to protect the special interests that benefit from the law's nooks and crannies.

Look at the fiasco that is the Consumer Product Safety Improvement Act of 2008, which has cost tens of thousands of jobs and hundreds of millions of dollars. The Congress cannot move itself to remedy even its most absurd overreaches. Once on the books, we are stuck with Obamacare with all of its unseen deals.

Nor will we be able to see until it is too late what hasn't happened. Is the tort reform being promised by the president in any way real? Do the numbers add up? Will the Medicare cuts be as deeply destructive as advertised, or will they be suspended and thus the deficits in the out years far greater than advertised?

Liberals who are pushing for a final vote are pushing for a suspension of self-government, for an astonishing and sickening descent into "who cares, just do it" extremism that departs from the long legacy of the American constitutional project.

Every legislator who votes to proceed in this fashion is participating in a shameful humbling of the role of the Congress. They will deserve to be thrown out regardless of the merits of Obamacare because they could not possibly have known what those merits are.


Obama Bribes, Threatens, and Rewards Congress to Pass Health Care

All aspects of President Obama's Chicago-style tactics are on display as he cajoles, bullies and bribes the House to pass his health care proposals despite the overwhelming public rejection with which they have been met.

To some, he offers bribes. Rep. Jim Matheson, endangered species -- a Utah Democrat -- succeeded in getting his brother Scott appointed to a federal judgeship. Matheson voted against Obamacare when it first passed the House. With his new-found winnings in his pocket, he now professes to be undecided. He faces a clear conflict between his district and his conscience on the one hand and the bribe to his brother on the other. The conscience will probably lose.

Matheson supports his party 91 percent of the time according to The Washington Post even though John McCain got 58 percent of the vote in his district in 2008. But Matheson got re-elected -- by professing independence from the Democratic Party's liberal line -- with 63 percent of the vote, so he probably figures he can sneak in a vote for health care and still con his district into re-electing him. After all, he's not heavy. He's my brother.

Even as Matheson basks in the glow of presidential bribery, Eric Massa, a renegade Democrat from the Southern Tier of New York state faces his wrath. Massa's sin was to vote against Obamacare. So Pelosi and the ethically challenged House Ethics Committee are investigating him for "verbally abusing" a male member of his staff.

In this age of more serious offenses, using "salty language" to express his displeasure with staff work would not seem to rank high on the list of indictable offenses. If it were, Lyndon Johnson would have been impeached. But Massa is being hung out to dry as an example to other would-be independent-minded Democrats. The attacks on him have gotten so bad that Massa has announced his retirement after only one term in office.

But there is a reward waiting for House members who ignore the wishes and interests of their constituents and vote for Obama's health care proposals. Alan Mollohan has had a pesky FBI investigation hanging over his head for a few years. Now, presto, right before the health care vote, it went away. The Justice Department, headed by Attorney General Eric Holder, announced that the FBI was closing the inquiry.

Mollohan's sin? He pushed for earmarks for nonprofit enterprises in his district and then went into a real estate deal in Florida with the head of the company under financial terms that were distinctly favorable to the congressman. But Mollohan toes the party line and is now getting his unjust reward.

With health care reform coming up for a vote in the next few days, such tactics send a message to the House, where Nancy Pelosi is having trouble lining up her votes: Obama will do anything -- anything at all -- to pass this bill.

For those of us without judgeships or the FBI at our disposal, we can only call and write the swing congressmen (go to for a list and their phone numbers) or donate to the League of American Voters to step up its fierce media offensive in their districts to urge them to vote no.


Leftist British government ignored safety warnings for years over children's heart surgery

Ministers repeatedly ignored warnings about the safety of Britain's child heart surgery units, it can be revealed. In 2001, a public inquiry into the deaths of dozens of babies at Bristol Royal Infirmary said cardiac units should be barred from carrying out paediatric surgery unless they met safety standards, including carrying out a minimum number of operations per year. The recommendation to ensure surgery was only carried out by those skilled enough to perform the most delicate procedures was made to prevent the recurrence of a scandal such as Bristol – dubbed "the killing fields" in the 1990s.

Later this month, the Department of Health (DoH) will say no unit will be allowed to operate unless it has four surgeons and carries out at least 400 operations a year. The ruling will mean around half of Britain's 11 child heart surgery units must close, while the remainder expand. It means departments such as that at John Radcliffe Hospital, which suspended surgery last week following four deaths, and carried out just 100 operations in the last year, could not continue in their current form.

Today we reveal how:

* Ministers dismissed a warning in 2003 by the UK's most senior heart surgeon that half of Britain's units should be closed. As President of the Society for Cardiothoracic Surgeons (SCTS) of Great Britain and Ireland, Prof James Monro was commissioned by ministers to propose changes following the Bristol inquiry, yet "the Government did absolutely nothing" about his key demand, he told The Sunday Telegraph;

* Sir Bruce Keogh, medical director of the health service, told NHS bosses two years ago that he feared "another Bristol" tragedy because specialists were so thinly spread;

* The consultant told this newspaper "there has been frankly little progress" reorganising services to make them safer since the public inquiry reported in 2001. Sir Bruce recently told colleagues that failing to make changes now would leave "a stain on the soul" of his profession.

* Britain's leading children's heart charity says Labour ministers "ran scared" from introducing an overhaul of the specialist system which could have saved lives, and prevented major disabilities.

The public inquiry into the Bristol heart deaths scandal was the most damning in the history of the NHS. It said botched heart operations killed 30 to 35 babies between 1990 and 1995, while over a longer period, up to 170 babies died who might have been saved elsewhere. Sir Ian Kennedy, the inquiry's chairman, ordered a reorganisation of services to improve safety, with each unit carrying out a specified minimum number of operations.

The DoH asked Prof James Monro, then President of the Society for Cardiothoracic Surgeons, to carry out a review, which in 2003 said the figure should be set at 300 operations annually – meaning the closure of at least half of the centres. Prof Monro told The Sunday Telegraph: "That was our main recommendation and the Government did absolutely nothing about it at all. Not a single unit was closed, and many of them should have closed years ago".

The surgeon, now retired, said he thought it was "extraordinary" that the whole process was being started again now, years after the recommendations were shelved. Prof Monro said he never received an explanation for the rejection of his report, but said "politicians had their fingers in the pie" and were fearful of making changes which might upset local constituencies. In 2003, Stephen Ladyman, the then-health minister, dismissed the recommendation claiming the report contained "no evidence" to justify such closures, despite its inclusion of studies showing higher mortality at small units.

Four years later, Sir Bruce Keogh, then President of the SCTS wrote to health service bosses, expressing concerns about the current and future safety of Britain's paediatric cardiac units. He wrote the letter because he feared several units had become perilously short-staffed. Sir Bruce told this newspaper: "A number of surgeons had retired or stopped doing paediatric work, and I was worried things were looking a bit unstable. "In short, I was worried about the risk of another 'Bristol', and I felt anxious that we had a situation where two or three units were working single-handed."

Months after sending the letter, he was appointed NHS medical director, and ordered an urgent review of the service, which will result in a blueprint for children's heart surgery, to be published later this month. The document will say each service should carry out at least 400 and ideally 500 operations a year, and have 4 surgeons, so it can provide safe around-the-clock cover and perform a larger range of complex procedures. As a result, about half of England's 11 centres will be earmarked to close.

Sir Bruce was so fearful of an immediate crisis in cardiac care that in a letter seen by this newspaper, and sent in May 2008, he warned the head of NHS specialist services to draw up a "risk strategy" in case immediate problems emerged before the reorganisation could be carried out. The letter followed his explicit warning to the NHS management board that "another Bristol" could emerge in the foreseeable future.

Anne Keatley-Clarke, chief executive of the Children's Heart Federation, said families who had experienced the trauma of high-risk surgery were furious that politicians had delayed changes which could have saved lives. "Parents who know about heart surgery are hugely angry and frustrated about this. The clinicians were ready to do this a long time ago, the parents expected it; we think the politicians ran scared and blocked it," Mrs Keatley-Clarke said. She added: "We will never know how many children these delays have affected; whether that is in terms of needless deaths, or more children ending up with learning disabilities because they suffered neurological damage which could have been avoided."

Sir Bruce said there had been "frankly little progress" to make the changes since Kennedy reported in 2001, but said it was "too easy" to blame politicians given the likelihood of fierce constituency battles once the names of the units to close become public. He urged fellow surgeons to show leadership, and support changes even if it meant uprooting themselves and moving hundreds of miles to a different unit. Any more delays would create "a stain on the soul" of his profession, he said.

The largest units at Great Ormond Street and Royal Brompton Hospital in London, and Birmingham Children's Hospital, currently carry out more than 400 operations a year, while Alder Hey Hospital in Liverpool and Evelina Hospital, part of Guys and St Thomas' Foundation trust in London carry out around 350. The threat of closure looms largest over units at John Radcliffe Hospital in Oxford, which carried out just 100 operations in the last year, while hospitals in Leicester, Southampton, Newcastle, Bristol and Leeds all did less than 300.

This review will report this autumn, after considering which hospitals can best expand, and taking into account transport links for families. However Sir Bruce indicated that the John Radcliffe, which last week suspended its service amid an investigation into the deaths of four babies operated on by surgeon Caner Salih, is at greatest threat of closure. Sir Bruce said: "All of the judgements have yet to be taken, but the eye does fall on Oxford, given it's got the lowest number of operations by far, and only one surgeon [since the departure of Salih]".

Yesterday grieving mother Aida Lo, 29, from Oxford, spoke of her shock and anger at finding out that the death of her daughter, three-week old Nathalie, was one of four cases in less than three months which will form part of the inquiry announced last week. The hospital said Mr Salih, who started work at the hospital just three months ago, has left the hospital to work elsewhere. A spokesman said his departure was not connected to the investigation.

Sir Ian, who headed the public inquiry into the Bristol deaths, has recently been appointed to run the Government panel which will decide which paediatric cardiac units can stay open. Asked about the delay of almost a decade since he made his recommendations, he said only: "I did my bit – it was for others to take action. "Obviously I made the recommendation in the expectation action will be taken; I look forward to that happening."

The DoH said it had been monitoring children's heart surgery closely, and that to date, all units were providing acceptable results.


NHS patients routinely treated in mop cupboards and corridors, nurses' survey says

A shortage of space in overcrowded NHS hospitals means patients are routinely treated in television rooms, mop cupboards and corridors, a survey of nurses suggests today. Kitchens and storage areas are also used while extra beds are put on wards, increasing the the risk of infections spreading.

The poll of more than 900 nurses for Nursing Times found that 63 per cent were aware of patients being placed in areas not designed for clinical care. Almost eight in 10 respondents (79 per cent) said they believed this resulted in patient safety being put at risk, due to patients not having access to call bells or water, or fire exits being blocked.

Of those who were aware of the practice, 29 per cent said it happened every day, 29 per cent said several times a week and 11 per cent said once a week. The remainder said it happened once a month or less.

Reasons cited for the use of non-clinical areas included the hospital being “full”, A&E being “under pressure” or a risk that the Government’s four hour target for people to be seen in A&E may be breached, leading to unnecessary hospital admissions.

More than 300 nurses who responded to the survey revealed specific examples of what happened to patients. One anonymous nurse said the areas had been described as an “overspill car park”, while another said: “If a patient’s condition suddenly deteriorated resulting in them having a cardiac arrest we would not be able to get the crash trolley to them.” Another nurse added: “Urine bottles are not emptied, meals are missed, as staff are not aware of the patient.”

A total of 83 per cent of nurses said they had raised concerns about the practice with senior staff but only 4 per cent said it had then been stopped. Others said the move had been authorised by senior managers, while some nurses said they had been bullied and accused of “not being a team player” for raising their concerns.

In a statement, the Department of Health said that the vast majority of NHS patients experienced good quality, safe and effective care. “However, we acknowledge there is more to do and will continue to strive to make services even safer.”” It was for local health authorities and providers to assess services locally, a spokesman added. “Every nurse must comply with the standards, performance and ethics outlined in the Nursing and Midwifery Council code. In particular, any nurse who is concerned about any risk to their patients should report their concerns to their manager, in writing if necessary.”

Katherine Murphy, director of the Patients Association, added: “Not only is this potentially unsafe, but it is completely undignified. In extreme circumstances the NHS might need to resort to this, but the results of this survey suggest it is a widespread practice.”


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