Monday, March 08, 2010

The Health Care Bill That Just Won't Die

Just when you think that the Democrats' Health Care Bill is dead . it rises from the grave like a zombie propelled by the sheer will of liberals in Washington who think they alone know what's best for the American people. President Obama today ordered Congress to pass the Health Care Bill in the next two weeks so that it can be written into law by a strategy called "reconciliation". The promise of bipartisanship has faded. Now, the bill will pass without Republican support.

While the Democrats in the House are busy lining up their votes, one wonders if any will take the time to read the more than 2,000 page monstrosity. In the meantime, the American people are left to question what the role of government should be on health care.

Everyone in this country wants better and more affordable health care made available to a larger number of people. Those in this debate are not arguing about whether more people should be insured, the debate is about how to increase coverage for more people. The Democrats make it seem like our choice is between the current, albeit imperfect system, and radical reform. This is not true. As we saw in the last election, voting for change doesn't necessarily get you the kind of change you want. Sometimes a change can be a change for the worse.

The federal mandate to purchase health insurance has been part of this bill for several months. However, President Obama recently pegged the penalty to not comply with the mandate at 2.5% of annual income. The problem is the mandate. The mandate exists to force people to purchase the amount and type of insurance favored by the federal government. The decision about what kind of health care you want to buy - or if you want to buy it - is fundamentally the same kind of decision as where you want to live or where you want to work: a private matter that is related to fundamental values about how you want to live your life. A mandate of this kind is a substantial infringement on your individual freedom.

Mandating universal health coverage and making the government the ultimate provider of health insurance takes our private choices about lifestyle, health, and medicine and turns them into public, social choices. Whether you eat donuts or hamburgers or get a check-up so many times a year is no longer a choice about your life, but rather a public, political choice about how politicians will control the distribution of resources in society. Since we'll all be tied together through a social health care system, you will no longer make private decisions about your lifestyle. This is a scary prospect. We don't want to live in a society where a National Health Director can decide that it is verboten to eat Krispy Kreme donuts because those who do have become a social liability.

This Health Care debate is about the American Dream. It is about the personal decisions each of us make every day as we live our own, respective lives. It is time to dare to dream again about an America that celebrates and protects the freedom to live your life based on what you think is best, not what a gaggle of Washington politicians believe.


Obama comforts House liberals: Don’t worry, this bill is just the beginning of what we’ll do with health care

Thus confirming what many conservatives have predicted

Don’t look surprised. The left has been remarkably candid about this over the past year or two. Again and again and again and again and again and again and again they’ve warned people that the dream is bigger than universal coverage or even the public option. Memo from The One to progressives: Keep the dream alive.
Obama argued to the group of progressive members that his health care reform bill should be looked at as the foundation of reform, that can be built on in the future. He asked them to help gather votes for the final health care battle and promised that as soon as the bill was signed into law, he’d continue to push to make it stronger. But in a matter of weeks, he stressed, he could sign into law legislation that would lead to 31 million new people being insured, including the woman who wrote him…

“He just said that the public option, something that he has supported along the way, is not something that we can pass. And he emphasized the fact that the decision now is between doing as much as we can do and doing nothing. That’s it. He thought the whole foundation thing — that this is definitely something we could be proud of, something we could build off [of],” said Schakowsky.

Woolsey told Obama that she’d be introducing legislation to create a public option and Obama said he encouraged the effort, according to Schakowsky.

Here’s an especially fun passage. Remember, Obama was self-described proponent of single-payer as recently as 2003 before deciding that it’s simply too impractical to pass. For now.
None of the members, including Kucinich, indicated that they would vote any differently this time around. “I think [Kucinich] left the meeting leaving the impression with the president that he’s a no-go,” said Schakowsky.

But, said one attendee, Obama pointed Kucinich toward single-payer language that Sen. Bernie Sanders (I-Vt.) was able to get into the bill. Kucinich fought for an amendment that would allow states to adopt single-payer systems without getting sued by insurance companies. Obama told Kucinich that Sanders’s measure was similar but doesn’t kick in for several years. “He definitely wrote it down,” said one member of Kucinich, suggesting that he’d look into it.

I can’t decide between thinking that he’s saying this earnestly — if so, given the fallout in November, he’s going to be waiting awhile for ye olde public option — or just telling these idiots what they need to hear to vote for the much-despised Reid bill. This would, in theory, give him some cover even if he goes ahead and stabs them in the back by dropping reconciliation. After all, if this is just the first small step towards socialized medicine, who cares how small that step is? Pass anything. Just get a foot in the door so that you can swing it open in a decade or two when the wheel turns towards progressivism again.

Exit question: Think anyone in the White House press corps will lean on Gibbs tomorrow to explain what, specifically, this bill is a “foundation” for?


A proposal built on lies

“No one has talked about reconciliation,” Senate Majority Leader Harry Reid declared during last week’s health care summit. It was a lie shocking in its boldness.

Live on national television, the Democrats’ leader in the U.S. Senate told the nation that not a single person had discussed even the possibility of using the Senate’s budget reconciliation rules, which require a simple majority vote instead of 60, as needed under regular Senate rules, to pass President Obama’s health care reform plan. Yet, a week before, Reid himself had said publicly that reconciliation was an option for passing the plan, reported. Of the Senate’s 59 Democrats, 23 had already signed a letter urging the president to pass the plan via reconciliation by the time Reid said “no one” was even talking about it. And of course, a week later, President Obama, as expected, urged Democrats to pass the bill through the reconciliation process if necessary.

In other words, the Democratic Party leadership in Washington hadn’t just talked about reconciliation. It was central to their strategy.

Reid’s blatant revisionism perfectly encapsulates the Democratic leadership’s plan for passing legislation to completely remake health care in the United States. Simply put, the plan is this: Lie. Thus, President Obama and the leadership in Congress have lied about nearly everything, from start to finish. Obama said that if you have health insurance you like, you’ll absolutely get to keep it under his plan. That was a lie. As he eventually acknowledged, millions of Americans will lose their existing coverage if the changes he wants become law.

Similarly, Obama spent all last summer saying health care reform wouldn’t raise taxes on anyone but the rich. But on August 2 the Associated Press reported that the administration admitted that taxes might have to be raised on the middle class to pay for the health care bill.

Obama has said repeatedly that insured families pay about $1,000 a year to cover the costs of the uninsured. puts the figure at $200.

Obama said our current health care system causes a bankruptcy every 30 seconds. That’s not remotely true. If every bankruptcy in the United States in which health care costs played any factor at all were counted as a bankruptcy caused by health care, the figure would be one per minute, not double that.

In the summer, Obama was claiming that health care reform was paid for. At the time, the Congressional Budget Office concluded that the House bill added $239 billion to the federal deficit over a decade and the Senate bill $597 billion. The president’s claims still aren’t true because of tricks such as removing the “doc fix” provisions and putting them into a separate bill.

Obama claimed health care reform would save the average American family $2,500 a year. could find no evidence for that at all. Obama apparently just made it up.

Obama promised at least eight times that the health care negotiations would be televised live on C-SPAN. They weren’t. They were done, as everything in Washington is done, behind closed doors.

There us no shortage of additional examples. When it comes to health care, on point after point after point, the American people have been lied to – systematically, methodically and deliberately.

It should go without saying that opponents of the Democrats’ plans haven’t always been truthful, either. Some attacks have contained intentional falsehoods, others inadvertent ones. I don’t defend any of those. But they don’t make any less outrageous the fact that our own government has systematically misled us in an attempt to generate support for a plan the president and leaders in Congress knew we would never accept if we knew the whole truth about it.

Sure, politicians have always lied. But this administration, with its campaign theme of hopeful “change,” was supposed to be the most open and transparent administration in history. Even Congress was supposed to be different. Nancy Pelosi promised the most ethical Congress in history. Instead, the White House and its Congressional allies have joined forces to launch an almost daily barrage of falsehoods designed to trick us into supporting a dramatic transformation of one sixth of the American economy. And here’s the worst part about the politics of the healthcare debacle: We have at least three more years of this to look forward to.


Government medical records are already a shambles

But Obama wants more of the same. If government bureaucrats can't keep records for 4 million people straight, what chance with 300 million?

The electronic health record (EHR) network portal for the U.S. Department of Defense (DoD) and Department of Veterans Affairs (VA) was shut down this week after the VA found errors in some patients' medical data that clinicians downloaded from the defense network, according to a patient safety alert. Among the errors the VA detected through the Computerized Patient Record System's (CPRS) Remote Data View (RDV) -- its graphical user interface for clinicians -- was a prescription for vardenafil for a female patient. Vardenafil is used for treating male erectile dysfunction.

"The DoD pharmacy staff checked the prescription number and determined the vardenafil prescription was for another patient and verified the vardenafil prescription had not been ordered for or dispensed to the female VA patient," the alert stated.

The decision to shut down the portal was first reported by As of Monday, all access to electronic Defense Department records through the computerized record system and VistAWeb was disabled, the VA said. The agency was not sure when the system would be restored.

VistAWeb is the VA's intranet portal to eHealth records through CPRS, and it allows remote medical facilities access to the VA's VistA EHR system. VistA stands for Veterans Health Information Systems and Technology Architecture.

Jean Scott, director of the Veterans Health Administration's Information Technology Patient Safety Office, said in the alert that the VA pulled the plug on the system because "the potential exists for decisions regarding patient care to be made using incorrect or incomplete data."

The VistAWeb is operated by the VA and is the largest and most comprehensive EHR system in existence, serving more than four million service members. Many medical IT experts consider it to be the archetype for EHR systems in the private sector, and vendors have copied its architecture in their own products. As of March 13, all medical records for the DoD will be accessed by phone, fax, paper or other alternative methodologies, the VA said.

Other errors with VistAWeb and CPRS system include displaying some patient data incorrectly, incompletely or not displaying queried data at all. "The VA clinician may see the patient's data during one session, but another session may not display the data previously seen," the VA said in its alert. "This problem occurs intermittently and has been reported when querying DoD Laboratory, Pharmacy, and Radiology reports."

The government has uncovered other prescription errors related to EHR systems that have been rolled out in private-sector hospitals as well. Sen. Charles E. Grassley (R-Iowa), sent a letter in January to some of the nation's largest health care facilities asking for any information on "issues or concerns that have been raised by your health care providers" over the past two years.

Grassley said the letter was prompted by concerns brought to his attention in recent months about EHR systems that included "administrative complications, formatting and usability issues, errors and interoperability." In some of the most serious cases, incorrect medication dosages are being miscalculated by software that is interchanging patient body weights with kilograms and pounds.

IT managers also have voiced concerns that new regulatory deadlines from the government aimed a spurring EHR adoption in the private sector could wind up causing problems as people rush to deploy systems so they can claim a portion of billions of dollars in federal incentive monies.

According to the VA, no patients were harmed as a result of the errors in the EHR system. Although the agency moved to shut down down the eHealth records exchange this week, it said it first discovered the problem in February with the Defense Department's EHR system, known as the Armed Forces Health Longitudinal Technology Application. That's when the erectile dysfunction prescription error occurred.


Mencken on Merchants of Idiotic Ideas

Last night, driving back from teaching my wonderful Principles of Microeconomics students, I heard on a DC radio station an interview with an aide to House Speaker Nancy Pelosi approvingly repeat Pres. Obama’s insistence that, once those Americans who now oppose Obamacare actually get that care, they’ll grow to love it.

This outcome is unlikely – or, rather, it would be unlikely if all the problems with collective decision-making (as identified by public-choice economics) didn’t distort political perceptions. As H.L. Mencken observed: “The kind of man who demands that government enforce his ideas is always the kind whose ideas are idiotic.*”

Being sensible, sensible ideas seldom must be imposed by force. Sometimes sensible ideas are adopted gradually, as practices with widespread advantages displace less-advantageous practices and become part of customary behavior. Sometimes sensible ideas are adopted consciously and quickly, through the art of persuasion or the rigors of scientific demonstration.

In contrast, idiotic ideas have nothing going for them. Most people who voluntarily adopt idiotic ideas in their private lives soon abandon them if these ideas hamper their ability to thrive in the real world. The only way to implement an idiotic idea widely and surely is through force – which is the root of Obamacare.


Canadian healthcare at work

Incompetent surgeon allowed to keep operating -- with grievous results

A Leamington, Ont., woman, who had an unnecessary mastectomy last fall, has launched a $2.2 million lawsuit against the surgeon who removed her breast, the pathologist who analyzed her biopsy and two hospitals in the Windsor, Ont.-area. Laurie Johnston, who never had breast cancer, is suing surgeon Dr. Barbara Heartwell, pathologist Dr. Olive Williams, Hotel-Dieu Grace Hospital and Leamington District Memorial Hospital.

At a news conference in Toronto Wednesday, Johnston said she believed she was in the hands of a good surgeon who would help her fight breast cancer, a disease that also struck her mother and sister. Instead, Johnston says she walked out of Heartwell's office a "disfigured" and forever-changed woman — for no reason. Johnston underwent radical surgery last fall in which Heartwell removed her left breast and six lymph nodes, only to find out she never had cancer.

Johnston is seeking $1 million in general and special damages and another $1 million in punitive and aggravated damages. Her daughters, aged 22 and 15, and her sister are seeking another $200,000 in damages under the Family Law Act. "To learn that my breast was removed unnecessarily is devastating for me and (my family)," Johnston told a throng of reporters Wednesday at the office of Toronto law firm Torkin Manes LLP. "Sometimes, I'm alone and I just sit there and think about it, and I start to cry," she said. "If I'm not crying, I'm angry, I'm anxious."

The lawsuit, filed Tuesday in Windsor, alleges Heartwell failed to properly diagnose Johnston and "failed to read or properly understand" the pathology report which showed Johnston's lump was benign. The suit also alleges Williams, who examined Johnston's biopsy samples taken at Leamington hospital, produced a confusing pathology report which contributed to Heartwell's error. The allegations have not been proven in court.

Hotel-Dieu officials have said that Williams' pathology report was correct but that Heartwell misread it. The top of the report lists a clinical diagnosis of ductal carcinoma, based on initial findings. Further down the page, Williams listed a pathological diagnosis of fibroadenoma — a benign growth in the breast.

Johnston's lawyer, Barbara MacFarlane, said Hotel-Dieu ought to have known at the time of Johnston's surgery that Heartwell had performed another unnecessary mastectomy in 2001 on Janice Laporte, who was cancer-free. Laporte, who now lives in Sarnia, Ont., came forward with her story after hearing about Johnston in the media. Laporte settled a lawsuit against Heartwell out of court. That suit did not name Hotel-Dieu.

MacFarlane said both Hotel-Dieu and Leamington hospitals should have known that Williams was "incompetent." Williams was suspended Jan. 4. Heartwell voluntarily stopped performing surgeries at Hotel-Dieu last week. The hospital is also reviewing her past cases. Both physicians are under investigation by the College of Physicians and Surgeons of Ontario. The Ontario Ministry of Health has also launched a probe into surgical and pathology errors in Windsor.

In a statement, Hotel-Dieu said it has not yet received official notice of Johnston's claim. "We are profoundly sorry that this tragic situation has occurred and we know this is an extremely difficult time for Ms. Johnston," hospital CEO Warren Chant said, adding that Hotel-Dieu has offered support to Johnston and "will we will continue to do so."

Meantime, a Toronto hospital where Williams worked more than 12 years ago will be conducting its own review of her old cases. Wolf Klassen, vice-president of program support at Toronto East General Hospital, told Canwest News Service Wednesday the hospital will pull a random sample of Williams's pathology reports to check for mistakes. "In light of everything that's been reported in the media, we are doing this as a precaution," he said.

The ministry-appointed investigators, Dr. John Srigley, Dr. Robin McLeod and Dr. Barry McLellan, will also look more broadly at the quality of patient care. "When I heard about what happened in Windsor, I thought that was important enough to send in (investigators)," said Ontario Health Minister Deb Matthews. "It's a very rare thing to do, but I thought the circumstances warranted it."

Despite calls for a provincewide pathology review, Matthews said the probe will remain focused on Windsor. Matthews said she has been in frequent contact with McLellan, Ontario's former chief coroner who is heading up the investigation, and if he believes the review should be expanded beyond Windsor, "then I will take that very seriously."


The British Labour party hid the ugly truth about the National Health Service

DAMNING reports on the state of the National Health Service, suppressed by the government, reveal how patients’ needs have been neglected. They diagnose a blind pursuit of political and managerial targets as the root cause of a string of hospital scandals that have cost thousands of lives.

The harsh verdict on the state of the NHS, after a spending splurge under Labour between 2000 and 2008, raises worrying questions about the future quality of the health service as budgets are squeezed. One report, based on the advice of almost 200 top managers and doctors, says hospitals ignored basic hygiene to cram in patients to meet waiting-time targets. It says “several interviewees” cited the Maidstone and Tunbridge Wells [NHS Trust in Kent where 269 deaths during 2005-6 were caused by infection with Clostridium difficile bacteria].

“Managers crowded in patients in order to meet waiting-time targets and, in the process, lost sight of the fundamental hygiene requirements for infection prevention,” the report stated. There were subsequent failings at health trusts in Basildon in Essex, and Mid Staffordshire. Filthy wards and nurse shortages led to up to 1,200 deaths at Stafford hospital.

Lord Darzi, the former health minister, commissioned the three reports from international consultancies to assess the progress of the NHS as it approached its 60th anniversary in 2008. They have come to light after a freedom of information request.

The first report, by the Massachusetts-based Institute for Healthcare Improvements (IHI), identified the neglect of patients as a serious obstacle to improving the NHS. “The lack of a prominent focus on patients’ interests and needs ... represents a significant barrier to shifting the trajectory of quality improvement in the NHS.” One heading in the report says: “The patient doesn’t seem to be in the picture.” It adds: “We were struck by the virtual absence of mention of patients and families ... whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality. “Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experience of care.”

This weekend it emerged the recommendations of the reports, intended to help the NHS improve, have not even been circulated. The stark assessments, collected from leading NHS clinicians and managers, include:

* A damaging rift between doctors and managers: “The GP and consultant contracts are de-professionalising, and have had the peculiar effect of simultaneously demoralising and enriching doctors. We’ve lost the volitional work of the doctors and far too many of us are now just working to rule.”

* Pointless new structures. “Stop the restructurings. The only thing they generate is redundancy payments.” One body responsible for improving standards reported to five different ministers and had three different names in the space of 30 months.

* A culture of fear and slavish compliance. “The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.”

The IHI report, whose interviewees included Lord Crisp, chief executive of the NHS between 2000 and 2006, also described a system of self-assessment where only 4% of trusts are externally inspected.

A similar picture emerges in the second report, by the US-based Joint Commission International. It says the “quality and integrity of [NHS]performance data is suspect”. Dennis O’Leary, its lead author and an international expert on patient safety and improvement, said it was not intended as an exposé but as a series of useful suggestions for change. “Our instructions were to pull no punches and tell it like it was, but the report wasn’t overstated,” he said. “It was how we saw things based on interviews with more than 50 people.”

The third report, by the US-based Rand Corporation, expresses surprise at the lack of a requirement to identify the specific drug involved when patient accidents are reported.

In 2008 Darzi issued his own blueprint for the future of the NHS, High Quality Care for All, but resigned from the government last July to return to his surgical commitments. Last week he said: “The NHS is continuing a journey of improvements, moving from a service that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care.

“High Quality Care for All has gone to every NHS organisation in the country where it is being implemented to ensure that the NHS delivers safe and effective treatment every time, with our patients being treated with compassion, dignity and respect when in our care." A Department of Health spokesman maintained that the three reports were never intended for “wider circulation” and said they were extensively discussed by experts advising Darzi on the production of his report.

However, Brian Jarman, emeritus professor at Imperial College London and an expert in hospital standards, said the findings should have been made available to Robert Francis QC, who led the inquiry into the Mid Staffordshire NHS Foundation Trust. He said: “These reports have never seen the light of day. We desperately need a better monitoring system for the NHS which actually works.”


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