Obama demands vote on health care

The end game at hand, President Barack Obama took command Wednesday of one final attempt by Democrats to enact bitterly contested health care legislation, calling for an "up or down vote" within weeks under rules denying Republicans the ability to kill the bill with mere talk.

Appearing before a White House audience of invited guests, many of them wearing white medical coats, Obama firmly rejected calls from Republicans to draft new legislation from scratch. "I don't see how another year of negotiations would help. Moreover, the insurance companies aren't starting over," the president said, referring to a recent round of announced premium increases affecting millions who purchase individual coverage.

While Obama said he wanted action within a few weeks, Senate Majority Leader Harry Reid, D-Nev., seemed to hint a final outcome could take far longer. "We remain committed to this effort and we'll use every option available to deliver meaningful reform this year," he said.

The results will affect nearly every American, mandating major changes in the ways they receive and pay for health care or leaving in place current systems that leave tens of millions with no coverage and many others dissatisfied with what they do get. With Republicans united in opposition, there is no certainty about the outcome in Congress - or even that Democrats will go along with changes Obama urged on Wednesday in what he described as a bipartisan gesture.

With polls showing voters unhappy and Democrats worried about this fall's elections, Obama also sought to cast the coming showdown in terms larger than health care, which is an enormously ambitious undertaking in its own right. "At stake right now is not just our ability to solve this problem, but our ability to solve any problem," he said.

Republicans dug in for another struggle on an issue that they agreed would echo into the fall campaign. The Senate GOP leader, Mitch McConnell of Kentucky, said a decision by Democrats to invoke rules that bar filibusters would be "met with outrage" by the public. "This is really not an argument between Democrats and Republicans. It's an argument between Democrats and the American people," he said.

At its core, the legislation under discussion still is largely along the lines Obama has long sought and GOP critics attack as a government takeover of health care. It would extend coverage care to tens of millions of uninsured Americans while cracking down on insurance company practices such as denying policies on the basis of a pre-existing medical conditions.

A new "insurance exchange" would be created in which private companies could sell policies to consumers under terms fixed by the federal government. Much of the cost of the legislation, nearly $1 trillion over a decade, would be financed by cuts in future Medicare payments to hospitals and other providers and higher payroll taxes on individuals earning more than $200,000 and couples over $250,000.

The president's appearance marked a presumably final pivot point in a long, uphill effort by Obama and other Democrats to enact far-reaching changes to the health care system - and with his own administration at an important crossroads. Eager to turn attention to efforts to stimulate the economy and create jobs, the president is seeking a victory on health care that can also give him a boost on other priority legislation. At the same time, a defeat could damage Obama's ability to help fellow Democrats heading into the fall campaign. Failure on health care could well lead to a shake-up of the president's White House team, which has received criticism recently from Democratic lawmakers.

After nearly a year of struggle, the House and Senate passed separate bills late last year, and appeared on course for approving a final compromise version early in 2010. But those efforts were abruptly abandoned when Republicans unexpectedly won a special election in Massachusetts. Sen. Scott Brown's victory gave the GOP an ability they had lacked, the strength to sustain a filibuster, a form of opposition that requires supporters of a bill to post 60 Senate votes in order to cut off debate and force a final decision. Democrats went into something of a political fetal position, and have begun to stir in recent days only as Obama asserted his determination with a bipartisan summit followed by a revised set of proposals.

Obama said the use of rules that deny the minority the right to a filibuster had been used numerous times in recent years, including on passage of welfare reform legislation in the 1990s and twice when President George W. Bush pushed tax cuts to passage. Health care "deserves the same kind of up or down vote" as those earlier measures, he said.

Under the rather complicated approach under discussion, the House would be asked to approve the bill that passed the Senate late last year, despite objections by many members of the rank and file to several provisions. Simultaneously, both houses would also vote for a companion measure whose purpose would be to make changes in the first bill sought by either House Democrats or the White House.

Obama said he was exploring GOP proposals for cracking down on fraudulent medical charges, revamping ways to resolve malpractice disputes, boosting doctors' Medicaid reimbursements and offering tax incentives to curb unnecessary patient visits to doctors. The ideas include an experiment that would establish special courts in which judges with medical expertise would decide malpractice allegations. The idea has been criticized by the Center for Justice & Democracy, a consumer group that prefers the current system of awarding damages. It said health courts would be "anti-patient."

The White House and Democratic leaders said they hoped that Obama's maneuvering would at least win the votes of wavering conservative and moderates in their own party, even if it didn't entice Republicans. But there was no guarantee of success, despite Obama's vow to do everything in his power to succeed - and a White House announcement that he would travel to Pennsylvania and Missouri next week to campaign for the legislation.

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Pelosi tells vulnerable Dems to take one for the team on Obamacare

House Speaker Nancy Pelosi says vulnerable Democrats in Congress need to be willing to sacrifice their own political futures for the sake of passing the party's health care plan.

But Republicans say they plan to use the majority party's insistence on the unpopular package to win races this fall and then repeal the package if Pelosi and her team can actually pass it. With nearly 50 Democratic House candidates in highly competitive races, Pelosi has yet to come up with the 217 votes needed to pass the $1 trillion health care bill President Obama has proposed.

Making the talk show rounds Sunday, Pelosi sent a message to the dozens of vulnerable Democratic lawmakers who are reluctant to vote for the plan. "We're not here just to self-perpetuate our service in Congress," Pelosi said on ABC's "This Week." "We're here to do the job for the American people."

Republicans, though, warned that the Democrats are putting their majority in peril, particularly if the legislation is passed in the Senate using budget reconciliation, a parliamentary maneuver that would require just 51 votes, rather than the traditional 60.

Support for the health care bill has continued to wane in public opinion polls, with more people wanting Congress to avoid using reconciliation and to start over on a new bill. "If they ram through this bill using reconciliation, they will lose their majority in Congress in November," House Minority Whip Eric Cantor, R-Va., said on NBC's "Meet the Press."

Pelosi will have the toughest time convincing moderate Democrats, some of whom hint they could vote against the plan even though they voted for the more liberal House version that passed by just three votes in November.

Sen. Lamar Alexander, R-Tenn., appearing on "This Week," defined the political risk for Democrats. "For the next three months, Washington will be consumed with the Democrats trying to jam ... through in a very messy procedure an unpopular health care bill," Alexander said. "And then for the rest of the year, we're going to be involved in a campaign to repeal it."

Pelosi signaled that the Senate would have to take the first, painful step toward passage. She said she is waiting for a new bill that reflects the changes to the Senate plan outlined by President Obama before his health summit last week. "When we have the bill, we'll see what the Senate can do, and then the House will act upon that," Pelosi said.

Pelosi's comments could signify a potential rift with her Senate counterparts who want her chamber to first pass its version of the president's plan. Both chambers would then vote on a second bill with the changes desired by the House. The Senate would use the 51-vote reconciliation tactic to clear the second bill in its chamber. Sen. Kent Conrad, D-N.D., last week declared health care "dead" unless the House passed the Senate bill first.

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No health care summit bounce, apparently

The first evidence on whether Barack Obama got a bounce from the health care summit comes from the overnight Rasmussen polling. The short answer: No. Or perhaps: au contraire. Rasmussen shows Obama’s strong approval at 22% and strong disapproval at 43%, for a net approval index—this is Rasmussen’s term—of minus 21. That matches the low recorded in Rasmusssen polling on December 21 (reported on December 22), as the Senate was preparing to pass its health care bill and Senate Majority Leader Harry Reid was in the process of delivering the Louisiana Purchase and the Cornhusker Kickback.

One night’s results are not overwhelming proof of anything, and the one-day downtick in Obama’s numbers is not statistically significant. But it’s interesting that his numbers fall when health care legislation leads the news. Not what White House strategists want to see.

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Alice in Health Care

What is most like Alice in Wonderland is discussing medical care reform in the abstract, as if there are not already government-run medical care systems in this country and elsewhere. Yet there seems to be remarkably little interest in examining how government-run medical care actually turns out-- medically and financially-- whether in Medicare, Medicaid, Veterans Administration hospitals in this country, or in government-run medical systems in other countries.

We are repeatedly being told that we need to have a government-controlled medical care system, because other countries have it-- as if our policies on something as serious as medical care should be based on the principle of monkey see, monkey do. By all means look at other countries, but not just to see what to imitate. See how it actually turns out. Yet there seems to be an amazing lack of interest in examining what government-controlled medical care produces.

While our so-called health care "summit" last week was going on, British newspapers were carrying exposes of terrible, and often deadly, conditions in British hospitals under that country's National Health Service. But this has not become part of our debate on what to expect from government-controlled medical care. Such scandals are an old story under the National Health Service in Britain, one repeatedly producing fresh scandals that their newspapers carry, but ours ignore.

In addition to a whole series of National Health Service scandals in Britain over the years, the government-run medical system in Britain has far less high-tech medical equipment than there is in the United States. Neither in Britain, Canada, nor in other countries with government-run medical care systems can people get to see doctors, especially surgeons, in as short a time as in the United States.

It is not uncommon for patients in those countries to have to wait for months before getting operations that Americans get within weeks, or even days, after being diagnosed with a condition that requires surgery. You can always "bring down the cost of medical care" by having a lower level of quality or availability.

But, again, you may never learn any of this by following most of the American mainstream media. It is not that they don't make comparisons between medical care in different countries. But they tend to feature news that will promote government-controlled care. One of the statistics they spin endlessly is that life expectancy in some countries with government-controlled medical care is higher than in the United States. What they don't tell you is that, in some of these countries, all the infants that die are not included in infant mortality statistics, as they are in the United States.

More important, both political and media supporters of government-controlled medical care consistently confuse medical care with health care. Much, if not most, of health care depends on what individuals do in the way they live their own lives-- including eating habits, alcohol intake, exercise, narcotics and homicide. A study some years ago found that Mormons live a decade longer than other Americans. But nobody believes that Mormons' doctors are that much better than other doctors. When you don't do a lot of things that shorten your life, you live longer. That is not rocket science. Americans tend to have higher rates of obesity, narcotics use and homicide than people in some other countries. And there is not much that doctors can do about that.

If those who make international comparisons were serious, instead of clever, they would compare the things that medical science can have a great effect on-- cancer survival rates, for example. Americans have some of the highest cancer survival rates in the world, and for some particular cancers, the highest.

When you can get to see a doctor faster, and get treatments underway without waiting for months, while the cancer grows and spreads, you have a better chance of surviving. That, too, is not rocket science. But it is also something that you are not likely to see featured in most of the media, where people are promoting their own pet notions and agendas, instead of giving you the facts on which you can make up your own mind.

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Doubling down

The president’s determination to enact his collectivist health-reform agenda at any political cost despite overwhelming public opposition is unprecedented in modern times.

Today, Mr. Obama is expected to say he will not heed the will of three-quarters of the American people who either want Congress to stop work on health reform altogether or start over, and will instead tell Congress to charge ahead through the minefield of budget reconciliation to pass a bill that will put one-sixth of our economy under government control.

Rational arguments and facts are discarded. When Rep. Paul Ryan (R., Wisc.) detailed at the summit the budget gimmicks in the bills that would put executives of private companies in jail, the president just brushed past his remarks and said he “disagrees.”

That means Mr. Obama disagrees with the Congressional Budget Office and the chief Medicare actuary whose analyses are based upon the facts of his double-counting of Medicare savings, ten years of taxes with six years of spending, creation of new budget-busting entitlements, one-fifth of Medicare providers going out of business and jeopardizing care for seniors, and health-insurance premiums rising even faster if the bill is passed than if not.

The president’s offer to adopt four Republican ornaments, including one very bad idea by Sen. Tom Coburn, is a joke. Senator Coburn’s idea to send federal undercover agents into doctors’ offices to pose as patients is a police-state tactic that will compromise care for every patient and make it even more difficult for new patients — strangers who might be federal plants — to get appointments.

The White House clearly has no new ideas. The president is expected to ask the Senate to twist its rules to force its health-overhaul legislation through a process designed exclusively for budget and spending-related issues. These are desperate, hard-ball political tactics.

In order to move the president’s process forward, House members who fear for their political lives will be forced to vote for a Senate bill that they hate. That means they will have to vote for a bill that contains the Cornhusker Kickback, the Louisiana Purchase, the Union Payback, and liberal abortion language. And then they must trust that the Senate can fix it through a second reconciliation bill that also must pass both houses of Congress, followed by a likely third piece of legislation to address changes that can pass through reconciliation. That is going to require an unprecedented level of trust that no one has seen on Capitol Hill in a very long time.

The American people are doing everything they can to stop this. If Congress manages to pass this before the Easter Recess as planned, the uprising during Easter recess town-hall meeting will make August look like a children’s tea party.

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British Hospital sent toddler home with plaster cast on the wrong leg

And then they blame the mother!

A toddler with a broken leg was sent home from hospital with a plaster cast on the wrong limb. Medical staff blamed Rafe Powell’s mother for not noticing their mistake after they strapped up her 21-month-old son’s healthy right leg – leaving him in agony with a fractured left leg. Bella Powell, 45, took Rafe to the accident and emergency department at Torbay Hospital in Devon after he fell out of his high chair at their home in nearby Brixham.

X-rays revealed that he had broken his tibia, and after nurses had fitted the crying child with a cast, he was discharged. But when they arrived home, Mrs Powell and husband Guy, 48, who have six children, noticed that Rafe’s left leg had become red and swollen. They made a second trip to the hospital – where staff implied that Mrs Powell was at fault for failing to spot the error during the first visit.

On Wednesday, the hospital apologised for its mistake and the ‘unacceptable comments’ made to Mrs Powell.

Mr Powell, a retired policeman, said: ‘For a mistake like this to be made is too surreal to believe. The worst thing is that they tried to deflect the blame on to my wife. Bella had to do her best to comfort our son as they held his broken leg down and put a cast on the wrong leg. ‘He is a 21-month-old boy – he was upset and in shock and unable to point out which leg hurt so you have to trust the hospital staff to treat the right one. ‘The hospital staff were very dismissive the whole time. It was like we were invisible.’

'Housewife Mrs Powell added: ‘It was all quite an ordeal, with Rafe crying as they held him down while they tried to plaster his leg. ‘I couldn’t believe my ears when the doctor tried to say it was my fault and why hadn’t I said – I felt absolutely awful.’

A hospital spokesman said they had sent a letter of apology to the family and implemented changes to avoid a repeat of the mistake. He added: ‘We have taken measures ensuring all plaster casts that are applied are checked by another member of staff. ‘The two male members of staff who they felt made inappropriate comments have also offered their apologies.’

Rafe will return to the hospital next week for further X-rays to check whether his leg has healed and the cast can be removed.

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How stupid can you get? British bureaucrats think they can improve nursing standards in NHS hospitals by getting nurses to sign yet another piece of paper

A fat lot of good all the previous paperwork has done

Nurses have been told to remember their bedside manner after a series of scandals exposed poor standards of care across the NHS. A commission set up by the Prime Minister yesterday called on nurses and midwives to help strengthen battered public trust in the health service by signing a pledge to treat patients with compassion and dignity.

It comes a week after a report into hundreds of deaths at Stafford Hospital found nurses ignored requests to use the toilet or change sheets - forcing patients to remain dirty for up to a month. And last year it emerged that nurses in Basildon hospital, Essex, were so lazy they did not help frail elderly patients eat meals.

Critics said it was astonishing standards had dropped so low that nurses needed to be reminded to treat people well. There are increasing concerns that trainee nurses spend too much time in lecture halls and not enough on wards - meaning they no longer see cleaning and feeding patients as part of their job.

The solution, according to the Prime Minister's Commission on the Future of Nursing and Midwifery in England, which was set up a year ago, is to ask all hospital trusts to make nurses and midwives sign a six-point pledge.

The commission said patients and staff wanted a new beginning. 'As one nurse from Trafford Hospital put it,' the report stated, 'it was time to remind nurses of the pledge they made when they qualified and received their badges.' Nurses already sign the code of the Nursing and Midwifery Council before they are allowed to work in the NHS. This states: 'The people in your care must be able to trust you with their health and wellbeing. 'To justify that trust, you must make the care of people your first concern, treating them as individuals and respecting their dignity.'

The commission's public pledge would reaffirms the code and adds that nurses 'will accept responsibility for and take charge of the quality of care, service and outcomes for every service user in their care'. It also says: 'Each one of us will speak out and act wherever and whenever care falls below the agreed standard.'

While another section appears to suggest a responsibility among nurses to avoid becoming obese. 'We acknowledge that we are seen as role models of healthy living and will try to live up to this responsibility,' it says.

But last night Patients' Association director Katherine Murphy said: 'While we welcome the pledge, it's a sad indictment that there is a need to restate the commitment of nurses and midwives to high-quality patient care.' Gordon Brown called the publication of the commission's report a 'great day for nursing', adding: 'There hasn't been the recognition of how much training and expertise, science and knowledge a nurse needs to do the job.'

And Government health spokesman Ann Keen said the public image of nursing needed to be updated. 'We need to demonstrate they are not poorly educated handmaidens to doctors,' she said.

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