"CARING" BUREAUCRATS AT WORK AGAIN

"Don't bother me" is the only goal of a bureaucrat.

Two different pictures are emerging of the Napa State Hospital in the wake of a recent scathing federal report detailing problems at the facility. The first is the image portrayed in the U.S. Department of Justice report, which describes a perilously understaffed mental hospital crawling with illegal drug use, poor supervision of suicidal and dangerous residents, and a staff too quick to restrain, medicate and isolate patients - sometimes for hundreds of hours at a stretch.

The second is the view of state mental health officials and many who work and live at the hospital, who say a previously trouble-plagued hospital is changing its ways and shifting focus to the individual needs of each patient. Some of the accusations, they say, have been overblown and taken out of context. "Nobody denies that ugly - and unacceptable - things have happened within the historic walls of the 130-year-old hospital at the mouth of the Napa Valley. "We take issue with some things (from the report)," said Stephen Mayberg, director of the state Department of Mental Health. "But there are other things that we knew and that we are trying to address and we are aggressively addressing."

The Department of Justice is blunt in its findings, detailed as "widespread and systemic deficiencies" in a 23-page letter to Gov. Arnold Schwarzenegger on June 27 that recently became public. Of particular concern, the letter states, the hospital has failed to adequately supervise suicidal patients and protect its general population from patients prone to violence. In one instance cited, staff failed to prevent a patient from hanging himself in December despite previous suicide attempts and warnings from his family that he was despondent and in need of attention. The report cites six suicides at the hospital since 1999, the most recent when a patient hanged himself in a locked bathroom in March.

In another case, a patient was strangled to death in May 2002 by his roommate, who had a history of violence and attacking sleeping patients. "Patient advocates and patients themselves tell us that staff often fail to intervene with violent patients because the staff are afraid," the report states. The report also details allegations that patients have access to marijuana and cocaine and that one patient died of a drug overdose in fall 2004. The federal agency also accused state officials of failing to cooperate with the federal investigation and of repeatedly refusing to allow access to the facility. Eric Holland, a spokesman for the Justice Department, said the agency had no comment beyond the report.

State mental health officials say they are preparing a formal response and that they had been working to cooperate. Kirsten Macintyre, a spokeswoman for the Department of Mental Health, said the hospital had been trying to set up time for federal investigators to pore over thousands of documents and interviews they sought. "The timing of this thing caught us off guard because we were negotiating with them," she said. "We've always been open and believed in transparency."

Mayberg said the state was aware of many of the problems outlined in the report, and already had begun massive staff retraining and a widespread shift in the treatment philosophy at all of the state hospitals, including Napa. They have moved toward a model that emphasizes the individual and seeks to encourage patients to interact, learn new skills and reduce the amount of seclusion, he said. "We've raised the standards. We can't say that we can predict everybody's behavior at this stage but we are building in as many checks and balances to make sure that none of that occurs (again)," Mayberg said. He said many of the problems - and the needed remedies - stem from a shift in recent years in the type of patients who reside at the hospitals to criminals who have "much more propensity toward violence."

About 90 percent of the 4,600 patients in the state hospitals now come through the criminal justice system. Most have committed violent crimes, including murder, and have been found mentally incompetent to stand trial or not guilty by reason of insanity. "There's nothing that can be said to say that we even defend or justify (the deaths and violence)," Mayberg said. "We have a very different population. The folks we are dealing with now bring a whole new set of challenges." In the aftermath of the report, officials also are making an effort to open their doors to journalists and elected officials.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

PRIVATE HEALTH CARE IS ACCESSIBLE TO ALL IN AUSTRALIA

Earlier on today I went to visit an old friend in hospital who has just had a major procedure. Brisbane has quite a few large private hospitals but I had not been to the Holy Spirit hospital at Chermside before. As the name implies, it operates under the aegis of the Catholic church and my friend has given up the Communism of her youth to return to the faith of her childhood. Admission to the hospital is, however, open to all.

What I found when I went there was a huge institution that was in every way just like a first class hotel. It was immaculate. Conrad Hilton would not be able to do better. And most pleasing of all my friend's procedure had gone well and she was recovering rapidly. And while I was there, there were three visits to her by staff members looking to see what they could do for her.

Clearly, then, she is very rich, No? Someone who has has divorced well, perhaps? Not a bit of it! She has had her fair share of problems in life and has got nothing she did not work hard for. She has however always looked ahead and budgeted for the important things -- including private health insurance. So her stay in hospital is costing her virtually nothing. So she must at least have a good job? Not a bit of it! She is an old-age pensioner (Social Security recipient) who owns her own house but not a lot more.

So how can she afford private health insurance when others cannot? Basically because she does not blow her money on things like beer and cigarettes (though I don't think I will be betraying anything to note that she still enjoys a couple of glasses of wine after dinner).

I guess that you can predict that she has a very low opinion of people who DON'T put aside money for health insurance and who then complain about how badly the "free" government system treats them. I think "No excuse for it", was her phrase.





California trying to make health insurance unaffordable

"Sometimes I really hate being right. Look at my website. On September 17, 2004 ("Oops, Government Does It Again") and June 6, 2003 ("We're From the Government and We're Here to Help You") both predicted massive increases in health care premiums and huge increases in the uninsured from continued regulation of health care financing, principally regulation of health insurance.

This week, the Insurance Commissioner, an advocate for socialized medicine, wrote a report, which he called "Priced Out," showing that insurance premiums have increased 61 per cent, and the number of uninsured has increased to 6.6 million Californians. He blames insurance companies for this.

He is particularly upset at one insurance company who offers an insurance product to young people (18 to 30 year olds) with reduced benefits, high deductibles and low premiums. The product is wildly popular, giving young, healthy people protection against major medical problems at a price they can afford. These younger workers, who just last year were among the ranks of the uninsured, are now insured, and the Insurance Commissioner is mad.

Why?

I thought being insured was good. Well, the report says that those bad insurance companies are giving these workers a choice, buy cheap insurance without pregnancy coverage if you want. That is wrong, complains the Commissioner because those insurance companies should require young, 25 year old single men to pay for insurance coverage for pregnancy because young women get pregnant. Those insurance companies are cherry picking their customers, he claims, by getting these young, single (and usually healthy) men to buy this cheap policy.

Who is he kidding? One of the choices that every worker has is the choice to not be insured. If government raises the price of health insurance, these young men will simply choose to spend the money on their cars, and run the risk of getting really sick and not being able to pay. Then, if the bills get too high, they will just file bankruptcy, and you and I will eat the bill in our insurance coverage.

Those are the choices. Forcing coverage on people doesn't result in more coverage; it will actually result in no coverage at all. More government regulation will continue to drive more people to the ranks of the uninsured because it will price them out of the market.

The recommendations of the Insurance Commissioner to mandate gold-plated health insurance policies for everyone are tantamount to a government order that everyone own a Rolls Royce. Sure the Rolls-Royce is a good car, but not everyone can afford one. If the government ordered that every car look and work like a Rolls, many people would have to go without a car, because the government-mandated car would be too expensive. Those who can't afford the Commissioner's mandated gold-plated health insurance policy will simply go without insurance.

The Insurance Commissioner is correct when he says that the number of uninsured in California has increased because the price of insurance has increased 61 per cent in the last six years in California. It is not greedy insurance companies that have caused the increase, however. It is the number of health insurance policy mandates (well in excess of twenty) enacted by government that have increased the price, and thus increased the number of uninsured. In California, we are all required to buy a Cadillac health policy, or have no health insurance at all. Many have chosen, for financial reasons, to have none at all.

The prescription for this problem by the Insurance Commissioner is more government. Government created the problem with more mandates, more regulation, and more bureaucrats. When will those in government learn that more government cannot fix a problem that more government created?"

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

DANGEROUS OVERCROWDING IN A BRAND-NEW PUBLIC HOSPITAL

The "free" public hospital system in Queensland is one of the world's oldest. So it has had lots of time to show how such systems end up -- as bloated bureaucracies where patients are just an inconvenience. The hospital mentioned below is brand new and much bigger than the one it replaced. Its corridors are filled with staff -- but doctors and nurses are rare

DANGEROUS overcrowding in one of Queensland's largest hospitals is at tipping point with emergency specialists vowing to leave patients in ambulances on the ramp outside. A leaked internal memorandum describes pandemonium in Brisbane's Princess Alexandra Hospital, due to a chronic shortage of beds in intensive care, coronary care, mental health, general wards and the chronic overloading of the emergency department.

Princess Alexandra Hospital's emergency department director Phil Kay and nurse unit manager Julie Finucane sent the memo to Queensland Health executives after a crisis meeting with specialists and nursing staff. The memo highlights how serious problems in Queensland's health system are also acute at major teaching hospitals in Brisbane due to undersupply of hospital beds and staff shortages. "Declarations of danger by qualified emergency specialists trained in the field have been over-ridden by non-clinical administration personnel who on almost all occasions have not attended the emergency department to see for themselves," the memo says.

"The senior nursing and medical staff can no longer tacitly support this system of allowing the facility to become so overloaded and crowded that basic safety standards are unable to be supplied by the organisation. We have been forced to unload ambulances into corridors where there are no or inadequate nursing staff and no ability to visually monitor patients. In the opinion of clinicians this has already contributed to one patient being found moribund who subsequently died.

"Patients will be left on trolleys in (ambulance) care either at triage or on the ramp but outside the emergency department work area until a safe treatment area can be found for them."

The above news item appeared in the Brisbane "Courier Mail" of August 6, 2005





MEDICAL CARE FOR CASH IS A BIG SUCCESS FOR ALL

Tremendous savings by eliminating bureaucracy and paperwork. I go to a general practice like that here in Australia. I pay $45 per visit to a very knowledgeable and pleasant GP and later claim the cost on health insurance -- who give me back about $30 of it

Dr. Brian Forrest thought he'd probably take a pay cut when he opened a family practice in 2002 with plans to quit accepting health insurance, charge half what most doctors do and increase the length of patient visits. Instead, the practice is thriving on $45 office visits and Forrest, 33, earns more than he did while working in urgent-care centers. He prefers not to disclose his income, beyond acknowledging that he nets significantly better than the median annual net income for primary care doctors nationally. That was $161,816 last year, according to the Medical Group Management Association, a national professional group.

The trick? The practice, Access Healthcare, sees fewer patients and charges less but collects 100 percent of fees, which are posted in the lobby for all to see, from patients at the time of service. Nationally, medical practices collect less than 70 percent of billed charges, according to research by the association. And to collect even that much, practices must invest in costly computer systems and employees dedicated to handling insurance matters, such as preauthorizing care, filing and refiling claims. That increases overhead and cuts into profit.

Insurance-free or "cash" medical practices such as Access are still a rarity, but Forrest and others see that changing when the advantages -- for both patients and physicians -- become more widely known. Physicians can earn a good living while giving patients time and personal attention. Patients with or without health insurance can get quality health care at an lower cost.

The trend to reduce health insurance premiums by shifting to policies with higher deductibles, may make practices like Access even more relevant. A patient with a $1,000 deductible, for example, is going to be responsible for the majority of day-to-day expenses. That person is going to want the kind of value a low-overhead practice can provide, Forrest said. At Access, cholesterol tests are $25, a finger splint is $15 and a school or camp physical is $25. "For primary care, I think in five years, this is going to be the predominant model," said Forrest. Last year, he recruited a nurse practitioner, Sara Hubbell, to help meet rising demand for care. And Forrest is planning to open a second Triangle location within a year, though he hasn't decided where.

Last month, Dr. Douglas Keith, a Raleigh physician who owns urgent care centers in Garner and Durham, opened an insurance-free primary care practice in North Raleigh. It's a much more cost-effective way to run a medical office, he said. A standard patient visit in his urgent-care clinic costs $115. At Keith Medical Center, the insurance-free practice, it's $50. "At the Garner clinic I have to see 30 patients a day to break even," Keith said. "Here, I need to see 5.6 patients to break even." So far, about 90 percent of Keith Medical Center's patients are uninsured. Only about one in four of Forrest's patients is uninsured, though initially, he expected to see far more.

Forrest found patients with insurance are willing to pay out-of-pocket for the personal attention his practice can give them. He and Hubbell have the luxury of spending 45 minutes or more with patients, if they need to. Many insured patients file claims with their insurer on their own and receive partial reimbursement. "People tell us it's worth it to them, even if they have to pay a little more," Forrest said.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

MEDICAID HAS GIVEN AMERICA SOCIALIZED MEDICINE

The nation has so vastly extended taxpayer-funded Medicaid to the working poor this decade that it has produced the biggest expansion of a government entitlement since the Great Society was launched in the 1960s, a USA TODAY analysis has found. With little notice, the medical care program paid by federal and state taxpayers has grown from covering 34 million people in 1999 to 47 million in 2004, an examination of government data shows. The expansion has cemented government's role as the nation's primary health insurer. About 100 million people - 1 in 3 - now have government coverage through Medicaid, Medicare, the military and federal employee health plans. More than 10 million others are eligible for Medicaid but have not signed up.

The expansion has won bipartisan support in Washington and state capitals, as a consensus has emerged to provide medical care for the poor, especially children. President Bush has proposed spending $1 billion over two years to encourage eligible families to sign up for Medicaid. Medicaid's growth has continued despite debates about spiraling costs and controversial efforts in Tennessee and Missouri to scale it back. The growth is an aftershock of welfare reform, which since 1997 has pushed individuals off welfare and into the workforce. To support low-wage workers, Congress and state legislatures expanded coverage to low-income working families. Medicaid previously had gone primarily to welfare recipients. Today, a family of four can earn as much as $40,000 a year in most states and get government health insurance for children. The nation's median household income was $43,318 in 2003, the Census Bureau says.

The expansion has had far-reaching consequences: More children insured. The portion of children without insurance fell from 14.8% in 1997 to 11.7% in 2004, the Health and Human Services Department reports. The rate of young children being vaccinated has increased from 72% in 2000 to a record 81% in 2004. Higher costs. Medicaid spending grew from $159 billion in 1997 to $295 billion in 2004. That 85% increase is nearly twice the rise in Medicare, which insures seniors. Washington pays 59% of Medicaid's cost; states pay the rest. Reduced private insurance. Many low-income workers are choosing Medicaid over employer insurance because it is less expensive and often covers more. Medicaid is free or nearly free for recipients. Out-of-pocket costs and the range of services covered vary by state. The percentage of children covered by private insurance fell from 65% in 1999 to 59% in 2004, while those on Medicaid rose from 22% to 29%.

Critics of Medicaid's expansion say it is adding to the federal budget deficit - $412 billion in 2004 - and luring people from employer-offered insurance. "Shame on us for creating perverse incentives that cause people to give up private coverage for Medicaid," says Michael Cannon, director of health care studies at the libertarian Cato Institute in Washington.

But supporters say most Medicaid recipients have no other option and need coverage to keep working. John Begala, a member of the Ohio Commission to Reform Medicaid, says Medicaid's expansion "is one of the great policy success stories of the decade."

Source






HO HUM! THE BAD NEWS FROM THE BRITISH NHS NEVER CEASES

The patient British have had such bad service for so long that most know no better. Note: "A&E" is British for what Americans call "ER" and Australians call "Casualty"

Only half of all children and elderly patients with broken limbs receive adequate pain relief within an hour of arriving at accident and emergency departments. Research by the Healthcare Commission, the health inspectorate, revealed that few A&E departments come close to achieving the government target of providing pain relief within 20 minutes. Even after an hour, only 53 per cent of children and 42 per cent of elderly patients in moderate or severe pain had been given pain-relieving drugs. However, the researchers found that 71 per cent of A&E patients rated their overall standard of care as excellent or very good. There were "disconcerting" variations between hospitals, the commission found. Staffing is not the reason, it concluded. Many departments have acquired extra staff without any improvement, suggesting that investment in services has been wasted. "Extra staff are only likely to yield beneficial results when the purpose of the extra staff is very tightly focused - for example where a problem or bottleneck has been identified," the commission concludes.

The report was based on information about three conditions: children in pain from a broken elbow or wrist, elderly patients with a hip fracture and also patients who had taken an overdose of paracetamol. Standards for treatment were laid down by the British Association of Emergency Medicine. So few met the standards that the commission had to modify them to make a meaningful comparison. But even when A&E departments were allowed an hour to provide pain relief, many failed. In some hospitals only a fifth of children and a seventh of elderly patients had been given painkillers within an hour. Some managed to treat 100 per cent of patients within an hour.

Anna Walker, Chief Executive of the Healthcare Commission, said: "A&E departments have overall made great strides in improving services, in particular on waiting times, which are very important to patients. "They now have to go the extra mile if they are to deliver the care their patients need, and that means focusing on quality as well as waiting."

For patients with a broken hip, X-rays should be taken within an hour. Only a third of patients were treated within the target. Only about 65 per cent of patients who arrived at A&E within eight hours of a paracetamol overdose were treated within the stipulated eight-hour target. The results of the December 2003 audit were shown to hospitals which were then audited again in February 2005. Only 50 out of more than 200 were able to respond in the time given, and these hospitals showed some improvements.

The commission also carried out patient surveys, which showed that the great majority were satisfied, saying that their care had been excellent or very good. Waiting time was the main key to patient satisfaction. The report found no clear correlation between staffing levels and performance of A&E departments. Since 2000 the average department has 20 per cent more nurses, 27 per cent more doctors and 37 per cent more consultants.....

More here

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

California's health care system in 'death spiral,' commissioner says

Californian legislators are trying to bring in universal government health care in their State yet this guy is bitching about too many people depending on California's existing government health care. California logic, I guess

With 6.6 million Californians uninsured and costs soaring, state Insurance Commissioner John Garamendi called Wednesday for a series of reforms to save the health care system from what he called a "death spiral." Garamendi released a 73-page report entitled "Priced Out: Health Care in California" that, among other things, showed the average health insurance premium in the state increased 61 percent between 2000 and 2004. He said Californians are paying more for health insurance but getting less as employers offer fewer benefits or pass on a greater share of costs to workers. The increasing cost "is simply placing every Californian at risk," Garamendi said at a news conference outside a closed hospital in North Hollywood. "I believe the California health care system is in a death spiral," he said.

In his introduction to the report, Garamendi, who regulates insurers operating in California, decried the health care system for the poor. "We are already well on our way to having an inequitable health care system where the wealthy live and prosper while others are priced out," he said. "Forty-five million Americans and 6.6 million Californians can already attest to this." Garamendi, a Democrat who has announced he will run for lieutenant governor in 2006, proposed reforms that could eventually ensure every state resident has basic health coverage, either through the government or the private sector. However, he acknowledged that the political climate for such coverage was poor. Californians have repeatedly rejected such proposals in ballot initiatives. In addition, the federal government has legislative control over many of the medical issues involved. Garamendi said it was unlikely the United States would have universal coverage "until we get a different administration in Washington."

He was also critical of health savings accounts, including some plans backed by the White House. The White House referred questions on the issue to the Department of Health and Human Services, which in turn deferred comment to the Treasury Department, which oversees the accounts Garamendi has criticized. No one answered a call at the Treasury Department after hours Wednesday.

Garamendi referred to reduced benefit plans as "skeletal policies" that offer less coverage as a way to reduce costs when major illnesses strike. He specifically pointed to a Blue Cross plan known as Tonik that he said is being marketed to young adults for about $70 a month but doesn't include maternity care or catastrophic illness coverage. Garamendi asked what would happen if a young woman with the policy got pregnant or had a major illness that wasn't covered. "They're going to wind up, probably, on the government dole in the Medi-Cal program," he said.

Blue Cross of California spokesman Michael Chee said Garamendi was misinterpreting the Tonik plan, which provides coverage for everything except maternity. "It's absolutely false to say it doesn't cover catastrophic" care, Chee said. "This is full insurance coverage." The company used focus groups and other research to tailor the plan's cost and coverage for people 18 to 30 years old who represent the largest portion of the state's uninsured, Chee said. "This program was designed with this age group in mind," he said. "We looked at the same uninsured data that Mr. Garamendi sees and determined there was a need for this product for this particular segment."

Joining Garamendi at the news conference was Alicia Ayala, 75, of East Los Angeles, who serves as a board member of a not-for-profit chain of clinics called AltaMed Health Services Corp. Ayala said she has a lower back problem that used to be fully covered by her insurance. Increasing premiums caused her to change coverage, and now she must pay $15 for each visit to physical therapy and $200 for more serious care when the ailment flares up, she said. "We are living longer," Ayala said. "You need to take care of us."

Richard Brown, director of the UCLA Center for Health Policy Research, said many people are being forced into "medical bankruptcy" by increasing premiums, deductibles and copayments, even though they have health insurance. In California, an individual can pay as much as a $10,000 a year for health coverage when all those costs are included, while families can pay as much as $16,000 a year, Brown said. Garamendi has planned a hearing next month in San Francisco on the policies detailed in his report. In October, he plans a hearing on the profits of health insurers.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

Whoever put the care in Australia's "Medicare" was kidding

Australia has a system of universal "free" healthcare that was introduced by the socialists (the Labor Party) and which is called "Medicare". Subsequent conservative governments have been afraid to tinker too much with it except that they give you a partial refund if you opt out of the system and take private insurance instead. So about a third of Australians do opt out and use our excellent network of private health facilities. The Queensland private health system is fabulous in my opinion -- and I use it often. What the Australian public health system generally is like is alluded to below by Dr John Graham, an emeritus consultant physician at Sydney Hospital where he is also chairman of the Department of Medicine.

Australia truly is the lucky country, especially when considering the available health care for its citizens. But none of this can be attributed to Medicare and its "medical benefits". In 1966, when I began my clinical years at Sydney Hospital, Australia could rightly boast the world's best in medical and nursing care. Moreover, the doctors and nurses loved their work, and most patients showed a commensurate respect and gratitude in return.

Most doctors still enjoy good relationships with their patients, but very few love their work any more. Doctoring has been progressively driven off the rails by political and economic expediency. Workplace morale, especially in public hospitals, has plummeted. The artificial barriers to both excellence and expedition in hospital care are endless. Optimal outcomes are frustrated beyond all reason. Patients must sometimes wonder whether or not they are pawns, rather than people. How often must they leave a hospital ward or a doctor's rooms and ask themselves: "Does anyone really care?" When the truth is known, Medicare certainly doesn't, and for any medical practice reliant on Medicare it's almost impossible to.

What is hard to fathom is that Labor, which historically stood up for the least well-off in our society, was the party that brought about the situation where the least well-off are finding it more difficult than ever to get the top level of hospital care for any problems other than emergencies. It was Labor that forsook the honorary (unpaid) specialist system in public hospitals to tighten government control on the doctors. It was Labor in NSW that got rid of the means test that had protected the needy by giving them access to plenty of beds in public hospitals. No wonder waiting lists for the less well-off have blown out. It was Labor, under Gough Whitlam, that introduced Medibank and then entrenched it as the rebadged Medicare under Bob Hawke. It was Labor that embedded the concept of bulk-billing by GPs, which forced them to downscale the quality of their services to fit the remuneration on offer.

The Coalition can't be let off the hook, either. The Federal Government has had more than enough years to rectify the problems and yet has done nothing to change a system that is all about economics and politics and has nothing to do with health care.

Let's look at an example of Medicare in the doctor's office. Why on earth would a bulk-billing GP be enticed to devote 39 minutes to a level-C consultation if he or she could trim it to 20 minutes and get the identical reimbursement from Medicare? With similar farces in Medicare rebates for specialist consultations, it's little wonder Medicare has, through its economics, caused many specialist doctors to stop listening, examining and thinking, and to simply become proceduralists. There is a significant shortage of real doctors doing real doctoring.

In looking at our supply of new doctors, which is patently inadequate, why is the Federal Government limiting the intake of students wanting to study medicine at universities? The answer is Medicare. For every new medical graduate, there is an application to be given a provider number. Without this, a doctor's patients would be ineligible for a Medicare rebate. The Government is worried that more doctors would mean more provider numbers, and hence a bigger government outlay on health. The rationale for limiting entry to medical schools is thus based purely on Medicare doctrine and not on any desire to improve health care.

Whatever the economists' views on Medicare, it has been an experiment without historical foundation, and without any humanitarian intent or scientific validity. And so what should be done?

First, rescind Medicare, and in its place introduce a safety-net rebate scheme for approved welfare-card holders to receive medical and surgical care in GP's surgeries and public hospitals (both as inpatients and outpatients).

Second, return to private arrangements for all other services. Doctors will then have to value those services fairly, while letting patients demand value for their dollar.

Third, let all health insurance funds offer whatever insurance covers they choose, for whatever range of health services their clients may choose.

Fourth, provide 100 per cent tax deductibility for all private health insurance and for all out-of-pocket expenses for medical, dental and pharmaceutical services.

Fifth, amalgamate the state and federal health responsibilities under a federal banner.

Sixth, give back an honorary board of governors to every public hospital so that better trust and meaningful communication can lead to greater efficiency and better staff morale. Greater productivity and generally improved health outcomes will ensue automatically.

And finally, with no Medicare, abolish the ridiculous Medicare levy. Hopefully, the Prime Minister, John Howard, and the Health Minister, Tony Abbott, will show the courage for, and commitment to, genuine reform that will greatly benefit all Australians.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

Public hospital waiting times force British boy to go all the way to India for surgery

Pity he cannot get the treatment his parents have already paid for through their taxes

A British mother is flying her fourteen-year-old son to India for treatment after discovering he would have to wait months for an operation in the NHS. Elliot Knott was told he would have to wait more than four months for an appointment after being left housebound from an ice-skating injury, then face a further wait of at least nine months for an operation. Elliott is suffering from spondylolisthesis, a debilitating condition caused when a vertebrae slips out of line in the spinal column and presses on a nerve. Surgery may be needed if slippage continues or if the back pain does not respond to routine treatment. A spinal fusion is performed and sometimes an internal brace of screws and rods is used to hold together the vertebra as the fusion heals.

The Dorchester schoolboy was referred to Southampton general hospital in May by his local hospital, which does not carry out the procedure. But his mother decided to get her son treated in Delhi after discovering that private treatment in the UK would cost 25,000 pounds, according to a report in the Times. The same operation in India costs just 4,700 pounds. Southampton University Hospitals NHS trust today urged the family to get in touch with the hospital to discuss quicker treatment. A statement issued today by the trust said maximum waiting times being quoted by the family were reducing "all the time".

"Staff with the highly specialised knowledge and skills to treat Elliot and other patients with similarly complex needs are in short supply, and much of their time is taken up with emergency cases. We obviously have to give highest priority to those patients with the greatest clinical need. The consultant can always be contacted by Elliot's GP if he or she believes Elliot needs more urgent treatment for clinical reasons."

The statement continued: "We understand how frustrating this situation is for patients and their families, and are certainly not inflexible or unsympathetic. "We are simply trying to balance scarce skills against high demand for this complex operation."

Elliot's plight coincides with a report published today by health thinktank the King's Fund, which warned that government waiting time targets were under threat from the constraints of financial pressures, unexpected increases in demand, and staff shortages in clinical areas. Its report argues that the government has reasons to feel optimistic that no patient will wait more than 18 weeks from GP appointment to hospital treatment by 2008. [How reassuring!] But the government will need to monitor carefully the impact of potentially destabilising policies, such as payment by results and the extension of patient choice, it warned.

Even if the 18-week target is met, it will not be the "end of waiting times" that ministers have claimed. The government should look carefully at the potential costs and benefits of reducing waits even further by developing policies to remove variations in access to services and unacceptable differences in the quality of clinical practices, the report urged. The report's author, Anthony Harrison, said: "Waiting time targets are based on assumptions that are rarely made explicit: namely that the right people are being identified and referred for the right treatment at the right time."

Source






HOW BUREAUCRATIC MEDICINE WORKS IN THE USA

Great stuff! More is obviously needed!

As far back as 1999, federal and state regulators began to receive complaints that the heart surgery unit at Palm Beach Gardens Medical Center in Florida was a breeding ground for germs. Dust and dirt covered some surgical equipment. Trash cans and soiled linens were stored in hallways. IV pumps were spattered with dried blood. One patient's wife said she saw a medical assistant tear surgical tape with his teeth. State inspectors in 2002 found "massive post operative infections" in the heart unit, requiring patients to undergo more surgery and lengthy hospital stays. In a four-year period, 106 heart patients at Palm Beach Gardens developed infections after surgery, according to lawsuits and government records. More than two dozen were readmitted with fevers, pneumonia and serious blood infections. The lawsuits included 16 patients who died.

How did Medicare, the federal health insurance program for the elderly, respond? It paid Palm Beach Gardens more. Under Medicare's rules, each time a patient comes back for another treatment, a hospital qualifies for an additional payment. In effect, Palm Beach Gardens was paid a bonus for its mistakes.

Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine. "It's the exact opposite of what you would expect," said Mary Brainerd, chief executive officer of HealthPartners, a nonprofit health plan based in Bloomington, Minn. Her Medicare HMO ranked among the top 10 in the nation last year for quality but was paid thousands of dollars less per patient by Medicare than lower-performing plans. "The way Medicare is set up," Brainerd said, "it actually punishes you for being good."

As Medicare approaches its 40th anniversary on Saturday, much of the debate about the nation's largest health insurance program revolves around whether it will remain solvent for aging baby boomers. Yet another critical question is often overlooked: whether taxpayers and patients get their money's worth from the $300 billion Medicare spends each year -- now about 15 percent of federal spending and projected to grow to nearly a quarter of the budget in a decade.

More -- much more -- here

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

MEDICAL MUSICAL CHAIRS

Even spendthrift California cannot afford to pay for its "public" medicine system

Downey Regional Medical Center may have to close its emergency room because of the exorbitant costs of treating uninsured patients, hospital officials said. Nine other emergency rooms in the county have shut down since 2003. Downey's, which served 46,307 patients last year, would be the largest recent closure and would force crowded hospitals in Whittier and Bellflower to absorb its patients, county officials said. "It's going to be horrible," said Carol Meyer, the county's head of emergency services. "Our emergency system is falling apart."

On Tuesday, the private nonprofit hospital asked the county Board of Supervisors to help pay for treating poor patients by approving a plan that would have entailed a tax hike. Supervisors rejected that appeal, arguing that helping Downey could prompt other hospitals to come calling for aid. The county's Department of Health Services is staring at a $1 billion shortfall over the next three years. "I don't know how you could ask us to subsidize a private nonprofit," Supervisor Gloria Molina said. "Every single hospital would line up, because they have the same situation as you do."

The number of uninsured patients using private emergency rooms in Los Angeles County has leaped by a third in the last five years, according to a recent study commissioned by the Hospital Association of Southern California. About 2.25 million county residents are uninsured - one of the highest percentages of any major U.S. metropolitan area.

Emergency room losses cost Downey Regional between $7 million and $11 million last year, said Robert Fuller, the hospital's chief operating officer. He said the hospital has gobbled up a $60 million surplus during the last five years, with half of that spent on treating uninsured people. As an alternative to closing its emergency room, the hospital is considering no longer accepting patients brought in by ambulance from outside Downey's city limits.

Source




Second bogus psychiatrist revealed in Queensland public hospital system

Still trust your local regulators?

The Queensland Government's health crisis deepened yesterday when it was revealed that a second bogus psychiatrist had worked in one of the state's major regional hospitals. Documents sent by Queensland Premier Peter Beattie to hospital inquiry commissioner Tony Morris QC yesterday showed that Vitomir Zepinic - a Yugoslav immigrant with no medical or psychiatric qualifications - worked as a psychiatrist at Toowoomba Hospital for almost two years. The revelation that Mr Zepinic had worked at the hospital west of Brisbane from April 2000 to March 2002 came just a day after it was revealed at the Morris inquiry that Vincent Berg, a bogus psychiatrist with phony qualifications from the former Soviet Union, had worked at Townsville Hospital in 2000. The existence of the two impostors was not revealed to the public until this week.

However, the documents produced by Mr Beattie revealed that the Government had a contingency plan for Wendy Edmonds, then health minister, to announce the two cases in parliament in 2002 in the event that the Opposition learned of the bogus psychiatrists. Under the heading "Topic: Bogus Shrinks", a ministerial staff member prepared an answer for Ms Edwards to a "possible parliamentary question". The documents revealed further evidence of efforts made by former Queensland Health director-general Steve Buckland to conceal Mr Berg's tenure at the hospital from the public, including his former patients.

Psychiatrists and administrators at Townsville Hospital sent a briefing note to Ms Edmonds recommending that Mr Berg's activities be made public so that all of his former patients could be located to determine whether they needed treatment. They said that the patients should be informed that Mr Berg's qualifications were invalid. But in a handwritten notation, Dr Buckland said that his decision not to inform the patients was "appropriate, ethical and clinically sound given that the client base have a mental illness". Dr Buckland was sacked last week in a major overhaul of Queensland Health prompted by the Morris inquiry's investigation of Jayant "Dr Death" Patel.

John Allan, director of Townsville Hospital's Mental Health Unit, told the inquiry in its second day of Townsville sittings that when he tracked down more than 200 of Mr Berg's former patients, he felt frustrated and "compromised" by his inability to tell them that the self-styled psychiatrist was a fake. Mr Allan said one of Mr Berg's worst mistakes was to take a long-term schizophrenic, who was facing a murder charge, off his medication. The man was later acquitted of murder because of his mental illness.

Mr Zepinic was deregistered by the Medical Board of Queensland in May 2002 after it was discovered that although he had completed post-graduate training in psychotherapy, he had no formal medical qualifications.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

Phony psychiatrist's havoc 'was hushed up' by the Queensland public health system

Your regulators will protect you -- NOT

A bogus psychiatrist with phony qualifications from the former Soviet Union worked for 12 months at the Townsville Hospital mental health unit, but his dangerous reign was hidden from the public in a cover-up by Queensland Health. The Morris inquiry was told yesterday that Vincent Berg treated at least 250 people, changed medication prescribed to patients by other psychiatrists and told patients with obvious mental problems that there was nothing wrong with them. The inquiry also heard one of his patients had committed suicide, while another who had been prescribed medication that caused dizziness died of a head injury after falling from a bed.

In his CV, Mr Berg said he was a refugee from the Soviet Union who had arrived in Australia in 1992. He claimed to have been a Russian Orthodox priest who had been persecuted by the KGB for his religious beliefs. Queensland Health's employment of Mr Berg was revealed publicly for the first time yesterday when the inquiry began hearing evidence in Townsville, shifting its focus from Jayant "Dr Death" Patel to problems with the public health system in north Queensland. Commissioner Tony Morris QC accused recently-sacked Queensland Health director-general Steve Buckland of deliberately withholding information about Mr Berg from the inquiry. Mr Morris said investigators had been forced to conduct "something of a raid" at Townsville Hospital to obtain evidence. The seized documents included emails from Dr Buckland warning staff not to give information on Mr Berg to the media, the police or the Queensland Crime and Misconduct Commission.

Townsville Hospital medical services director Andrew Johnson said that after Mr Berg left the hospital in early 2001 and his phony qualifications were exposed, he planned to publicise the story so that former patients who might have been mistreated by him could come forward. Dr Johnson said an audit by the hospital's psychiatric director John Allan in January 2003 identified 60 patients considered at high risk who needed to be contacted and reassessed. But Dr Johnson said he was told by district health manager Ken Whelan that the word had come down from senior management that neither the CMC nor the media should be contacted. He believed the order had come from Dr Buckland, then general manager of health services. Dr Johnson said Mr Berg, who started work at the hospital as a registrar in January 2000, had been registered by the Medical Board of Queensland. He claimed to have been a fully qualified psychiatrist in the Soviet Union and to have a medical degree from Voronezh State University. But investigations by the Royal Australian and New Zealand College of Psychiatrists in 2002 revealed the qualifications were forgeries.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

SOME IDEAS FOR REFORM OF AMERICA'S HEALTH SYSTEM

America's health care system is sick, and needs help. Health insurance premiums continue to grow at double-digit rates each year. Prescriptions are too expensive for too many people. There is little choice of insurance providers. Lawsuit abuse drives up costs and drives doctors out of practice, leaving the sick in some parts of the country with no one to treat them. And millions of Americans are uninsured.

The current system is the result of trying again and again to reform the system with more government control and less individual choice. It is time to try something different. There are short-term changes that can bring quick improvements within the system and long-term systemic changes that can permanently bring better and more affordable health care.

In the short term, giving more power to consumers will drive down costs and increase the number of insured Americans. According to the Institute of Medicine most adults who do not have health insurance cite the high cost as the reason. Studies also show that state mandates increase the costs of coverage by 15 to 30 percent and drive as much as 25 percent of the uninsured out of coverage.

Consumers need the power to combat the special-interest groups driving the increase in mandated state coverage, which drives up prices. Michael Cannon of the libertarian Cato Institute reports that required coverage in some states includes wigs (seven states), acupuncturists (11), marriage therapists (11), massage therapists (four), osteopaths (24), alcoholism (45), infertility treatment (14) and contraceptives (29). Former Vermont Gov. Howard Dean, a physician himself, was one of the first leaders to try to bring an end to this nonsense. As governor, he pleaded with Vermont's legislature to stop enacting such mandates because they were making coverage too expensive.

Dean's plight is currently being taken up at the federal level by Sen. Jim DeMint, R-S.C., Rep. John Shadegg, R-Ariz., and House Speaker Dennis J. Hastert, R-Ill. Their recently introduced "Health Care Choice Act" would empower consumers to use the Internet and other means to find affordable health insurance policies sold nationwide. It would allow someone in Virginia who did not want to pay for the state's 58 mandated categories of coverage to save money by buying insurance in Idaho, where there are only 13 mandated categories.

Such a policy change would bring the country closer to consumer-driven health care, where we could choose the policies with the benefits we really need and not be forced to pay for things we do not need. And, as Hastert argued, it "gets rid of the red tape that's pricing millions of Americans out of the health insurance market."

Consumer-driven health care is also the long-term solution to what ails the American system. Congress took a big step in this direction in 2003 when it made health savings accounts an option for all. These accounts, funded by tax-free contributions from employers and employees, are coupled with low-cost, high-deductible insurance policies that cover catastrophic expenses.

Because we own these accounts, we can take them with us when we change jobs. Money invested in them can be put in checking accounts, money market accounts, mutual funds and certificates of deposit. Money withdrawn for medical expenses is never taxed and can be passed on to a spouse tax-free upon death.

If this sounds somewhat familiar, it is because health savings accounts have a lot in common with what President Bush is proposing for Social Security: the option of accounts that workers would own and be able to pass on. The American Institute for Full Employment (AIFE) has made this connection, and taken it one step further with a comprehensive "7.65 Percent Solution."

AIFE proposes allowing us to put half of our Social Security tax dollars and half of our Medicare tax dollars, which equals 7.65 percent of our income, into an account to be used for all retirement expenses, including health care. Using historical averages as a guide, AIFE says a 23-year-old worker starting one of these accounts today, while earning just $20,000 a year, would have an account of more than $600,000 by age 63 and more than $2 million by age 78. Such large assets would provide security in place of the financially failing government retirement programs of Medicare and Social Security.

A nationwide insurance market and millions of Americans with health savings accounts, 7.65 percent accounts or any other type of individually owned account would have a transforming effect on our health-care system. It would empower us to re-take control of the system and focus it on the treatments and services we really want and need. Health care providers and insurers would have no choice but to listen to us, because we would have the money in our accounts and the choice of shopping elsewhere.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

DIRTY BRITISH HOSPITALS CLAIM ANOTHER VICTIM

Though they are trying to wriggle out of it, of course

One of the Australian survivors of London's bomb blasts has been hospitalised again and risks having her foot amputated after becoming infected with Britain's most notorious hospital superbug. The tragic double misfortune struck NSW woman Alison Sayer, 36, last week as she was recuperating at home in London. Ms Sayer's right knee was shattered on July 7, when she was blown out of her Underground train carriage by the force of suicide bomber Mohammad Sadique Khan's explosives. She spent 10 days in St Mary's Hospital in London, and was discharged a fortnight ago. But a gash on her left ankle, which had been stitched and treated at the hospital, became increasingly inflamed and painful. Ms Sayer's specialist diagnosed the widely feared MRSA bug — better known in Australia as golden staph — which is a major killer in British hospitals.

Now being treated in a private London hospital, Ms Sayer has undergone several operations to have the infection cut out. Doctors have told her family there is a danger her foot may need to be amputated. Ms Sayer's sister, Sydney nurse Amy Gent, has just returned to Australia from London after caring for her sister. "Alison was sort of glad to be home; she's not impressed to be back in hospital," Ms Gent said.

The MRSA bug is the scourge of British hospitals. Ms Gent said she had been worried about the open ward in which her sister was kept during the week after the bombing. "My sister and I thought it might have been from the shower … it didn't seem to be cleaned very often," she said. St Mary's Hospital yesterday told The Sunday Age: "We are very sorry to hear that Ms Sayer has contracted MRSA during what must already be a traumatic time for her. "However, based on the information we have been given today, it is difficult to draw the conclusion that she contracted MRSA during her six days with us. "Our record of her care does not indicate she was displaying any symptoms of being MRSA-positive at the time of her discharge 13 days ago."

MRSA can be picked up anywhere, including in the community. An estimated 30 per cent of healthy adults and children carry a form of the bacteria on their skin or in their nasal passages. The hospital said it had introduced a new infection-control policy dictating that patients should have only two visitors at their bedside at any one time. The policy, it said, was difficult to enforce at the time of the July 7 bombings.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

SPEECH BY DR. JACQUES CHAOULLI: DEFEATER OF CANADA'S MEDICAL SOVIET

Up to the end, most of the commentators thought I would fail. But on June 9, 2005, I won. Across Canada, the elite was astonished. The Dean of Canada's Osgoode Hall law school, Patrick Monahan, was quoted by Canada's National Post three days ago as saying, "I didn't expect a majority of the court to uphold Chaoulli's claim." A constitutional law professor from the same law school, Jamie Cameron, was quoted as being "surprised at the judges' activism.... It's a huge step for Section 7 [of the Canadian Charter of Rights and Freedoms}. I think that the constraints that used to apply to Section 7 have pretty much blown out of the water."

It is significant that I won against a number of lawyers and top expert witnesses representing the government side. For example, during the trial I cross-examined Professor Theodore Marmor from Yale University. Justice Deschamps, concurring with the majority, rejected his testimony, on paragraphs 63, 64 and 67 of the judgment.

For many years, in survey after survey, a majority of Canadians said that they were in favor of private health care alongside the public system. After my victory, ordinary people felt a sense of relief to hear that, for the first time ever, the highest court in the land condemned the Canadian single-payer health care system for causing situations in which patients suffered and died on waiting lists, in violation of the rights to life, liberty, and security protected by Section 7 of the Canadian Charter of Rights and Freedoms.

As a result of this historic judgment, Canadian legal scholars have now classified Canada's legal history about rights and freedoms into two distinct periods: before Chaoulli and after Chaoulli. For many years, I have been studying constitutional law, most of the time alone, and during a short period of time, in year 2000, as a full-time law student in Canada. As a law student, I argued against most of my Canadian professors of law, whose interpretation of the Canadian Charter of Rights and Freedoms was opposed to my own interpretation. Ironically, five years later, in 2005, the Canadian Supreme Court upheld my own interpretation of that Canadian Charter of Rights and Freedoms.

To my knowledge, it is the first time that a court has invalidated a government health care action that had effectively resulted in the suffering or deaths of individuals. The Canadian Supreme Court ruled that a state may not force an individual to endure poor quality health care services or unreasonable waiting times for medically required services, and it cannot prevent average individuals from getting access to private health insurance.

Opportunity for Private Health Care

This Canadian Supreme Court ruling was like the fall of a second Berlin Wall. It opens up a unique opportunity, in the United States and in several OECD countries, to counter what is called in the United States "liberal," and what I call "socialist," lobbies that are pushing their agenda for socialized medicine.

Some commentators believe that this ruling would apply only to Quebec and not to the rest of Canada. I respectfully disagree with their opinion. In my view, a proper reading of the judgment leads to the conclusion that similar legislation in other Canadian provinces may already be considered as violating Section 7 of the Canadian Charter of Rights and Freedoms, which protects the right to life, liberty, and security. For that reason, in my view, there is no need to launch additional legal challenges in other Canadian provinces.

About private hospitals, I was asking the court to declare my right to establish a private hospital in Montreal. The majority of the Canadian Supreme Court gave me the green light to go ahead in establishing a private hospital, when Justice Deschamps, concurring with the majority, ruled at paragraph 51 of the judgment that: "the Minister may not refuse to issue a permit solely because he or she wishes to slow down the development of private institutions that are not under agreement," and when at paragraph 54, she said: "Not only are the restrictions real but Mr. Chaoulli's situation shows clearly that they are."

Practically speaking, that ruling opens the door for a parallel private health care system in Canada running alongside the continuing socialized and compulsory Medicare program run by the "States" or "Provinces," as in other countries of Northern and Southern Europe, Australia, and New Zealand. Obviously, in terms of public health policy, such a result is not good enough. Those who are unable to pay twice, through general taxation and the additional cost of parallel private health care services, will continue to fall through the cracks of a deficient Medicare program.

For a long time, several experts have suggested that legislators should permit individuals to opt out of a state's compulsory Medicare program [In Australia they are allowed to -- to some degree]. But as you well know, legislators from around the world, including here in the United States, have to deal with a potato which is not only hot, but also burning!

Lessons for the U.S.

This victory is particularly important for American people, since they are facing important health policy issues, both at the federal level, regarding the Medicare program, and at the state level. The states of Vermont and California have engaged, or are engaging themselves, in the process of establishing a single-payer health care system which--there is no doubt in my mind--shall lead, like in Canada, to a situation whereby some patients will suffer and die on waiting lists.

I believe that, were it not for particular interest groups pushing for their own agenda, most people around the world would reject such a health care system that inevitably leads to suffering and to death. In 2002, particular interest groups thought they could introduce a single-payer health care system in Oregon, through the initiative and referendum called Measure 23. But three-quarters of the population of Oregon rejected that model. Then, legislators in Vermont passed a bill establishing a single-payer system. A few weeks ago, the Senate of California passed a bill that is even more extremist, in the sense that, like in Quebec, it bans private health insurance covering services already covered under a new California State Universal Medicare program. That bill is likely to pass the Assembly as well. Maybe the governor of California will use his veto power to block that bill, but such a veto would last only as long as that same governor would remain in power. What about the people of California if the bill is passed again and the next governor fails to the veto that bill?

In Canada, in the United States, and elsewhere, liberal groups should be confronted with the failure of socialized medicine, which the four majority justices exposed in the so-called Chaoulli judgment. Moreover, and even perhaps more importantly, they should be confronted with the terrifying opinion of the three dissenting justices. Although the dissenting justices acknowledged that some patients die as a result of the state monopoly, they went on to say that the state monopoly is necessary in order to avoid what they call an unfair situation, whereby those able to pay in a parallel private health care system would save their own life, while those unable to pay would have to wait in the public sector.

For the first time in Canada, a Supreme Court Justice criticized publicly a dissenting colleague sitting on the same bench. Justice Deschamps, about whom I have spoken, wrote at paragraph 16 of the judgment: "The debate about the effectiveness of public health care has become an emotional one.... The tone adopted by my colleagues Binnie and Lebel JJ. is indicative of this type of emotional reaction." Also, she clearly challenged the view of the three dissenting justices, when at paragraph 85, she said: "It must be possible to base the criteria for judicial intervention on legal principles and not on a socio-political discourse that is disconnected from reality."

But make no mistake about it. Although the Berlin Wall fell in 1989, many groups driven by a socialist ideology are still very active in all the OECD countries, including here in the United States, and they share the view of the three dissenting justices I have mentioned.

You might hear from the legislators of Vermont that the Chaoulli judgment is irrelevant to them since the bill they passed doesn't ban private health insurance. They would be right to say that their bill doesn't ban a parallel private health care system. Still, down the road, like in Canada, in the UK, and in several other OECD countries, I believe some patients from Vermont shall inevitably suffer and die on waiting lists if the single-payer health care system is to be implemented in that state. Justice Deschamps had it right when she wrote, at paragraph 96: "Given the tendency to focus the debate on a socio-political philosophy, it seems that governments have lost sight of the urgency of taking concrete action. The courts are therefore the last line of defence for citizens."

I suggest her comment applies as well to the United States and to many countries around the world. I suggest the time has come to take advantage of this historic judgment in order to inform people in Canada, in the United States, and elsewhere about the consequences in terms of human suffering from letting legislators adopt, or maintain, single-payer health care systems.

More here

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

STUPID CANADIANS

Canada spends more on health care than most European and Asian nations but has some of the longest wait times and worst access to physicians in the world, concludes a report released Thursday. The paper, released by the right-leaning Fraser Institute, compares 27 countries that all guarantee access to health care, regardless of ability to pay. The report says Sweden, Japan, France and Australia all outperform Canada in the following areas: keeping women with breast cancer alive; preventing death from disease; waiting times for health services and the number of years people can expect to live without a disability.

"Canadians continue to not get value for their money," says Nadeem Esmail, co-author of the report. "We are spending a huge amount of money and getting terrible wait times, inferior access to technology and mediocre health outcomes." Canada ranks in the bottom half of nations when it comes to patient access to mammograms, CT scanners and MRI machines -- technologies routinely used to detect cancer.

The report also said Canada has fewer physicians than other industrialized nations: It ranks 24th out of 27 nations with 2.3 doctors per 1,000 people. In 1970, by comparison, the year public insurance was first fully applied to services from physicians, Canada had the second-highest number of physicians, per capita. Iceland boasts almost twice as many physicians per capita while nations such as Italy, Germany, France and Finland all have significantly more than Canada.

The report found that of all 27 countries, only Canada outlaws a parallel private system while others with universal health care, such as Sweden, Japan and Australia, allow some mix of user fees, private insurance and private hospitals to compete for patient demand. "They allow patients the freedom to see care on their own terms if the public system is unwilling or unable to meet their needs," says Esmail, a senior health policy analyst at the Vancouver-based organization.

Canada is one of only four countries with universal care that spends more than 10 per cent of its gross domestic product on health. Only Iceland and Switzerland spend more than Canada. But Albert Schumacher, president of the Canadian Medical Association, says Canada has some good reasons for spending more than most European countries -- such as the cost of serving remote areas and the complex health needs of aboriginals, immigrants and refugees. "None of these countries has jet fuel as a major health care expenditure," says Schumacher. "If we moved the rest of the country into southern Ontario, we would have a very effective health-care system." And he suggests better health outcomes in some of the European countries could be due to increased social spending in other areas, such as lengthy maternity leave, subsidized childcare, shorter work weeks and longer vacations.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

NO DIGNITY IN PUBLIC HEALTH SYSTEMS

An excellent post from the Adam Smith blog:

Britain's health system regulator, the Healthcare Commission, says that (thanks to an injection of tens of billions a year) the state-run National Health Service is now meeting lots of its targets, but is failing to treat taxpaying patients as customers. One figure I saw is that 25% of patients say they are treated 'as if they are not there'.

It is this, more than anything else, which defines the failure of state-run healthcare. Sure, when you look at the statistics, you find that some things the NHS does are actually very good, while others (like our performance on killer diseases like cancer and stroke) are pretty poor compared to other countries'. But what the statistics don't pick up is how people are treated as people.

A couple of years back I spent a good deal of time around one of Britain's 'flagship' hospitals, during the last illness of an elderly relative. Since then I've been determined never to set foot in the place again if I can help it. It was filthy, of course: one expects that. But the staff were also stressed out and frankly hadn't the time, or weren't well-managed enough, to handle their elderly patients with the dignity that any of us have a right to expect. There was no joined-up liaison with the family doctor, so my relative was not given an essential medicine, with disastrous results. She lost her wedding ring (very precious to her) but the ward had no system to deal with lost property. There was no plan to provide care for her when she went back home from the hospital. And so on. It was awful, and inhumane.

I don't believe that any amount of money will change this. Yes, it might mean that more women get breast screening or that family doctors can give you an appointment within the week. But it won't mean that patients are treated like valued customers, because in our system they are not. Only if we can devise a system in which the providers are paid solely on the basis of the patients' own choices will we ever do that.

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

Threat to patient care as third of British public hospitals in red

No money is ever enough where you have hungry bureaucrats to feed

Despite rapidly increasing budgets, more than a third of hospitals and a quarter of all NHS trusts failed to break even last year. The Healthcare Commission, publishing its annual star ratings, said that the overall deficit was œ500 million, a small fraction of the NHS budget of 69.7 billion pounds.

But, with the NHS facing a tougher future, with no big increases in funding after 2008 and a new and riskier financial regime, the failure hints at future problems and should be taken seriously, Anna Walker, the chief executive of the commission, said. "Financial management is really important. Patient care will suffer if it is not put right," she added. "Quality of care is inextricably linked to good financial management. Temporary instability must not lead to a permanent problem. If it does, patients will lose out because the standards of care will suffer."

The 2004-05 star ratings - the last that will appear in this form - also show that tighter targets in accident and emergency departments have caught hospitals out. For the first nine months of the year, all trusts met the target that 90 per cent of patients should wait less than four hours. But, when the bar was raised to 98 per cent for the last three months of the year, 62 out of 159 trusts with A&E departments failed to meet the higher standard.

The star ratings will be replaced by a new system that, to the casual eye, may not look very different. The "annual health check" promised by the commission will provide, it says, a more comprehensive picture of performance, but it will end, just like the star ratings, with a four-point scale, ranging from excellent to weak. For excellent, read three stars; for weak, no stars.

The star ratings' final hurrah paints a picture of gradual improvement across the NHS, despite the financial problems. Sir Ian Kennedy, the chairman of the commission, said: "There is no doubt that star ratings have been an important step on the road to effective measurement of the performance of the NHS. "They have played a part in the improvement of care, not least in a significant reductions in waiting times. But the system has not provided a comprehensive picture. We need a richer picture, reflecting the needs of patients."

Gill Morgan, chief executive of the NHS Confederation, which represents hospital managers, relished the demise of star ratings. She said: "The scrapping of star ratings is a good day for patients who may believe that their local hospital has lost a star because its services have deteriorated over the past year. "In fact, trusts have been measured against targets that have become progressively tougher and so some NHS trusts may earn fewer stars this year despite providing a better standard of care. We believe that, in some instances, star ratings have become a perverse system that scares patients and the public unnecessarily and demoralises hard-working NHS staff. That's why we are delighted that star ratings are being abolished and replaced with a new, fairer system of assessment."

This year's figures show improvements in death rates for diseases such as heart disease and cancer and a more rapid service in hospitals, with waiting times for elective operations halved from 18 to 9 months.

While 13 more Primary Care Trusts achieved a three-star rating, only 19 per cent in all earned the top status - compared with 42 per cent of ambulance trusts. But Ms Walker said that they also had concerns about the performance of trusts in the South East, an affluent part of the country with fewer health problems than more deprived areas in the North. "There are some hospitals that are not performing so well," she said. "Whether this is really a pattern or is random we don't yet know." But Andrew Lansley, the Shadow Health Secretary, said that the star ratings did not reflect the reality of clinical standards in the NHS. "Many clinical priorities aren't recorded and some targets, like A&E and GP bookings, create more problems than they solve," he said. "However, the star ratings do reflect the reality of financial performance. NHS finances are close to meltdown. One quarter of NHS trusts failed to break even last year and more are facing deficits this year

Source






About Those Uninsured Americans...

Over the past several years there has been much discussion in both public policy circles and the media about the plight of those Americans who lack health insurance. "Over 43 million U.S. residents, nearly one in six Americans under the age of 65, lack health coverage," says the website of the nonprofit Institute of Medicine of the National Academies. This or some similar statistic is often used as evidence that there exists a large subset of the country's population that has little or no access to healthcare and that the crisis will only grow worse if some action -- typically government-funded and/or government-mandated healthcare coverage -- is not taken immediately. The facts are somewhat different.

One problem with the 43-45 million uninsured Americans figure is the fact that the statistic is dynamic, not static. "[T]he uninsured population is fluid, with many people gaining and losing coverage," reported the Congressional Budget Office on May 12, 2003, in a brief on Americans who lack health insurance coverage. "Between half and two-thirds of the people who experienced a period of time without insurance in 1998, for example, had coverage for other portions of the year." Thus, the 40-odd million uninsured people in December of a given year are mostly a different group of people from the 40-odd million uninsured from the previous January.

Another problem with the statistic is that it tells us how many uninsured Americans there are, but not who they are. This is an important distinction. A 70 year old with multiple medical problems who lacks health insurance is obviously in a much direr situation than a healthy 20 year old who lacks health insurance. Michael F. Cannon, director of health policy studies at the Cato Institute, looked into the aforementioned report from the Congressional Budget Office to find out just who the uninsured are. He discovered that "the persistently uninsured are mostly young (39 percent are under age 25, and another 22 percent are under age 35) or healthy (86 percent report their health to be 'good,' 'very good,' or 'excellent')."

In discussions about the uninsured, there appears to be a tendency -- in some cases unintentional, in others almost certainly deliberate -- to regard "health insurance" and "access to healthcare" as synonymous. Not having health insurance obviously curtails one's ability to obtain certain medications, office visits, and procedures for fractions of their actual cost since the cost is not defrayed by the premiums contributed by thousands of other policy-holders. But it is inaccurate and misleading to equate health insurance with access to nominal or even emergency medical services.

At my own practice, we frequently see uninsured or "private pay" patients. Some of these patients are working people whose employer does not offer health insurance coverage. A fair number of these patients are small business owners. If asked, most of these people would say that they cannot afford health insurance, but this is simply another way of saying that it makes no financial sense for them to pay an insurance company hundreds of dollars per month in premiums so that the charge for a $55.00 office visit can be reduced to a $25.00 co-pay. While the private pay approach to healthcare carries the obvious risk of great personal financial hardship due to medical expenses in the event of developing a serious medical condition or sustaining a major injury, the unlikelihood of this happening must be weighed against the absolute certainty of having to repeatedly pay out insurance premiums to cover likelier and less costly medical services whose monthly or annual totals will most probably exceed the cost of paying out of pocket for the same services.

A lack of healthcare insurance does not preclude access to emergency medical services; indeed, such access is guaranteed by the Emergency Medical Treatment and Labor Act of 1986 at any hospital taking part in Medicare. While even a brief trip to the emergency room can be tremendously expensive for the private paying patient, relatively few such trips are made.

Reuters health and science correspondent Maggie Fox filed a story in October 2004 citing a study that debunks the idea that the poor and uninsured fill America's emergency departments. "Contrary to popular perception, individuals who do not have a usual source of care are actually less likely to have visited an emergency department than those who have such care," said Dr. Ellen Weber, a professor in the division of emergency medicine at the University of California San Francisco, who led the study which was published in the journal Annals of Emergency Medicine. According to the study, 85 percent of patients who visit the country's emergency departments have medical insurance and 79 percent have incomes above the poverty level. Said Dr. Weber, "The mistaken belief that emergency departments are overcrowded by a small, disenfranchised portion of the U.S. population can lead to misguided policy decisions."

None of this should be construed to mean that there is no problem with the delivery of healthcare in America. There are undeniable flaws in our healthcare system that prevent a significant subset of patients from getting the healthcare they require. But such flaws cannot be properly addressed if the problems are defined by statistics that are inflated or considered out of context. Just as an inaccurate set of vital signs or laboratory tests can result in a patient being given an incorrect diagnosis and improper treatment, false assumptions about the extent and character of the problem of uninsured Americans can likewise lead us to spurious remedies.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************

Cheaper Health Insurance

A little competition can go a long way

Republicans haven't been getting much credit on the health policy front, despite their misguided 2003 drug entitlement masquerading as Medicare "reform." That could change soon. Last week the House Energy and Commerce Committee approved a bill that could dramatically reduce the ranks of the uninsured and spur general economic growth--all without costing a dime to the Treasury.

The idea behind the legislation, sponsored by GOP Representative John Shadegg of Arizona, is disarmingly simple: Allow Americans to buy health insurance from vendors in any one of the 50 states.

Right now Americans who aren't lucky enough to get insurance from large employers or poor enough to qualify for Medicaid find themselves at the mercy of the legislators and insurance commissioners of the state in which they happen to live. This can be OK in states that exercise this regulatory function judiciously. But in others, the young and working poor find themselves effectively priced out of the market by special-interest regulations dressed up as consumer protections.

New York requires every insurance policy sold there to cover podiatry. Acupuncture coverage is mandated in 11 states, massage therapy in four, osteopathy in 24, and chiropractors in 47. There are an estimated 1,800 or so such insurance "mandates" across the country, and the costs add up. "It is always the providers asking for the mandate; it is never the consumer," says health policy guru John Goodman, who has testified before legislatures considering such rules.

What's more, states like New Jersey and New York add two more ultra-expensive requirements: "Guaranteed issue" allows people to wait till they are sick and then buy insurance; "community rating" prevents insurers from charging different prices to people of different ages and health status. These may sound like compassionate ideas, until you realize they make insurance so expensive that millions of people are exposed to financial ruin because they aren't allowed to buy basic policies focused on catastrophic costs.

How expensive? A 2004 study by eHealthInsurance.com found that a typical insurance policy ($2,000 deductible, 20% co-insurance) for a family of four could be had for as little in as $172 per month in a reasonably regulated locality like Kansas City, Missouri. But in New York that family's only option--managed care--would run $840 per month, and in New Jersey family policies run a whopping $1,200-plus. We bet Democratic Representative Frank Pallone's constituents in New Jersey would be interested in his view that insurance in his state is only "slightly" more expensive than elsewhere.

As for the arguments against the bill, let's dismiss the phony federalism objection first. The Founders wrote a Commerce Clause into the Constitution precisely so Congress could act against internal restraints on trade of the sort represented by today's 50-state health-insurance market. The system has never made much sense; it is even more of an anachronism in the age of Amazon and eBay.

Critics also allege that freeing up interstate commerce will result in a "race to the bottom" in which fly-by-night insurers operating in poorly regulated states would be able to take advantage of consumers. But we've yet to hear which poorly regulated states they're talking about. The best analogy for what to expect here is probably our experience with interstate banking, which has indeed resulted in operators moving to friendly climes like Delaware and South Dakota but which has also proven nothing but a boon to consumers. A national market has allowed the growth of big, financially stable institutions that have earned consumer trust.

Nor, contrary to the self-interested arguments being put forth by the BlueCross BlueShield Association--which has effectively monopolized many highly regulated markets and fears the competition--would free commerce jeopardize the "risk pool" (i.e. the overall pool of money that makes insurance possible by allowing the healthy to subsidize the sick). In high-cost, guaranteed-issue states the young and healthy don't participate in the individual insurance market anyway; a larger national market can only improve matters.

As a major side benefit, interstate commerce in health insurance would remove a huge barrier to the efficient allocation of human resources in our economy. Right now untold numbers of Americans fear moving, switching jobs or starting their own businesses for fear of losing their health insurance. That would change if they were able to shop nationwide for policies that would follow them wherever they go.

But the most important issue here is justice. It is simply immoral that millions should be exposed to the possibility of financial ruin because of the all-or-nothing choice offered by the insurance regulations of states like New York and New Jersey. Amazingly, we hear the entire GOP delegations from both states are leaning against the bill, which may come before the full House in September. Their names belong on a dishonor roll should they end up letting the special-interest lobbies mentioned above determine their vote. We hope President Bush--who supports the Shadegg bill--is prepared to twist arms as he did on the Medicare vote. It's no exaggeration to say this could turn out to be the most humane and consequential domestic achievement of the Bush years.

Source






PRIVATE AID TO CUT WAIT FOR TESTS IN BRITAIN

The British government goes private

Patients facing long waits for tests at their local hospital will be offered treatment at a private clinic, it was revealed yesterday. Health Secretary Patricia Hewitt announced the move in a bid to cut the sick lists. About 80,000 patients waiting for non-urgent diagnostic tests such as MRI and CT scans will be given the option to have treatment more quickly at another NHS or private hospital. The new policy for patients waiting for more than 20 weeks comes into force in November.

Mrs Hewitt said: "We know many patients are caught in a bottleneck of waiting for a scan or other diagnostic service before they are referred for an operation. "This can be a worrying and uncertain time for patients. This scheme will help to tackle this hidden waiting list." She claimed by 2008 no one will wait longer than 18 weeks from GP referral to hospital treatment. GPs already fast-track more serious cases - such as when they suspect a patient has cancer - for hospital diagnostic tests.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************