Faux health reform
Regulations will jack up costs and the number of uninsured
Democrats are in turmoil. In the wake of last week's Republican Senate victory in liberal Massachusetts, there's no agreement about what to do with the government health care bill. A dazed Speaker Nancy Pelosi admitted she didn't have the votes to pass it in the House, but House Majority Leader Steny Hoyer and Senate Majority Whip Dick Durbin still seem determined to ram it through.
President Obama and some other Democrats are putting out sounders about scaled-down health regulations. Striking his new populist pose, Mr. Obama told ABC News, "We know that we need insurance reform, that the health insurance companies are taking advantage of people." The problem with the president's anti-business stance is that if enacted into law, it will destroy private health insurance.
You don't have to take our word for it. Liberals like New York Times columnist Paul Krugman are warning about the president's suggestion. Regarding the regulation to forbid insurance companies from taking into account preexisting health conditions, Mr. Krugman wrote, "healthy people [will] choose to go uninsured until they get sick, leading to a poor risk pool, leading to high premiums, leading even more healthy people dropping out." In other words, proposed regulations would produce more uninsured Americans and higher insurance costs.
To illustrate how bad this idea is, imagine if motorists could buy automobile insurance right after an accident and then were allowed to drop it once the car was fixed. Without revenue from regular premiums, insurance companies couldn't cover all the claims and would go under.
In the current Senate bill, people who didn't buy insurance would be fined on an escalating scale that would start at $200 in 2014 and peak at $750 by 2017. In 2008, the average price of an insurance policy was $4,704 for individuals and $12,682 for a family of four. It's not hard to see how quickly private insurance companies would go bankrupt with those numbers.
Some Republicans are tempted to support this faux reform. If they do, they will share the blame with Democrats for the impending insurance collapse.
SOURCE
Kill Obamacare
From the Harvard Crimson!
Democrats look different these days. They look thinner. Last week, they lost their sixtieth vote in the Senate to Massachusetts Senator-elect Scott Brown. But Brown’s victory is only the latest bruise. Three weeks ago, North Dakota Senator Byron Dorgan and Connecticut Senator Chris Dodd announced their retirements. And last month, Alabama Congressman Parker Griffith switched parties.
True, more Republicans are planning to retire from Congress than Democrats—for now. But conservative Democrats who voted for Obamacare look pale for some reason. Maybe they’re sweating the fact that in Rasmussen Reports’ exit polls from last week’s election, 56 percent of voters said that health care was the most important factor in their decisions, and 51 percent opposed the Democrats’ plan—in Massachusetts.
Democrats’ troubles stem from their handling of health care, an issue on which their arrogance is patent. The Democrats’ proposal arrogates to themselves control of a sixth of our economy. They demand that insurers disregard preexisting conditions but that insurers distinguish between the sick and the healthy because the former are more expensive. If insurers cannot charge different prices, they’ll charge the healthy more to cover the difference. And if plans prove too pricey, the healthy will drop them, sucking money from the pool and raising premiums for the sick. So Democrats want everyone to buy coverage or face a fine, yet the fine they’ve prescribed is too low to deter dropouts. A higher fine, they fear, would provoke outrage.
On top of this morass, Democrats assert that their plan, which subsidizes about 30 million people so that they can afford coverage, will lower the deficit. Fears of higher taxes and bigger deficits, they sneer, are unfounded. Their reasoning? The Congressional Budget Office (CBO) says so. But they raise taxes to pay for the subsidies—a surcharge on the rich in the House of Representatives, a tax on “Cadillac plans” in the Senate—taxes that could have gone exclusively to reducing the deficit. And the CBO warns that the deficit will lessen only if Congress cuts billions from Medicare. Yeah right.
Yet Democrats scoff at critics. Republicans, they say, offer criticism but no solutions. What about Arizona Congressman John Shadegg’s proposal to allow people to buy insurance across state lines? Or Wisconsin Congressman Paul Ryan’s offer to tax employer-provided insurance and provide tax credits for individual coverage? Or Arizona Senator John McCain’s push for caps on exorbitant lawsuits against medical malpractice? Or former Massachusetts Governor Mitt Romney’s suggestion that states lift their mandates on insurers that force them to cover particular services—like in vitro fertilization?
“Please, Republicans are tools of Big Business,” they counter. Really? Pharmaceutical Research and Manufacturers of America (PhRMA) authorized its lobbyists to spend $150 million on television commercials in support of President Barack Obama’s plan. Democrats had to bribe Louisiana Senator Mary Landrieu and Nebraska Senator Ben Nelson with millions of dollars in funding to their states for their votes. And President Obama had to break his pledge to broadcast negotiations on C-SPAN, because the more people learn about his plan, the more they dislike it.
Besides their unworkable policies and their weak counterarguments, Democrats demonstrate arrogance with their flabby campaigning. “Republicans are culture warriors,” Democrats used to tell us, “who attack candidates’ personal lives to avoid discussing issues.” Yet Virginia State Senator Creigh Deeds, the Democrats’ failed gubernatorial candidate, aired television ads attacking his Republican opponent, Virginia Governor Bob McDonnell, on his graduate thesis. President Obama, when he campaigned in Massachusetts for the Democrats’ failed senatorial candidate, Massachusetts Attorney General Martha Coakley, ridiculed Brown’s pickup truck. Coakley herself stressed Brown’s party label, believing his association alone could sink him. This year, Democrats are the culture warriors.
After these candidates flopped, Democrats patronizingly blamed their misfortunes on voters’ “anger.” “People are angry, and they’re frustrated,” Obama told George Stephanpoulos, “not just because of what’s happened in the last year or two years, but what’s happened over the last eight years.” This tactic smells stale. In 1994, Peter Jennings, then-host of ABC Nightly News, said voters threw a “temper tantrum” after Republicans won control of Congress. And Time magazine declared on its cover that Newt Gingrich had “perfected the politics of anger.” Democrats dismiss disagreement as mere emotion.
So here’s my plea for humility. President Obama should drop his plans for health care and focus on the economy, which remains Americans’ main concern. Democrats have spent months trying to fool people into believing that expanding government is fiscally responsible and have failed. The current floundering is only trying people’s patience.
Most damning is their attempt to pooh-pooh their defeats as the result of voter anger against incumbents. People have legitimate objections to Obamacare, and no amount of spin can change that. For Democrats to try, they make themselves look ridiculous—and desperate.
SOURCE
Obamacare Is Dead and Here’s Why
As the Massachusetts blame game unfolds, the president’s unpopular health bill leads the list. But the substantive provisions of the bill were just part of the problem. Perhaps more important, voters were appalled by how the deal unfolded.
Consider the pre-election giveaway to the labor unions. Negotiators agreed to exempt union contracts until 2018 from the tax on so-called Cadillac health-insurance plans. That backroom bargain not only outraged the voters, it also violated the Fifth Amendment to the Constitution, requiring the federal government to extend equal protection of the laws to all U.S. persons. Of course, not all voters understood the constitutional nuances, but they sensed that something was very wrong; and they reacted.
For the record, here's the constitutional framework: If government were to discriminate against a specially protected class (racial, religious, or by nationality), its laws would be rigorously scrutinized by the courts. So too if government infringed on a "fundamental" right (such as speech, press, religion). But enrollees in non-union Cadillac health plans are not a specially protected class, and the right to an untaxed Cadillac plan is not deemed fundamental. That means the tax would be reviewed by the courts under a more relaxed standard. Essentially, courts would give great deference to the legislature, which could do pretty much anything that's reasonable. Rarely would a court override the judgment of our elected representatives. But “rarely” is not the same as “never.” Congress may not classify groups for differential treatment based on a criterion that bears no plausible relationship to the asserted goals of the legislation. The justification for discriminatory regulation must be legitimate – not simply a payoff to get the bill passed.
Yes, tax legislation often discriminates among parties. But discriminatory taxes are typically tied to social costs (e.g., cigarette taxes offset public expenditures for smoking-related illnesses), or regulatory objectives (e.g., alcohol taxes discourage excessive liquor consumption), or reciprocal benefits (e.g., gasoline excises pay for highways), or income redistribution (e.g., taxes on Cadillac health plans subsidize policies for the uninsured). By contrast, the tax on non-union plans was tied to none of those. Non-union plans do not impose higher social costs than union plans. There are no regulatory reasons that would justify unequal taxes. No benefits are extended to enrollees in non-union plans that are denied to enrollees in union plans. Nor is income redistribution from non-union to union workers a rational goal of health care reform.
Pure and simple, the tax on Cadillac plans was designed to generate revenue for Obamacare. That goal might have been reasonable; but the revenue could just as well have been generated by taxing all such plans or even selecting plans at random. Singling out non-union plans was merely a sop to the unions – a naked bribe to buy their support. Paradoxically, the bribe would make it tougher to raise sufficient revenue. Indeed, the Obama-union pact produced a $59 billion reduction in estimated tax receipts over ten years. And “bending the health care cost curve,” which might justify taxing Cadillac plans, did not justify taxing only non-union Cadillac plans.
Behind the scenes, the dispute over Cadillac plans threatened to drive a wedge between the White House and its union supporters, who played a major role in Obama’s 2008 campaign. The internecine warfare was so intense that AFL-CIO president Richard Trumka tipped off his Democratic friends they might not get union support in the upcoming election. One union even warned it would no longer endorse the health bill. So, unless Congress revised the tax on Cadillac plans, the President’s top legislative priority might be jeopardized and unions might sit on the sidelines while Republicans recapture the House.
This sordid episode, piled on top of Sen. Ben Nelson’s special Medicaid exemption for Nebraska, bred more voter cynicism about a political process that had gotten out of hand. A few men and women, behind closed doors, negotiating in secret, kowtowed to politically connected special interests. The losers weren’t represented at the bargaining table. Predictably, they were left holding the bag – penalized for not having a union-sponsored medical plan. As the health bill evolved, its victims couldn’t see or identify the negotiating parties, couldn’t hear the negotiations, and couldn’t protest their victimization. Take it for granted, they were told, that one political party would promote the welfare of all Americans. It just wasn’t so.
That’s why Obamacare is dead.
SOURCE
Tuesday, January 26, 2010
Monday, January 25, 2010
Another rogue overseas doctor in an Australian public hosital
Helen Kerner trusted her "nice, clean-cut" neurosurgeon when he said he had performed the delicate spinal operation she required 1500 times before. The 60-year-old was confused when she woke up incontinent, still in pain, with no feeling in her legs or pelvis, and upset when he tried to discharge her from hospital two days into recovery.
But when Suresh Surendranath Nair confessed that his "drill slipped" during the procedure, severing several nerves in her spine, Ms Kerner said she felt sorry for the doctor, who was then 38. "I felt like 'my goodness me, he must be feeling awful for what he's done'," Ms Kerner said. "But not now, not now, I'm pretty angry now."
The Health Care Complaints Commission is reportedly reviewing all surgery performed at Nepean Public Hospital under the direction of Dr Nair, 41, who faces drugs charges following the death in November of a 22-year-old student in his $1.7 million apartment. Sydney West Area Health Service has admitted a breach of duty of care in Ms Kerner's case.
Another neurosurgeon described the procedure, performed in 2006, as a standard operation and said Dr Nair's mistake was "usually so rare as to be virtually unheard of". The Malaysian-born, Australian-trained surgeon's registration had been suspended in 2004, after an appearance before the NSW Medical Board's Impaired Registrants Panel. He was suspended again in 2008 and on November 26 last year, following his arrest.
Ms Kerner, a former relief manager at Anglicare second-hand shops, said she did not know Dr Nair had been suspended when she was referred to him in 2006. "I had very bad back pain, sciatic pain, and all the doctor had to do was remove a bone spur away from the nerve, just grind it away from the nerve," Ms Kerner said. "The drill slipped … and my life changed, completely changed."
Sydney West Area Health Service would not comment. Dr Nair's solicitor, Mitchell Cavanagh, said he was not aware of the case and had not yet been able to discuss it with his client.
Ms Kerner, formerly a keen dancer and gardener, now uses walking sticks because she cannot feel her left leg and her foot is deformed. She is bowel and bladder incontinent, has lost all sexual function and lives with constant, severe pain in her legs and feet, according to a statement of claim filed in the NSW Supreme Court. "I'm very depressed. I wake up in the morning crying sometimes … I'm very embarrassed to go out because of things that happen," she said. "That's my life now. I don't have one."
Ms Kerner said she knew something was wrong as soon as she woke up. "I spoke to Dr Nair the next morning and he didn't tell me he slipped with the drill … He told me [he] stretched one of the nerves and it had to be repaired," she said. "He said within three months it should heal itself and I believed him because he's my doctor." Her confusion was compounded when Dr Nair tried to have her discharged from hospital two days after the procedure, before she had been seen by an continence adviser or physiotherapist.
It was not until Ms Kerner noticed the word "severed" written on her observation chart that she pressed for answers. At a meeting Ms Kerner said she attended with her then partner, the hospital's nursing manager and a clinical liaison officer, Dr Nair confessed his mistake. "I said, 'But you didn't tell me that before' and he said, 'Yes I did' … " she said.
At a second meeting attended, according to Ms Kerner, by her continence adviser and a friend, two hospital administrators told her she could sue for negligence. Legal proceedings began in November 2008 and Sydney West Area Health Services wrote to Ms Kerner's solicitor on November 3 last year, admitting a breach of duty of care.
"As far as I'm concerned the hospital should have got rid of him at the start, in 2004," Ms Kerner said. "If he was gone I wouldn't be like this."
Dr Nair has been in police custody since January 9 after he breached his bail conditions, which prohibited him from hiring prostitutes or taking illicit drugs. He is due in court on March 1. The State Coroner is also investigating the death of an escort, Victoria McIntyre, whose body was found in Dr Nair's apartment last February.
A NSW Supreme Court hearing in July will determine what compensation and damages NSW Health must pay Ms Kerner.
SOURCE
America's working poor unimpressed by Obamacare
And ignored by the Democratic party
There is already sufficient evidence from Massachusetts to suggest that poorer working families in the old factory towns there - frugal households in Fitchburg, Gardner or Peabody who have purchased private health insurance at considerable costs to their style of life - are disinclined to donate their tax dollars to further subsidising the healthcare costs of those who don't appear able to budget as tightly as they do. No doubt this shows a regrettable diminution of the impulses of universal humanity and sympathy on their part. And yet who among us truly knows, if we fell upon genuinely hard times, how well our own impulses of universal benevolence would hold up?
In recent decades the historic role of the Democratic Party's "base" (that most over-invoked and self-glamorised of entities) has been to adopt the interests of non-white ethnic minorities and the very poor, along with the grand ideals and more pragmatic career-aspirations of the highly educated, but to neglect or reject the concerns of the majority of Americans between those two social extremes, seen for these purposes as morally uninteresting.
And yet, since the 1960s the greater purpose of every serious Democratic president has been to show themselves capable of taking to their hearts the troubles of poor white folks and poor black folks, migrants and old-timers, the struggling and the striving alike, against all the snobbish instincts and the noblesse oblige pretensions of the Democratic Party's so-called base. Obama's trouble now is that he appears to lack the moral and rhetorical resources to fulfil that role. In its absence the would-be Robespierres of the Democratic Party - the posturers, the self-glamorisers and the selective empathisers alike - are having a field day.
More here
Poll shows majority wants Congress to suspend work on ObamaCare, Democrats weigh options
A new Gallup poll shows that a majority now favor suspending work on ObamaCare, showing a 56% of independent voters holding that opinion as well:
According to the poll, 65% believe that Congress should focus on other issues first or believe that health care should not be a major priority.
This isn’t stopping Democrats from trying to get something on health care passed. As I pointed out the night that Scott Brown beat Martha Coakley in Massachusetts, they may try reconciliation, which would bypass the filibuster but still could result in non-revenue producing measure being stripped from the bill if a point of order is raised.
Some news outlets are reporting today that Democrats may try to pass a list of changes to the health care bill as a separate piece of legislation as a way to get something moved through Congress this year. That could still meet a Republican filibuster in the Senate, assuming Senate Majority Leader Harry Reid (D-NV) can’t win over one of the two Senators from Maine.
ObamaCare isn’t dead, but it is on life support and with each passing day comes the reality that the president’s domestic agenda was defeated in Massachusetts on January 19th.
SOURCE
Pelosi and Reid Plot Secret Plan for Obamacare
Highly informed sources on Capitol Hill have revealed to me details of the Democratic plan to sneak through Congress Obamacare, despite collapsing public approval for healthcare "reform" and disintegrating Congressional support in the wake of Republican Scott Brown's victory in Massachusetts. President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have all agreed to the basic framework of the plan.
Their plan is clever but can be stopped if opponents of radical healthcare reform act quickly and focus on a core group of 23 Democratic Congressman. If just a few of these 23 Democrats are "flipped" and decide to oppose the bill, the whole Obama-Pelosi-Reid stratagem falls apart.
Here's what I learned top Democrats are planning to implement. Senate Democrats will go to the House with a two-part deal. First, the House will pass the Senate's Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.
How will Pelosi's deal fly with rambunctious liberal members of her majority that don't like the Senate bill, especially its failure to include a public option, put heavy fines on those who don't get insurance and offering no income tax surcharge on the "rich"? That's where the second part of the Pelosi-deal comes in.
Behind closed doors Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members -- but only after the Senate bill is passed and signed into law by Obama. This deal will be secured by a pledge from Reid and the Senate's Democratic caucus that they will make "fixes" to the Senate bill after it becomes law with Obama's John Hancock.
But you may ask what about the fact that without Republican Scott Brown and independent Democrats like Joe Lieberman, Reid simply doesn't have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation? According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic Senators indicating they will pass the major changes, or "fixes", the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.
Reid has also agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under "reconciliation" and don't require 60 Senate votes. To pass the fixes, he won't need one Republican, he won't even need Joe Lieberman or wavering Democrats like Jim Webb of Virginia. His 52 pledged Senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi's House and signed by Obama.
This plan, of course, is a total subversion of the legislative process. Typically, the Senate and House pass their own unique legislation and then both bills go to a conference committee. In conference the leadership of both Democrat-dominated houses wheel and deal and iron out differences. The final compromise bill is then sent back to the full Senate and full House for a vote and has to pass both to go to the President. In the House a simple majority passes the legislation. But under Senate rules, major legislation requires 60 votes to end a filibuster.
As it stands, the House bill and Senate bill have major discrepancies. Reid does not have 60 votes to pass a compromise bill that would no doubt include some of the radical provisions House members have been demanding. But if the House passes the exact Senate bill that passed by a 60-39 Senate vote last month, there is no need for a conference on the bill. It will go directly to the President's desk.
There is a rub to all of this. This secret plan being hatched by Pelosi and Reid requires not only a pledge by 52 Democratic Senators to vote later for the House modifications. House liberals must actually believe these Senators will live up to their pledge and pass the fixes at some future date. A Senate source cautions: “Senators more than House members and both more than ordinary people, lie.”
Still, my Senate source and others in Washington believe that the liberals in the House, grasping at straws after the stunning Massachusetts defeat, will go along with the Reid-Pelosi plan to bypass a conference bill and and will ultimately vote for the Senate version without changes.
Among the key "fixes" House liberals are demanding the Senate pass in reconciliation at some later date include a “carve out” for unions from the “Cadillac policy” insurance tax. The Senate plan funds their health care plan by heavy taxes on so-called "Cadillac" insurance plans that provide those insured with exceptionally good coverage including almost unlimited health access with little or no co-payments. The Senate's view was that rich people have such plans and should be taxed for them to pay the less fortunate.
But many unions have "Cadillac' plans for their members, and they are furious their members will be hit with the Senate tax. The unions have told their minions in the House to oppose the Senate Cadillac plan tax. House liberals are also requiring a fix that increases fines for those who flout the law and don't buy health insurance (the Pelosi passed plan includes criminal penalties, including possible jail time if a person doesn't purchase insurance). Another fix will raise subsidies for low-income families seeking to buy insurance.
In the original House bill that passed, healthcare expansion costs would have been paid for by an income tax surcharge on the "rich." House liberals are pushing for that fix as well.
So what is the counter-move? How do opponents of Obamacare stop this? Opponents cannot rely on liberal Democrats in the House who might balk at passing the Senate bill with just a "pledge" from 52 Senators. I have no doubt House liberals, despite their skepticism, will fade under pressure from Pelosi and Obama. They will do their duty and pass the Senate bill, whatever their current posturing.
Instead, the key to stopping the Pelosi-Reid plan lies with conservative or “moderate” Democrats who voted for the health care bill the first time. There are 23 of these conservative-leaning Democratic House members who voted for Pelosi's Obamacare back in November, which passed by just five votes, with 39 Democrats defecting to vote against the bill. All 23 of these Congressman who did vote for the Pelosi bill are extremely vulnerable.
Opponents of Obamacare need to climb all over these 23 Congressmen with TV ads and advocacy campaigns in their districts to get them to change their vote this time, to vote "no" to the Senate bill when it comes before the House. Voters need to say, "You voted for Obamacare the first time. But your district opposes it by 2 to 1. Now it is coming up for a vote again. Listen to your constituents and vote no. We don’t want Medicare cuts or premium increases or rationing of medical care. Don’t monkey with our health care. Vote no this time.”
Since the House healthcare bill passed by five votes, much has happened and the political landscape has changed dramatically. The Massachusetts election of a Republican to Ted Kennedy's Senate seat has sent shock waves through Washington. Every one of these 23 Democrats knows they will face an angry backlash in their districts if they vote for the Senate bill and go along with Pelosi-Reid plan to ram through Obamacare. I believe now is the time to act for opponents to act. The truth is that Obamacare is hanging by a thread. Opponents, if they move now, can drive a stake through its heart.
Once these Congressmen hear from their aroused constituents, they won’t be able to back Obamacare. As I mentioned, the Pelosi health bill passed the House by only 220-215. Nancy Pelosi knows she has no margin for error. If only a handful of these 23 Congressman change their vote under public pressure, the Pelosi-Reid plan is stopped and Obamacare is dead.
SOURCE
Helen Kerner trusted her "nice, clean-cut" neurosurgeon when he said he had performed the delicate spinal operation she required 1500 times before. The 60-year-old was confused when she woke up incontinent, still in pain, with no feeling in her legs or pelvis, and upset when he tried to discharge her from hospital two days into recovery.
But when Suresh Surendranath Nair confessed that his "drill slipped" during the procedure, severing several nerves in her spine, Ms Kerner said she felt sorry for the doctor, who was then 38. "I felt like 'my goodness me, he must be feeling awful for what he's done'," Ms Kerner said. "But not now, not now, I'm pretty angry now."
The Health Care Complaints Commission is reportedly reviewing all surgery performed at Nepean Public Hospital under the direction of Dr Nair, 41, who faces drugs charges following the death in November of a 22-year-old student in his $1.7 million apartment. Sydney West Area Health Service has admitted a breach of duty of care in Ms Kerner's case.
Another neurosurgeon described the procedure, performed in 2006, as a standard operation and said Dr Nair's mistake was "usually so rare as to be virtually unheard of". The Malaysian-born, Australian-trained surgeon's registration had been suspended in 2004, after an appearance before the NSW Medical Board's Impaired Registrants Panel. He was suspended again in 2008 and on November 26 last year, following his arrest.
Ms Kerner, a former relief manager at Anglicare second-hand shops, said she did not know Dr Nair had been suspended when she was referred to him in 2006. "I had very bad back pain, sciatic pain, and all the doctor had to do was remove a bone spur away from the nerve, just grind it away from the nerve," Ms Kerner said. "The drill slipped … and my life changed, completely changed."
Sydney West Area Health Service would not comment. Dr Nair's solicitor, Mitchell Cavanagh, said he was not aware of the case and had not yet been able to discuss it with his client.
Ms Kerner, formerly a keen dancer and gardener, now uses walking sticks because she cannot feel her left leg and her foot is deformed. She is bowel and bladder incontinent, has lost all sexual function and lives with constant, severe pain in her legs and feet, according to a statement of claim filed in the NSW Supreme Court. "I'm very depressed. I wake up in the morning crying sometimes … I'm very embarrassed to go out because of things that happen," she said. "That's my life now. I don't have one."
Ms Kerner said she knew something was wrong as soon as she woke up. "I spoke to Dr Nair the next morning and he didn't tell me he slipped with the drill … He told me [he] stretched one of the nerves and it had to be repaired," she said. "He said within three months it should heal itself and I believed him because he's my doctor." Her confusion was compounded when Dr Nair tried to have her discharged from hospital two days after the procedure, before she had been seen by an continence adviser or physiotherapist.
It was not until Ms Kerner noticed the word "severed" written on her observation chart that she pressed for answers. At a meeting Ms Kerner said she attended with her then partner, the hospital's nursing manager and a clinical liaison officer, Dr Nair confessed his mistake. "I said, 'But you didn't tell me that before' and he said, 'Yes I did' … " she said.
At a second meeting attended, according to Ms Kerner, by her continence adviser and a friend, two hospital administrators told her she could sue for negligence. Legal proceedings began in November 2008 and Sydney West Area Health Services wrote to Ms Kerner's solicitor on November 3 last year, admitting a breach of duty of care.
"As far as I'm concerned the hospital should have got rid of him at the start, in 2004," Ms Kerner said. "If he was gone I wouldn't be like this."
Dr Nair has been in police custody since January 9 after he breached his bail conditions, which prohibited him from hiring prostitutes or taking illicit drugs. He is due in court on March 1. The State Coroner is also investigating the death of an escort, Victoria McIntyre, whose body was found in Dr Nair's apartment last February.
A NSW Supreme Court hearing in July will determine what compensation and damages NSW Health must pay Ms Kerner.
SOURCE
America's working poor unimpressed by Obamacare
And ignored by the Democratic party
There is already sufficient evidence from Massachusetts to suggest that poorer working families in the old factory towns there - frugal households in Fitchburg, Gardner or Peabody who have purchased private health insurance at considerable costs to their style of life - are disinclined to donate their tax dollars to further subsidising the healthcare costs of those who don't appear able to budget as tightly as they do. No doubt this shows a regrettable diminution of the impulses of universal humanity and sympathy on their part. And yet who among us truly knows, if we fell upon genuinely hard times, how well our own impulses of universal benevolence would hold up?
In recent decades the historic role of the Democratic Party's "base" (that most over-invoked and self-glamorised of entities) has been to adopt the interests of non-white ethnic minorities and the very poor, along with the grand ideals and more pragmatic career-aspirations of the highly educated, but to neglect or reject the concerns of the majority of Americans between those two social extremes, seen for these purposes as morally uninteresting.
And yet, since the 1960s the greater purpose of every serious Democratic president has been to show themselves capable of taking to their hearts the troubles of poor white folks and poor black folks, migrants and old-timers, the struggling and the striving alike, against all the snobbish instincts and the noblesse oblige pretensions of the Democratic Party's so-called base. Obama's trouble now is that he appears to lack the moral and rhetorical resources to fulfil that role. In its absence the would-be Robespierres of the Democratic Party - the posturers, the self-glamorisers and the selective empathisers alike - are having a field day.
More here
Poll shows majority wants Congress to suspend work on ObamaCare, Democrats weigh options
A new Gallup poll shows that a majority now favor suspending work on ObamaCare, showing a 56% of independent voters holding that opinion as well:
The USA Today/Gallup poll was conducted Jan. 20 to gauge initial reaction from Americans to Brown’s victory in the special election to fill the remainder of the late Sen. Edward Kennedy’s term. Massachusetts voters elected a Republican to the Senate for the first time since 1972. Americans widely agree that the election result has national political implications — 72% say it reflects many Americans’ frustrations, which the president and members of Congress should pay attention to, while 18% believe it is a reflection of political conditions in Massachusetts.
[…]
According to the poll, most self-identified Democrats (67%) want Congress to continue working toward passage of the bill. However, an even larger majority of Republicans (87%) call for suspension of Congress’ current work on the bill. The majority of political independents, whose support has been crucial to recent Republican election victories in Massachusetts, Virginia, and New Jersey, would also prefer to see the reform efforts put on hold rather than moved forward.
According to the poll, 65% believe that Congress should focus on other issues first or believe that health care should not be a major priority.
This isn’t stopping Democrats from trying to get something on health care passed. As I pointed out the night that Scott Brown beat Martha Coakley in Massachusetts, they may try reconciliation, which would bypass the filibuster but still could result in non-revenue producing measure being stripped from the bill if a point of order is raised.
Some news outlets are reporting today that Democrats may try to pass a list of changes to the health care bill as a separate piece of legislation as a way to get something moved through Congress this year. That could still meet a Republican filibuster in the Senate, assuming Senate Majority Leader Harry Reid (D-NV) can’t win over one of the two Senators from Maine.
ObamaCare isn’t dead, but it is on life support and with each passing day comes the reality that the president’s domestic agenda was defeated in Massachusetts on January 19th.
SOURCE
Pelosi and Reid Plot Secret Plan for Obamacare
Highly informed sources on Capitol Hill have revealed to me details of the Democratic plan to sneak through Congress Obamacare, despite collapsing public approval for healthcare "reform" and disintegrating Congressional support in the wake of Republican Scott Brown's victory in Massachusetts. President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have all agreed to the basic framework of the plan.
Their plan is clever but can be stopped if opponents of radical healthcare reform act quickly and focus on a core group of 23 Democratic Congressman. If just a few of these 23 Democrats are "flipped" and decide to oppose the bill, the whole Obama-Pelosi-Reid stratagem falls apart.
Here's what I learned top Democrats are planning to implement. Senate Democrats will go to the House with a two-part deal. First, the House will pass the Senate's Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.
How will Pelosi's deal fly with rambunctious liberal members of her majority that don't like the Senate bill, especially its failure to include a public option, put heavy fines on those who don't get insurance and offering no income tax surcharge on the "rich"? That's where the second part of the Pelosi-deal comes in.
Behind closed doors Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members -- but only after the Senate bill is passed and signed into law by Obama. This deal will be secured by a pledge from Reid and the Senate's Democratic caucus that they will make "fixes" to the Senate bill after it becomes law with Obama's John Hancock.
But you may ask what about the fact that without Republican Scott Brown and independent Democrats like Joe Lieberman, Reid simply doesn't have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation? According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic Senators indicating they will pass the major changes, or "fixes", the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.
Reid has also agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under "reconciliation" and don't require 60 Senate votes. To pass the fixes, he won't need one Republican, he won't even need Joe Lieberman or wavering Democrats like Jim Webb of Virginia. His 52 pledged Senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi's House and signed by Obama.
This plan, of course, is a total subversion of the legislative process. Typically, the Senate and House pass their own unique legislation and then both bills go to a conference committee. In conference the leadership of both Democrat-dominated houses wheel and deal and iron out differences. The final compromise bill is then sent back to the full Senate and full House for a vote and has to pass both to go to the President. In the House a simple majority passes the legislation. But under Senate rules, major legislation requires 60 votes to end a filibuster.
As it stands, the House bill and Senate bill have major discrepancies. Reid does not have 60 votes to pass a compromise bill that would no doubt include some of the radical provisions House members have been demanding. But if the House passes the exact Senate bill that passed by a 60-39 Senate vote last month, there is no need for a conference on the bill. It will go directly to the President's desk.
There is a rub to all of this. This secret plan being hatched by Pelosi and Reid requires not only a pledge by 52 Democratic Senators to vote later for the House modifications. House liberals must actually believe these Senators will live up to their pledge and pass the fixes at some future date. A Senate source cautions: “Senators more than House members and both more than ordinary people, lie.”
Still, my Senate source and others in Washington believe that the liberals in the House, grasping at straws after the stunning Massachusetts defeat, will go along with the Reid-Pelosi plan to bypass a conference bill and and will ultimately vote for the Senate version without changes.
Among the key "fixes" House liberals are demanding the Senate pass in reconciliation at some later date include a “carve out” for unions from the “Cadillac policy” insurance tax. The Senate plan funds their health care plan by heavy taxes on so-called "Cadillac" insurance plans that provide those insured with exceptionally good coverage including almost unlimited health access with little or no co-payments. The Senate's view was that rich people have such plans and should be taxed for them to pay the less fortunate.
But many unions have "Cadillac' plans for their members, and they are furious their members will be hit with the Senate tax. The unions have told their minions in the House to oppose the Senate Cadillac plan tax. House liberals are also requiring a fix that increases fines for those who flout the law and don't buy health insurance (the Pelosi passed plan includes criminal penalties, including possible jail time if a person doesn't purchase insurance). Another fix will raise subsidies for low-income families seeking to buy insurance.
In the original House bill that passed, healthcare expansion costs would have been paid for by an income tax surcharge on the "rich." House liberals are pushing for that fix as well.
So what is the counter-move? How do opponents of Obamacare stop this? Opponents cannot rely on liberal Democrats in the House who might balk at passing the Senate bill with just a "pledge" from 52 Senators. I have no doubt House liberals, despite their skepticism, will fade under pressure from Pelosi and Obama. They will do their duty and pass the Senate bill, whatever their current posturing.
Instead, the key to stopping the Pelosi-Reid plan lies with conservative or “moderate” Democrats who voted for the health care bill the first time. There are 23 of these conservative-leaning Democratic House members who voted for Pelosi's Obamacare back in November, which passed by just five votes, with 39 Democrats defecting to vote against the bill. All 23 of these Congressman who did vote for the Pelosi bill are extremely vulnerable.
Opponents of Obamacare need to climb all over these 23 Congressmen with TV ads and advocacy campaigns in their districts to get them to change their vote this time, to vote "no" to the Senate bill when it comes before the House. Voters need to say, "You voted for Obamacare the first time. But your district opposes it by 2 to 1. Now it is coming up for a vote again. Listen to your constituents and vote no. We don’t want Medicare cuts or premium increases or rationing of medical care. Don’t monkey with our health care. Vote no this time.”
Since the House healthcare bill passed by five votes, much has happened and the political landscape has changed dramatically. The Massachusetts election of a Republican to Ted Kennedy's Senate seat has sent shock waves through Washington. Every one of these 23 Democrats knows they will face an angry backlash in their districts if they vote for the Senate bill and go along with Pelosi-Reid plan to ram through Obamacare. I believe now is the time to act for opponents to act. The truth is that Obamacare is hanging by a thread. Opponents, if they move now, can drive a stake through its heart.
Once these Congressmen hear from their aroused constituents, they won’t be able to back Obamacare. As I mentioned, the Pelosi health bill passed the House by only 220-215. Nancy Pelosi knows she has no margin for error. If only a handful of these 23 Congressman change their vote under public pressure, the Pelosi-Reid plan is stopped and Obamacare is dead.
SOURCE
Sunday, January 24, 2010
A British death panel at work again
Fertility regulators are allowing doctors to screen out embryos that could lead full lives despite having a genetic condition
FERTILITY regulators have triggered a new row over designer babies by allowing doctors to destroy embryos affected by more than 100 genetic conditions, including many illnesses that are not life-threatening. The genetic “defects” that can now be routinely screened out include conditions carried by a number of leading figures, such as Pete Sampras, the tennis champion, and Sergei Rachmaninoff, the Russian concert pianist and composer. In some cases it will mean the elimination of an embryo that has been identified as carrying genetic material inherited from a stricken grandparent, but which may not necessarily develop the same illness.
The Human Fertilisation and Embryology Authority (HFEA), has published a list of 116 inherited conditions that fertility clinics can screen out without requiring special permission. Although many of the conditions can cause gross deformity, protracted pain and premature death, the list also includes illnesses, including cancer and blindness, which can strike late in life after a victim has enjoyed decades of good health.
A number of the conditions are not life-threatening or can be readily treated because of advances in medicine. The disorders include Marfan syndrome, a congenital weakness of connective tissue that can lead to abnormal growth. Among the people thought to have suffered from the illness are Rachmaninoff, who was noted for his large hands, Charles de Gaulle, the French leader, and Abraham Lincoln, the American president.
Another condition that the HFEA allows to be screened out is the blood disorder thalassemia. Sampras, who won 14 Grand Slam singles titles during his career, has a version of the trait that can cause mild anaemia.
Sion Simon, the minister for creative industries, suffers from choroideremia, an inherited form of progressive blindness that is also on the HFEA list. Simon, 41, rarely speaks about the condition, but writing in The Spectator eight years ago, he said: “Being approximately half-blind now, I know perfectly well that the diurnal exigencies of deteriorating vision are no fun. They are tedious. And yet going blind carries a certain prestige that other losses of faculty do not. There are many much worse things.”
The HFEA said it takes into account the age of onset and the variability of physical and intellectual impairment when deciding which genetic conditions can be screened. The unpleasantness of medical treatment available for a given condition is also considered when deciding whether an affected individual will have a worthwhile life.
However, David King, director of Human Genetics Alert, a pressure group, said he was concerned about the use of selection for non-fatal conditions. “It contributes to a social climate in which even minor deviations from ‘normality’ are seen as unacceptable,” he said.
The established procedure for identifying inherited genetic abnormality is to remove one or two cells from an eight-cell embryo three days after fertilisation. The cells are then put through pre-implantation genetic diagnosis (PGD), a search for one or more defective characteristics. Abnormal embryos are discarded, while healthy ones are kept for implantation into the mother’s womb.
The HFEA is now considering adding a further 24 inherited disorders to its list of genetic conditions. Decisions on eight of them are expected this week. They include porphyria, a potentially painful condition caused by overproduction of red blood cell pigment that was linked to the “madness” of George III. Karen Harris, of the British Porphyria Association, said: “I have porphyria, so does one of my three children and so does his child.” Although Harris said she would not have used PGD to select her own children, she would not condemn its use by other families. “If you have lived with someone unable to function and on constant morphine because of the pain, you would take a different view.”
Joyce Harper, co-founder of the PGD centre at University College London, said the selection procedure is expensive and seldom available on the NHS. However, she has agreed to use the technique for a couple who want to ensure their child is not affected by a family gene causing deafness. She admitted: “It’s controversial and it’s going to get more controversial.”
SOURCE
No NHS doctors available -- so British baby dies
No diagnostic tests when the baby was first seen of course. Tests are expensive -- and babies are expendable, apparently!
One of England’s biggest counties has only two GPs on call on some nights to cover a population of more than 600,000. Doctors admit the out-of-hours service in Suffolk is so stretched that it is threatening patient safety. On some occasions, residents have resorted to summoning an ambulance after failing to get hold of a GP.
In one case, a couple whose baby was seriously ill were told to wait up to four hours for a telephone call from a doctor. The nine-month-old boy, who was in fact suffering from meningitis, died later that night.
The GP skeleton service from 11.30pm to 8am is provided by Take Care Now (TCN), a private company that uses foreign doctors to cover some shifts. Three doctors are supposed to provide cover, but one is sometimes replaced by a nurse.
The situation in Suffolk is reflected across rural England, with the number of doctors on call plummeting in the past five years. The pressures on the service are revealed in a new report by the Primary Care Foundation, an independent body, which found that only 16 of the 80 primary care trusts it examined met the target of clinically assessing 90% of urgent calls within 20 minutes.
TCN has been under scrutiny since the death of David Gray, 70, from Manea, Cambridgeshire, in February 2008. Gray died after being given a huge overdose of diamorphine by Daniel Ubani, a German-based doctor who was on his first shift for the company.
TCN won the contract to provide out-of-hours services for NHS Suffolk, the primary care trust, in 2004 after GPs were permitted to opt out of providing round-the-clock care. The NHS trust covers the entire county, apart from one surgery that did not opt out and the Waveney district, which is covered by a separate trust.
Other out-of-hours providers in England also provide a skeleton night staff compared with the 1990s. However, GPs have written to the trust, complaining that patient safety could be at risk. Dr Claire Giles, chairwoman of Suffolk’s Local Medical Committee, which represents GPs, said: “The patches covered by these doctors have got bigger and bigger as the funding has been cut.”
TCN says most people are satisfied with its services and it hits all the NHS’s out-of-hours targets. But residents say the targets fail to reflect the delays in the system.
One couple, Mark and Jennifer Smith, from Kesgrave, Ipswich, lost their nine-month-old son to meningitis after being told they faced a wait of up to four hours to speak to an out-of-hours doctor. The couple visited an out-of-hours clinic at the Riverside centre in Ipswich at about 6pm on Saturday, March 14, last year with their sick baby, Taylor. The doctor there told them he was suffering from a bug.
When Taylor awoke at 2am that night with a bright rash, the couple telephoned NHS Direct and were told they would have to wait up to four hours for the doctor to call back. At 5am, the out-of-hours doctor rang and the Smiths explained the symptoms. Clearly concerned, the doctor advised the couple to check the baby. It was too late, however — their son had died of the blood poisoning that accompanies meningitis. “Our beautiful little boy had gone,” said Mark Smith.
He said the family had been failed by the NHS during the night. “It should not take four hours to get a call back from a doctor when you have a sick baby.”
Other residents say they have been forced to call ambulances rather than wait for an out-of-hours GP.
TCN, which is being investigated by the Care Quality Commission, had its contract with NHS Cambridgeshire terminated last November. It is also being replaced by a new out-of-hours service in Suffolk in April. The company is, however, defended by some GPs who say it is underfunded and that its problems are shared by similar providers.
NHS Suffolk said: “We are continually monitoring patient safety and experience and will continue to do so.” [Blah! blah!]
SOURCE
Dems mull options for health care bill
President Barack Obama and Democratic leaders insist they will push ahead with efforts to overhaul the U.S. health care system despite losing undisputed control of the Senate. They just haven't decided what it will look like or how they will pass it. In fact, they aren't explaining much.
A senior Democratic aide said Saturday that House and Senate leaders are considering changes to the health care bill passed by the Senate that could make it acceptable to the House. Under one scenario, Democratic senators would make the agreed-upon fixes using a special budget procedure that requires only 51 votes to overcome Republican delaying tactics. The House would then pass the Senate bill, sending it to Obama for his signature and allowing the health care remake to become law.
But the aide, who described the discussions on condition of anonymity because of the sensitivity of the issue, said no decisions have been made. The strategy would be politically risky because it would enrage Republicans, and the legislation itself lacks strong public support.
Obama acknowledges running into a "bit of a buzz saw" of opposition. A top Democrat suggested that Congress slow down on health care, a sign of eroding political will in the wake of a Republican's upset victory in the Massachusetts Senate race Tuesday.
Democratic Sen. Chris Dodd of Connecticut, who got health legislation through the Senate's health committee last year after the death of his friend, Sen. Edward M. Kennedy, said Obama and lawmakers could "maybe take a breather for a month, six weeks."
Just a week ago the health legislation had appeared on the cusp of passage after Obama threw himself into marathon negotiations with congressional leaders to work out differences between the separate health care reform bills passed by the House and Senate. "There are things that have to get done. This is our best chance to do it. We can't keep on putting this off," Obama said Friday at a town hall meeting in Elyria, Ohio. "I am not going to walk away just because it's hard," the president said.
Obama seemed to pull back from a suggestion he made Wednesday that lawmakers unite behind the elements of the legislation everyone can agree on. Obama said scaling back health care presented problems because some of the popular ideas, such as banning denial of coverage to people with medical problems, can't be done unless most Americans are insured. "A lot of these insurance reforms are connected to some other things we have to do to make sure that everybody has some access to coverage," he said. For example, insurers wouldn't be able to end the practice of denying coverage to people with health conditions unless more people were covered. Otherwise people could wait until they got sick to buy insurance and premiums could skyrocket.
Obama has used immense political capital to advance the health care overhaul and remake a system that has frustrated past administrations, most recently Democrat Bill Clinton's in 1994. Whether he can succeed where others have failed is now unclear. "Here's the good news. We've gotten pretty far down the road, but I have to admit, we had a little bit of a buzz saw this week," the president said.
Despite Dodd's suggestion that Democrats take a breather, both House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid insist the health care legislation will go forward. They just haven't said how.
The changes under discussion to the Senate bill would reflect agreements leaders of both chambers made during negotiations at the White House two weeks ago. That includes weakening the Senate bill's tax on high-cost insurance plans, opposed by labor unions and considered a nonstarter in the House. Closing gaps in prescription drug coverage for the elderly is also under consideration.
One potential approach could allow the Senate to act with a simple majority instead of the 60-vote total Democrats now lack with the election of Republican Scott Brown in Massachusetts. A supermajority of 60 votes is needed to overcome Republican filibusters -- a legislative procedure that blocks measures from coming up for a final vote.
But House Republican leader John Boehner said the election of Scott Brown in Massachusetts has sent a loud warning to Democrats -- cease and desist on health care overhaul. "For the better part of those nine months, Democrats in Washington have been focused on this government takeover of health care that working families just can't afford and want nothing to do with," Boehner said in his party's radio and Internet address Saturday.
Obama has made fixing a broken health care system the top domestic policy priority of his first term, but has faced solid opposition from the Republican minority. Despite assurances from Obama and his administration, opposition to his plans have grown among people who bought into allegations of higher taxes, unbearable government deficits and serious government meddling in health care.
The United States is the only industrialized country without a version of universal health care. Americans get their health insurance mainly through their employers, with government programs to cover mainly retirees, military veterans and members of Native American tribes. Forty million to 50 million Americans are uninsured and get medical care largely through hospital emergency rooms.
SOURCE
Obamacare Will Decrease the Deficit? Yeah, Right!
The vote looming in the Senate to raise the debt limit should serve as a wake-up call that federal spending is out of control. Instead, Democratic leadership has tried to convince Americans that passing costly health care legislation is not only sensible, but requisite, and must be done now.
Neither is true. The bills use weak spending limits, weak tax provisions, and even weaker cuts to current spending to pay for reform. Democrats claim these provisions mean that the massive health bill will not only be paid for, but will decrease the federal deficit. In a recent testimony to the House Budget Committee, health care expert James Capretta outlines why this is contrary to Obamacare’s more likely fiscal future.
Weak Cost Control on New Entitlements. Both bills increase coverage by expanding Medicaid or offering subsidies to purchase insurance on the exchange. Lavish subsidies will be available to those who do not qualify for Medicaid but make under 400 percent the Federal Poverty Level. While 127 million Americans fall in this category, only 18 million are projected to receive the subsidy, due to a “firewall” to prevent those who are offered employer-sponsored coverage from receiving it. This creates gross inequity within income brackets. As is the way with Congress, lawmakers will likely give in to taxpayer pressure down the road to extend the subsidies and eliminate the inequity. Expanding this entitlement will cost billions, adding to the deficit.
The bills create another new entitlement via the CLASS Act, which provides community living assistance. Beneficiaries would pay premiums but would not receive benefits until years later, thus creating one-time savings at the programs onset. Obviously, years down the road this spending cushion would deteriorate, and the program would become insolvent. This is not accounted for in ten year cost projections.
Weak and Unpopular New Taxes. The Senate bill is paid for with a 40 percent excise tax on high-cost insurance plans. This provision is to deter Americans from purchasing unnecessarily extravagant health plans, but it is also responsible for about half of the revenue used to pay for the bill. This tax is widely unpopular, and Washington has already begun and will likely continue to carve out favored constituencies who balk at this tax. Union members have already been exempt through 2017, which eliminates 40 percent of expected revenue from this tax.
Presumed Cuts to Medicare. Finally, both bills are largely paid for by cuts to Medicare of approximately half a trillion dollars. These cuts will presumably be made to payment rates for certain care providers by decreasing inflation updates. The expectation that this will actually occur is almost laughable. At the same time that lawmakers are proposing to pay for health care form using cuts to Medicare, they are trying to pass the “doc fix” legislation to end cuts to Medicare that were enacted to—you guessed it—contain costs. Every year, Congress is supposed to decrease physician payment rates in order to control Medicare spending. And every year, Congress votes to suspend the doctors’ payment decrease due to pressure from the industry. The House recently passed legislation that would get rid of the payment cuts for good. And yet without blinking an eye, they propose to use the same failed method to pay for health care reform.
These cuts to Medicare are even more unlikely considering their full impact. As Capretta points out, “The Chief Actuary of the Medicare program has warned that these arbitrary reductions could have serious consequences for beneficiaries’ access to care, as [they] would push about one out of every five hospital facilities into insolvency.”
The House and Senate bills received positive cost estimates by the Congressional Budget Office based on these weak spending controls and the fact that the CBO analysis looks at the first ten year window, which for both bills, includes ten years of raising revenue, but only six years of spending. The country is facing a fiscal crisis as the population faces a demographic transformation of 30 million citizens entering old age within the next twenty years, Capretta points out. Lawmakers need to acknowledge the precariousness of America’s fiscal future and be honest about the true cost of Obamacare.
SOURCE
Obama hunkers down as health care falters
The loss of their 60th Senate seat on Tuesday night in Massachusetts struck fear into Democrats. The president, who two weeks ago was driving deals to settle disagreements among House and Senate Democrats, sent mixed signals this past week that betrayed a lack of certainty about his intentions. Old divisions resurfaced, leaving Democrats confused and frustrated.
Obama on Friday sought to recover his equilibrium. "I didn't take this on to score political points," a defiant Obama told workers in recession-weary Ohio. "And I'm not going to walk away just because it's hard. We're going to keep on working to get this done _ with Democrats, I hope with Republicans _ anybody who's willing to step up."
Step up. That's what some Democratic lawmakers are saying Obama needs to do. "I think he has got to get even more deeply involved," said Rep. Elijah Cummings, D-Md. "He's a key factor and we have to see exactly to what degree he wants to play that role." "He has the ability to bring us all together," said Sen. Christopher Dodd, D-Conn., one of the negotiators in recent White House talks. "He did that ... to try to resolve the differences between the House and Senate. Again, it's going to take that kind of leadership." ....
Lawmakers came to work Wednesday morning facing a new reality. Democrats no longer had the votes in the Senate to keep Republicans from blocking the health care bill, and the rest of Obama's agenda. With the loss of Kennedy's seat, Obama seemed to retreat _ and stumble. In an interview with ABC News, the president who only days before had been functioning as nightshift foreman of the health care talks said it wasn't his role to delve into the details of legislative strategy. He suggested lawmakers might want to regroup around a smaller package of popular measures.
With House Speaker Nancy Pelosi, D-Calif., trying to gauge support for passing the Senate's bill, Obama's candor unnerved White House aides, who scrambled to reinterpret their boss' remarks. It was no use. After meeting with Democratic lawmakers Thursday morning, Pelosi delivered the news that she didn't have the votes to pass the Senate bill.
Suddenly every Democrat had his or her own idea about what to do next. Some wanted to move on, noting that jobs and the economy are more important to voters than health care. Many called for scaling back the bills to more manageable and understandable dimensions. Some demanded a heroic attempt to enact comprehensive changes.
Not two weeks ago, Pelosi was close to a final handshake with Senate Majority Leader Harry Reid, D-Nev. By Thursday, she dismissed the Senate bill as a nonstarter tainted by backroom deals. Reid complained that the House doesn't listen to him. Pelosi huffed that the House, unlike the Senate, doesn't have surprise elections.
By Friday, Obama was back to arguing that comprehensive health care legislation remains the best route for the nation.
Democrats are now in a self-imposed cooling off period of uncertain duration. No decisions have been made on how to salvage health care.
More here
Fertility regulators are allowing doctors to screen out embryos that could lead full lives despite having a genetic condition
FERTILITY regulators have triggered a new row over designer babies by allowing doctors to destroy embryos affected by more than 100 genetic conditions, including many illnesses that are not life-threatening. The genetic “defects” that can now be routinely screened out include conditions carried by a number of leading figures, such as Pete Sampras, the tennis champion, and Sergei Rachmaninoff, the Russian concert pianist and composer. In some cases it will mean the elimination of an embryo that has been identified as carrying genetic material inherited from a stricken grandparent, but which may not necessarily develop the same illness.
The Human Fertilisation and Embryology Authority (HFEA), has published a list of 116 inherited conditions that fertility clinics can screen out without requiring special permission. Although many of the conditions can cause gross deformity, protracted pain and premature death, the list also includes illnesses, including cancer and blindness, which can strike late in life after a victim has enjoyed decades of good health.
A number of the conditions are not life-threatening or can be readily treated because of advances in medicine. The disorders include Marfan syndrome, a congenital weakness of connective tissue that can lead to abnormal growth. Among the people thought to have suffered from the illness are Rachmaninoff, who was noted for his large hands, Charles de Gaulle, the French leader, and Abraham Lincoln, the American president.
Another condition that the HFEA allows to be screened out is the blood disorder thalassemia. Sampras, who won 14 Grand Slam singles titles during his career, has a version of the trait that can cause mild anaemia.
Sion Simon, the minister for creative industries, suffers from choroideremia, an inherited form of progressive blindness that is also on the HFEA list. Simon, 41, rarely speaks about the condition, but writing in The Spectator eight years ago, he said: “Being approximately half-blind now, I know perfectly well that the diurnal exigencies of deteriorating vision are no fun. They are tedious. And yet going blind carries a certain prestige that other losses of faculty do not. There are many much worse things.”
The HFEA said it takes into account the age of onset and the variability of physical and intellectual impairment when deciding which genetic conditions can be screened. The unpleasantness of medical treatment available for a given condition is also considered when deciding whether an affected individual will have a worthwhile life.
However, David King, director of Human Genetics Alert, a pressure group, said he was concerned about the use of selection for non-fatal conditions. “It contributes to a social climate in which even minor deviations from ‘normality’ are seen as unacceptable,” he said.
The established procedure for identifying inherited genetic abnormality is to remove one or two cells from an eight-cell embryo three days after fertilisation. The cells are then put through pre-implantation genetic diagnosis (PGD), a search for one or more defective characteristics. Abnormal embryos are discarded, while healthy ones are kept for implantation into the mother’s womb.
The HFEA is now considering adding a further 24 inherited disorders to its list of genetic conditions. Decisions on eight of them are expected this week. They include porphyria, a potentially painful condition caused by overproduction of red blood cell pigment that was linked to the “madness” of George III. Karen Harris, of the British Porphyria Association, said: “I have porphyria, so does one of my three children and so does his child.” Although Harris said she would not have used PGD to select her own children, she would not condemn its use by other families. “If you have lived with someone unable to function and on constant morphine because of the pain, you would take a different view.”
Joyce Harper, co-founder of the PGD centre at University College London, said the selection procedure is expensive and seldom available on the NHS. However, she has agreed to use the technique for a couple who want to ensure their child is not affected by a family gene causing deafness. She admitted: “It’s controversial and it’s going to get more controversial.”
SOURCE
No NHS doctors available -- so British baby dies
No diagnostic tests when the baby was first seen of course. Tests are expensive -- and babies are expendable, apparently!
One of England’s biggest counties has only two GPs on call on some nights to cover a population of more than 600,000. Doctors admit the out-of-hours service in Suffolk is so stretched that it is threatening patient safety. On some occasions, residents have resorted to summoning an ambulance after failing to get hold of a GP.
In one case, a couple whose baby was seriously ill were told to wait up to four hours for a telephone call from a doctor. The nine-month-old boy, who was in fact suffering from meningitis, died later that night.
The GP skeleton service from 11.30pm to 8am is provided by Take Care Now (TCN), a private company that uses foreign doctors to cover some shifts. Three doctors are supposed to provide cover, but one is sometimes replaced by a nurse.
The situation in Suffolk is reflected across rural England, with the number of doctors on call plummeting in the past five years. The pressures on the service are revealed in a new report by the Primary Care Foundation, an independent body, which found that only 16 of the 80 primary care trusts it examined met the target of clinically assessing 90% of urgent calls within 20 minutes.
TCN has been under scrutiny since the death of David Gray, 70, from Manea, Cambridgeshire, in February 2008. Gray died after being given a huge overdose of diamorphine by Daniel Ubani, a German-based doctor who was on his first shift for the company.
TCN won the contract to provide out-of-hours services for NHS Suffolk, the primary care trust, in 2004 after GPs were permitted to opt out of providing round-the-clock care. The NHS trust covers the entire county, apart from one surgery that did not opt out and the Waveney district, which is covered by a separate trust.
Other out-of-hours providers in England also provide a skeleton night staff compared with the 1990s. However, GPs have written to the trust, complaining that patient safety could be at risk. Dr Claire Giles, chairwoman of Suffolk’s Local Medical Committee, which represents GPs, said: “The patches covered by these doctors have got bigger and bigger as the funding has been cut.”
TCN says most people are satisfied with its services and it hits all the NHS’s out-of-hours targets. But residents say the targets fail to reflect the delays in the system.
One couple, Mark and Jennifer Smith, from Kesgrave, Ipswich, lost their nine-month-old son to meningitis after being told they faced a wait of up to four hours to speak to an out-of-hours doctor. The couple visited an out-of-hours clinic at the Riverside centre in Ipswich at about 6pm on Saturday, March 14, last year with their sick baby, Taylor. The doctor there told them he was suffering from a bug.
When Taylor awoke at 2am that night with a bright rash, the couple telephoned NHS Direct and were told they would have to wait up to four hours for the doctor to call back. At 5am, the out-of-hours doctor rang and the Smiths explained the symptoms. Clearly concerned, the doctor advised the couple to check the baby. It was too late, however — their son had died of the blood poisoning that accompanies meningitis. “Our beautiful little boy had gone,” said Mark Smith.
He said the family had been failed by the NHS during the night. “It should not take four hours to get a call back from a doctor when you have a sick baby.”
Other residents say they have been forced to call ambulances rather than wait for an out-of-hours GP.
TCN, which is being investigated by the Care Quality Commission, had its contract with NHS Cambridgeshire terminated last November. It is also being replaced by a new out-of-hours service in Suffolk in April. The company is, however, defended by some GPs who say it is underfunded and that its problems are shared by similar providers.
NHS Suffolk said: “We are continually monitoring patient safety and experience and will continue to do so.” [Blah! blah!]
SOURCE
Dems mull options for health care bill
President Barack Obama and Democratic leaders insist they will push ahead with efforts to overhaul the U.S. health care system despite losing undisputed control of the Senate. They just haven't decided what it will look like or how they will pass it. In fact, they aren't explaining much.
A senior Democratic aide said Saturday that House and Senate leaders are considering changes to the health care bill passed by the Senate that could make it acceptable to the House. Under one scenario, Democratic senators would make the agreed-upon fixes using a special budget procedure that requires only 51 votes to overcome Republican delaying tactics. The House would then pass the Senate bill, sending it to Obama for his signature and allowing the health care remake to become law.
But the aide, who described the discussions on condition of anonymity because of the sensitivity of the issue, said no decisions have been made. The strategy would be politically risky because it would enrage Republicans, and the legislation itself lacks strong public support.
Obama acknowledges running into a "bit of a buzz saw" of opposition. A top Democrat suggested that Congress slow down on health care, a sign of eroding political will in the wake of a Republican's upset victory in the Massachusetts Senate race Tuesday.
Democratic Sen. Chris Dodd of Connecticut, who got health legislation through the Senate's health committee last year after the death of his friend, Sen. Edward M. Kennedy, said Obama and lawmakers could "maybe take a breather for a month, six weeks."
Just a week ago the health legislation had appeared on the cusp of passage after Obama threw himself into marathon negotiations with congressional leaders to work out differences between the separate health care reform bills passed by the House and Senate. "There are things that have to get done. This is our best chance to do it. We can't keep on putting this off," Obama said Friday at a town hall meeting in Elyria, Ohio. "I am not going to walk away just because it's hard," the president said.
Obama seemed to pull back from a suggestion he made Wednesday that lawmakers unite behind the elements of the legislation everyone can agree on. Obama said scaling back health care presented problems because some of the popular ideas, such as banning denial of coverage to people with medical problems, can't be done unless most Americans are insured. "A lot of these insurance reforms are connected to some other things we have to do to make sure that everybody has some access to coverage," he said. For example, insurers wouldn't be able to end the practice of denying coverage to people with health conditions unless more people were covered. Otherwise people could wait until they got sick to buy insurance and premiums could skyrocket.
Obama has used immense political capital to advance the health care overhaul and remake a system that has frustrated past administrations, most recently Democrat Bill Clinton's in 1994. Whether he can succeed where others have failed is now unclear. "Here's the good news. We've gotten pretty far down the road, but I have to admit, we had a little bit of a buzz saw this week," the president said.
Despite Dodd's suggestion that Democrats take a breather, both House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid insist the health care legislation will go forward. They just haven't said how.
The changes under discussion to the Senate bill would reflect agreements leaders of both chambers made during negotiations at the White House two weeks ago. That includes weakening the Senate bill's tax on high-cost insurance plans, opposed by labor unions and considered a nonstarter in the House. Closing gaps in prescription drug coverage for the elderly is also under consideration.
One potential approach could allow the Senate to act with a simple majority instead of the 60-vote total Democrats now lack with the election of Republican Scott Brown in Massachusetts. A supermajority of 60 votes is needed to overcome Republican filibusters -- a legislative procedure that blocks measures from coming up for a final vote.
But House Republican leader John Boehner said the election of Scott Brown in Massachusetts has sent a loud warning to Democrats -- cease and desist on health care overhaul. "For the better part of those nine months, Democrats in Washington have been focused on this government takeover of health care that working families just can't afford and want nothing to do with," Boehner said in his party's radio and Internet address Saturday.
Obama has made fixing a broken health care system the top domestic policy priority of his first term, but has faced solid opposition from the Republican minority. Despite assurances from Obama and his administration, opposition to his plans have grown among people who bought into allegations of higher taxes, unbearable government deficits and serious government meddling in health care.
The United States is the only industrialized country without a version of universal health care. Americans get their health insurance mainly through their employers, with government programs to cover mainly retirees, military veterans and members of Native American tribes. Forty million to 50 million Americans are uninsured and get medical care largely through hospital emergency rooms.
SOURCE
Obamacare Will Decrease the Deficit? Yeah, Right!
The vote looming in the Senate to raise the debt limit should serve as a wake-up call that federal spending is out of control. Instead, Democratic leadership has tried to convince Americans that passing costly health care legislation is not only sensible, but requisite, and must be done now.
Neither is true. The bills use weak spending limits, weak tax provisions, and even weaker cuts to current spending to pay for reform. Democrats claim these provisions mean that the massive health bill will not only be paid for, but will decrease the federal deficit. In a recent testimony to the House Budget Committee, health care expert James Capretta outlines why this is contrary to Obamacare’s more likely fiscal future.
Weak Cost Control on New Entitlements. Both bills increase coverage by expanding Medicaid or offering subsidies to purchase insurance on the exchange. Lavish subsidies will be available to those who do not qualify for Medicaid but make under 400 percent the Federal Poverty Level. While 127 million Americans fall in this category, only 18 million are projected to receive the subsidy, due to a “firewall” to prevent those who are offered employer-sponsored coverage from receiving it. This creates gross inequity within income brackets. As is the way with Congress, lawmakers will likely give in to taxpayer pressure down the road to extend the subsidies and eliminate the inequity. Expanding this entitlement will cost billions, adding to the deficit.
The bills create another new entitlement via the CLASS Act, which provides community living assistance. Beneficiaries would pay premiums but would not receive benefits until years later, thus creating one-time savings at the programs onset. Obviously, years down the road this spending cushion would deteriorate, and the program would become insolvent. This is not accounted for in ten year cost projections.
Weak and Unpopular New Taxes. The Senate bill is paid for with a 40 percent excise tax on high-cost insurance plans. This provision is to deter Americans from purchasing unnecessarily extravagant health plans, but it is also responsible for about half of the revenue used to pay for the bill. This tax is widely unpopular, and Washington has already begun and will likely continue to carve out favored constituencies who balk at this tax. Union members have already been exempt through 2017, which eliminates 40 percent of expected revenue from this tax.
Presumed Cuts to Medicare. Finally, both bills are largely paid for by cuts to Medicare of approximately half a trillion dollars. These cuts will presumably be made to payment rates for certain care providers by decreasing inflation updates. The expectation that this will actually occur is almost laughable. At the same time that lawmakers are proposing to pay for health care form using cuts to Medicare, they are trying to pass the “doc fix” legislation to end cuts to Medicare that were enacted to—you guessed it—contain costs. Every year, Congress is supposed to decrease physician payment rates in order to control Medicare spending. And every year, Congress votes to suspend the doctors’ payment decrease due to pressure from the industry. The House recently passed legislation that would get rid of the payment cuts for good. And yet without blinking an eye, they propose to use the same failed method to pay for health care reform.
These cuts to Medicare are even more unlikely considering their full impact. As Capretta points out, “The Chief Actuary of the Medicare program has warned that these arbitrary reductions could have serious consequences for beneficiaries’ access to care, as [they] would push about one out of every five hospital facilities into insolvency.”
The House and Senate bills received positive cost estimates by the Congressional Budget Office based on these weak spending controls and the fact that the CBO analysis looks at the first ten year window, which for both bills, includes ten years of raising revenue, but only six years of spending. The country is facing a fiscal crisis as the population faces a demographic transformation of 30 million citizens entering old age within the next twenty years, Capretta points out. Lawmakers need to acknowledge the precariousness of America’s fiscal future and be honest about the true cost of Obamacare.
SOURCE
Obama hunkers down as health care falters
The loss of their 60th Senate seat on Tuesday night in Massachusetts struck fear into Democrats. The president, who two weeks ago was driving deals to settle disagreements among House and Senate Democrats, sent mixed signals this past week that betrayed a lack of certainty about his intentions. Old divisions resurfaced, leaving Democrats confused and frustrated.
Obama on Friday sought to recover his equilibrium. "I didn't take this on to score political points," a defiant Obama told workers in recession-weary Ohio. "And I'm not going to walk away just because it's hard. We're going to keep on working to get this done _ with Democrats, I hope with Republicans _ anybody who's willing to step up."
Step up. That's what some Democratic lawmakers are saying Obama needs to do. "I think he has got to get even more deeply involved," said Rep. Elijah Cummings, D-Md. "He's a key factor and we have to see exactly to what degree he wants to play that role." "He has the ability to bring us all together," said Sen. Christopher Dodd, D-Conn., one of the negotiators in recent White House talks. "He did that ... to try to resolve the differences between the House and Senate. Again, it's going to take that kind of leadership." ....
Lawmakers came to work Wednesday morning facing a new reality. Democrats no longer had the votes in the Senate to keep Republicans from blocking the health care bill, and the rest of Obama's agenda. With the loss of Kennedy's seat, Obama seemed to retreat _ and stumble. In an interview with ABC News, the president who only days before had been functioning as nightshift foreman of the health care talks said it wasn't his role to delve into the details of legislative strategy. He suggested lawmakers might want to regroup around a smaller package of popular measures.
With House Speaker Nancy Pelosi, D-Calif., trying to gauge support for passing the Senate's bill, Obama's candor unnerved White House aides, who scrambled to reinterpret their boss' remarks. It was no use. After meeting with Democratic lawmakers Thursday morning, Pelosi delivered the news that she didn't have the votes to pass the Senate bill.
Suddenly every Democrat had his or her own idea about what to do next. Some wanted to move on, noting that jobs and the economy are more important to voters than health care. Many called for scaling back the bills to more manageable and understandable dimensions. Some demanded a heroic attempt to enact comprehensive changes.
Not two weeks ago, Pelosi was close to a final handshake with Senate Majority Leader Harry Reid, D-Nev. By Thursday, she dismissed the Senate bill as a nonstarter tainted by backroom deals. Reid complained that the House doesn't listen to him. Pelosi huffed that the House, unlike the Senate, doesn't have surprise elections.
By Friday, Obama was back to arguing that comprehensive health care legislation remains the best route for the nation.
Democrats are now in a self-imposed cooling off period of uncertain duration. No decisions have been made on how to salvage health care.
More here
Saturday, January 23, 2010
British woman sent to a maternity unit with no doctor despite 'disastrous' family history of birthing problems
A girl who suffered brain damage at birth after her mother was sent to a maternity unit with no doctor despite a “disastrous” family history of birthing problems has been awarded more than a million pounds. Colchester Hospital University Trust, in Essex, who have not admitted liability, have agreed to pay the child £1.25m in damages. The trust will also make annual inflation–linked payments currently set at between £96,000 and £130,000 to the girl, now aged five and named only as X.
Her mother, aged 21 when she gave birth, had a family history of troubled labours, including stillbirths and haemorrhages. She insists that she was not told about the lack of medical facilities at Clacton Hospital, which is staffed only by midwives and not doctors.
The birth was difficult and X was eventually delivered "blue and floppy" in the back of an ambulance as her mother was being rushed to Colchester General, 16 miles away, on May 5, 2004. She suffered brain damage at birth, is severely physically disabled, cannot see or talk and will require 24-hour care for the rest of her life.
A spokesman for the Trust said: “There remain significant differences between the parties, but the Trust acknowledges some failings for which it apologises and, as a consequence, made improvements. “We are sorry that this girl sustained a brain injury at birth and wish her and her family best wishes for the future."
Approving the settlement in the High Court, Mrs Justice Slade praised the child’s parents, describing them as "devoted". Late last year the chairman of the trust was fired after a health watchdog found that it was failing patients and had mortality rates 12 per cent above the national average.
SOURCE
British doctors repeatedly treat a healthy boy just on his mother's say-so
They clearly were not mentally involved -- just bureaucrats filling in their hours
A "SADISTIC" mother has been jailed in England for subjecting her healthy son to "24 hour-a-day torture" by pretending he was severely ill to gain publicity and cash. Lisa Hayden-Johnson, from Brixham, Devon, was said to have "reveled" in the national attention her young son received. The mother-of-two conned charities out of dream holidays and donations and secured meetings with royalty, celebrities and former UK prime minister Tony Blair. She even successfully lobbied for her son - who she falsely claimed suffered from cerebral palsy, cystic fibrosis and dysphagia among a litany of illnesses - to receive a Child of Courage Award in 2005.
The 35-year-old was jailed for three years and three months at Exeter Crown Court, having previously admitted child cruelty and perverting the course of justice.
Prosecutor Andrew Macfarlane said Hayden-Johnson "organised, orchestrated and ensured a regime of medical, physiological and psychological mistreatment amounting to 24 hour-a-day torture that touched on every aspect of his young vulnerable life".
She frequently described her son "as the most ill child in Britain", the lawyer told the court. He continued: "As a result of her sadistic fabrication of non-existent symptoms, the defendant achieved much publicity and national attention, including an encounter with royalty and the then prime minister."
Hayden-Johnson subjected the child to a total of 325 medical encounters, during which he was subjected to a series of "physical intrusions and interventions", Mr Macfarlane said. These included blood tests, intravenous treatments and a gastrostomy, and he was fed through a tube and confined to a wheelchair. He still believed he was seriously ill, more than two years after his ordeal ended, Mr Macfarlane said.
SOURCE
Negligent British health bureaucracy: Nigerian doctor who killed British patient 'avoided English test'
A German doctor who gave a patient a fatal overdose of drugs had failed an English test at one NHS health care trust before being accepted to work by another, an inquest heard.
Dr Daniel Ubani was told he had not passed the language exam in June 2007, but a month later successfully applied to a different trust for formal registration as a GP. The Cornwall and the Isles of Scilly PCT did not enforce the test because he was an EU doctor and subsequently placed him on the nationwide performance register. This meant Dr Ubani could work anywhere in England and Wales and never worked in the south west, accepting his first job in Cambridgeshire, the hearing was told.
On his first out of hours NHS shift on February 16, 2008, he gave 70-year-old David Gray up to 20 times the recommended dose of diamorphine, killing him within hours.
It emerged yesterday that the out of hours’ company which used Dr Ubani’s services told him to return to Germany that day after he killed Mr Gray, who had suffered from kidney stones. Dr Ubani, 67, has since been suspended by the General Medical Council in the UK but continues to practice in Germany.
At the inquest into Mr Gray’s death, held at Wisbech Magistrates Court in East Cambridgeshire, the different level of medical scrutiny between NHS trusts across the country was exposed. Dr Ubani was accepted on the GMC register in October 2006 because he held a Certificate of Good Standing in Germany. Shortly afterwards, the Nigerian-born doctor, who specialises in cosmetic surgery, applied for a place as a GP on the performance register at Leeds PCT.
Without registration, he would not be allowed to practice medicine in the UK, the hearing was told. He was asked to take part in the International English Language Testing System (IELTS) through the West Yorkshire NHS Central Services Agency. On the form, Dr Ubani stated that his first language was Igbo, a Nigerian language, but later told officials that he had been taught in English at school. In May 2007, his results showed that he got 4.5 for his listening, 4.5 for his reading, seven for his writing and seven for his speech. This gave him an overall mark of six, but Leeds PCT demanded a pass mark of seven, the inquest heard.
Concerns were also raised about his references, one of which was from a medical professional who had never worked with him. Dr Ubani was told that his application would not be successful and so he withdrew his form on July 2.
He immediately applied for registration with the Cornwall and Isle of Scilly PCT and 16 days later, on July 18, 2007, his application was accepted. Adrian Tyas, the former director of Cornwall and Isles of Scilly Primary Care Support Agency, was responsible for placing doctors on the performance list. He said the PCT was not aware that Dr Ubani had failed a language test because he had withdrawn his application from the Leeds PCT and therefore had not been formally rejected. “The PCT did not carry out test on the competency of English for EU nationals,” he said.
David Locke, representing the Cambridgeshire PCT, responded: “But Mr Tyas, if you cannot speak English, you cannot function as a doctor in England, can you?” “That is correct,” he conceded. “Do you think you should have at checked at the least that a doctor could speak English?” Mr Tyas replied: “I think the PCT has a responsibility, but so do the people employing someone as a locum doctor.”
The inquest heard that Dr Ubani was paid by the company Cimarron, which supplied his services to Take Care Now, an out of hours’ company subcontracted to the Cambridgshire PCT.
Mr Tyas admitted that Dr Ubani had not given any detail about his experience as a GP. “You had no idea if he treated children, had any experience in palliative care, you had no idea if he had three patients or 3,000?” asked Mr Lock. “No,” replied Mr Tyas.
Sharon Brooks, from Cimarron, said Dr Ubani was told to return to Germany the day after he killed Mr Gray. She said Dr Christopher Browning, clinical governance lead at TCN, had advised the doctor to go home. Mrs Brooks told the inquest: “I got a phone call from Dr Ubani telling me that he had spoken to Dr Browning at TCN who told him it was best to go back to Germany. “I told him that if Dr Browning had told him to go home, that is what he should do.”
Mrs Brooks, who does not have a medical background, said Dr Ubani was registered with the GMC and the NHS performers' register before they employed him. However, she conceded that his specialisation in cosmetic surgery including botox, was in no way relevant to his job as a GP.
SOURCE
Democrats Drop Health Plan In Face of Voter Anger
Congressional Democrats are abandoning their massive health care package in the face of strong public resistance manifested in the election of Republican Scott Brown of Massachusetts to the Senate. Brown's victory Tuesday halted the intense backroom negotiations aimed at merging competing House and Senate versions of President Obama's health plan.
The bills, developed over more than a year of legislative work, would have expanded coverage for the poor, created a national health insurance plan and paid for it with increased taxes and Medicare cuts.
"Both of those bills, as they stand now, are dead," said Rep. Bill Pascrell, D-N.J., after a caucus meeting with panicked House Democrats, who characterized Brown's win and the message it sent as their party's Hurricane Katrina. "I got the sense that people want to move on and not look back at the House or Senate bill."
Democrats pulled the plug two days after Brown's shocking victory over Democrat Martha Coakley to fill the Senate seat long held by liberal icon Ted Kennedy. Brown campaigned on the pledge to be the Republicans' 41st vote in the Senate, enabling the GOP to block the president's health plan.
House Speaker Nancy Pelosi, D-Calif., confirmed Thursday that there is not enough support in the House to pass the less expensive Senate version of the Obama plan. The Senate bill does not include a government-run insurance program but would have forced all Americans to buy insurance and levied a hefty tax on expensive insurance coverage. "I don't see the votes for it at this time," Pelosi said.
Pelosi insisted that health care reform will move forward in some way, but she may have difficulty passing anything as ambitious as the now-discarded House or Senate bills. "The worst position for a politician to be in is to say to the public, 'Open wide and swallow, this is good for you,' " said Rep. Gerry Connolly, D-Va., who is president of the House's politically vulnerable freshman class. "I don't want to be in this situation and my colleagues don't either."
Democrats are now considering a drastically scaled-back plan that could be passed in smaller, separate pieces. It would not include a public option, mandatory insurance or the creation of any new entitlement programs.
Pascrell said he is proposing a plan that would address insurance malpractice reform, increase insurance competition and bring reforms to the insurance industry. The bill could be passed in pieces over the course of several weeks and would allow the House to turn its attention to job creation. "It has appeal to a lot of people," Connolly said of the idea.
Leadership aides confirmed that Pelosi is considering the piecemeal approach, but there is no agreement on what it should include. Brown's election, one top leadership aide said, "has changed the dynamic completely and now we have to regroup and choose the best way forward."
Republicans are touting their own bill, which would forbid insurance companies to deny coverage because of pre-existing conditions and place limits on medical malpractice lawsuits. "Republicans are not going to work off of this monstrosity," Minority Leader John Boehner, R-Ohio, said of the proposal to retool the president's plan. "There's just not enough common ground."
SOURCE
The Snare of Incremental Heath Care “Reform”. Perilous days lie ahead
Opponents of (more) government control of health care and health insurance are breathing a sigh of relief after Tuesday’s upset senatorial election in Massachusetts. But now that the celebrations are subsiding, I feel compelled to warn that the most perilous days may lie ahead. How can that be, when Sen. Edward Kennedy’s seat is about to be assumed by a man who campaigned on a promise to vote against Obamacare, depriving the ruling majority of its critical 60th vote?
It’s simple: In place of 2,000-page omnibus monstrosities, we are likely to see a series of micro “reforms” — that is, government interventions — that may well garner bipartisan support. The new buzzword on Capitol Hill is “incrementalism.” This is a strategy to break the big House and Senate bills into several small ones — to slice the salami into manageable portions. Instead of one 2,000-page piece of legislation, we might see ten 200-pagers, or perhaps 100 20-pagers.
Will that make a difference substantively? Most likely not, because those micro bills are unlikely to be the needed repeals of the government’s impediments to free competition, such as the ban on interstate insurance commerce, the Food and Drug Administration, the patent system, and the tax-code bias toward employer-purchased insurance.
Instead we’ll probably see bills that embody most of the elements of President Obama’s, Speaker Pelosi’s, and Majority Leader Reid’s proposals. But since the series of small bills won’t look like an overambitious program to reinvent 16 percent of the U.S. economy in one unreadable fell swoop, much of the congressional opposition could be defused. Its previous talking points and photo ops regarding legislation that stacks three feet high will be useless.
Furthermore, individual elements in Obamacare have populist appeal. Many people (rightly) feel abused by big insurance companies, and being ignorant of both economics and the intricacies of current policy, they could be attracted to what appear to be modest consumer protections. (See this.) With the House of Representatives and a third of the Senate up for election this year, a preponderance of members may fear alienating those voters.
In other words, the incremental approach may be to the omnibus approach what (as the old folk warning has it) slowly cooking a frog is to tossing it into boiling water. (For the record, frogs will jump out of gradually heated water if they can.)
The majority party may kick itself for not thinking of this strategy sooner. One big bill is easy to scare people with — a bunch of smaller, less intimidating bills is not.
What might the series consist of? It seems certain that a bill will be introduced to require insurance companies to cover people who are already sick; that is, an end to the preexisting condition exclusion. Other bills will require guaranteed renewal, community rating (uniform premiums for all members of a group regardless of health status), and a limit on the difference between premiums for younger and older policyholders. (Today the premium for an older person can be six or seven times that of a young person, which is not surprising because older people tend to consume more medical services. Yet the pending legislation would permit only a two- or threefold difference. See Prateik Dalmia’s analysis here.)
Will members of the minority party go for the proposals? All indications up to now say yes. For example, as Sam Stein of the Huffington Post pointed out last November, “Many of the most respected health care voices in the GOP have historically treated the idea of eliminating pre-existing condition exclusions as an obvious plank in any reform effort…. Even deeply conservative figures like Senator Tom Coburn (R-Okl) insisted as recently as August that ‘everyone agrees’ that legislation should ‘eliminate pre-existing conditions’ as an excuse for denying coverage…. Another Senate Republican who was heavily involved in negotiating health care reform, Chuck Grassley of Iowa, has unequivocally declared that the government has ‘to prohibit insurers from denying coverage to people with preexisting medical conditions and charging higher premiums to people who are sick.’”
This, to say the least, is ominous. (And see Sen.-elect Scott Brown’s comments here.) For one thing, it won’t be enough to compel insurers to accept people who are already sick. In all likelihood, insurers would also be prohibited from charging sick customers more than well ones. (There’s no political point otherwise.) If the minority party will go for this, what won’t they go for? New taxes perhaps?
As I’ve pointed out before, coverage for an existing illness at someone else’s expense is not insurance. It is charity, or if forced through the state, subsidy and welfare. Once that intervention is enacted, others will follow.
Which brings us to the individual insurance mandate. Proponents justify the mandate on grounds that, to protect the viability of the insurance market, young healthy people must be forced to buy insurance when the companies are obliged to cover sick people at actuarially unsound premiums. From the beginning of the discussion in 2009, the majority party has insisted on the mandate (and one on employers too). It’s is an obvious violation of individual liberty, but where was the minority party’s protest? If one of the incremental bills calls for a mandate, as is most likely, will it pass the Senate? Let’s hope not, but we’ll have to wait and see.
It’s not time to breathe easy yet.
SOURCE
A girl who suffered brain damage at birth after her mother was sent to a maternity unit with no doctor despite a “disastrous” family history of birthing problems has been awarded more than a million pounds. Colchester Hospital University Trust, in Essex, who have not admitted liability, have agreed to pay the child £1.25m in damages. The trust will also make annual inflation–linked payments currently set at between £96,000 and £130,000 to the girl, now aged five and named only as X.
Her mother, aged 21 when she gave birth, had a family history of troubled labours, including stillbirths and haemorrhages. She insists that she was not told about the lack of medical facilities at Clacton Hospital, which is staffed only by midwives and not doctors.
The birth was difficult and X was eventually delivered "blue and floppy" in the back of an ambulance as her mother was being rushed to Colchester General, 16 miles away, on May 5, 2004. She suffered brain damage at birth, is severely physically disabled, cannot see or talk and will require 24-hour care for the rest of her life.
A spokesman for the Trust said: “There remain significant differences between the parties, but the Trust acknowledges some failings for which it apologises and, as a consequence, made improvements. “We are sorry that this girl sustained a brain injury at birth and wish her and her family best wishes for the future."
Approving the settlement in the High Court, Mrs Justice Slade praised the child’s parents, describing them as "devoted". Late last year the chairman of the trust was fired after a health watchdog found that it was failing patients and had mortality rates 12 per cent above the national average.
SOURCE
British doctors repeatedly treat a healthy boy just on his mother's say-so
They clearly were not mentally involved -- just bureaucrats filling in their hours
A "SADISTIC" mother has been jailed in England for subjecting her healthy son to "24 hour-a-day torture" by pretending he was severely ill to gain publicity and cash. Lisa Hayden-Johnson, from Brixham, Devon, was said to have "reveled" in the national attention her young son received. The mother-of-two conned charities out of dream holidays and donations and secured meetings with royalty, celebrities and former UK prime minister Tony Blair. She even successfully lobbied for her son - who she falsely claimed suffered from cerebral palsy, cystic fibrosis and dysphagia among a litany of illnesses - to receive a Child of Courage Award in 2005.
The 35-year-old was jailed for three years and three months at Exeter Crown Court, having previously admitted child cruelty and perverting the course of justice.
Prosecutor Andrew Macfarlane said Hayden-Johnson "organised, orchestrated and ensured a regime of medical, physiological and psychological mistreatment amounting to 24 hour-a-day torture that touched on every aspect of his young vulnerable life".
She frequently described her son "as the most ill child in Britain", the lawyer told the court. He continued: "As a result of her sadistic fabrication of non-existent symptoms, the defendant achieved much publicity and national attention, including an encounter with royalty and the then prime minister."
Hayden-Johnson subjected the child to a total of 325 medical encounters, during which he was subjected to a series of "physical intrusions and interventions", Mr Macfarlane said. These included blood tests, intravenous treatments and a gastrostomy, and he was fed through a tube and confined to a wheelchair. He still believed he was seriously ill, more than two years after his ordeal ended, Mr Macfarlane said.
SOURCE
Negligent British health bureaucracy: Nigerian doctor who killed British patient 'avoided English test'
A German doctor who gave a patient a fatal overdose of drugs had failed an English test at one NHS health care trust before being accepted to work by another, an inquest heard.
Dr Daniel Ubani was told he had not passed the language exam in June 2007, but a month later successfully applied to a different trust for formal registration as a GP. The Cornwall and the Isles of Scilly PCT did not enforce the test because he was an EU doctor and subsequently placed him on the nationwide performance register. This meant Dr Ubani could work anywhere in England and Wales and never worked in the south west, accepting his first job in Cambridgeshire, the hearing was told.
On his first out of hours NHS shift on February 16, 2008, he gave 70-year-old David Gray up to 20 times the recommended dose of diamorphine, killing him within hours.
It emerged yesterday that the out of hours’ company which used Dr Ubani’s services told him to return to Germany that day after he killed Mr Gray, who had suffered from kidney stones. Dr Ubani, 67, has since been suspended by the General Medical Council in the UK but continues to practice in Germany.
At the inquest into Mr Gray’s death, held at Wisbech Magistrates Court in East Cambridgeshire, the different level of medical scrutiny between NHS trusts across the country was exposed. Dr Ubani was accepted on the GMC register in October 2006 because he held a Certificate of Good Standing in Germany. Shortly afterwards, the Nigerian-born doctor, who specialises in cosmetic surgery, applied for a place as a GP on the performance register at Leeds PCT.
Without registration, he would not be allowed to practice medicine in the UK, the hearing was told. He was asked to take part in the International English Language Testing System (IELTS) through the West Yorkshire NHS Central Services Agency. On the form, Dr Ubani stated that his first language was Igbo, a Nigerian language, but later told officials that he had been taught in English at school. In May 2007, his results showed that he got 4.5 for his listening, 4.5 for his reading, seven for his writing and seven for his speech. This gave him an overall mark of six, but Leeds PCT demanded a pass mark of seven, the inquest heard.
Concerns were also raised about his references, one of which was from a medical professional who had never worked with him. Dr Ubani was told that his application would not be successful and so he withdrew his form on July 2.
He immediately applied for registration with the Cornwall and Isle of Scilly PCT and 16 days later, on July 18, 2007, his application was accepted. Adrian Tyas, the former director of Cornwall and Isles of Scilly Primary Care Support Agency, was responsible for placing doctors on the performance list. He said the PCT was not aware that Dr Ubani had failed a language test because he had withdrawn his application from the Leeds PCT and therefore had not been formally rejected. “The PCT did not carry out test on the competency of English for EU nationals,” he said.
David Locke, representing the Cambridgeshire PCT, responded: “But Mr Tyas, if you cannot speak English, you cannot function as a doctor in England, can you?” “That is correct,” he conceded. “Do you think you should have at checked at the least that a doctor could speak English?” Mr Tyas replied: “I think the PCT has a responsibility, but so do the people employing someone as a locum doctor.”
The inquest heard that Dr Ubani was paid by the company Cimarron, which supplied his services to Take Care Now, an out of hours’ company subcontracted to the Cambridgshire PCT.
Mr Tyas admitted that Dr Ubani had not given any detail about his experience as a GP. “You had no idea if he treated children, had any experience in palliative care, you had no idea if he had three patients or 3,000?” asked Mr Lock. “No,” replied Mr Tyas.
Sharon Brooks, from Cimarron, said Dr Ubani was told to return to Germany the day after he killed Mr Gray. She said Dr Christopher Browning, clinical governance lead at TCN, had advised the doctor to go home. Mrs Brooks told the inquest: “I got a phone call from Dr Ubani telling me that he had spoken to Dr Browning at TCN who told him it was best to go back to Germany. “I told him that if Dr Browning had told him to go home, that is what he should do.”
Mrs Brooks, who does not have a medical background, said Dr Ubani was registered with the GMC and the NHS performers' register before they employed him. However, she conceded that his specialisation in cosmetic surgery including botox, was in no way relevant to his job as a GP.
SOURCE
Democrats Drop Health Plan In Face of Voter Anger
Congressional Democrats are abandoning their massive health care package in the face of strong public resistance manifested in the election of Republican Scott Brown of Massachusetts to the Senate. Brown's victory Tuesday halted the intense backroom negotiations aimed at merging competing House and Senate versions of President Obama's health plan.
The bills, developed over more than a year of legislative work, would have expanded coverage for the poor, created a national health insurance plan and paid for it with increased taxes and Medicare cuts.
"Both of those bills, as they stand now, are dead," said Rep. Bill Pascrell, D-N.J., after a caucus meeting with panicked House Democrats, who characterized Brown's win and the message it sent as their party's Hurricane Katrina. "I got the sense that people want to move on and not look back at the House or Senate bill."
Democrats pulled the plug two days after Brown's shocking victory over Democrat Martha Coakley to fill the Senate seat long held by liberal icon Ted Kennedy. Brown campaigned on the pledge to be the Republicans' 41st vote in the Senate, enabling the GOP to block the president's health plan.
House Speaker Nancy Pelosi, D-Calif., confirmed Thursday that there is not enough support in the House to pass the less expensive Senate version of the Obama plan. The Senate bill does not include a government-run insurance program but would have forced all Americans to buy insurance and levied a hefty tax on expensive insurance coverage. "I don't see the votes for it at this time," Pelosi said.
Pelosi insisted that health care reform will move forward in some way, but she may have difficulty passing anything as ambitious as the now-discarded House or Senate bills. "The worst position for a politician to be in is to say to the public, 'Open wide and swallow, this is good for you,' " said Rep. Gerry Connolly, D-Va., who is president of the House's politically vulnerable freshman class. "I don't want to be in this situation and my colleagues don't either."
Democrats are now considering a drastically scaled-back plan that could be passed in smaller, separate pieces. It would not include a public option, mandatory insurance or the creation of any new entitlement programs.
Pascrell said he is proposing a plan that would address insurance malpractice reform, increase insurance competition and bring reforms to the insurance industry. The bill could be passed in pieces over the course of several weeks and would allow the House to turn its attention to job creation. "It has appeal to a lot of people," Connolly said of the idea.
Leadership aides confirmed that Pelosi is considering the piecemeal approach, but there is no agreement on what it should include. Brown's election, one top leadership aide said, "has changed the dynamic completely and now we have to regroup and choose the best way forward."
Republicans are touting their own bill, which would forbid insurance companies to deny coverage because of pre-existing conditions and place limits on medical malpractice lawsuits. "Republicans are not going to work off of this monstrosity," Minority Leader John Boehner, R-Ohio, said of the proposal to retool the president's plan. "There's just not enough common ground."
SOURCE
The Snare of Incremental Heath Care “Reform”. Perilous days lie ahead
Opponents of (more) government control of health care and health insurance are breathing a sigh of relief after Tuesday’s upset senatorial election in Massachusetts. But now that the celebrations are subsiding, I feel compelled to warn that the most perilous days may lie ahead. How can that be, when Sen. Edward Kennedy’s seat is about to be assumed by a man who campaigned on a promise to vote against Obamacare, depriving the ruling majority of its critical 60th vote?
It’s simple: In place of 2,000-page omnibus monstrosities, we are likely to see a series of micro “reforms” — that is, government interventions — that may well garner bipartisan support. The new buzzword on Capitol Hill is “incrementalism.” This is a strategy to break the big House and Senate bills into several small ones — to slice the salami into manageable portions. Instead of one 2,000-page piece of legislation, we might see ten 200-pagers, or perhaps 100 20-pagers.
Will that make a difference substantively? Most likely not, because those micro bills are unlikely to be the needed repeals of the government’s impediments to free competition, such as the ban on interstate insurance commerce, the Food and Drug Administration, the patent system, and the tax-code bias toward employer-purchased insurance.
Instead we’ll probably see bills that embody most of the elements of President Obama’s, Speaker Pelosi’s, and Majority Leader Reid’s proposals. But since the series of small bills won’t look like an overambitious program to reinvent 16 percent of the U.S. economy in one unreadable fell swoop, much of the congressional opposition could be defused. Its previous talking points and photo ops regarding legislation that stacks three feet high will be useless.
Furthermore, individual elements in Obamacare have populist appeal. Many people (rightly) feel abused by big insurance companies, and being ignorant of both economics and the intricacies of current policy, they could be attracted to what appear to be modest consumer protections. (See this.) With the House of Representatives and a third of the Senate up for election this year, a preponderance of members may fear alienating those voters.
In other words, the incremental approach may be to the omnibus approach what (as the old folk warning has it) slowly cooking a frog is to tossing it into boiling water. (For the record, frogs will jump out of gradually heated water if they can.)
The majority party may kick itself for not thinking of this strategy sooner. One big bill is easy to scare people with — a bunch of smaller, less intimidating bills is not.
What might the series consist of? It seems certain that a bill will be introduced to require insurance companies to cover people who are already sick; that is, an end to the preexisting condition exclusion. Other bills will require guaranteed renewal, community rating (uniform premiums for all members of a group regardless of health status), and a limit on the difference between premiums for younger and older policyholders. (Today the premium for an older person can be six or seven times that of a young person, which is not surprising because older people tend to consume more medical services. Yet the pending legislation would permit only a two- or threefold difference. See Prateik Dalmia’s analysis here.)
Will members of the minority party go for the proposals? All indications up to now say yes. For example, as Sam Stein of the Huffington Post pointed out last November, “Many of the most respected health care voices in the GOP have historically treated the idea of eliminating pre-existing condition exclusions as an obvious plank in any reform effort…. Even deeply conservative figures like Senator Tom Coburn (R-Okl) insisted as recently as August that ‘everyone agrees’ that legislation should ‘eliminate pre-existing conditions’ as an excuse for denying coverage…. Another Senate Republican who was heavily involved in negotiating health care reform, Chuck Grassley of Iowa, has unequivocally declared that the government has ‘to prohibit insurers from denying coverage to people with preexisting medical conditions and charging higher premiums to people who are sick.’”
This, to say the least, is ominous. (And see Sen.-elect Scott Brown’s comments here.) For one thing, it won’t be enough to compel insurers to accept people who are already sick. In all likelihood, insurers would also be prohibited from charging sick customers more than well ones. (There’s no political point otherwise.) If the minority party will go for this, what won’t they go for? New taxes perhaps?
As I’ve pointed out before, coverage for an existing illness at someone else’s expense is not insurance. It is charity, or if forced through the state, subsidy and welfare. Once that intervention is enacted, others will follow.
Which brings us to the individual insurance mandate. Proponents justify the mandate on grounds that, to protect the viability of the insurance market, young healthy people must be forced to buy insurance when the companies are obliged to cover sick people at actuarially unsound premiums. From the beginning of the discussion in 2009, the majority party has insisted on the mandate (and one on employers too). It’s is an obvious violation of individual liberty, but where was the minority party’s protest? If one of the incremental bills calls for a mandate, as is most likely, will it pass the Senate? Let’s hope not, but we’ll have to wait and see.
It’s not time to breathe easy yet.
SOURCE
Friday, January 22, 2010
British hospitals must cut services to stay afloat, watchdog warns
Hospitals will have to reduce services, sell off buildings and move into smaller premises to cope with financial pressures in the next few years, the head of the foundation trusts’ regulatory body has warned. William Moyes, who steps down from his role as executive chairman of Monitor after six years next week, told The Times that too many hospitals were not grasping the economic challenges ahead. While political parties have promised to protect NHS funding and avoid service cuts, Mr Moyes said it was inevitable that some hospitals would have to reduce services and sell off assets to keep afloat.
Any hospital department that was treating too few patients to cover its costs risked compromising the quality of care, he said. Some maternity and paediatric units, which are very costly to run, might be merged or relocated, while A&E departments could be downgraded to minor injury units if they had a small number of serious cases that could be sent elsewhere. “People need to know where they are making money or losing money. If you find a service where the income can’t cover the cost, you may eventually have to question whether the income is ever going to be sufficient, and whether this is in fact the wrong activity for the hospital. “In quite a lot of places the number of births is too small to support the cost of giving a high-quality service. You have three choices: increase the flow of patients, move the service elsewhere or stay as you are and risk compromising the care.”
Mr Moyes, who oversees the regulation of finances and governance of England’s 125 flagship foundation trusts, said that as well as focusing on core departments, trusts would need to consider stripping out “uneconomic” facilities such as pathology laboratories and scanning units in some hospitals that were being used for very small numbers of patients. “There may be surplus assets — buildings, land, equipment, stuff they think they might need in years to come under their development plans — and in some cases working in a much smaller physical space and disposing of all the hospital penumbra that can be brought into the main building.”
Mr Moyes said he had requested that foundation trust chief executives resubmit a “downside assessment” — stripping back their budgets — to get a more realistic grasp of the funding pressures they faced. He said that he was disappointed when, on being asked to revise their financial predictions in September, a number of trusts had resubmitted even more rosetinted forecasts of growth. “You can’t assume everything will go well and if a problem arises the Department of Health will bail you out,” he said.
His warnings were echoed yesterday by Sir David Nicholson, the chief executive of the NHS, who described the coming years as “extremely challenging”. Giving evidence to the Commons Health Select Committee, Sir David warned of pay cuts and service reorganisation. “It is going to be very tough,” he said, adding that tighter budgets would mean the 1 per cent pay cap demanded by the Treasury would be treated by NHS managers as a maximum rise, not an entitlement. His comments came a day after inflation hit 2.9 per cent when unions are already angry over a pay freeze on council workers. “There is essentially a trade-off between pay and numbers of jobs,” he told the committee. “In a cash-limited system, that is the big unknown for us. We need to talk through with the trade unions and staff associations about what that trade-off is.”
Sir David has previously warned that the NHS would have to find productivity and efficiency savings of between £15 billion and £20 billion over the three years 2011-12 to 2013-14.
The head of the Audit Commission added to the debate, saying that political pledges to safeguard spending on health and education were “insane”. Steve Bundred told the Commons public administration committee that billions would have to be saved. “It seems to me absurd to imagine that the only services where no efficiencies can be found are those that have been the most generously funded for ten years,” he said.
Mr Moyes said he thought that an “unintended benefit” of future economic turbulence would be to heighten hospitals’ understanding that they had to operate with a robust business model. “A lot of hospitals, even the very good ones, are at the stage of learning how to think long-term,” he said. “We are good at strong visions, big pictures, but we need to learn to be very good at pessimism and what will happen if things are not going to turn out well.”
SOURCE
A record 10,000 British public hospital patients hit by malnutrition IN HOSPITAL
At least 10,000 patients left hospital last year after becoming malnourished while under NHS care - the highest number on record. Official NHS figures show that in 2008/09 175,003 patients were victims of malnutrition or another nutritional difficulty when they were admitted to hospital. But 185,446 were suffering the same conditions when they were discharged. The difference between the figures, obtained by the Tories, is 10,443, a 27 per cent rise on the previous year's 8,229.
Critics said it was almost unbelievable that hospitals were routinely sending people home in a worse condition than when they arrived. In 1997/98, Labour's first year in power, just 75,431 patients were discharged in a malnourished state, of whom only 4,773 had become malnourished while in NHS care. The total of 185,446 patients discharged in a malnourished state last year is 18 per cent more than the 157,175 the year before. This is the sharpest rise on record, largely because the number of patients admitted with nutritional difficulties was itself 17 per cent higher.
The continuing problems come despite years of Labour promises to improve hospital food. The Daily Mail's Dignity for the Elderly campaign has highlighted the scandal of old people not being fed properly in hospital. The food is often so unappetising that patients do not eat, and sometimes placed out of their reach and taken away untouched.
Nurses often claim they are too busy to help patients eat. Age Concern says 60 per cent of older patients, who occupy two thirds of hospital beds, are at risk of worsening health or becoming malnourished.
Andrew Harrop, head of policy, said: 'It's scandalous to see that malnutrition is still a huge problem. 'Nutritious food and help with eating are an essential part of basic care which must be recognised by all staff. 'Despite a commitment from the Government, many NHS trusts are yet to introduce protected mealtimes and one in three haven't introduced red-tray systems to identify those who need help. 'Until nutrition is given top priority in every ward, older people will continue to be needlessly malnourished, putting their health at risk.'
Tory health spokesman Stephen O'Brien said: 'These figures are of serious concern. 'It has been a growing problem for a number of years and yet Labour has done very little to protect these vulnerable people. 'Nutrition is important for people who aren't ill: how much more for those recovering from serious illnesses and operations? 'It is scandalous that people come out of hospital in a worse state than when they go in, particularly due to something as basic as being given decent food.'
The Department of Health said last night: 'It is misleading to suggest that an increase in patients discharged with malnutrition is due to poor care or the quality of food. 'Many patients who are admitted to hospital are already malnourished. Malnutrition can be a consequence of serious illness or medication. 'Many patients who have malnutrition and are discharged from hospital continue their care through primary care and social care. 'In 2009 a survey found that 94.5 per cent of NHS hospitals achieved an excellent or good rating for quality, choice and availability of food.'
SOURCE
Australian health bureaucrats think they know better than the doctors
EXCESSIVELY strict interpretation of rules governing the prescription of human growth hormone is compromising the care of children with medical conditions that make them abnormally short, specialists say.
The doctors say officials are rejecting legitimate applications to put children on the program, and restricting others to doses too low to be effective, after changes at the Department of Health and Ageing that have made new staff reluctant to continue a tradition of informal agreement over who should qualify and instead insist on the letter of the rules.
They want the department to update its regulations based on new research showing larger doses should be given early in a child's treatment for maximum effectiveness, and to consider research suggesting it is useful in a wider range of disorders.
But the department has made a submission to the independent Pharmaceutical Benefits Advisory Committee, which sets rules for subsidised treatment, arguing for more tightly defined eligibility and dosage criteria.
The Australian Paediatric Endocrine Group had made a submission arguing for more liberal prescribing, its president, Andrew Cotterill, said.
Dr Cotterill said he understood the department's dilemma, but he wanted "to work … to develop a process that is gentler around the hard edges". The prescribing system had previously worked as a "gentlemen's agreement" in which public servants usually accepted specialists' advice that patients needed the drug if they fell marginally outside the criteria. But the approach had toughened and more applications were being rejected. "The current medical literature is pointing towards the first year of treatment [offering] the best chance of a response," Dr Cotterill said, meaning children should be moved quickly towards the maximum dose if they did not respond to lower doses. But the rules say the dose should be increased slowly.
Growth hormone is prescribed to about 1500 children a year, costing typically $5000 to $10,000 a patient. More than half goes to those whose failure to grow has no known cause - but only if they are in the lowest 1 per cent of the expected height range based on their parents' statures. Other reasons include the genetic Turner syndrome, which affects only girls, cancer radiotherapy to the head, and kidney failure, along with hormone deficiency resulting from biochemical imbalance.
A Sydney endocrinologist, Maria Craig, said officials were "reading the guidelines very literally and overriding clinical experience … So much has to be taken in the context of a child's age, ethnic background, bone age, and [stage of puberty]. To have guidelines that are overly prescriptive just doesn't make sense." Dr Craig said the official dosing regime when a child started on the hormone was already conservative, offering "one of the lowest doses by global standards".
The chairman of the Pharmaceutical Benefits Advisory Committee, Lloyd Sansom, said a special meeting in December had discussed how the hormone might be used to treat chromosomal abnormalities and other disorders and "certain issues about dose escalation". He said the process was intended to set general terms for public subsidy and recommendations had been sent to the federal Health Minister, Nicola Roxon. A separate committee of specialised doctors could advise government on individual cases, but it was the Health Department's prerogative to make the final funding decision. "There is a limited health dollar, and decisions have to be made that can sometimes seem draconian," Professor Sansom said.
SOURCE
Obama rediscovers bipartisanship -- when he is forced to
He talked the talk. Now he might have to walk the walk
President Obama signaled on Wednesday that he might be willing to scale back his proposed health care overhaul to a version that could attract bipartisan support, as the White House and Congressional Democrats grappled with a political landscape transformed by the Republican victory in the Massachusetts Senate race. “I would advise that we try to move quickly to coalesce around those elements of the package that people agree on,” Mr. Obama said in an interview on ABC News, notably leaving near-universal insurance coverage off his list of core goals.
But it was not clear that even a stripped-down bill could get through Congress anytime soon. Throughout the day, White House officials and Democratic Congressional leaders struggled to find a viable way forward for the health care bill and to digest the reality that much of their agenda, including an energy measure and an overhaul of banking regulations, had been derailed by the outcome in Massachusetts.
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed. “People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill...
At a news conference at the Capitol, the Senate majority leader, Harry Reid of Nevada, sought to minimize health care as compared with jobs and the economy. But he made clear that Democrats did not see a clear path forward...
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy. Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said....
More here
Obamacare in Cloud Cuckoo Land
When the majority of voters in the bluest of blue states elects a candidate opposed to Obamacare to fill the Senate seat previously held by the man who was that proposal's most prominent supporter, there is a clear message: You lost because of what you've been doing for the past year, so stop doing it.
Incredibly, President Obama's political brain trusts and his most powerful allies on Capitol Hill don't understand this reality. Witness Obama adviser David Axelrod saying of Republican Scott Brown's victory in Tuesday's special election: "I think that it would a terrible mistake to walk away now. If we don't pass the bill, all we have is the stigma of a caricature that was put on it. That would be the worst result for everybody who has supported this bill."
Robert Gibbs, Obama's White House press secretary, saw nothing in the Massachusetts results but reasons to keep on keeping on, "not that we somehow abandon our pursuit on things that are important to the middle class." Similarly, even before all the votes in Massachusetts were counted, House Speaker Nancy Pelosi was vowing to reporters she will plunge ahead to pass Obamacare: "We will get the job done. I am confident of that."
The same refusal to see what everybody else sees was reflected in commentary by the president's most vigorous supporters on the nation's editorial pages. The Boston Globe, for example, saw nothing in Brown's win to "negate the resounding mandate that President Obama and Democrats in Congress received in 2008 to address escalating health costs." The Globe encouraged Obama and House Speaker Nancy Pelosi to "bring the legislative process to a close by pushing House members to pass the Senate version."
Then there are Obama's supporters in academe like Yale's Jacob S. Hacker and Georgetown's Daniel Hopkins, political scientists both, who even before they knew the outcome of Tuesday's election confidently explained in The Washington Post that "running from reform" would be the wrong message for Democrats to glean from the Massachusetts contest. Hacker and Hopkins thus provide a sterling illustration of minds being made up before becoming confused by the facts.
Obama and Democratic leaders would do well to listen to these words of wisdom from one of their own, Rep. Anthony Weiner of New York: "If there isn't any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant." Translation: If voters are so angry that Republicans can get Ted Kennedy's Senate seat, there isn't a safe Democratic incumbent anywhere in the country.
SOURCE
Obama health plan in doubt as Dems reject fast fix
Though reeling from a political body blow, House Democrats rejected the quickest fix to their health care dilemma Thursday and signaled that any agreement on President Barack Obama's signature issue will come slowly, if at all. Democrats weighed a handful of difficult options as they continued to absorb Republican Scott Brown's election to the Massachusetts Senate seat long held by Edward M. Kennedy. Several said Obama must forcefully help them find a way to avoid the humiliation of enacting no bill, and they urged him to do so quickly, to put the painful process behind them.
House leaders said they could not pass a Senate-approved bill, standing by itself, because of objections from liberals and moderates alike. Such a move could have settled the matter, because it would not have required further Senate action. Brown's stunning victory restored the GOP's power to block bills with Senate filibusters.
Democratic leaders weighed two main options, both problematic. The first would require congressional Democrats to muscle their way past stiff GOP objections despite warning signs from Massachusetts voters and worries about next November's elections. The other would pare down the original health care legislation in hopes of gaining some Republican support. But the compromise process is more difficult than many lawmakers suggest.
Democrats' hopes of settling on a strategy by the weekend seemed to fade, as lawmakers struggled to comprehend the drawbacks of every option. "We have to get a bill passed," said House Speaker Nancy Pelosi, D-Calif., because her party would have no excuse for failing to revamp health care when it controls Congress and the White House.
Some lawmakers said it will take time for congressional Democrats, who huddled repeatedly Thursday, to realize how limited their options are. "People are at various levels of the seven stages of grief," said Rep. Anthony Weiner, D-N.Y.
The first chief option would require House Democrats to approve the Senate-passed bill along with a guarantee that the Senate would make several simultaneous changes to health law desired by the House. Senate Democrats presumably would do so with a tactic called "budget reconciliation." It requires only a simple-majority vote for certain budget-related matters, but it cannot be used for every issue. Both parties have used the tactic at times.
When Brown is sworn in, Democrats will control 59 of the Senate's 100 seats. They need 60 to block GOP filibusters.
The second option calls for drafting a new, compromise bill more palatable to moderates, including some Republicans. But numerous officials said it's far easier said than done. For instance, a widely popular goal is to bar health insurers from refusing coverage to people already suffering medical problems. But without requiring most people to buy coverage, millions might wait until they have a serious problem before buying a policy, driving coverage costs to unsustainable levels. Moreover, "individual mandates" to buy insurance would almost certainly require government subsidies for low-income people. And that in turn would require new government revenues, such as taxes.
Many of these interconnected features drew strong objections, especially from Republicans, when the House and Senate passed competing versions of health care revisions last month.
Pelosi cited the dilemma Thursday. "I don't think anybody disagrees with 'Let's pass the popular part of the bill,'" she told reporters. "But some of the popular parts of the bill is the engine that drives some of the rest of it," which is far less popular, she said.
Outside groups were more blunt. "You can't do it," said Ron Pollack of the liberal-leaning Families USA. Enacting popular "insurance reforms" won't work without the more controversial and expensive steps of expanding coverage to the uninsured, he said.
Some lawmakers talked of placing partial limits on insurance companies' ability to deny coverage to those with pre-existing medical conditions. Companies might be required to cover sick children, or to keep covering customers who become sick and failed to disclose every detail of their medical histories when first buying their policies. Such compromises could leave Obama well short of the universal coverage he touted during his 2008 campaign.
House Democrats cite many objections to the Senate-passed bill, which make them wary of adopting it without some type of ironclad guarantee of improvements by the newly configured Senate. But budget reconciliation is one of Congress's most complex and controversial exercises, and it's not clear how many House objections can be remedied with the process.
A widely criticized feature of the Senate bill made special Medicaid concessions to Nebraska, demanded by Democratic Sen. Ben Nelson. Senators promised to expand the help to all 50 states, but Brown's election cut that negotiation process short. Congressional budget referees said Thursday it would cost $35 billion over 10 years to extend the so-called "Cornhusker Kickback" to every state.
Some Democrats said Obama must lead his dispirited party to a resolution. "He has got to bring the Senate and the House together," said Rep. Elijah Cummings, D-Md. "He has got to help all of us pave a way to get it done." White House spokesman Robert Gibbs said Obama thinks the best path is "giving this some time, by letting the dust settle, if you will, and looking for the best path forward." He said Obama does not believe a major health care revision is dead.
Asked what is next for the legislation, Sen. Debbie Stabenow, D-Mich., shaped her hand like a gun and pointed to her head. "We're looking to see what there's support to do," she said.
SOURCE
Hospitals will have to reduce services, sell off buildings and move into smaller premises to cope with financial pressures in the next few years, the head of the foundation trusts’ regulatory body has warned. William Moyes, who steps down from his role as executive chairman of Monitor after six years next week, told The Times that too many hospitals were not grasping the economic challenges ahead. While political parties have promised to protect NHS funding and avoid service cuts, Mr Moyes said it was inevitable that some hospitals would have to reduce services and sell off assets to keep afloat.
Any hospital department that was treating too few patients to cover its costs risked compromising the quality of care, he said. Some maternity and paediatric units, which are very costly to run, might be merged or relocated, while A&E departments could be downgraded to minor injury units if they had a small number of serious cases that could be sent elsewhere. “People need to know where they are making money or losing money. If you find a service where the income can’t cover the cost, you may eventually have to question whether the income is ever going to be sufficient, and whether this is in fact the wrong activity for the hospital. “In quite a lot of places the number of births is too small to support the cost of giving a high-quality service. You have three choices: increase the flow of patients, move the service elsewhere or stay as you are and risk compromising the care.”
Mr Moyes, who oversees the regulation of finances and governance of England’s 125 flagship foundation trusts, said that as well as focusing on core departments, trusts would need to consider stripping out “uneconomic” facilities such as pathology laboratories and scanning units in some hospitals that were being used for very small numbers of patients. “There may be surplus assets — buildings, land, equipment, stuff they think they might need in years to come under their development plans — and in some cases working in a much smaller physical space and disposing of all the hospital penumbra that can be brought into the main building.”
Mr Moyes said he had requested that foundation trust chief executives resubmit a “downside assessment” — stripping back their budgets — to get a more realistic grasp of the funding pressures they faced. He said that he was disappointed when, on being asked to revise their financial predictions in September, a number of trusts had resubmitted even more rosetinted forecasts of growth. “You can’t assume everything will go well and if a problem arises the Department of Health will bail you out,” he said.
His warnings were echoed yesterday by Sir David Nicholson, the chief executive of the NHS, who described the coming years as “extremely challenging”. Giving evidence to the Commons Health Select Committee, Sir David warned of pay cuts and service reorganisation. “It is going to be very tough,” he said, adding that tighter budgets would mean the 1 per cent pay cap demanded by the Treasury would be treated by NHS managers as a maximum rise, not an entitlement. His comments came a day after inflation hit 2.9 per cent when unions are already angry over a pay freeze on council workers. “There is essentially a trade-off between pay and numbers of jobs,” he told the committee. “In a cash-limited system, that is the big unknown for us. We need to talk through with the trade unions and staff associations about what that trade-off is.”
Sir David has previously warned that the NHS would have to find productivity and efficiency savings of between £15 billion and £20 billion over the three years 2011-12 to 2013-14.
The head of the Audit Commission added to the debate, saying that political pledges to safeguard spending on health and education were “insane”. Steve Bundred told the Commons public administration committee that billions would have to be saved. “It seems to me absurd to imagine that the only services where no efficiencies can be found are those that have been the most generously funded for ten years,” he said.
Mr Moyes said he thought that an “unintended benefit” of future economic turbulence would be to heighten hospitals’ understanding that they had to operate with a robust business model. “A lot of hospitals, even the very good ones, are at the stage of learning how to think long-term,” he said. “We are good at strong visions, big pictures, but we need to learn to be very good at pessimism and what will happen if things are not going to turn out well.”
SOURCE
A record 10,000 British public hospital patients hit by malnutrition IN HOSPITAL
At least 10,000 patients left hospital last year after becoming malnourished while under NHS care - the highest number on record. Official NHS figures show that in 2008/09 175,003 patients were victims of malnutrition or another nutritional difficulty when they were admitted to hospital. But 185,446 were suffering the same conditions when they were discharged. The difference between the figures, obtained by the Tories, is 10,443, a 27 per cent rise on the previous year's 8,229.
Critics said it was almost unbelievable that hospitals were routinely sending people home in a worse condition than when they arrived. In 1997/98, Labour's first year in power, just 75,431 patients were discharged in a malnourished state, of whom only 4,773 had become malnourished while in NHS care. The total of 185,446 patients discharged in a malnourished state last year is 18 per cent more than the 157,175 the year before. This is the sharpest rise on record, largely because the number of patients admitted with nutritional difficulties was itself 17 per cent higher.
The continuing problems come despite years of Labour promises to improve hospital food. The Daily Mail's Dignity for the Elderly campaign has highlighted the scandal of old people not being fed properly in hospital. The food is often so unappetising that patients do not eat, and sometimes placed out of their reach and taken away untouched.
Nurses often claim they are too busy to help patients eat. Age Concern says 60 per cent of older patients, who occupy two thirds of hospital beds, are at risk of worsening health or becoming malnourished.
Andrew Harrop, head of policy, said: 'It's scandalous to see that malnutrition is still a huge problem. 'Nutritious food and help with eating are an essential part of basic care which must be recognised by all staff. 'Despite a commitment from the Government, many NHS trusts are yet to introduce protected mealtimes and one in three haven't introduced red-tray systems to identify those who need help. 'Until nutrition is given top priority in every ward, older people will continue to be needlessly malnourished, putting their health at risk.'
Tory health spokesman Stephen O'Brien said: 'These figures are of serious concern. 'It has been a growing problem for a number of years and yet Labour has done very little to protect these vulnerable people. 'Nutrition is important for people who aren't ill: how much more for those recovering from serious illnesses and operations? 'It is scandalous that people come out of hospital in a worse state than when they go in, particularly due to something as basic as being given decent food.'
The Department of Health said last night: 'It is misleading to suggest that an increase in patients discharged with malnutrition is due to poor care or the quality of food. 'Many patients who are admitted to hospital are already malnourished. Malnutrition can be a consequence of serious illness or medication. 'Many patients who have malnutrition and are discharged from hospital continue their care through primary care and social care. 'In 2009 a survey found that 94.5 per cent of NHS hospitals achieved an excellent or good rating for quality, choice and availability of food.'
SOURCE
Australian health bureaucrats think they know better than the doctors
EXCESSIVELY strict interpretation of rules governing the prescription of human growth hormone is compromising the care of children with medical conditions that make them abnormally short, specialists say.
The doctors say officials are rejecting legitimate applications to put children on the program, and restricting others to doses too low to be effective, after changes at the Department of Health and Ageing that have made new staff reluctant to continue a tradition of informal agreement over who should qualify and instead insist on the letter of the rules.
They want the department to update its regulations based on new research showing larger doses should be given early in a child's treatment for maximum effectiveness, and to consider research suggesting it is useful in a wider range of disorders.
But the department has made a submission to the independent Pharmaceutical Benefits Advisory Committee, which sets rules for subsidised treatment, arguing for more tightly defined eligibility and dosage criteria.
The Australian Paediatric Endocrine Group had made a submission arguing for more liberal prescribing, its president, Andrew Cotterill, said.
Dr Cotterill said he understood the department's dilemma, but he wanted "to work … to develop a process that is gentler around the hard edges". The prescribing system had previously worked as a "gentlemen's agreement" in which public servants usually accepted specialists' advice that patients needed the drug if they fell marginally outside the criteria. But the approach had toughened and more applications were being rejected. "The current medical literature is pointing towards the first year of treatment [offering] the best chance of a response," Dr Cotterill said, meaning children should be moved quickly towards the maximum dose if they did not respond to lower doses. But the rules say the dose should be increased slowly.
Growth hormone is prescribed to about 1500 children a year, costing typically $5000 to $10,000 a patient. More than half goes to those whose failure to grow has no known cause - but only if they are in the lowest 1 per cent of the expected height range based on their parents' statures. Other reasons include the genetic Turner syndrome, which affects only girls, cancer radiotherapy to the head, and kidney failure, along with hormone deficiency resulting from biochemical imbalance.
A Sydney endocrinologist, Maria Craig, said officials were "reading the guidelines very literally and overriding clinical experience … So much has to be taken in the context of a child's age, ethnic background, bone age, and [stage of puberty]. To have guidelines that are overly prescriptive just doesn't make sense." Dr Craig said the official dosing regime when a child started on the hormone was already conservative, offering "one of the lowest doses by global standards".
The chairman of the Pharmaceutical Benefits Advisory Committee, Lloyd Sansom, said a special meeting in December had discussed how the hormone might be used to treat chromosomal abnormalities and other disorders and "certain issues about dose escalation". He said the process was intended to set general terms for public subsidy and recommendations had been sent to the federal Health Minister, Nicola Roxon. A separate committee of specialised doctors could advise government on individual cases, but it was the Health Department's prerogative to make the final funding decision. "There is a limited health dollar, and decisions have to be made that can sometimes seem draconian," Professor Sansom said.
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Obama rediscovers bipartisanship -- when he is forced to
He talked the talk. Now he might have to walk the walk
President Obama signaled on Wednesday that he might be willing to scale back his proposed health care overhaul to a version that could attract bipartisan support, as the White House and Congressional Democrats grappled with a political landscape transformed by the Republican victory in the Massachusetts Senate race. “I would advise that we try to move quickly to coalesce around those elements of the package that people agree on,” Mr. Obama said in an interview on ABC News, notably leaving near-universal insurance coverage off his list of core goals.
But it was not clear that even a stripped-down bill could get through Congress anytime soon. Throughout the day, White House officials and Democratic Congressional leaders struggled to find a viable way forward for the health care bill and to digest the reality that much of their agenda, including an energy measure and an overhaul of banking regulations, had been derailed by the outcome in Massachusetts.
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed. “People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill...
At a news conference at the Capitol, the Senate majority leader, Harry Reid of Nevada, sought to minimize health care as compared with jobs and the economy. But he made clear that Democrats did not see a clear path forward...
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy. Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said....
More here
Obamacare in Cloud Cuckoo Land
When the majority of voters in the bluest of blue states elects a candidate opposed to Obamacare to fill the Senate seat previously held by the man who was that proposal's most prominent supporter, there is a clear message: You lost because of what you've been doing for the past year, so stop doing it.
Incredibly, President Obama's political brain trusts and his most powerful allies on Capitol Hill don't understand this reality. Witness Obama adviser David Axelrod saying of Republican Scott Brown's victory in Tuesday's special election: "I think that it would a terrible mistake to walk away now. If we don't pass the bill, all we have is the stigma of a caricature that was put on it. That would be the worst result for everybody who has supported this bill."
Robert Gibbs, Obama's White House press secretary, saw nothing in the Massachusetts results but reasons to keep on keeping on, "not that we somehow abandon our pursuit on things that are important to the middle class." Similarly, even before all the votes in Massachusetts were counted, House Speaker Nancy Pelosi was vowing to reporters she will plunge ahead to pass Obamacare: "We will get the job done. I am confident of that."
The same refusal to see what everybody else sees was reflected in commentary by the president's most vigorous supporters on the nation's editorial pages. The Boston Globe, for example, saw nothing in Brown's win to "negate the resounding mandate that President Obama and Democrats in Congress received in 2008 to address escalating health costs." The Globe encouraged Obama and House Speaker Nancy Pelosi to "bring the legislative process to a close by pushing House members to pass the Senate version."
Then there are Obama's supporters in academe like Yale's Jacob S. Hacker and Georgetown's Daniel Hopkins, political scientists both, who even before they knew the outcome of Tuesday's election confidently explained in The Washington Post that "running from reform" would be the wrong message for Democrats to glean from the Massachusetts contest. Hacker and Hopkins thus provide a sterling illustration of minds being made up before becoming confused by the facts.
Obama and Democratic leaders would do well to listen to these words of wisdom from one of their own, Rep. Anthony Weiner of New York: "If there isn't any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant." Translation: If voters are so angry that Republicans can get Ted Kennedy's Senate seat, there isn't a safe Democratic incumbent anywhere in the country.
SOURCE
Obama health plan in doubt as Dems reject fast fix
Though reeling from a political body blow, House Democrats rejected the quickest fix to their health care dilemma Thursday and signaled that any agreement on President Barack Obama's signature issue will come slowly, if at all. Democrats weighed a handful of difficult options as they continued to absorb Republican Scott Brown's election to the Massachusetts Senate seat long held by Edward M. Kennedy. Several said Obama must forcefully help them find a way to avoid the humiliation of enacting no bill, and they urged him to do so quickly, to put the painful process behind them.
House leaders said they could not pass a Senate-approved bill, standing by itself, because of objections from liberals and moderates alike. Such a move could have settled the matter, because it would not have required further Senate action. Brown's stunning victory restored the GOP's power to block bills with Senate filibusters.
Democratic leaders weighed two main options, both problematic. The first would require congressional Democrats to muscle their way past stiff GOP objections despite warning signs from Massachusetts voters and worries about next November's elections. The other would pare down the original health care legislation in hopes of gaining some Republican support. But the compromise process is more difficult than many lawmakers suggest.
Democrats' hopes of settling on a strategy by the weekend seemed to fade, as lawmakers struggled to comprehend the drawbacks of every option. "We have to get a bill passed," said House Speaker Nancy Pelosi, D-Calif., because her party would have no excuse for failing to revamp health care when it controls Congress and the White House.
Some lawmakers said it will take time for congressional Democrats, who huddled repeatedly Thursday, to realize how limited their options are. "People are at various levels of the seven stages of grief," said Rep. Anthony Weiner, D-N.Y.
The first chief option would require House Democrats to approve the Senate-passed bill along with a guarantee that the Senate would make several simultaneous changes to health law desired by the House. Senate Democrats presumably would do so with a tactic called "budget reconciliation." It requires only a simple-majority vote for certain budget-related matters, but it cannot be used for every issue. Both parties have used the tactic at times.
When Brown is sworn in, Democrats will control 59 of the Senate's 100 seats. They need 60 to block GOP filibusters.
The second option calls for drafting a new, compromise bill more palatable to moderates, including some Republicans. But numerous officials said it's far easier said than done. For instance, a widely popular goal is to bar health insurers from refusing coverage to people already suffering medical problems. But without requiring most people to buy coverage, millions might wait until they have a serious problem before buying a policy, driving coverage costs to unsustainable levels. Moreover, "individual mandates" to buy insurance would almost certainly require government subsidies for low-income people. And that in turn would require new government revenues, such as taxes.
Many of these interconnected features drew strong objections, especially from Republicans, when the House and Senate passed competing versions of health care revisions last month.
Pelosi cited the dilemma Thursday. "I don't think anybody disagrees with 'Let's pass the popular part of the bill,'" she told reporters. "But some of the popular parts of the bill is the engine that drives some of the rest of it," which is far less popular, she said.
Outside groups were more blunt. "You can't do it," said Ron Pollack of the liberal-leaning Families USA. Enacting popular "insurance reforms" won't work without the more controversial and expensive steps of expanding coverage to the uninsured, he said.
Some lawmakers talked of placing partial limits on insurance companies' ability to deny coverage to those with pre-existing medical conditions. Companies might be required to cover sick children, or to keep covering customers who become sick and failed to disclose every detail of their medical histories when first buying their policies. Such compromises could leave Obama well short of the universal coverage he touted during his 2008 campaign.
House Democrats cite many objections to the Senate-passed bill, which make them wary of adopting it without some type of ironclad guarantee of improvements by the newly configured Senate. But budget reconciliation is one of Congress's most complex and controversial exercises, and it's not clear how many House objections can be remedied with the process.
A widely criticized feature of the Senate bill made special Medicaid concessions to Nebraska, demanded by Democratic Sen. Ben Nelson. Senators promised to expand the help to all 50 states, but Brown's election cut that negotiation process short. Congressional budget referees said Thursday it would cost $35 billion over 10 years to extend the so-called "Cornhusker Kickback" to every state.
Some Democrats said Obama must lead his dispirited party to a resolution. "He has got to bring the Senate and the House together," said Rep. Elijah Cummings, D-Md. "He has got to help all of us pave a way to get it done." White House spokesman Robert Gibbs said Obama thinks the best path is "giving this some time, by letting the dust settle, if you will, and looking for the best path forward." He said Obama does not believe a major health care revision is dead.
Asked what is next for the legislation, Sen. Debbie Stabenow, D-Mich., shaped her hand like a gun and pointed to her head. "We're looking to see what there's support to do," she said.
SOURCE
Thursday, January 21, 2010
THE HUGELY WASTEFUL AND STULTIFYING BUREAUCRACY OF AUSTRALIA'S SOCIALIZED MEDICINE SYSTEM
Two current articles below -- from two different Australian States
Doctors highlight a cancerous medical bureaucracy in Queensland
Medicos wage war on billions wasted on bureaucrat jobs
AUSTRALIA'S peak medical group will demand Queensland Health stop hiring bureaucrats as part of a new name and shame campaign targeting the hundreds of millions of dollars it claims are being wasted in hospitals. The Australian Medical Association will today unveil a "War on Waste" campaign in a bid to highlight problems in the beleaguered health system, ahead of proposed reform by the Rudd Government later this year.
AMA Queensland president Mason Stevenson last night told The Courier-Mail the campaign would attempt to pressure both the state and federal governments to act on health reform, given an estimated $4 billion was being wasted nationwide. The group claims, for example, one in 10 surgery patients is admitted to hospital and prepared for surgery but discharged before their operation because of a lack of theatres. "The wastage is widespread and is costing lives," Dr Stevenson said.
The move comes amid a heated debate over a proposed federal takeover of hospitals, with the Rudd Government still considering recommendations from a top-level report.
But the Bligh Government last night produced a letter written last year by Queensland Health director-general Mick Reid asking to consult with the AMA about red tape. It claimed that request has been met with silence from the AMA.
The AMA campaign includes a list of questions Queensland Health will be asked to answer within two weeks, including how much extra hospital floor space bureaucrats have been given in the past decade. The AMA has also called for a moratorium on hiring bureaucrats, saying department figures showed the number of administration jobs had swollen from 5060 to 13,645 positions since 1995. Doctor jobs, meanwhile, had risen from 3095 to 6715 positions.
But Health Minister Paul Lucas defended the administration staff, saying they were crucial to taking paperwork from doctors and nurses who had been hired in record numbers. He instead accused the AMA of trying to introduce its own red tape and waste. "The AMA criticises Surgery Connect now but this is just sour grapes from an organisation that in 2006 supported the initiative and wanted to charge the State Government a $1.7 million 'management' fee to administer the program," he said. "Every hour of paperwork taken out of doctors' hands by booking clerks and patient liaison officers is an extra hour spent treating patients."
But Dr Stevenson said a moratorium was necessary to stop wastage.
SOURCE
A "Soviet style" hospital bureaucracy in NSW
Over the past 18 months I have spent an inordinate amount of time in public hospitals in NSW, not as a patient but as a witness to the ordeals of family members. There were multiple trips to the emergency department - where elderly people were piled up in corridors - and wards in which four very sick people crammed in one room managed to be pleasant to each other while overstretched nurses remained cheerful and the doctors adept.
There was the hand clinic with an inexplicable waiting time every week of four to six hours, but with world-class doctors fixing broken fingers for free, and the deserted endocrinology clinic, which a specialist opens by himself on Saturdays so his sickest patients don't have to wait.
I walked along deserted corridors at night and marvelled at how such a massive, ingenuity-sapping bureaucratic institution somehow still manages to save lives and bring out the best in people who work there. Two things were notable: first, the professionalism, expertise and good humour of most doctors and nurses; and second, the extent to which they must work around a government bureaucracy of Soviet-style ineptitude. Their successes are in spite of the system, about which they are openly scathing.
How did our hospitals become so remote from the needs of patients and the good sense of medical professionals? Two doctors with a combined total of more than 80 years in the NSW public hospital system, and a passion for public service, are speaking out about their experience of the "chaos, tragedy and sometimes downright farce" they have encountered in the second half of their careers.
Dr John Graham, the chairman of the Department of Medicine at Sydney Hospital and Sydney Eye Hospital, and Dr X, a staff specialist physician at a large hospital in the Northern Tablelands, (who cannot give his name for fear of being sacked) say the problem is not a lack of funding but the dead hand of bureaucracy. They have prescribed the remedy to restore public hospitals to their former place among the most trusted and well run institutions in the country: to reinstate local autonomy, with independent hospital boards taking full control of the budget.
Dr X, who is also a senior officer in the army reserve who served in Rwanda, Afghanistan and Banda Aceh after the tsunami, knows a thing or two about organising medical teams. "I have an appreciation of organisations, of command and control, of man management and of assessing clinical priorities and planning for them," he says. "In criticising the Department of Health, I am not an anarchist or privateer; I believe in our public institutions."
He says the amalgamation in 2004 of the Hunter and New England Health services into one giant administration was "an absolute disaster". "I can honestly say that in my three decades here I have never seen the system more dysfunctional. It just gets more and more bloody difficult."
His hospital is so stretched for doctors he has been without a day off and on call every second night since November. In an impassioned letter written on New Year's Eve while he was on call, he stated: "At the moment I have no resident medical officer, no registrar or secretary. I am expected to be all of these. "Meanwhile, in hospital I have patients waiting for investigations and treatment which will not be available for several weeks [due to holiday closures]. I am being pressured to discharge patients before they are ready, and to not admit patients who should be admitted.
"I am supposed to compromise patient care in order to save the hides of non-clinical incompetents who make irresponsible decisions without any consultation or consideration of the likely consequences. "Such a situation would never have occurred when communities had 'ownership' of their local hospitals and governed them though their local hospital boards . . . "And it is not as though the Hunter-New England Area Health Service is short of money; with a budget of $1 billion dollars, you could be forgiven for thinking that the staffing of its hospitals with appropriately experience doctors would be a priority."
Like Dr X, Dr Graham traces the rot back to the 1980s and 1990s when local hospital boards were replaced with area health services. In a policy paper for the Centre for Independent Studies in October, he argued that "the disastrous reorganisation of public hospital administration over the past 25 years needs to be reversed". Decision-making in hospitals used to be quick and effective, but now "funding is not spent optimally and trust, co-operation, morale and institutional loyalty has been sapped . . . Resource misallocation involving extraordinary growth in the size and cost of the bureaucracy has led to a massive waste of taxpayer's money."
The bimonthly department meetings that he attends at Sydney Hospital show how dysfunctional the system has become. "The department's time is mainly occupied in dealing with centralised directives issued by the South Eastern Sydney and Illawarra Area Health Service and NSW Health . . . Doctors and nurses these days are forever wasting time and energy complying with the new sets of orders issued by an intrusive, arbitrary, and seemingly unaccountable bureaucracy." For instance, there are new rules issued to medical staff every day about everything from handwashing to how to write a blood test request or talk to the grieving relatives of a patient. "They're constantly telling you your business," Dr Graham says.
And if you buck the system, "there is a lot of heavy-handed pressure brought to bear, especially on younger doctors and nurses. NSW is really like what it would have been in Moscow 20 years ago." Dr Graham, who is semi-retired, says that he is able to speak out because he is in the "lucky situation where they can't hurt me".
In an indication that the deteriorating state of our hospitals will be a major election issue, the Australian Medical Association this week called for wide-scale health reform in its submission to the 2010 budget. It's about time someone listened to the doctors.
SOURCE
Barack Obama has learnt nothing
Barack Obama will attempt to push through health care reform despite the shock loss of a previously safe Democrat senate seat in Massachusetts, aides have said. Advisers said tactics would have to be rethought but the president remained determined to stick to his political agenda.
Little-known Republican Scott Brown triumphed in one of the most liberal states in the country, which had delivered landslides to the late Edward Kennedy for 47 years.
On what was a grim first anniversary of Mr Obama's inauguration, Democrat leaders in Congress held urgent meetings to assess how they could salvage health legislation. The election defeat cost them their 60-vote majority in the Senate which was needed to see off Republican threats to filibuster the bill.
David Axelrod, a senior adviser in the White House, said: "We'll have to think through this next year from the standpoint of tactics but in substance the mission can't change. It's not an option simply to walk away from a problem that's only going to get worse."
David Plouffe, the president's former campaign manager, said that passing what was meant to be the cornerstone of the administration's domestic agenda would demonstrate strong leadership. "We have a good health care plan," he said on ABC. "We need to pass that. We have to lead and then explain it. We can't cut and run, it would be devastating for the country."
Republican leaders in Congress called for a reworking of the bill, which would provide near universal coverage and aimed to bring down long-term costs. But Nancy Pelosi, the Democratic House Speaker, argued that because Massachusetts already had near-universal health coverage under a state law, the vote should not be seen as a referendum on the issue. "We don't say a state that already has health care should determine whether the rest of the country should. We will get the job done. I'm very confident," she said.
Others in the party fear that their own seats are now at risk in November's midterm elections, and are convinced that the message from Massachusetts, a state Mr Obama won by 26 points in 2008, is that they must go back to the drawing board on health care.
At a raucous victory rally on Tuesday night Mr Brown said: "We won because of a shared conviction with voters that the people do not want a trillion dollar health care plan that's being forced on the American people. "The bill hasn't been debated openly and it will raise taxes and destroy jobs and drive the country deeper into debt. We need to start afresh and work together to do the job better."
Jubilant supporters at a Boston hotel ballroom compared his victory to the uprising against the British in the same city in 1773. "The revolution started here 230-something years ago, the same thing is happening tonight. Last time it was George III, now it's Washington we're going for," said Dave Knight, who volunteered for the Brown campaign.
With the Democrats' filibuster-proof majority gone, plans to introduce a cap and trade system for carbon emissions are also now at risk. A bill passed the House of Representatives but has been stuck in the senate for months.
The trial of five September 11 suspects at criminal court may also be in jeopardy. The proposal to move them from Guantanamo to the mainland for trial needs approval by Congress and Senator-elect Brown is fervently opposed to the notion. "Giving new rights to terrorists is wrong for our country," he said. "Our tax dollars should be spent on weapons to attack them, not lawyers to defend them."
Mitch McConnell, the Republican leader in the Senate, said the result should encourage Mr Obama to be more accommodating. "If he turns to govern in the middle we would be happy to meet him there," he said. But given a near complete breakdown in either side's ability to work with the other, observers said that seemed an unlikely scenario.
The Republican beat his Democratic rival and Massachusetts attorney general Martha Coakley by 52 per cent to 47 per cent.
SOURCE
Did the Dems secret deals on health care elect Brown?
During this morning's press conference, newly elected Massachusetts Senator Scott Brown discussed what he had heard from voters driving while driving around Massachusetts. He said that voters were tired of "business as usual," and he specifically cited anger over Nebraska Senator Ben Nelson's shady "cornhusker kickback" in the health care legislation as an example of why Massachusetts voters produced a stunning upset by voting for him the previous evening.
Brown isn't the only one who thinks that the populist backlash against these secret deals on health care reform is major reason why Democrats are in big trouble right now. In a memo yesterday that losing Democrat Martha Coakley gave to the press, her campaign blamed Washington Democrats for losing. The memo observed that Coakley declined steadily in the polls immediately following the Christmas eve passage of the health care bill. Further, the Coakley campaign's internal polls showed Brown's argument that the health care legislation and cap-and-trade were effectively tax increases were the most effective arguments with voters.
"We Democrats had to explain to Massachusetts voters and other Americans why non-Nebraskans and nonunion members have to pay more taxes, while Nebraskans and union members get to pay less. Those two deals seem to have alienated most people across the political spectrum. That’s not easy," wrote former Clinton Special Counsel Lanny Davis in the Wall Street Journal this morning.
And yesterday, The New York Times quoted one Massachusetts voter saying, "I'm just devastated by what Obama’s doing. I don’t think he cares enough about anything other than his own personal agenda or this foolish health care bill." The same voter also specifically cited the unfairness of the union tax exemption the health care bill as unfairly punishing her daughter and her husband who worked at a non-unionized business. It's also worth noting that Massachusetts has the highest average health care premiums in the country at almost $14,000 annually per family -- as such, the "cadillac" tax that unions received their exemption from would unduly hit Massachusetts residents. The unfairness of the union deal was likely not lost on them.
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With new GOP strength in Senate, will Obamacare die in House?
Throughout the Massachusetts Senate race, we heard the number "41" repeated over and over -- as in Scott Brown would become the 41st Republican senator, whose presence would deprive Democrats of a filibuster-proof majority and stop President Obama's national health care plan. But now that Brown actually is the 41st GOP senator, the most important number in politics is 218 -- as in, can House Speaker Nancy Pelosi amass a majority of 218 votes for House Democrats to pass the health care bill already approved by the Senate, thus sending it to Obama's desk to be signed into law.
That is the essence of what's known as Plan B. The Senate is out of the game, now that Democrats no longer have their 60-vote majority. Any new version of a bill combining elements of the House and Senate versions won't be able to get through a Senate with 41 Republicans united against it. So the only course of action available to Democrats is to have the House pass the Senate bill verbatim, and then promise to quickly make changes to satisfy the objections of lawmakers in both houses.
But to do that, House Speaker Nancy Pelosi will need 218 votes to pass the Senate bill. And all across the House, Democrats and Republicans are doing the math.
When the House passed its version of the health care bill last November, the margin was 220 to 215. But the House has changed since then. First, Democratic Rep. Robert Wexler, a strong supporter of national health care, has quit to become president of a Washington-based think tank. That leaves Democrats with 219 votes. Then Republican Rep. Joseph Cao, the only GOP lawmaker to vote for the bill, announced that he would vote against it the next time, leaving Democrats with 218 -- the bare majority needed to pass the health care bill.
In addition, the House Republican leadership calculates that 11 Democrats who voted for the health care bill will likely vote against the Senate version because it lacks the House bill's tighter language on the subject of abortion. These are Democrats who voted for the so-called Stupak amendment and then voted for final passage of the health care bill because it contained the Stupak amendment language. If 11 of them do indeed defect, Democrats will be down to 207 votes -- 11 short of the number needed for passage.
How to close that gap? Well, three Democrats who voted against the bill -- Reps. Brian Baird, Dennis Moore, and John Tanner -- have decided to retire. No longer facing voter wrath over health care, they might be convinced to change their votes. If they all changed their position, Democrats would get to 210. But after that, what? Pelosi would still need eight more votes.
It is widely believed that the Speaker held some votes in reserve when the House passed the health care bill last November. That is, there were some Democrats who really wanted to vote against the bill but could have been arm-twisted to vote for it if it were absolutely necessary. Since Pelosi had the votes needed for passage, she let those lawmakers vote against the bill. Now, she could lean on them to change their vote.
That will surely happen -- but the question is, will it happen at least eight times? No one knows. But Republicans expect the Speaker to pull out every stop, to make every deal, to go to any length to pass the bill. "They have so much riding on this, I think they'd do almost anything to pass it," says a highly-placed House GOP source. "If it failed, Pelosi would have to acknowledge that they were wrong, and we've seen no indications that they believe that anything they've done on this health care bill is wrong."
Look for Democrats to enter into intense negotiations in coming days. They might not move immediately -- and they don't have to, because the Senate bill has already been passed, giving the House the freedom to vote on it tomorrow, next week, or six months from now. But it's likely that the President's Day recess, scheduled for the week of February 15, will emerge as a self-imposed deadline for a deal. "Their natural break is President's Day," says the GOP source. "If you go home for a week and you haven't finished this, it gets even harder."
SOURCE
Does Mass. Health Law Cover Fewer People Than Believed?
More dubious statistics
As Massachusetts held a de facto referendum Tuesday on Democrats' national health plans, a new study says the state's own health overhaul law hasn't been as successful as its backers claim. Republican Scott Brown has vowed to be the 41st vote to block a health care overhaul if elected to the U.S. Senate. But as a state senator, he voted for landmark legislation in 2006 seeking to cover virtually all residents.
In 2006 the Census Bureau reported that 10% of Massachusetts residents were uninsured. In 2008, it had fallen to 3.8% . But that understates the uninsured by at least 45%, according to Michael Cannon, director of health policy studies at the libertarian Cato Institute. "The official estimates overstate the health coverage gains in Massachusetts in part because residents are concealing their coverage status," said Cannon, who co-authored a study with Aaron Yelowitz, an economics professor at the University of Kentucky.
The law's supporters accuse Cato of "sloppy research." "Cato has a far-right libertarian point of view, and they opposed reform even before it passed," said Brian Rosman, research director of Health Care For All, a liberal advocacy group in Massachusetts.
The state requires people to buy insurance or pay a fine. That may affect how people answer Census questions about their insurance status, Cannon argues.
Nondenial Denials? Some respondents don't answer questions on insurance status. The Census tries to correct for that by comparing them with people with similar characteristics who did answer the question. "We find evidence that these imputations rose in Massachusetts, not just after the law passed but relative to other New England states," said Cannon. "Using those other states as controls, it shows that nonresponse to the health insurance question is growing in Massachusetts for some reason that is unique to the Bay State."
Cannon and Yelowitz find that the uninsured rate could be closer to 5.1% vs. the official 3.8%. "And that's only one strategy for concealing your health insurance status from the government pollster," said Cannon. "You can refuse to participate in the survey or you can lie."
Rosman isn't buying any of it. "When confronted with numbers that don't support their conclusion, Cato makes up a reason why people are lying," he said. "No one goes to jail here for not having insurance. It's no different than other issues on your taxes." He adds that reports looking at people — not samples — are "completely consistent with each other."
SOURCE
Two current articles below -- from two different Australian States
Doctors highlight a cancerous medical bureaucracy in Queensland
Medicos wage war on billions wasted on bureaucrat jobs
AUSTRALIA'S peak medical group will demand Queensland Health stop hiring bureaucrats as part of a new name and shame campaign targeting the hundreds of millions of dollars it claims are being wasted in hospitals. The Australian Medical Association will today unveil a "War on Waste" campaign in a bid to highlight problems in the beleaguered health system, ahead of proposed reform by the Rudd Government later this year.
AMA Queensland president Mason Stevenson last night told The Courier-Mail the campaign would attempt to pressure both the state and federal governments to act on health reform, given an estimated $4 billion was being wasted nationwide. The group claims, for example, one in 10 surgery patients is admitted to hospital and prepared for surgery but discharged before their operation because of a lack of theatres. "The wastage is widespread and is costing lives," Dr Stevenson said.
The move comes amid a heated debate over a proposed federal takeover of hospitals, with the Rudd Government still considering recommendations from a top-level report.
But the Bligh Government last night produced a letter written last year by Queensland Health director-general Mick Reid asking to consult with the AMA about red tape. It claimed that request has been met with silence from the AMA.
The AMA campaign includes a list of questions Queensland Health will be asked to answer within two weeks, including how much extra hospital floor space bureaucrats have been given in the past decade. The AMA has also called for a moratorium on hiring bureaucrats, saying department figures showed the number of administration jobs had swollen from 5060 to 13,645 positions since 1995. Doctor jobs, meanwhile, had risen from 3095 to 6715 positions.
But Health Minister Paul Lucas defended the administration staff, saying they were crucial to taking paperwork from doctors and nurses who had been hired in record numbers. He instead accused the AMA of trying to introduce its own red tape and waste. "The AMA criticises Surgery Connect now but this is just sour grapes from an organisation that in 2006 supported the initiative and wanted to charge the State Government a $1.7 million 'management' fee to administer the program," he said. "Every hour of paperwork taken out of doctors' hands by booking clerks and patient liaison officers is an extra hour spent treating patients."
But Dr Stevenson said a moratorium was necessary to stop wastage.
SOURCE
A "Soviet style" hospital bureaucracy in NSW
Over the past 18 months I have spent an inordinate amount of time in public hospitals in NSW, not as a patient but as a witness to the ordeals of family members. There were multiple trips to the emergency department - where elderly people were piled up in corridors - and wards in which four very sick people crammed in one room managed to be pleasant to each other while overstretched nurses remained cheerful and the doctors adept.
There was the hand clinic with an inexplicable waiting time every week of four to six hours, but with world-class doctors fixing broken fingers for free, and the deserted endocrinology clinic, which a specialist opens by himself on Saturdays so his sickest patients don't have to wait.
I walked along deserted corridors at night and marvelled at how such a massive, ingenuity-sapping bureaucratic institution somehow still manages to save lives and bring out the best in people who work there. Two things were notable: first, the professionalism, expertise and good humour of most doctors and nurses; and second, the extent to which they must work around a government bureaucracy of Soviet-style ineptitude. Their successes are in spite of the system, about which they are openly scathing.
How did our hospitals become so remote from the needs of patients and the good sense of medical professionals? Two doctors with a combined total of more than 80 years in the NSW public hospital system, and a passion for public service, are speaking out about their experience of the "chaos, tragedy and sometimes downright farce" they have encountered in the second half of their careers.
Dr John Graham, the chairman of the Department of Medicine at Sydney Hospital and Sydney Eye Hospital, and Dr X, a staff specialist physician at a large hospital in the Northern Tablelands, (who cannot give his name for fear of being sacked) say the problem is not a lack of funding but the dead hand of bureaucracy. They have prescribed the remedy to restore public hospitals to their former place among the most trusted and well run institutions in the country: to reinstate local autonomy, with independent hospital boards taking full control of the budget.
Dr X, who is also a senior officer in the army reserve who served in Rwanda, Afghanistan and Banda Aceh after the tsunami, knows a thing or two about organising medical teams. "I have an appreciation of organisations, of command and control, of man management and of assessing clinical priorities and planning for them," he says. "In criticising the Department of Health, I am not an anarchist or privateer; I believe in our public institutions."
He says the amalgamation in 2004 of the Hunter and New England Health services into one giant administration was "an absolute disaster". "I can honestly say that in my three decades here I have never seen the system more dysfunctional. It just gets more and more bloody difficult."
His hospital is so stretched for doctors he has been without a day off and on call every second night since November. In an impassioned letter written on New Year's Eve while he was on call, he stated: "At the moment I have no resident medical officer, no registrar or secretary. I am expected to be all of these. "Meanwhile, in hospital I have patients waiting for investigations and treatment which will not be available for several weeks [due to holiday closures]. I am being pressured to discharge patients before they are ready, and to not admit patients who should be admitted.
"I am supposed to compromise patient care in order to save the hides of non-clinical incompetents who make irresponsible decisions without any consultation or consideration of the likely consequences. "Such a situation would never have occurred when communities had 'ownership' of their local hospitals and governed them though their local hospital boards . . . "And it is not as though the Hunter-New England Area Health Service is short of money; with a budget of $1 billion dollars, you could be forgiven for thinking that the staffing of its hospitals with appropriately experience doctors would be a priority."
Like Dr X, Dr Graham traces the rot back to the 1980s and 1990s when local hospital boards were replaced with area health services. In a policy paper for the Centre for Independent Studies in October, he argued that "the disastrous reorganisation of public hospital administration over the past 25 years needs to be reversed". Decision-making in hospitals used to be quick and effective, but now "funding is not spent optimally and trust, co-operation, morale and institutional loyalty has been sapped . . . Resource misallocation involving extraordinary growth in the size and cost of the bureaucracy has led to a massive waste of taxpayer's money."
The bimonthly department meetings that he attends at Sydney Hospital show how dysfunctional the system has become. "The department's time is mainly occupied in dealing with centralised directives issued by the South Eastern Sydney and Illawarra Area Health Service and NSW Health . . . Doctors and nurses these days are forever wasting time and energy complying with the new sets of orders issued by an intrusive, arbitrary, and seemingly unaccountable bureaucracy." For instance, there are new rules issued to medical staff every day about everything from handwashing to how to write a blood test request or talk to the grieving relatives of a patient. "They're constantly telling you your business," Dr Graham says.
And if you buck the system, "there is a lot of heavy-handed pressure brought to bear, especially on younger doctors and nurses. NSW is really like what it would have been in Moscow 20 years ago." Dr Graham, who is semi-retired, says that he is able to speak out because he is in the "lucky situation where they can't hurt me".
In an indication that the deteriorating state of our hospitals will be a major election issue, the Australian Medical Association this week called for wide-scale health reform in its submission to the 2010 budget. It's about time someone listened to the doctors.
SOURCE
Barack Obama has learnt nothing
Barack Obama will attempt to push through health care reform despite the shock loss of a previously safe Democrat senate seat in Massachusetts, aides have said. Advisers said tactics would have to be rethought but the president remained determined to stick to his political agenda.
Little-known Republican Scott Brown triumphed in one of the most liberal states in the country, which had delivered landslides to the late Edward Kennedy for 47 years.
On what was a grim first anniversary of Mr Obama's inauguration, Democrat leaders in Congress held urgent meetings to assess how they could salvage health legislation. The election defeat cost them their 60-vote majority in the Senate which was needed to see off Republican threats to filibuster the bill.
David Axelrod, a senior adviser in the White House, said: "We'll have to think through this next year from the standpoint of tactics but in substance the mission can't change. It's not an option simply to walk away from a problem that's only going to get worse."
David Plouffe, the president's former campaign manager, said that passing what was meant to be the cornerstone of the administration's domestic agenda would demonstrate strong leadership. "We have a good health care plan," he said on ABC. "We need to pass that. We have to lead and then explain it. We can't cut and run, it would be devastating for the country."
Republican leaders in Congress called for a reworking of the bill, which would provide near universal coverage and aimed to bring down long-term costs. But Nancy Pelosi, the Democratic House Speaker, argued that because Massachusetts already had near-universal health coverage under a state law, the vote should not be seen as a referendum on the issue. "We don't say a state that already has health care should determine whether the rest of the country should. We will get the job done. I'm very confident," she said.
Others in the party fear that their own seats are now at risk in November's midterm elections, and are convinced that the message from Massachusetts, a state Mr Obama won by 26 points in 2008, is that they must go back to the drawing board on health care.
At a raucous victory rally on Tuesday night Mr Brown said: "We won because of a shared conviction with voters that the people do not want a trillion dollar health care plan that's being forced on the American people. "The bill hasn't been debated openly and it will raise taxes and destroy jobs and drive the country deeper into debt. We need to start afresh and work together to do the job better."
Jubilant supporters at a Boston hotel ballroom compared his victory to the uprising against the British in the same city in 1773. "The revolution started here 230-something years ago, the same thing is happening tonight. Last time it was George III, now it's Washington we're going for," said Dave Knight, who volunteered for the Brown campaign.
With the Democrats' filibuster-proof majority gone, plans to introduce a cap and trade system for carbon emissions are also now at risk. A bill passed the House of Representatives but has been stuck in the senate for months.
The trial of five September 11 suspects at criminal court may also be in jeopardy. The proposal to move them from Guantanamo to the mainland for trial needs approval by Congress and Senator-elect Brown is fervently opposed to the notion. "Giving new rights to terrorists is wrong for our country," he said. "Our tax dollars should be spent on weapons to attack them, not lawyers to defend them."
Mitch McConnell, the Republican leader in the Senate, said the result should encourage Mr Obama to be more accommodating. "If he turns to govern in the middle we would be happy to meet him there," he said. But given a near complete breakdown in either side's ability to work with the other, observers said that seemed an unlikely scenario.
The Republican beat his Democratic rival and Massachusetts attorney general Martha Coakley by 52 per cent to 47 per cent.
SOURCE
Did the Dems secret deals on health care elect Brown?
During this morning's press conference, newly elected Massachusetts Senator Scott Brown discussed what he had heard from voters driving while driving around Massachusetts. He said that voters were tired of "business as usual," and he specifically cited anger over Nebraska Senator Ben Nelson's shady "cornhusker kickback" in the health care legislation as an example of why Massachusetts voters produced a stunning upset by voting for him the previous evening.
Brown isn't the only one who thinks that the populist backlash against these secret deals on health care reform is major reason why Democrats are in big trouble right now. In a memo yesterday that losing Democrat Martha Coakley gave to the press, her campaign blamed Washington Democrats for losing. The memo observed that Coakley declined steadily in the polls immediately following the Christmas eve passage of the health care bill. Further, the Coakley campaign's internal polls showed Brown's argument that the health care legislation and cap-and-trade were effectively tax increases were the most effective arguments with voters.
"We Democrats had to explain to Massachusetts voters and other Americans why non-Nebraskans and nonunion members have to pay more taxes, while Nebraskans and union members get to pay less. Those two deals seem to have alienated most people across the political spectrum. That’s not easy," wrote former Clinton Special Counsel Lanny Davis in the Wall Street Journal this morning.
And yesterday, The New York Times quoted one Massachusetts voter saying, "I'm just devastated by what Obama’s doing. I don’t think he cares enough about anything other than his own personal agenda or this foolish health care bill." The same voter also specifically cited the unfairness of the union tax exemption the health care bill as unfairly punishing her daughter and her husband who worked at a non-unionized business. It's also worth noting that Massachusetts has the highest average health care premiums in the country at almost $14,000 annually per family -- as such, the "cadillac" tax that unions received their exemption from would unduly hit Massachusetts residents. The unfairness of the union deal was likely not lost on them.
SOURCE
With new GOP strength in Senate, will Obamacare die in House?
Throughout the Massachusetts Senate race, we heard the number "41" repeated over and over -- as in Scott Brown would become the 41st Republican senator, whose presence would deprive Democrats of a filibuster-proof majority and stop President Obama's national health care plan. But now that Brown actually is the 41st GOP senator, the most important number in politics is 218 -- as in, can House Speaker Nancy Pelosi amass a majority of 218 votes for House Democrats to pass the health care bill already approved by the Senate, thus sending it to Obama's desk to be signed into law.
That is the essence of what's known as Plan B. The Senate is out of the game, now that Democrats no longer have their 60-vote majority. Any new version of a bill combining elements of the House and Senate versions won't be able to get through a Senate with 41 Republicans united against it. So the only course of action available to Democrats is to have the House pass the Senate bill verbatim, and then promise to quickly make changes to satisfy the objections of lawmakers in both houses.
But to do that, House Speaker Nancy Pelosi will need 218 votes to pass the Senate bill. And all across the House, Democrats and Republicans are doing the math.
When the House passed its version of the health care bill last November, the margin was 220 to 215. But the House has changed since then. First, Democratic Rep. Robert Wexler, a strong supporter of national health care, has quit to become president of a Washington-based think tank. That leaves Democrats with 219 votes. Then Republican Rep. Joseph Cao, the only GOP lawmaker to vote for the bill, announced that he would vote against it the next time, leaving Democrats with 218 -- the bare majority needed to pass the health care bill.
In addition, the House Republican leadership calculates that 11 Democrats who voted for the health care bill will likely vote against the Senate version because it lacks the House bill's tighter language on the subject of abortion. These are Democrats who voted for the so-called Stupak amendment and then voted for final passage of the health care bill because it contained the Stupak amendment language. If 11 of them do indeed defect, Democrats will be down to 207 votes -- 11 short of the number needed for passage.
How to close that gap? Well, three Democrats who voted against the bill -- Reps. Brian Baird, Dennis Moore, and John Tanner -- have decided to retire. No longer facing voter wrath over health care, they might be convinced to change their votes. If they all changed their position, Democrats would get to 210. But after that, what? Pelosi would still need eight more votes.
It is widely believed that the Speaker held some votes in reserve when the House passed the health care bill last November. That is, there were some Democrats who really wanted to vote against the bill but could have been arm-twisted to vote for it if it were absolutely necessary. Since Pelosi had the votes needed for passage, she let those lawmakers vote against the bill. Now, she could lean on them to change their vote.
That will surely happen -- but the question is, will it happen at least eight times? No one knows. But Republicans expect the Speaker to pull out every stop, to make every deal, to go to any length to pass the bill. "They have so much riding on this, I think they'd do almost anything to pass it," says a highly-placed House GOP source. "If it failed, Pelosi would have to acknowledge that they were wrong, and we've seen no indications that they believe that anything they've done on this health care bill is wrong."
Look for Democrats to enter into intense negotiations in coming days. They might not move immediately -- and they don't have to, because the Senate bill has already been passed, giving the House the freedom to vote on it tomorrow, next week, or six months from now. But it's likely that the President's Day recess, scheduled for the week of February 15, will emerge as a self-imposed deadline for a deal. "Their natural break is President's Day," says the GOP source. "If you go home for a week and you haven't finished this, it gets even harder."
SOURCE
Does Mass. Health Law Cover Fewer People Than Believed?
More dubious statistics
As Massachusetts held a de facto referendum Tuesday on Democrats' national health plans, a new study says the state's own health overhaul law hasn't been as successful as its backers claim. Republican Scott Brown has vowed to be the 41st vote to block a health care overhaul if elected to the U.S. Senate. But as a state senator, he voted for landmark legislation in 2006 seeking to cover virtually all residents.
In 2006 the Census Bureau reported that 10% of Massachusetts residents were uninsured. In 2008, it had fallen to 3.8% . But that understates the uninsured by at least 45%, according to Michael Cannon, director of health policy studies at the libertarian Cato Institute. "The official estimates overstate the health coverage gains in Massachusetts in part because residents are concealing their coverage status," said Cannon, who co-authored a study with Aaron Yelowitz, an economics professor at the University of Kentucky.
The law's supporters accuse Cato of "sloppy research." "Cato has a far-right libertarian point of view, and they opposed reform even before it passed," said Brian Rosman, research director of Health Care For All, a liberal advocacy group in Massachusetts.
The state requires people to buy insurance or pay a fine. That may affect how people answer Census questions about their insurance status, Cannon argues.
Nondenial Denials? Some respondents don't answer questions on insurance status. The Census tries to correct for that by comparing them with people with similar characteristics who did answer the question. "We find evidence that these imputations rose in Massachusetts, not just after the law passed but relative to other New England states," said Cannon. "Using those other states as controls, it shows that nonresponse to the health insurance question is growing in Massachusetts for some reason that is unique to the Bay State."
Cannon and Yelowitz find that the uninsured rate could be closer to 5.1% vs. the official 3.8%. "And that's only one strategy for concealing your health insurance status from the government pollster," said Cannon. "You can refuse to participate in the survey or you can lie."
Rosman isn't buying any of it. "When confronted with numbers that don't support their conclusion, Cato makes up a reason why people are lying," he said. "No one goes to jail here for not having insurance. It's no different than other issues on your taxes." He adds that reports looking at people — not samples — are "completely consistent with each other."
SOURCE
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