Wednesday, January 31, 2007


This is the sort of thing the Democrats are wishing onto Americans -- people being sent blind by a system that refuses to treat them

A former MP who is going blind is set to sue the NHS after it refused to give her a new drug that could help save her sight, it emerged yesterday. Veteran left-winger Alice Mahon has lost most of the sight in one eye while waiting for treatment. The former Labour MP - and thorn in Tony Blair's side - is now preparing to go to the High Court to make the Health Service pay for a drug that can help her.

Miss Mahon, aged 69, was told by her consultant in November that she should get Lucentis - one of a new generation of drugs for wet age-related macular degeneration (AMD). The drug, which costs 12,000 pounds for a year's treatment, stabilises vision loss and may reverse the damage, but needs to be given quickly because the sight can rapidly deteriorate. But an urgent application for funding from Calderdale primary care trust (PCT) was rejected because the Government's 'rationing' body had not yet approved the drug for NHS use.

Although Mrs Mahon is wating for the outcome of an appeal, she lost much of the vision in her left eye in the nine weeks since the original application. She has now been forced to pay more than 5,000 pounds for private treatment to stop herself going blind. The former Halifax Labour MP is now taking legal action in a move that could help an estimated 18,000 Britons who go blind each year due to wet AMD, with some denied funding by cash-strapped PCTs.

Mrs Mahon said: "I have been an ardent supporter of the NHS all my life, and now feel totally let down. "The excuses that PCTs are giving for not funding treatment are scandalously lame. "Everyone has a right to free treatment on the NHS for a condition that results in blindness and devastates lives. "Supporting people who are blind or partially sighted, who may need home help and suffer injuries from falls, is far more expensive than the treatment. "The Chancellor must ensure the NHS budget is large enough to fund such a basic health care need. "I have written personally to Gordon Brown, and not as yet received a reply."

Mrs Mahon, who is being treated at Calderdale Royal Hospital and has a "dry" form of AMD in her right eye, was turned down for funding in December by the PCT's exceptional cases committee. However, a patient leaflet prepared by the PCT last autumn claimed those using the drug "were very likely to enjoy stable vision" and over one-third got a significant improvement.

A study published in the New England Journal of Medicine showed 30 per cent of patients receiving monthly injections of the drug into the affected eye had a "marked improvement" in vision. It prevented vision loss in nine out of 10 patients. The drug targets abnormal blood vessels that grow behind the eyeball - these vessels can leak and cause damage to parts of the eye responsible for central vision.

Lucentis was licensed earlier this month but, along with another wet AMD drug called Macugen, will not be considered for approval by the National Institute for Health and Clinical Excellence (NICE) until October. [Take your time boys! Nothing is ever urgent in a bureaucracy!] However, Health Secretary Patricia Hewitt has made clear to PCTs that they cannot withhold NHS funding simply on the grounds that NICE has not made a decision.

Mrs Mahon's solicitor, Yogi Amin, from Irwin Mitchell, wrote to her PCT in Calderdale and also Kirklees PCT, which share an exceptional cases committee, saying their refusal to fund the drug breaches her human rights. The letter says the PCTs have until today to overturn their decision or "we will proceed with an application for judicial review in the High Court". It says "Mrs Mahon has been forced to fund her urgent treatment privately, for which she has had to pay the amount of 5,325 pounds in order to avoid losing her eyesight while her application was and her appeal is being considered." Mrs Mahon will be joined by other MPS in Parliament today to speak out against the refusal to fund treatment for wet AMD patients.

The Royal National Institute for the Blind (RNIB) has been campaigning to stop people going needlessly blind. It says PCTs can use their discretion when deciding whether to fund the drugs, yet some have imposed an outright ban while others wait until the patient has gone blind in one eye before treating the other. Steve Winyard, head of campaigns at the RNIB, said "Fifty people a day are being condemned to blindness because PCTs are refusing to fund a licensed treatment, even though it could save patients" sight. "The actions of these PCTs are simply unacceptable."

In the UK, 220,000 people with AMD registered blind or partially sighted. According to the RNIB, 57 per cent of all people newly-registered blind or partially sighted in the UK have AMD. A spokeswoman for Calderdale PCT said it did not comment on individual cases.


The U.S. tax-code quirk and the health care mess

Wading into the fraught issue of health care during his State of the Union address, President Bush noted that for most Americans, "private health insurance is the best way to meet their needs. But many Americans cannot afford a health insurance policy."

Why is health insurance so expensive? One explanation is that the extraordinary gains medical science has made over the last few decades come with hefty price tags. The revolution in cardiac care, the myriad new drugs, the invention of CAT scanners and MRIs, the ability to transplant organs -- these and so many other lifesaving medical miracles didn't come cheap. It stands to reason that insurance covering the cost of such miracles doesn't come cheap either.

But wait -- *does* it stand to reason? Information technology has exploded in recent decades too, yet computers have never been as affordable as they are now. Agriculture is far more advanced, and the quality and variety of food available to consumers far greater, than they were 50 years ago, yet the real cost of food has plummeted. The price of a primitive color television in 1954 was equal to three months' wages for an average American worker; today that worker gets a sparkling picture on a 25-inch screen for just three days of work.

"Why is it," asks David Gratzer, a physician and scholar at the Manhattan Institute, "that in every other field where enormous technological strides have been made, total costs have fallen over time, but in health care they have increased?" The answer, he writes in The Cure, a lively and engrossing new book on the American health care mess, is simple: Health care costs so much because most of us pay so little for it. And we pay so little -- out-of-pocket expenses amount to just 14 cents of every health dollar spent in this country -- because a third party nearly always picks up the tab. For most working Americans, that third party is an insurance company paid by their employers. (For the poor and elderly who rely on programs such as Medicare and Medicaid, it's the government.)

Why does it matter whether Americans pay for medical care directly or let insurers cover their bills? Because thrift and price awareness usually go out the window when we're spending other people's money. Under the present setup, most Americans have little incentive to be economical consumers of health care. As a result, health care expenditures -- and insurance premiums -- have been racing ahead at three and four times the rate of inflation.

All of this is due to a quirk in tax policy dating to World War II, when employers looking for a way to enhance workers' salaries without running afoul of federal wage controls hit on the idea of providing medical benefits. When the IRS agreed not to treat such benefits as taxable income, it triggered a far-reaching change in the way Americans paid for health care.

What had been a relatively free market in medical services, with patients transacting directly with doctors and hospitals, gave way to a third-party system, in which employers paid the insurance companies, and insurance companies paid the bills. Americans increasingly used insurance to cover routine medical expenses, not just major unexpected costs like hospitalization or surgery. Imagine what automobile insurance would cost, writes Gratzer, "if people insisted on plans that had [low] deductibles . . . or policies that included not just major body work, but also oil changes and gas."

To properly disentangle this snarl, Congress ought to end the tax exclusion that causes it. Employers don't generally provide workers with homeowner's or auto insurance, or for that matter with food, clothing, or housing. Ideally, medical treatment would be handled no differently, and Americans would benefit from a far more robust and competitive healthcare market than they do now.

But after 60 years, it's probably infeasible to simply eliminate the tax deduction altogether, so the president has proposed a second-best alternative: eliminating the bias for employer-provided health insurance by giving every family with health insurance a $15,000 deduction ($7,500 for individuals) -- no matter where their insurance comes from or how little it costs. Employer-sponsored insurance would become taxable income -- but since most insurance policies cost less than $15,000, most employees would enjoy a significant tax break.

Under the Bush plan, the tax code would no longer penalize Americans who don't get health insurance through their employers, since they too would be eligible for the $15,000 tax deduction. Millions of others would have an incentive to shop around for a health plan less pricey than the one available through work, since cheaper insurance would end up meaning a bigger tax break. That would put pressure on insurers to develop more high-deductible, low-premium plans -- and on health care consumers to start paying attention to prices. Bush's prescription won't cure everything that ails American health care. But there's no question it would make an excellent start.



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

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


Tuesday, January 30, 2007


Surgery by doctors who have had no sleep for days!! There's nothing like the government to look after you! Thankfully

A trainee surgeon has told how she feared she would kill a patient, after being forced to work four days straight without sleep. The surgical registrar, from a major southeast Queensland public hospital, said she routinely had to operate on patients when she was so tired she felt drunk. I haven't killed someone yet, but probably one day it's going to happen because of my lack of sleep," she told The Sunday Mail. "I'm regularly operating on people when I haven't had sleep for two days. I know I'm making mistakes, I am just fortunate they haven't been any huge errors. "I know some of my colleagues have made errors and they're also worried."

The medic said anyone who spoke out risked being kicked off the surgical training program. She said that over the Christmas long weekend, she worked from Friday to Monday without sleeping at all. Junior doctors - residents and interns - are also working excessive shifts on relatively low pay while they try to establish themselves. They say "mandatory" eight-hour breaks between shifts are non-existent.

"It feels a bit like when you were 16 and you had a really big binge-drinking session," said the surgeon. "Of most concern to me is, I think, your hand-eye co-ordination skills go after two days. Performing surgery in those conditions is poor." She said the most dangerous shifts were on weekends, when doctors were commonly "on call". The weekend shift involves staying at the hospital from 7am Friday until Monday afternoon, and sleeping no more than three hours at a time. "We just need our mandatory break. You need someone to cover you," she said.

The surgeon spoke out as Australian Salaried Medical Officers' Federation president Don Kane seeks an urgent meeting with Health Minister Stephen Robertson to try to combat dangerous work hours. "Queensland Health has sat on its hands and done nothing. It is all promises," Dr Kane said. The union has been keeping examples of "horror shifts" to expose the dangerous working hours. In some cases, doctors had reported working three weeks without a day off.

The shifts continue five years after an overworked junior doctor was involved in a young girl's death. Elise Neville, 10, died two days after being sent home by a junior doctor in charge of Caloundra Hospital's emergency ward in 2002. Dr. Doneman was 20 hours into a 24 hour shift. He did not admit the girl to hospital or perform tests that would have shown she had a serious head injury.

Judge Debbie Richards, from the Queensland Health Practitioners Tribunal, said in 2004: "If this tragedy leads to nothing else, it should lead to the abolition of such brutally long shift hours." Dr Kane said little had changed since.

Health Minister Stephen Robertson said he was concerned by the doctor's comments but blamed long hours on a national shortage of doctors and said hospitals had always used on-call shifts. "That's been a feature of doctors' working hours for you would have to close hospitals, particularly in rural Queensland." He said the Government had been on a recruitment drive to increase the number of doctors in the state and decrease working hours. Rural Doctors Association president Christian Rowan said solo doctors in remote areas were routinely rostered to work 22 days on, then six days off. The Australian Medical Association's Alex Markwell said Queensland's public hospitals relied on junior medics working long hours. "If they go home because they're tired, there's not necessarily anyone else to do their work. People can die if there's no doctors around," Dr. Markwell said.

The above report by David Murray appeared in the Brisbane "Sunday Mail" on January 28, 2007

NHS patients need to buy organs from Third World to survive

British doctors had written "Joseph" off, saying he was too old to be treated on the National Health Service. But, at 72, he flew to Asia for a double-lung transplant and now claims to be the oldest man in Britain to have survived the operation. Joseph - not his real name - is one of a growing number of Britons who, frustrated with NHS waiting lists, are venturing into the murky world of organ brokers offering kidneys and livers harvested from the poorest quarters of the world, sometimes illicitly. Buying an organ is illegal in Britain, but generally not in Asia.

A former factory worker, Joseph is far from wealthy. He owes his life to his two daughters who used their savings and sold a holiday home to pay the 220,000 pound bill. "Without their sacrifice I would probably have been dead by now," said Joseph. He remains unsure where his new lungs came from. The Singapore surgeons told him only that they had been donated by the family of a much younger man who died from an unspecified head trauma.

His daughters are delighted with his recovery. "You cannot guarantee the success of any major operation. But now he is out hiking," said the eldest last week. "Just looking at him, smiling, brings tears to my eyes."

The family acknowledges its debt to James Cohan, a self-styled "organ transplant co-ordinator" from California who spoke for the first time last week about his pioneering role in the booming organ trade. Cohan has been "matchmaking" dangerously ill Europeans and Americans with Asian and African hospitals for 20 years. He says that over the past decade British inquiries have grown from a trickle into a flood.

Cohan, a tall, slim 66-year-old who lives in the hills outside Los Angeles, works like a stock-market day trader - with a phone and internet connection in a bedroom. He says he has seldom left home since he was arrested in Italy in 1998 for allegedly dealing in stolen body parts from South Africa, charges that were later dismissed. He says he breaks no American laws and deals with 15 hospitals that he has verified are using only legally donated organs.

A cultural and legal mismatch between Asia and the West has led to the current "grey market" where criminal gangs thrive and the sick die on waiting lists, he claimed. "Nightmarish tales of children snatched from streets for their organs will carry on until supply and demand are balanced. Right now there are 300,000 people on waiting lists whose lives could be saved with a more open approach to donation," he said.

This week David Kilgour, a former Canadian MP, will publish a follow-up report to his 2006 investigation that forced China to admit its hospitals sold organs taken from executed prisoners. Kilgour is concerned that executions are timed to coincide with operations, and that surging demand may even influence sentencing.

In May, Nancy Scheper-Hughes, professor of medical anthropology at the University of California, Berkeley, will publish The Ends of the Body, which will expose the horrors of the 300m-a-year trade. She will name Asian towns known as "kidney zones", where hundreds of locals bear a diagonal scar marking the removal of an organ for 300 pounds, and have suffered ill health ever since. "This is a cruel, unfair trade," she said. "Technology and greed have far outstripped any government's abilities to regulate it. It's out of control."

Doctors at the Aadil hospital in Lahore, Pakistan, which charges 7,500 for a kidney transplant and deals with up to 30 western organ brokers at a time, say they seek healthy organs from dozens of countries. "Our priority is health, not politics," said a spokesman last week. "We always abide by current laws."

However, surgeons have warned that the failure rate of overseas operations is high and have called for the trade to be banned. Professor Nadey Hakim, president of the International College of Surgeons, said that more than half such operations end up with a bad transplant or the patients die. "The donors get paid very little. The recipient who gets the organ is not treated well either and they get sent back in a very bad condition," he said. I am betting that patients get BETTER treatment in Singapore than they do in the filthy NHS. Han Chinese surgeons are often brilliant and Singapore is immaculate.



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

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


Monday, January 29, 2007


California Governor Arnold Schwarzenegger kicked off his first full term in office this week by announcing during his state-of-the-state address that he intends to implement a state health insurance plan to cover all residents, including illegal aliens. But before riding the universal health care train too far, Gov. Schwarzenegger might want to make a stop in Nashville to see exactly how such a plan has actually worked for Tennessee, where that state's abysmal TennCare program has forced dozens of hospitals out of business, pushed thousands of doctors and other health care professionals out of the state, destroyed any semblance of competitive health insurance market, and nearly drove the state government into bankruptcy.

Tennessee's disastrous experiment with universal health care coverage began in 1994 in the wake of Hillary Clinton's failed national single-payer plan. The Clinton Administration was anxious to see the program implemented on a smaller scale, so Vice President Al Gore was tasked to enlist then-Tennessee Democrat Gov. Ned McWherter to agree to the plan with the assurance that such a program would save the state money in the long-run and that the federal government would kick in the majority of the cost of running the program.

By the year 2000, however, McWherter was long gone and TennCare was now the problem of the hapless Republican, Gov. Don Sundquist. Just days after Sundquist's successful 1999 reelection campaign came to a close, during which he had repeatedly vowed never to consider instituting a state income tax, his fiscal advisors broke the sad news that the state was going broke as a result of TennCare. The program had become the line item that had consumed the state budget - ballooning more than 200 percent in less than six years.

When the Tennessee Democrats began the TennCare program the intent was, much like Gov. Schwarzenegger's proposal, to make sure that the state's uninsured and those who were uninsurable had health care coverage. Almost immediately, the ranks of the uninsured exploded as employers dropped at-risk employees or eliminated their plans altogether, effectively shifting the risk or the entire cost of employees' health care to taxpayers. In short order, one quarter of the state's population was on TennCare.

Of course, TennCare had the full backing of Tennessee's health insurance companies, who also had their risk covered as they employees they lost through their corporate policies came right back as TennCare enrollees. In fact, the largest insurer in the state, Blue Cross/Blue Shield of Tennessee, was openly selling uninsurable letters to anyone with any remotely identifiable risk for $25 - all with the awareness and approval of state authorities.

When things came crashing down with TennCare during the 2000 legislative session, I was able to witness the spectacle first-hand. At the time, I was a policy analyst for the Tennessee Institute for Public Policy, and the state budget was one my issues I covered. Almost daily, news stories would run about the rampant fraud within TennCare - enrollees living in a Trump Tower penthouse in Florida, Fortune 500 CEOs flying their ailing children to Tennessee on their private planes to get qualified for TennCare and to receive organ transplants, and thousands of enrollees whose only connection to Tennessee was a P.O. box located in one of the many border cities around the state. One TennCare director confessed during a legislative hearing that the department estimated that one-quarter of enrollees (250,000+) were fraudulent or didn't actually qualify for the program. Needless to say, in the matter of weeks that TennCare director was out of a job.

Fraud, however, wasn't the only issue. The financial savings promised by Al Gore and the Clinton Administration were supposed to come from the implementation of managed care within the program. But as soon as TennCare was launched, liberal "public advocacy" groups waged a litigation campaign to force the state to cover more under the program. By 2000, the benefits under TennCare were so generous as a result of court-orders (many agreed to by the state) that one could not find a private insurance policy with such extensive coverage no matter how much you had available to spend. Managed care simply didn't exist, and neither did the promised savings. And anytime the state tried to get the cheats and free-riders off the program, the same liberal "public advocacy" groups successfully sued to prevent the state from eliminating them from the TennCare rolls.

The state, however, didn't bear the entire brunt of TennCare: hospitals and doctors also bore a large part of the costs associated with Tennessee's universal health care experiment. In the first six years of TennCare, a dozen hospitals had closed around the state - all of them in underserved areas. Physicians were leaving the state in droves. And as the quality of health care continued to decline for all Tennesseans, taxpayers were getting stuck with the bill.

But rather than address the 800-pound gorilla sitting in the corner of the smoke-filled hearing rooms at Legislative Plaza, Gov. Sundquist and the Democratic legislative leaders settled on the easiest way to deal with the problem - a state income tax (Tennessee being one of the few states without one). This proposal was met with overwhelming outrage by the people of Tennessee. As the politicians plotted during the 2000 legislative session to secure enough votes to push the income tax through, the public rage at the TennCare program simmered just below the boiling point. Almost daily I was being interviewed by talk radio hosts about a study I had authored identifying the glaring problems with TennCare and proposing a radical plan to completely overhaul the system. In a matter of weeks, even as state officials and the mainstream media (including Al Gore's former employer, The Tennessean) peddled the lie at every opportunity that TennCare was saving the state money, TennCare became the focal point of the state income tax debate.

Then, as it looked as though the income tax was going to get pushed through and TennCare receive a reprieve in the last few days of the legislative session in June 2000, something amazing happened - the civic pot finally boiled over and the citizens of Tennessee rose up in open revolt. It began in the early morning hours of the day that the legislature was scheduled to vote on the tax proposal. The talk radio stations had set up shop in Legislative Plaza that morning, and I was running back and forth between their respective locations giving interviews.

At 7:30am, at the instigation of the talk radio hosts, cars, trucks, and virtually every other type of motor vehicle you could imagine began circling the state capitol blaring their horns. Thousands of angry citizens swarmed into downtown Nashville and traffic all around town came to a virtual standstill. By noon that day, with the deafening sound of car horns continuing to blare non-stop (in fact, I lost part of my hearing that fateful day), legislators supporting the income tax called in the State Troopers to bar the doors of the state capitol. One pro-tax legislator was carted away by ambulance with heart problems - threatening the razor-thin majority in support of the tax hike.

By late afternoon, the legislature had abandoned the income tax proposal entirely, closed the state budget gaps with temporary measures, and ended the legislative session for the year while they could still get out of town with their lives. Car horns continued to blare well into the night. In all my years working in public policy in Washington D.C. and several state capitals, it is the most exhilarating experience I have been privileged to be witness to and be a part of.

The Tennessee Tax Revolt of 2000 denied politicians the only financial avenue to keep TennCare afloat as it was. In the political aftermath, Gov. Don Sundquist became the most reviled governor in Tennessee history (no mean feat in a state where political scandal and corruption have been the norm), and many of the state legislators who had supported the state income tax chose not to run for reelection the next election cycle faced with the inevitability that they would be tossed from office; many of those legislators that tried to keep their seats got the boot. Sundquist's successor, Democratic Governor Phil Bredesen, has been forced to dismantle the program a piece at a time, and the bloated remains of TennCare still stress the state budget.

The catastrophic consequences of the TennCare experiment have been the dramatic lowering of the quality of health care statewide due to numerous hospital closures and the exit of countless doctors and health care professionals to other states, the neglect of many other critical areas of the state budget to cover TennCare costs, and the utter devastation of the health insurance market in Tennessee (at the time my study was published, only seven health insurance carriers in the country would write policies in Tennessee; I understand that it is even less today).

There is much for Gov. Schwarzenegger to learn from Tennessee's first-hand experience with universal health care before committing the largest state in the US to it. But perhaps the most important is that trying to defy virtually every known law of economics is a fool's proposition, no matter how loudly you are cheered on by the media, state bureaucrats, liberal activists and Democratic legislators in Sacramento and Washington D.C. When the fiscal music stops, the taxpayers will be the only one left without a chair.

Secondly, beware of the siren songs of big business. In Tennessee's case, many employers gladly dumped their health care plans and transferred their employees to the public dole and added that money to their bottom line. Gov. Schwarzenegger hopes to counteract that effect under his plan by making almost all employers who do not have health plans to pay additional business taxes. But with all employers constantly facing astronomical increases in premiums, they will gladly pay the new tax to unload their liability. Additionally, the health insurance companies that clamored loudest for TennCare are the few that still remain in the state today, with the state covering all of their riskiest cases. They have made out like bandits.

Finally, California is already seeing many workers and businesses protesting that state's high taxes and near-tyrannical regulatory system by voting with their feet. Nevada, Arizona, and Oregon have been the unlikely beneficiaries of the Golden State's tax-and-spend, regulate-and-oppress policies. Destroying the state's health care system and condemning California taxpayers to perpetual tax increases to finance a cannibalistic universal health care plan is unlikely to stop their rapid egress.

The staggering number of uninsured Americans is truly a tragedy, and Gov. Schwarzenegger has his heart in the right place by trying to tackle the problem head-on. But trying to solve the problem with taxpayer-financed universal health care coverage is a prescription for an unmitigated fiscal and health care disaster. If he doubts the veracity of these claims, the next time he needs a heart valve replaced or a broken leg repaired, he should seek care in Memphis or Nashville and see first-hand the wonders that universal health care have wrought there.


NHS managers "incompetent"

The man who narrowly missed out on securing the post of NHS chief executive has launched a stinging attack on NHS management. In a new report for independent think tank Reform, Building a World Class NHS, private sector manager Ian Smith condemns what he perceives as “dysfunctional organisation and poor management at all levels”.

Mr Smith reserves his greatest criticism for DoH civil servants and senior NHS managers, who he says are “not competent” to manage the reforms required to cut waste and improve patient value. Front-line NHS managers are let off more lightly. The report says these staff are “victims of a centralised bureaucracy” and are being distracted from longer term objectives by the latest government fads.

A lack of clinician engagement is identified as a key problem in NHS management. The report says clinicians are “prevented” from using their expertise to improve patient care and often feel deliberately excluded by management. This is despite them being responsible for 75 per cent of health-care expenditure.

The report proposes that the healthcare system is de-politicised and a clear vision for the future established. More managers with private sector experience should be recruited, and greater levels of competition introduced. However, Mr Smith points out that most of this competition should come from foundation trusts as opposed to the private sector.

Andrew Haldenby, director of Reform, said the report offered a unique opportunity “to see what might have been” if Mr Smith had been appointed NHS chief executive last year, instead of David Nicholson. Mr Haldenby added: “The health service needs relentless focus in improving services for patients and value for money. If any Government is to achieve that … the introduction of modern management practise is a minimum condition.” A second report by Reform argued that NHS deficits should be written off, so that service reconfiguration is not confused by efforts to reduce costs.



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

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


Sunday, January 28, 2007

America's Next Great Debate: Health Care

Post lifted from MedGadget

Recently, Gov. Schwarzenegger announced his plan to provide universal coverage for health care and declared a war on physicians. We were shocked and appalled to learn that the Governator actually wants to penalize us, clinical providers, with a 2% gross revenue tax that will hit MDs with high operating costs especially hard. His action comes at a time when we are already experiencing unprecedented levels of loss of economic liberties and an ever increasing regulation of our profession.

Even more alarming is the acceptance with which this plan, and others like it, are supported by many of our fellow physicians, politicians and the media. Supporters of universal health care--i.e. socialized medicine--would have us believe that countries like Canada and Sweden provide superior care under their government controlled system. Furthermore, they would like to shame us for being 'the only advanced country without universal health care.' Yet, where does the world come for its health care? America. Where did Italy's richest politician go to have his pacemaker installed? Ohio. When confronted with examples like this, supporters of universal coverage don't deny the quality of care America provides but argue ours is a broken system that only provides quality care for the privileged. They would have us believe that socialized systems provide an optimal level of care, available 'for free' to the masses, yet they refuse to acknowledge the very real, very significant problems plaguing these systems. Should we ignore the stories of patients who had to flee Canada or Britain to receive their life saving medical treatment? How about nuclear medicine residents from Canada that have to go to the US to be trained in positron emission tomography? Are these isolated incidences? No. They are an inherent pathogen of every government run system.

To further advance our case, we have contacted Mark Steyn, a best selling author, who in his recent book America Alone: The End of the World as We Know It has an interesting description of health care in Canada. Mr. Steyn has given us kind permission to reproduce the passage from his book, and we are very grateful to him for the opportunity to present our readers with a thought provoking prospect of the future that might soon come to these shores.

By Mark Steyn:

In 2004, Debrah Cornthwaite gave birth to twin boys at the Royal Alexandra Hospital in Edmonton. That's in Alberta. Mrs. Cornthwaite had begun the big day by going to her local maternity ward at Langley Memorial Hospital. That's in British Columbia. They told her, yes, your contractions are coming every four minutes, but sorry, we don't have any beds. And, after they'd checked with the bed-availability helpline "BC Bedline," they brought her the further good news that there was not a hospital in the province in which she chould deliver her babies. There followed seven hours of red tape and paperwork. Then, late in the evening, she was driven to the airport and put on a chartered twin-prop to Edmonton. In the course of the flight, the contractions increased to every two and a half minutes--and most Lamaze classes don't teach timing your breathing to turbulence over the Rockies. How many Americans would want to do that on delivery day? You pack your bag and head to your local hospital in Oakland, and they say: Not to worry, we've got a bed for you in Denver.

Euro-Canadian socialized health care is, in essence, subsidized by American taxpayers: since the end of World War Two, Washington has assumed the defense costs of its allies, thereby freeing up those countries to spend their tax revenues on lavish social programs. But, if America follows the Hutton plan and "joins the world," it will reduce its defense expenditures to Euro-Canadian levels. So the next time a tsunami hits Sri-Lanka or Indonesia there will be no carrier groups to divert and save lives. So more people will die, waiting the weeks and weeks it took the sleepytime gals at the United Nations to arrive. Were America to "join the world," it would have to reduce its funding of the UN and other world bodies to European levels. And it might have to scale back its domestic agencies so that they're no longer able to serve in effect as international ones. Which will be tough when some kid in some village on the other side of the world comes down with some weird illness no one's seen before and they want to FedEx the test tube to the Centers for Disease Control in Atlanta to figure out what's going on.

Indeed, even relatively advanced societies admired by the likes of Will Hutton take it as routine that the CDC is a kind of Health Ministry of last resort. When SARS leapt from China to infect Toronto's hospitals in 2003, the principal contribution of the WHO (World Health Organization) was to issue a travel advisory warning visitors to steer clear of Ontario, leaving it to the CDC to provide advanced and practical analysis of the problem. Toronto's mayor, Mel Lastman, had a hard time keeping track of all the aconyms, and in one press conference launched into a bitter attack on the damaging effects of the travel advisory issued by the CDC.

The doctor next to him tried to correct him: "Who," she said. "The CDC," he repeated. "Who," she said. "The CDC," he repeated, wondering why she hadn't heard his answer to the question the first time. This diseased version of the Abbott and Costello routine went on a while longer, before the doc realized she had to spell it out: W-H-O, the World Health Organization. "Oh, yeah. Them, too," said Hizzoner.

Yet under the who's-on-first shtick lay an important truth: if an infection shows up in an Atlanta hospital, no American doctor looks for guidance from a Canadian government agency. But if it shows up in a Toronto hospital, the Ontario health system takes it for granted the best minds of the CDC in Atlanta will be staying late at the office trying to work out what's going on.

The answer to that Canadian doctor's vaudeville feed-- "Who's on first?"-- is America. When something goes awry, in a Sri Lankan beach resort or a Toronto hospital, it's the hyperpower who shows up. America doesn't need to "join the world": it already provides a lot of the world's infrastructure.


A young Indian MP told me a story about the Communist chief minister of the state of West Bengal, Jyoti Basu. Basu’s policies weren’t always popular, and there would often be large demonstrations and sit-down protests outside his office by the disaffected. Basu’s way of dealing with these outcries was to join them. He would slip unobtrusively into the crowd and eventually be found sitting among the protesters, holding a placard or chanting a slogan denouncing his own follies.

Perhaps Mr Basu’s disconcerting tactics have had a wider press than I realised, because in the past few weeks his approach seems to have caught on among British ministers. The Labour Party chair, Hazel Blears, has joined protests in her constituency aimed at saving the local maternity unit from merger. The Chief Whip, Jacqui Smith, has been trying to defend the status quo at the Alexandra Hospital in Redditch, and — perhaps most bizarrely — the junior health minister, Ivan Lewis, has been doing the same with regard to facilities at the Fairfield Hospital in Bury.

The national policy, of course, is to move some facilities to centres of excellence, which would provide a higher standard of medical care. Inevitably, because this involves shutting down smaller local units, the policy becomes the focus of local campaigning which — in Britain — is usually devoted to stopping something from happening, and exercises our native ingenuity at full stretch in discovering reasons as to why it shouldn’t.

Naysaying can sometimes be costly. A recent report from the Institute for Public Policy Research argued that successful resistance to the closure of some local A&E departments might well compromise patient care and lead to preventable deaths. “If heart attack victims are taken by ambulance past their local hospital to a specialist centre, they will be more likely to survive,” said the IPPR.

Which is why the Government, of which these three are members, supported the policy. Mr Lewis still does, but not in Bury. Ms Blears does, but not in Salford. Ms Smith does, but not in Redditch. Unsurprisingly the public has noticed that the policy seems to be right in general but wrong in all its specific applications. A BBC poll last weekend registered 72 per cent believing that it was hypocritical for ministers to campaign against the local consequences of their own national policies.

So we are at a strange moment in the recent history of the NHS, its strangeness emphasised because just when there ought to be a sharp political debate about its future, the Conservative Party has decided that it too will join the movement against change, and sit Basu-like on the steps.

By 2008 the Government will have raised the proportion of GDP spent on health in this country from 6.5 per cent to more than 9 per cent, and doubled expenditure in real terms. For that money it has managed a significant reduction in waiting times, an improvement in some key health indicators, a huge increase in numbers of NHS employees and a whacking great pay rise for doctors. Such a government funding bonanza couldn’t last, and the rate of growth will now slow substantially.

Last week we were told by Sir Michael Rawlins, head of the National Institute for Health and Clinical Excellence (NICE), that healthcare spending would have to rise above 9.3 per cent of GDP in the future to deal with medical inflation and the ageing population. “It is the elephant in the room, really,” he said. PricewaterhouseCoopers has estimated that there is a tax or an expenditure-cutting crunch coming some time soon if we are to keep up with the desire to maintain or improve health outcomes.

The obvious answer, to judge by yesterday’s news story, is for everyone to get a dog. The even more obvious answer is for everyone to eat properly and take exercise. So we won’t do that. Sections of the Labour Party, looking to its next leader, have begun agitating for a substantial rise in taxes, while simultaneously wanting an end to targets and a reduced reliance on involving the private sector in health. Which will leave us with the GPs’ contract story in spades, whereby we spend lots more money and don’t get much more work.

This should be the cue for the entrance, like a fragrant wind over a stagnant pool, of Mr David Cameron. Yesterday the Conservatives unveiled some of their new thinking on the radical policies needed to deal with the funding gap and get us all looking at health in a different way. Mr Cameron might well have noted that many of Labour’s early failures in health were as a consequence of suggesting, before 1997, that just by changing a policy (in Mr Blair’s case, the internal market), and spending a bit, lots of resource would be made available for patient care. Labour is still paying for that approach.

Mr Cameron must admire the early Blair because he seems hell-bent on repeating the error. First with his absurd Stop the NHS Cuts campaign, in which petitioners can “call on Gordon Brown to stop his mismanagement of the NHS”, and not — note — to provide any extra money, as if this absence of “mismanagement” will magically stop trusts running deficits. And, secondly, with the notion, promulgated yesterday, that all will be well if you just get rid of Labour’s “national top-down” waiting-list and other targets and replace them with Tory health outcome targets, to be called “objectives”, and somehow to be local and bottom-up. The difference is, of course, that everyone in the public sector knows that targets must be hit, while an objective is something you make progress towards. If you can. And if you can’t . . .

As to money: “Tony Blair’s great pledge,” said Mr Cameron, “was to raise health spending in Britain to the European average. Our aim is different — we won’t just concentrate on the money going in, but on what comes out as well.” So nothing about raising money from individuals by extending the scope of charging, which will shift some of the burden away from tax, and which is done in many European countries. Nothing about funding following the patient. Nothing at all, really.

Mr Cameron may well believe that his best chance of power comes from neutralising the fears of a Conservative government, only to be radical once in power. But history suggests that you can only do that if your radicalism goes with the grain of your assault on power. For their own long-term good, and ours, the Tories should be offering what Labour may be too conservative, too hidebound to suggest. They aren’t; and — for all the Basu-like nonsense from his leading colleagues — there still seems to be more chance of radical policies from Gordon Brown than from the Opposition.



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

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


Saturday, January 27, 2007

Universal Health Care: A lesson from Japan

If we in California and the United States had wings and infinite funds, we could fly the best available health care to everyone here, there, and everywhere. The ideological concept of "universal care" looks right, sounds moral, and feels good. California's Gov. Arnold Schwarzenegger deserves some credit for trying something bold. The problem is that history shows these programs do not work.

They have failed in Canada, Great Britain, France, Germany, and Sweden. Coverage has become too costly in Massachusetts in less than a year.

The etiology of health-care fever is always insufficient funds. The governor's plan is estimated to cost 12 billion a year. But if you believe that number, we have a long wide concrete bridge over Newport Bay to sell you for 23 bucks.

When the level of money injected into the blood sinks too low, the medical outcomes are rationing and restraint, accompanied by chronically high moral dilemmas. Medical care will be rationed, one way or another, so long as the government has finite resources and so long as people keep confusing insurance with fee-for-service.

Now, according to a recent release by the American Association of Physicians and Surgeons, it is failing in Japan. If universal care were the genuine cure-all, the one country where it should work is Japan. They have a homogenous population, healthier lifestyle, eat more fish and soy, more vegetables and far less obesity than here. If universal care does not work there why should it work anywhere?

According to Japanese legislator Takashi Yamamoto, who was just diagnosed with cancer, "abandoned cancer refugees are roaming the Japanese archipelago." Patients are told they1ll never get better, even when treatments exist, and many are not even informed of their diagnoses. Cancer mortality rates in Japan have been steadily climbing and are now more than 250 per 100,000, while U.S. rates are now around 180 per 100,000. Japanese public television showed the stark contrast. In the U.S., multiple specialists meet to discuss a cancer patient1s care. In Japan, a single doctor usually makes the diagnosis and carries out treatment with minimal consultation

While Japanese patients want American-style treatment, their policy-makers are alarmed. With a huge national debt and corporations worried about higher taxes, they say Japan can't afford to pour money into treatments that can1t extend life span by very much. "America did too much of this and that1s why their medical costs have grown," said Masaharu Nakajima, a surgeon and former director of the Health Bureau at the Ministry of Health, Labor and Welfare.

Since Japan enacted universal health insurance in the early 1960s, the emphasis has been on a minimum standard of care for all. People must pay a monthly health-insurance fee, and large companies pay also. Coverage decisions, doctors' pay, and other rules are set by the central government. Japanese doctors complain that they have no time to spend with patients. The experience of seeing a doctor is summarized as "a three-hour wait for a three-minute visit."

"Our rights as individuals are not being recognized," stated lung cancer patient Hidesuke Hashimoto. Mr. Hashimoto, a former math teacher, undertook to study his options on his own, moving along to a different hospital when told there was nothing more that could be done, and sometimes paying out of pocket (Landers, Wall Street Journal 1/11/07).

Commenting on the WSJ article, Craig Cantoni, a columnist in Scottsdale, Ariz., writes: "Like nationalized health care in other countries, the Japanese system is based on the premise that the state owns your body." Therefore, "the state can dictate what medical care can be withheld from you, either by policy or by making you wait so long for care that you die in the mean time. Nor is [this] justified by the fact that Japan spends about half as much per capita on health care as the United States, or by the fact that the Japanese have a longer life expectancy."

If rights are seized for reasons of cost or efficiency, no right is safe from do-gooders and busybodies, from lawyers, politicians, and bureaucrats, and from the tyranny of the majority. If the universal health-care system is failing in Japan, it will fail in California, just as in Massachusetts or any other state that experiments with it.


NHS cash crisis could cost diabetic children limbs

Thousands of diabetic children could risk losing limbs because the NHS cash crisis is hitting services, said a report out on Wednesday. Four out of five diabetic children have poor glucose control, putting them at risk of developing complications, it said. In the UK, there are 20,000 children under the age of 15 with type 1 diabetes, which means sufferers are dependant on insulin. Another 1,000 children have type 2, which is associated with obesity, but many more youngsters are undiagnosed.

The report, from the charity Diabetes UK, said there were poor services despite Government targets to provide good paediatric care. Comparing NHS performance between 2005 and 2006, it said services for children with diabetes had got worse in 75% of the areas studied in England. The cash crisis means Paediatric Diabetes Specialist Nurses (PDSNs) are overstretched, it said. According to the Royal College of Nursing, there should be no more than 70 children to each nurse but some NHS trusts have caseloads of up to 300 children, meaning PDSNs take on more. Almost every region in England has seen an increase in the number of children each PDSN manages, the reports said. Over a third (40%) of trusts have no protocols for transferring children into adult diabetic care while nearly a third of youngsters who want psychological support do not receive it, it added.

Douglas Smallwood, chief executive of Diabetes UK, said: 'No wonder 80% of children have poor blood glucose control. 'Most are struggling to even see a specialist nurse, so any additional support is out of the question. 'With the inevitable explosion of children with type 2 diabetes, with no additional resources, nurses will be faced with ever increasing caseloads. 'We can't afford to wait until our children start to lose their sight or need kidney dialysis before we make sure services improve. 'It is time resources are provided to supply the best possible specialised care and support for children with diabetes.'

A 'Diabetes InfoBank' is also being launched today, which will show progress in meeting Government targets. People will be able to access information on diabetic care in their area by going to



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

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


Friday, January 26, 2007

Chronic NHS delays turn fatal: Toddler with minor burns dies after a four-hour wait in hospital

And it sounds like the actual cause of death was one of the superbugs that are rife in dirty NHS hospitals

A father described yesterday how he watched helplessly as his 13-month-old son died after a four-hour hospital wait because doctors said that they were too busy to treat him. Zia Islam said that Ahil was taken to hospital after he suffered minor burns when a cup of tea fell on him at home.

Giving evidence at the child’s inquest, Mr Islam, a 37-year-old IT consultant from Watford, said that Ahil was transferred from a specialist burns unit to Watford General Hospital in October 2005 when his condition took a turn for the worse a few days after the mishap.

The boy and his mother arrived at 11am at the hospital’s Accident & Emergency department, where he later joined them. He said that despite the infant starting a fever, vomiting and suffering severe diarrhoea, they were kept waiting for four hours.

Mr Islam claimed that he and his wife, Nazmin, were treated as though there was “nothing wrong” with their son.

He said: “When I got to A&E, my wife and Ahil were in the waiting room. He was crying and I asked, ‘What are you both doing here... haven’t you been seen yet?’ I was getting very anxious.

“One doctor told me Ahil was seriously sick, another told me they were all busy. Before anyone could see him properly, he was suffering from extreme diarrhoea in the waiting room. Every time a doctor came past, he was getting progressively weaker.” The senior house officer examined Ahil nearly 90 minutes after his arrival. He thought he might have a chest infection and sent him for X-rays.

Mr Islam added: “As time progressed he was getting weaker, he was crying but he was beginning to lie still. At 2.15pm he went to the cubicle for a blood test. At around 3.45pm his breathing deteriorated, his eyes closed, and the doctors tried to resuscitate him.

“The only time there was a sense of urgency was when they tried to resuscitate him.When you are the parent of a very sick child, there is a limit to what you can do. You cannot offend someone or you will not get the best out of them.”

He said that he felt that he had not done everything possible. “I did not shout or make a scene — if I had we might not be sitting here today.” The hospital has admitted liability.

Dr Craig Platt, a paediatric pathologist at Guy’s and St Thomas’ Hospital, said that the cause of death was “most likely” to have been from a blood infection known as Staphylococcus aureus septicaemia triggered by 3 per cent burns. The infection is found in nearly half of children and normally remains dormant. However, in Ahil it caused a condition similar to toxic shock syndrome.

Ahil was first taken to the Watford casualty unit after the accident at home on September 30. He was transferred to the burns unit at Mount Vernon Hospital, northwest London, and discharged after treatment. But over the next two days he developed a fever, vomiting and then severe diarrhoea. His condition worsened and his parents took him back to Mount Vernon where he was kept in overnight. The next morning doctors decided he needed emergency treatment and he was sent back to Watford.


National Center for Public Policy Research Applauds President Bush's State of the Union Health Care Proposals

The National Center for Public Policy Research applauds President Bush's State of the Union proposal to change the tax treatment of health insurance. Under current law, only employers receive a tax deduction for providing health insurance to their employees, and the deduction is unlimited. President Bush's proposal lets individuals who purchase health insurance have the same tax deduction. It also puts a limit on the tax deduction of $7,000 for an individual and $15,000 for a family. "That is the best idea for health insurance since the enactment of health savings accounts," said NCPPR senior policy analyst David Hogberg. "This really helps level the playing field for the tax treatment of health insurance." Presently the tax code favors employees receiving their health insurance through their employer. "That really puts individuals at a disadvantage," said Hogberg. "This change will help lower the cost for those people who purchase insurance on the individual market."

The proposal to limit the tax deduction also deserves praise. With the current unlimited tax deduction, employees have more incentive to demand higher cost insurance policies that cover every little health expense. This leads to higher demand for health care, which leads to higher health care costs. That, in turn, boosts costs for health insurance. "The limit on the tax deduction will reduce the incentive to buy expensive, wasteful policies," said Hogberg. "That will result in lower health insurance costs for everyone."

Hogberg also disagrees with the criticism of Bush's proposal coming from some quarters of Congress. Congressman Charles Rangel (D-NY) said, "This is a dangerous policy that ultimately shifts cost and risk from employers to employees and could result in a higher number of uninsured." Congressman Pete Stark (D-CA), said, "Under the guise of tax breaks, the president is pursuing a policy designed to destroy the employer-based health care system through which 160 million people receive coverage."

"In fact, Bush's proposals would help stem the decline in employer-provided coverage," said Hogberg. "The cap on the deduction will help lower health insurance costs, making it easier for employers to provide coverage." Hogberg also noted that the proposals are likely to reduce the number of uninsured. "Many people who are uninsured do not have access to employer-provided coverage. Giving the tax break to those without employer-based coverage will make it easier for them to afford health insurance." "Overall, Bush's proposal is a big step in the right direction," said Hogberg.



What is the definition of irony? It may come any day now when Fidel Castro dies - the victim of his highly touted system of socialized medicine in the worker's paradise of Cuba. Even though Castro imported a doctor from Spain to treat his diverticulitis - an infection in the large intestine that rarely proves fatal in capitalist countries - the Communist dictator is said to be in grave condition following three failed surgeries.

It's not only irony, it's poetic justice. U.S. doctors look with stunned amazement at the relatively simple health-care problem Castro faced and the results - a hospitalization that has continued since late July. They suggest that medical procedures on Castro were botched. I would suggest the doctors caring for Castro did everything they could to save him. We're just now learning the truth about Cuba's health-care system after decades of lies.

Socialists in this country have been holding up Cuba as a model for medical care. How many times have you heard this lie? Yet, the real proof is that the best of Cuba's medical establishment couldn't successfully treat Castro for a routine ailment after six months. Is Hillary Clinton paying attention to this? Is Nancy Pelosi watching? Is Harry Reid understanding the significance of this amazing story?

Keep in mind, this is happening to the Comandante - not some sugar-cane harvesting peasant. It shows you just how bad socialized medicine gets. It atrophies to the point where it is incapable of healing, even when doctors' lives may depend upon it.

Without getting into the gory details of his illness, suffice it to say that diverticulitis causes bulges in the large intestines that get infected. The normal treatment is a colostomy, the removal of part of the intestine, the creation of an opening in the abdomen and the attachment of an external bag for the patient's excrement. A second operation is required to rejoin the intestine. But Castro's medical brain trust, in consultation with the Patient in Chief, opted for a shorter procedure - one that led to a second infection and two more surgeries. When Castro dies, it will likely be because toxins from his own sick body poisoned him.

But it is the toxic ideas of Castro that have taken their toll on his homeland of Cuba and spread through much of Latin America and the rest of the world. Despite his many crimes against humanity, Castro is still perceived throughout much of the Western world as a kind of harmless folk hero.

One of Castro's best-known slogans was "Socialism or death!" Many Cubans have asked, over the years of Castro's reign, "What's the difference?" Now, even Fidel will see it is no choice - they are one in the same.

No doubt there will be some who don't learn the obvious lesson from Castro's bout with socialized medicine. They will continue to insist it is a better way - a fairer system, a more equitable one, one that focuses on saving lives rather than profits. Let me leave you with one last thought: When was the last time you heard of some wealthy sick guy who chose to go to Cuba for treatment rather than, say, the Mayo Clinic or Johns Hopkins University? It doesn't happen. It never will happen. The only people who believe Cuban medical care is equal to or superior to what we have in the United States are those who teach at universities, attend them or pay to see Michael Moore movies.



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

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


Thursday, January 25, 2007

Schwarzenegger’s Health-Care Shakedown: The governor plans on having other states pay for his health-care program

Last week, California Gov. Arnold Schwarzenegger proposed to guarantee health insurance to all Californians — including many illegal immigrants. How would Gov. Schwarzenegger achieve this feat? To paraphrase another California governor: If it moves, he taxes it. If it still moves, he regulates it. And if it stops moving, he subsidizes it.

Or more precisely, YOU subsidize it. Gov. Schwarzenegger would fund nearly the entire plan through Medicaid. Under that program’s rules, roughly half the funding comes from California and half from the federal government — in other words, from taxpayers in other states. But, if you look closely at how the program will be funded, it becomes clear that Schwarzenegger wants to bend the rules so non-Californians would pay over three times as much as Californians would.

The governor’s thinly veiled shakedown is both dishonest and emblematic of what ails America’s health-care system. First, the taxes. The centerpiece of TerminatorCare is a requirement that every California resident purchase health insurance. Though many call this an “individual mandate,” that’s just a fancy term for a sort of tax. Instead of spending your money itself, the government forces you to spend your money according to its instructions. The result is the same: You end up with less money to use as you see fit.

The governor claims a mandate is necessary because the uninsured’s medical costs get shifted to everyone else; a mandate would ensure that all Californians have coverage. Yet the governor vastly overstates the free-rider problem, which is dwarfed by the amount of waste in our health-care system. And requiring people to purchase insurance doesn’t mean they’ll do it. California requires drivers to purchase auto insurance, yet one in four California drivers are uninsured.

The governor also wants to tax employers four percent of their payroll if they do not offer health benefits. If this proposal becomes law, we can expect to see California employers dropping coverage because the tax would be less than what many employers spend on health benefits.

As for regulation, the governor would require insurance companies to cover all applicants, regardless of health status. He also proposes to limit how much insurers can charge those with high expected-claims. Such regulations are supposed to make coverage more accessible for sicker individuals, yet on balance they tend to make coverage less accessible. In states such as New York and Washington, these regulations have increased insurance premiums, increased the number of uninsured, and caused insurers to flee the state.

And then there are the subsidies. The governor would increase spending on preventive care, reasoning that he can reduce health-care costs by catching diseases early. Yet when Stanford University economist Victor Fuchs polled health economists, only one out of nine agreed that greater spending on preventive care would even marginally reduce overall spending.

Schwarzenegger would expand government programs for the poor, including California’s version of Medicaid — i.e., Medi-Cal. In fact, he would expand these programs so much that they would cover many Californians who aren’t poor at all. Families of four making $60,000 per year — including illegal immigrants — would be eligible.

That would be dangerous: Such programs discourage people from climbing the economic ladder, because recipients lose benefits if their income rises. Expanding programs like these ensnares middle-class families in what experts call a “low-wage trap.” Such programs also tend to increase the cost of privately purchased medical care and insurance; expanding them would make private options even less affordable.

But the truly audacious part is that the governor wants non-Californians to pay for it all — or most of it, anyway — a fact that he and his advisors tried to disguise.

Here’s how it would work: The governor would increase Medi-Cal payments to doctors and hospitals by $2.2 billion, expecting Washington to chip in another $1.8 billion; that’s the way Medicaid works, with half of the costs being borne by the federal government. The governor would then tax $3.5 billion from the providers — i.e., from the doctors and hospitals, to whom payments had been increased by $2.2 billion. That means the state would recoup not just the $2.2 billion it originally paid the providers, but also $1.3 billion of what the federal government paid the providers. The proposed increase in payments to providers, which is subsequently revoked by taxes, is merely a ploy to get even more money from taxpayers in other states. It turns out that the governor wants to shake down non-Californians for over three-fourths of the costs of the increase.

If nothing else, the governor has highlighted what’s really wrong with America’s health-care system. Health care grows more expensive every year because everyone in the system is spending someone else’s money, and so no one spends responsibly. Even Medicaid encourages governors to make wild spending commitments because they can make taxpayers in other states pick up the tab.

The late Milton Friedman — a Nobel Prize-winning economist and philosophical mentor to Gov. Schwarzenegger — neatly summarized the problem with America’s health-care system: “nobody spends somebody else’s money as wisely or as frugally as he spends his own.”

Forcing more people to participate in this broken system is no solution. Health-care reformers need to change the incentives so that everyone starts acting responsibly. Thanks to Gov. Schwarzenegger, reformers now have a poster child.


Mother gives birth in toilet

Another great example of "Don't care" public hospitals. Third-world treatment in a First World country -- Australia

A mother says her baby daughter was born in a hospital toilet bowl and had to be rescued after staff ignored her screams for help. Kay, 24, was in the final stages of labour when she was rushed by ambulance to Monash Medical Centre on Tuesday last week. In a statement to the Herald Sun yesterday, the hospital said it regretted "the birth did not go according to plan".

At the hospital, the Mt Waverley mother of two was told to wait in a standard share room instead of being directed to a birthing suite, despite having contractions fewer than two minutes apart. "A midwife saw me when I came in and pressed on my stomach once. Nobody checked if I was dilated. I didn't even get offered a Panadol," Kay said. An hour after arriving, distressed and screaming in agony, she went to the toilet, where she gave birth to a girl.

Her husband Michael, who had become frantic, had hit an emergency buzzer in panic to try to get help, but he said none came in time so he kicked down the locked door and ran in, pulling the infant from the toilet bowl. Kay said she was terrified her daughter could have died, and described the ordeal as horrific. "I thought she could have been seriously hurt, or worse. If it wasn't for Michael coming to my aid, I don't know what the result would have been," Kay said. "It was the most traumatic thing we have had to go through. I would have thought it would have been one of the happiest times of our lives, but it was terrible."

Kay said Michael pressed the emergency buzzer three times, but no one responded until after a nearby caterer alerted medical staff. "When someone finally came, Michael asked why it took so long and they told him the buzzer didn't work," Kay said. "I was completely shocked. It is an emergency buzzer. This was an emergency."

But the director of nursing at Monash Medical Centre, Kym Forrest, said in a statement to the Herald Sun: "The buzzers were checked and both were working. The obstetrician and midwives were in fact alerted to the baby's arrival by the buzzer being sounded from Kay's room." Ms Forrest also denied the door had been kicked in. "It is a dual lock which can be opened from both sides and this was the way access was achieved," she said.

But Kay said the toilet cubicle, complete with broken door, "looked like a murder scene". "There was blood everywhere. I was screaming. It was just horrible," she said.

The couple are seeking a formal apology, but Ms Forrest said they had not lodged a formal complaint with the hospital. "We regret that Kay did not have the birth experience our midwives strive to provide to all the mums in their care," Ms Forrest said. "We are as disappointed as Kay and Michael that the birth of their second child did not go according to plan, but babies have a mind of their own sometimes."

Opposition health spokeswoman Helen Shardey called for the Government to investigate: "It is just lucky the baby was not seriously injured in this fiasco." A spokeswoman for Health Minister Bronwyn Pike said it was an operational matter for the hospital to deal with.



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

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


Wednesday, January 24, 2007


Paved with good intentions, California's proposed road to Universal Health Coverage will lead straight to chaos. The Governor's January 8th, 2007 proposal aims to provide relief for Californians suffering under a healthcare system in desperate need of repair. It does not lack noble goals. What it lacks is common sense.

Achieving a workable solution first requires that we understand the problem. For 4.8 million uninsured Californians, no further explanation is necessary (the often-cited figure of 6.5 million refers to those uninsured "at some point" during the prior year, including many who are currently covered). But for the rest of us, some background information is essential.

The cost squeeze

While medical spending has skyrocketed, doctors have been caught in a vicious cost squeeze. Health insurance premiums have risen at an unsustainable rate for consumers over the past decade, peaking at a 10.5% increase in 2002. Faced with rising costs, employers have been unable to maintain coverage, leaving workers with limited or no employer-based health insurance.

But the cost to physicians of providing medical care has also skyrocketed over the same period. Increasingly expensive medical equipment, office supplies, staff salaries, Malpractice/Worker's Comp/Liability insurance premiums-all squeeze the bottom line for doctors trying to keep their doors open for patients. Federal and State taxes excise an additional share of shrinking revenue.

Reimbursement for physicians has lagged far behind inflation. Medicare, after years of pay declines and freezes, has committed to a 10% pay cut for doctors in 2008, to be followed by a 5% cut for each of the successive six years. Doctors who care for Medicare recipients will pay a price for it. Given that private health insurance plans base their reimbursement on the Medicare-fixed prices, the cuts are magnified.

The situation is worst for doctors who accept Medi-Cal, California's version of Medicaid. This top-heavy State program, subsidized by the Federal Government and run by nearly 6,000 Sacramento-based bureaucrats, spends nearly $7,500 yearly per patient. This money could fund a private Blue Cross-type plan for every man, woman and child that Medi-Cal currently covers.

Because doctors are so badly paid by it, California physician participation in Medi-Cal is the lowest of any state sponsored program in the country. Medi-Cal payments to California physicians rank 49th in the U.S. The rates are based on 1969 data, with only a single increase in 20 years. Medi-Cal reimbursement often does not even cover the cost of keeping a doctor's office open during the patient's visit. Accepting Medi-Cal is the surest way to destroy the viability of a California medical practice.

The Governor's proposal ignores these realities. Medi-Cal and similarly inefficient programs would be expanded, not replaced or even diminished. The program inevitably will run into the law of supply and demand. The current shortage of physicians for those enrolled in Medi-Cal will worsen. Patients will not get more care, they will get less if there are fewer doctors serving them than before. And despite the finest intentions, that is likely to happen.

The $12 billion proposal supposedly addresses the problem of low reimbursement for doctors who care for Medi-Cal patients. Despite the fact that the Governor's 2006-07 budget included zero increases in Medi-Cal reimbursement (and faced a court battle when he attempted to force a 10% cut to doctors who accept Medi-Cal), the proposal promises to increase rates "significantly" for providers, hospitals and health plans. This proposed increase, however, is tied to new and unspecified performance measures. It is also tied to doctors' adoption of health information technology (HIT) such as Electronic Medical Records and e-prescribing.

This "carrot and stick" approach defies logic. Portable, universal, affordable HIT that adequately safeguards patient privacy currently does not exist. So the conditions mandated by Governor's Medi-Cal reimbursement plan are like requiring the paving of a road that is not yet on the map.

Violating federal and state mandates

While claiming to create "more efficient health care delivery," the governor's plan includes the "expansion of lower-cost models." This language actually means that patients will be treated by independently practicing Physician Assistants and Nurse Practitioners instead of doctors-a violation of current State and Federal statutes. While this practice may provide cost savings, it is certainly not Universal Coverage.

Moreover, limiting Californians' care to "Physician Extenders" without adequate Physician supervision contradicts the stated goals of improving patient safety. While Physician Assistants and Nurse Practitioners play a valuable role in caring for patients, they will newed supervision, which costs time and money. Patient safety cannot be traded for "efficient health care delivery," no matter how cost-effective. Patients deserve better.

The doctor and hospital tax

It is a basic economic principle that you get less of something when you tax it. The supply of medical services to will be diminished by the imposition of new taxes on the key actors: hospitals and doctors. The Governor proposes that all hospitals and doctors pay a new tax. According to the Governor's healthcare team's "State Fiscal Impact Summary," the tax will generate $3.5 billion. The same report reveals that the projected Medi-Cal reimbursement increase is $2.2 billion. Therefore, even if one assumes that any increase in payments is provided as the reward for caring for uninsured and underinsured Californians, doctors and hospitals will be forced to finance $1.3 billion in net new taxes. While supposedly delivering more care, they will take home substrantially less. This tax is in addition to the Governor's proposed "Pay or Play" 4% payroll tax on California employers, which doctors and hospitals will also face.

Paying for more care

If more care is required, taxing the supply of care will not do. If business owners, doctors and hospitals aren't forced to subsidize this program, what are the alternatives? What kinds of funding sources would do less damage? One answer might be foreign remittances, the payments immigrants send back to their home countries.

The most attention-getting aspect of the Governor's plan is that California's undocumented immigrants will receive health coverage under it. The reasoning is that California's doctors and hospitals already provide it-largely unreimbursed-so paying for their healthcare makes economic sense. Is this a sound premise? Consider these statistics:

Yet California's undocumented immigrants sent $9.6 billion back to Mexico in 2004. From 1960-2003, the amount sent increased by an average of 12.8% yearly. It is projected that by 2010, the total remittances sent by undocumented immigrants will reach $25 billion. According to Mexico's former President Vicente Fox in September 2003, remittances from Mexican nationals residing in the U.S. "are our biggest source of foreign income, bigger than oil, tourism or foreign investment."

A conservative estimate of California's undocumented immigrant population is four million. Using 2004 statistics, the annual remittance to Mexico from a family of four in California is a minimum of $2,400. The figure may well be higher, given the difficulty of tracking demographics in this population and the fact that the newest statistics are not yet published. The sum of $2,400 easily covers a basic family healthcare plan.

California's taxpayers are asked to fund health insurance for undocumented immigrants, a group with up to $3,000 in disposable income on average. Why should they not accept some financial responsibility when California's legal residents already struggle to do so for them. The logic that informs the Governor's proposal is elusive, if not simply unsound on this elementary point of social justice.

There is no question that uninsured and underinsured Californians do need help. But in order to treat them, doctors want to keep their office doors open and serve their communities. And so do hospitals. California hospitals, particularly trauma centers and Emergency Rooms, are overwhelmed by patients after the closure of scores of facilities across the State. Business owners want to provide for their employees, but are frustrated when constantly increasing costs force them to choose between offering health insurance and keeping their businesses solvent.

The Governor's proposal should be applauded for its good intentions. But it should not be enacted in its current form. What is needed now is not a new or expanded bureaucracy that will shuttle uninsured patients into State programs without the resources to provide quality, sustainable medical care. Nor will our critical problems be solved by empty promises of economic relief. The answer is not to levy a $3.5 billion tax on those who are already subsidizing care not covered by the State. Further burdening California's employers is an equally poor path. We can succeed, but only if we rely on sound economic principles, simplicity, accountability and-above all-ethical aims. The right road is not covered with unrealistic is paved with common sense.


The British medical bureaucracy is great at hounding good doctors but bad doctors? Forget about it!

See yesterday's postings. And note that even the vastly harmful Roy Meadow got off scot free and that IVF pioneer Steptoe was very nearly stopped by the British medical authorities. A lesser man would have given up

Rogue doctors and thousands of other health professionals who have been struck off for misconduct in other European countries are able to work in Britain because there is no mechanism in place to warn employers. In a letter to The Times today, ten leading medical regulators have expressed grave concerns about the vetting procedures.

The number of professionals - including doctors, nurses, dentists and chiropractors - from the European Economic Area registering to work in Britain has doubled in three years. The regulators said that although most were of benefit to Britain, a small, poorly trained minority were exploiting the system and could put patients at risk. The letter's signatories, members of the Alliance of UK Health Regulators on Europe, cite several examples, including two nurses identified in the past year who had been banned from working in Ireland and a Dutch doctor who was allowed to work in this country despite being convicted of rape in his homeland.

The alliance says that there is no system in place to test fitness to practise or language skills or to flag up those found guilty of professional misconduct or criminal offences or otherwise considered to be a danger to patients. They add in their letter that due to loopholes in EU legislation an unknown number of incompetent or convicted medical professionals could be working in Britain.

A healthcare professional from another EU state needs evidence only of recognised medical training and a "certificate of good standing" to work in Britain. Different countries apply different standards, making assessments unreliable. The alliance is calling on the European Commission to impose a legal duty on all European medical regulators to share information about professionals who transgress national codes of conduct. "In 2005, over 7,000 practitioners from the European Economic Area (the 27 EU states plus Iceland, Liechtenstein and Norway) came to Britain to register with our regulatory bodies and find work," their letter says. "While the UK undoubtedly benefits from this high level of mobility . . . there may be a minority who exploit free-movement rights and put patients at risk." It adds: "Regulators in Europe must be given the tools to enable them to facilitate this free movement while at the same time ensuring the safety of patients and the public."

Signatories to the letter, including the heads of the General Medical Council, the General Dental Council and the Nursing and Midwifery Council, call for sweeping reforms to facilitate proper checks on qualifications, experience and employment history. The letter is also endorsed by the General Optical, Osteopathic and Chiropractic councils, the Health Professions Council and the Royal Pharmaceutical Society of Great Britain. The alliance is due to present its findings to the European Commission today.

At present, British medical regulators apply strict performance tests, measuring practical skills and proficiency in English among other things, to professionals from outside Europe who wish to work in Britain.



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

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


Tuesday, January 23, 2007


A mother treated at Mohamed Taranissi’s groundbreaking clinic in London defends him against the Panorama/HFEA witch-hunt. A big reminder of how dangerous it can be to leave anything to bureaucrats

I have Mohamed Taranissi’s groundbreaking IVF clinic to thank for my beautiful son. And many more parents have had children thanks to the insights and efforts of the ‘miracle makers’ at his London clinic. So why are the regulators of human fertilisation work in Britain, who claim to protect our interests, now witch-hunting Mr Taranissi?

His clinic, the Assisted Reproduction and Gynaecology Centre (ARGC), is the most successful in Britain. Yet on Monday it came under assault from both the media and the industry regulator, in what appears to be a collaborative effort to undermine the credibility and reputation of the clinic and its chief consultant, Taranissi. On the same day that the BBC TV aired a Panorama special investigative report on the clinic, in which undercover journalists posed as infertile women, the regulatory body, the Human Fertilisation and Embryology Authority (HFEA), launched a police-assisted raid on both the ARGC and Taranissi’s other clinic, the Reproductive Genetics Institute (RGI).

The HFEA has denied that it worked in tandem with Panorama, instead claiming that the timing of the raid on the same day that the programme aired was purely coincidental. However, it certainly looks like a publicity stunt, and it’s not the kind of thing you would expect from what is supposed to be an impartial regulator with an ongoing inquiry into and legal dispute with a doctor. It raises questions not only about standards in public life but more pressingly: Why have they got it in for him?

Taranissi’s relationship with the HFEA has been a strained one. The fact that the ARGC has a fairly aggressive approach to the treatment of infertility means that as well as topping the HFEA’s own published league tables for IVF success rates for the past 11 years, the ARGC continually pushes against the current boundaries of ethical treatment. For instance, Taranissi pushed for the HFEA to allow preimplantation genetic diagnosis of embryos (PGD) in order that parents might produce a baby whose cord blood could possibly cure a sick older sibling. After there was widespread publicity and support for the successful treatment of British child Charlie Whitaker in this way, the HFEA finally dropped its official opposition to the use of PGD for such purposes.

It seems that Taranissi has been a bit of a thorn in the side of the HFEA, continually forcing it to rethink its extremely cautious approach to new treatments. For its part, the HFEA seeks to portray him as obstructionist, placing his clinic at the bottom of their table for compliance with industry standards – without, it seems, providing any breakdown of the way the results were compiled.

As well as getting up the noses of the regulator, Taranissi’s leadership and success in the field of infertility treatment has led to much resentment among his colleagues in the field. The fertility industry teems with doctors who sneer when his name is mentioned. This I know through personal experience; I went through a period of infertility and suffered recurrent miscarriages, and many of the fertility doctors I came into contact with had something negative to say about him. I was intrigued by the professional jealousy directed towards this extremely successful London consultant, often by doctors who usually told me there was nothing they could do for me and that I should adopt, try again, or just give up. Perversely, perhaps, it made me wonder what he had going for him and I sought a consultation at the ARGC to find out. This happily resulted in the birth of my son. After seeing, firsthand, the rivalries involved in the fertility profession, it did not surprise me in the least that Panorama could compile an impressive panel of experts to criticise Taranissi’s work.

Fertility treatment is an area of much uncertainty; it is fraught with ethical concerns. More research needs to be done, for sure, but advances will not be made if an over-cautious approach is taken. Attacks on those who are trying to push things forward because they irritate the regulator, or provoke jealousy among their colleagues, or are simply making a lot of money, will not help this state of affairs. In a climate in which there is a general fear and distrust of experimentation, we need people like Taranissi, people who are willing to challenge the status quo and experiment with new approaches. The ARGC was the first clinic to freeze and thaw human eggs, the first to perform PGD, and it is among the leaders in the field of reproductive immunology.

This latter area – immunological treatments – was of central concern to the BBC’s expert panel. While it is certainly a contested area of treatment, the Panorama programme did not mention that one of the experts it interviewed – Lesley Regan of St Mary’s miscarriage clinic – is herself overseeing a clinical trial into the effect of Natural Killer Cells on implantation. When I visited Regan’s clinic as a patient, I was told to await the outcome of this clinical research, which would have been published when I reached 40 years of age – that is, when my fertility would be seriously compromised by my age. I was glad to have the opportunity to try the treatment immediately at the ARGC.

As a former IVF patient and now a mum, I strongly object to the way that the Panorama programme portrayed patients as ‘vulnerable’ and ‘desperate’. I was actually rather well-informed; I was aware of the research and successful treatments conducted in the United States (where there is very little regulation of IVF clinics); and I was strong-willed enough not to take no for an answer. None of the women I know who has been through IVF at the ARGC was manipulated or exploited; they knew what they were going in for because Taranissi and his staff are very clear about the nature of the treatment and the risks and benefits involved.

Of course, IVF has no guarantees and it is a shame that it cannot be provided in a timely and cost-free manner on the National Health Service. But in the current situation, where 80 per cent of IVF treatments are private, many couples will lose money on the gamble that is fertility treatment. That is not any one individual’s fault, and, in fact, the high success rate of the ARGC means fewer couples are disappointed there than elsewhere. It is a shame that the BBC’s reporters did not see fit to interview some of Taranissi’s real patients rather than sending in journalists in an underhand subterfuge. I think they would have heard a very different story: one of a dedicated, hardworking and honest doctor, whose success comes largely from his close attention to detail and his amazing accessibility. As a patient of his, I was given his personal mobile phone number to call in case of any concerns or questions. I was also monitored daily, receiving phone calls to remind me of the dosage and timing of drug administration.

My son turned two in November. He is a constant reminder to me not only of luck and love, but of the miracle that is modern medicine.


Behind the IVF ‘trial by television’

There is more to the HFEA regulators' pursuit of top infertility doctor Mohamed Taranissi than meets the viewer's eye.

The Human Fertilisation and Embryology Authority (HFEA) claims that its investigations into IVF clinician Mohamed Taranissi – which have been splashed across the headlines this week – are part of its important regulation of IVF treatment in Britain. It even led raids on Taranissi’s clinic on Monday, in tandem with a BBC Panorama documentary ‘exposing’ Taranissi. However, spiked has learned that there is more to this than meets the eye, and that the HFEA has been curiously heavy-handed in its dealings with Taranissi, and possibly unprofessional in its dealings with Panorama.

On Monday, the BBC’s flagship current affairs programme Panorama launched its new-look series with an attack on Taranissi. On the day the programme was broadcast, the HFEA went to court to obtain a warrant to gain entry to Taranissi’s two clinics, the London-based Assisted Reproduction and Gynaecology Centre (ARGC) and the Reproductive Genetics Institute (RGI). They demanded access and removed paper files and computers – and it all occurred in time for the incident to be reported as part of the Panorama broadcast and then later in TV news bulletins.

For all the headlines about ‘Police raids on “illegal” IVF doctor’, the HFEA-led raids (more accurately inspections) had nothing to do with any scandal uncovered by Panorama. Rather they related to an ongoing dispute between Taranissi and the regulator about the licensing of his clinics. The only link between Panorama and the HFEA’s inspections would appear to be the coincidence of timing. And some influential figures are raising grave concerns about this apparent coincidence. Dr Evan Harris MP, a member of the House of Commons Science and Technology Committee, told BBC Radio 4’s Today programme: ‘It’s extremely unusual for an investigator, a regulator, to be seen to be cooperating with journalists in terms of releasing information about one of the people they are regulating, and also to be giving interviews to that programme which is clearly an investigative journalist programme.’

The HFEA says the raids were necessary because new information has come to light and whistleblowers have come forward, and because Taranissi and his lawyers have been difficult and obstructive in response to the HFEA’s requests for information. The HFEA tells me it is unable to provide further details on this new information, or on Taranissi’s ‘obstruction’, because there is an ‘ongoing regulatory process’.

Yet the question of why the HFEA suddenly decided to raid Taranissi’s offices, in time for a sensationalist TV documentary, is a pertinent one – because the HFEA and Taranissi had, until that moment, been in fairly civil and official discussions about the licensing of his clinics.

Only last Wednesday, 10 January, Taranissi and his lawyers visited the HFEA for a Licence Committee hearing. It was part of the ongoing discussion about the renewal of his licence for the RGI, and the HFEA’s threat at the end of 2006 to revoke his licence for the ARGC. According to Taranissi and his lawyer, they believed that at the meeting they supplied the HFEA with all the information it had requested, and met the conditions laid out by the HFEA to avoid the ARGC licence being revoked and to have the RGI licence reinstated.

At no point in the meeting did anyone indicate that there might be a problem with the information supplied, Taranissi’s lawyer tells me. Indeed, Taranissi later received a letter by fax thanking him for his attendance and for the work he put into his presentations. The letter said the HFEA needed more time to analyse the information provided by Taranissi, and said that if the Licence Committee was satisfied that all outstanding information had been submitted, and Taranissi had successfully completed a Person Responsible Entry Programme, the notice to revoke the licence for ARGC would be withdrawn immediately and his application for a renewal licence for the RGI clinic reconsidered. The letter suggested that the meeting be reconvened on 5 or 7 February.

Yet the next that Taranissi heard from the HFEA was when its head of inspection turned up on his London clinic’s doorstep, with police sergeants from Scotland Yard waving a warrant to search the premises and camera crews in tow. Why was a dramatic, TV-friendly raid necessary? The lead inspector says it was because Taranissi’s clinics had failed to provide all the information, despite repeated requests. Yet given that Taranissi was at the HFEA providing information just days earlier, and understood that he would be returning there in early February, surely it would have been more appropriate to have contacted him by letter or phone pointing out the deficiencies discovered subsequent to the letter faxed by the HFEA’s Licence Committee chair on Wednesday 10 January?

This is not the first time the HFEA has been prickly with Taranissi – it has previously treated him differently to other IVF doctors. Consider the dispute over the licensing of his RGI clinic in 2005/2006.

In 2005 there was a dispute over the renewal of his RGI licence, primarily because the clinic did not provide the requisite information to the HFEA in a timely fashion. In January 2006 the HFEA notified Taranissi that the RGI no longer had a licence and that he would have to operate under Special Directions to treat existing patients until matters were resolved. However, following further negotiations and discussions, Taranissi was offered a three-year licence for the RGI in June 2006. HFEA inspector Debra Bloor wrote to Taranissi on 19 June to outline the offer of a licence.

However, the offer contained a very specific condition – namely that no ‘three-embryo transfers’ could be carried out at the centre. Taranissi duly completed the form, ticking the box to say he accepted the licence and the conditions. He also added a handwritten one-sentence note at the bottom of the form, stating that he would like to make representations regarding the special condition on three-embryo transfers attached to the licence. Taranissi says he has done this kind of thing before, on other licence offers where there was a condition he wished to challenge, and it had never been a problem.

On this occasion, though, the HFEA decided that a licence could not be provided pending Taranissi’s representations about that one condition – that is, a licence would not be provided on the basis of his one-sentence written remark. The HFEA has decreed that three-embryo transfers are too risky; its Code of Practice stipulates that licensed centres must ensure that women under 40 receive no more than two eggs or embryos; but it does allow women over 40 to be given three eggs or embryos, but no more than three.

Taranissi says he is unaware of any other clinic being forbidden by the HFEA from carrying out any three-embryo transfers, as his RGI clinic was last year. And he thought it entirely reasonable to say that he wanted to make representations about this seemingly unfair measure. Taranissi also points out that the HFEA’s Code is not actually law, and he objects to interference in his clinical judgments made in consultation with his patients.

Because Taranissi has previously accepted licence offers while commenting on certain conditions, he assumed that the licence offered by the HFEA for RGI in June 2006 was in place, and he continued treating patients. When the HFEA found out, it wrote to Taranissi on 21 July saying a licence had not been granted to the RGI and that Special Directions would be put in place to allow the continued treatment only of patients whose treatment had begun before 24 July. A Licence Committee meeting on 27 July decided that the offer of a licence to RGI should now be withdrawn, due to a change in circumstances since the offer was made.

Things then spun further out of control. The HFEA continued to pursue Taranissi over his work at the RGI, and took the extraordinary step of effectively threatening to shut down both of his clinics.

On 25 September 2006, the HFEA’s director of regulation wrote to Taranissi asking for copies of all records of treatment carried out at the RGI since 21 July. The HFEA wanted the records by 4 October. When it didn’t receive them, the HFEA upped the stakes further – deciding that it could no longer be sure that Taranissi was a suitable person to be holding a licence to carry out fertility treatment. The HFEA wrote to him on 22 November 2006 informing him that the Licence Committee had decided to propose revoking his licence at his other, primary clinic, the AGRC. In layman’s terms, they were proposing to shut him down.

As Taranissi points out, none of this had anything to do with patient safety, and certainly the controversies seem bizarre when you consider that Taranissi is one of the most successful IVF doctors in Britain. Rather, the HFEA seems to have been chasing him, and proposing revoking his licence, over matters of paperwork. Here, the regulatory, bureaucratic impulse seems to take precedence over allowing Taranissi to continue successfully and safely treating many women. And the HFEA says it represents infertile women’s interests.

It was the HFEA’s proposal to revoke Taranissi’s licence for the ARGC as well as the RGI that led to the current clashes. A letter from the HFEA’s director of regulation, dated 24 November, listed for Taranissi all the information he had to submit if he wished to keep his licence. And Taranissi and his legal team believed they were providing precisely this information at the meeting with the HFEA on 10 January, a few days before the Panorama programme and the coinciding HFEA-led raids. Taranissi’s lawyer tells me that in that two-hour meeting, they painstakingly made sure that the information in two lever-arch files handed over to the HFEA contained, as far as they could tell, everything requested.

Yet days later, the police, the HFEA and camera crews came knocking.

There are other elements about the HFEA’s relationship to Panorama that Taranissi and his lawyers are unhappy about. Such as the fact that there was a camera crew there to greet them on the morning of the 10 January meeting at the HFEA; this footage was included in the programme and reported as Taranissi attending a disciplinary hearing. The HFEA’s solicitors had written to Taranissi’s solicitors the day before the meeting, to point out that there would be members of the press outside the HFEA’s offices on 10 January; but they claimed that it was in relation to an entirely separate issue and in no way related to their attendance at the HFEA.

Taranissi and his team are also upset that Panorama was provided with information that Taranissi had no means of commenting on. Following a Freedom of Information request, the Panorama team was given information about the ARGC clinic. It related to the HFEA’s Driving Improvements report published on 8 December 2006, in which the HFEA produced a graph ranking clinics according to their ‘compliance’ with HFEA Codes of Conduct and the HFE Act. The graph listed clinics anonymously, but Panorama managed to discover the score allocated to AGRC: it was minus 29, putting it close to the bottom. Taranissi was keen to know on what basis he scored minus 29, so that he could answer Panorama’s question about his clinic’s ranking; he suspected the compliance was measured by paperwork matters rather than success or safety rates. Between 20 December and being filmed by Panorama on Friday 12 January, he requested information about the graph five times, but it was not provided.

It is hard to avoid the conclusion that the HFEA has been pursuing Taranissi for many months, rattled by the fact that he is successful, experimental and not a big fan of the HFEA’s over-cautious rules and regulations.

What will be the end result of playing these disputes out in the media and presenting Taranissi as some kind of criminal whose clinics must be invaded by FBI-style raids? Patients and potential patients may have their confidence in Taranissi shaken. And if this is undeserved, as many of Tarassini’s former patients strongly argue, it could damage the all-important relationship of trust between doctor and patient during a procedure that is already as emotionally fraught as it is clinically complicated.

For the HFEA, however, which has been proactive in bringing this dispute to a head in a tawdry fashion, the consequences could be rather more grave. We await the new information that apparently necessitated the HFEA-led raids on Monday 15 January. But as things stand, this public regulatory body has shown both a defensive and an authoritarian streak, as it has ensured that its frustrations with one doctor get played out in the public gaze. How can the public have confidence in a body that behaves more like a bullying prefect in a playground than an impartial regulator of national healthcare?

What all this indicates, above all, is the need for a real public debate about fertility treatment, and the kind of regulation that we might want or need. Rather than the HFEA and Tarassini slogging out a dispute through their lawyers and now the media, we should take the opportunity to have a discussion about the broader issues involved in fertility treatment – and how it can continue to be improved and access to it can continue to be widened. Do we need public regulatory bodies empowered to make such decisions, or would we be better off scrapping the HFEA and developing something less bureaucratic instead?

Now, answering that question would make a good documentary.



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

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