Thursday, January 31, 2008

Don't treat the old and unhealthy, say NHS doctors

You've paid for your health insurance all your life only to be told you can't collect on it when you need it? That's a risk you take with socialism. And it's already happening to some extent in Britain

Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives. Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone. Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state.

The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "out-rageous" and "disgraceful". About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt. Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.

The Government announced plans last week to offer fat people cash incentives to diet and exercise as part of a desperate strategy to steer Britain off a course that will otherwise see half the population dangerously overweight by 2050. Obesity costs the British taxpayer 7 billion a year. Overweight people are more likely to contract diabetes, cancer and heart disease, and to require replacement joints or stomach-stapling operations.

Meanwhile, 1.7 billion is spent treating diseases caused by smoking, such as lung cancer, bronchitis and emphysema, with a similar sum spent by the NHS on alcohol problems. Cases of cirrhosis have tripled over the past decade.

Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to everyone and that some individuals should pay for services. One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements. Tony Calland, chairman of the BMA's ethics committee, said it would be "outrageous" to limit care on age grounds. Age Concern called the doctors' views "disgraceful".

Gordon Brown promised this month that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning restrictions on patients who bring health problems on themselves. The only sanction threatened so far, however, is to send patients to the bottom of the waiting list if they miss appointments.

The survey found that medical professionals wanted to go much further in denying care to patients who do not look after their bodies. Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for "social abortions" and fertility treatment.

Paul Mason, a GP in Portland, Dorset, said there were good clinical reasons for denying surgery to some patients. "The issue is: how much responsibility do people take for their health?" he said. "If an alcoholic is going to drink themselves to death then that is really sad, but if he gets the liver transplant that is denied to someone else who could have got the chance of life then that is a tragedy." He said the case of George Best, who drank himself to death in 2005, three years after a liver transplant, had damaged the argument that drinkers deserved a second chance.

However, Roger Williams, who carried out the 2002 transplant on the former footballer, said doctors could never be sure if an alcoholic would return to drinking, although most would expect a detailed psychological assessment of patients, who would be required to abstain for six months before surgery. Prof Williams said: "Less than five per cent of alcoholics who have a transplant return to serious drinking. George was one of them. It is actually a pretty successful rate. I think the judgment these doctors are making is nothing to do with the clinical reasons for limiting such operations and purely a moral decision."

Katherine Murphy, from the Patients' Association, said it would be wrong to deny treatment because of a "lifestyle" factor. "The decision taken by the doctor has to be the best clinical one, and it has to be taken individually. It is morally wrong to deny care on any other grounds," she said.

Responding to the survey's findings on the treatment of the elderly, Dr Calland, of the BMA, said: "If a patient of 90 needs a hip operation they should get one. Yes, they might peg out any time, but it's not our job to play God."


The Massachusetts mess

A further comment -- by Bob Parks

So let me get this straight.. The cost of Massachusetts' health insurance mandate will rise 85 percent, or $400 million, next year. Former Massachusetts Gov. Mitt Romney, who rammed this down all of our throats, won't have to answer for all this because the Mass healthcare plan doesn't fully go into effect until after the presidential election. How convenient. Tell everyone how great the plan, you stuck your old state with after you left office, is.

As it turns out, the same Mitt Romney who claims to be a Reagan conservative has left an already cash-strapped state with the inevitability of increased taxes to cover the additional costs of his national healthcare model. It's a shame we didn't parse his words like we did Bill Clinton. Sure, the plan didn't require a raise in taxes while he was governor. The plan wasn't in place yet. Romney said.

"I'd say each state needs to get busy on the job of getting all our citizens insured. It does not cost more money."

Nothing from Mitt about tort reform. One of the reasons healthcare costs are so high is that doctors have to carry outrageous amounts of malpractice insurance to protect themselves from people like John Edwards. That cost, along with the annual amounts of near-unfettered fraud, is always passed down to the consumer.

Also remember, there was a time when many of us didn't have health insurance. I can only remember going to the hospital or a clinic once or twice during my childhood. We didn't have helicopter moms taking us into the doctor's office as soon as our noses started running or our tummies hurt.

As a Massachusetts resident who saw the man in action, I told you Mitt Romney comes off as a phony, thus it's hard to believe anything the man says while in election mode. From a speech posted on Mitt's own website he said.

"Healthcare is not a Democrat issue. It's a Republican issue; it's a conservative issue. Democrats look at problems like this and they have one answer: government. `We need bigger government, they say, so we can manage problems like this.' That's the wrong answer. Conservative principles have the answer for health care."

He listed them off as "personal responsibility, free market dynamics, choice", and being able to do all this without a government takeover. Well, aside from throwing his conservative principles under the bus, we sure are as close as we'll ever get to a government healthcare takeover. How do we know this? Private industries seldom require tax increases.

Maybe it's just that I never knew what real conservatism was, but I was always under the impression that real conservatives were for government that didn't impose itself in our lives. I guess Mitt Romney has proven us wrong.


Wednesday, January 30, 2008

Incredible British medical negligence again

You are just one of a herd of cattle to NHS doctors

A BOY who spent most of his life being deaf in one ear has been cured after he discovered the wayward tip of a cotton bud. After being deaf in his right ear for nine years, 11-year-old Jerome Bartens identified the cause of his ailment while playing with friends at a church hall in Haverfordwest, in Wales. The Daily Mail said Jerome heard a popping sound in his ear and, after using his finger to investigate the cause of the noise, discovered the tip of a cotton bud.

His father told the newspaper he was shocked that doctors did not discover the object after years of examinations. “It was just incredible – his hearing returned to normal in an instant,” Carsten Bartens told the newspaper. “He was cured as suddenly as he became deaf… I had always suspected Jerome had stuck something in his ear when he was little and that was causing the problem. “But the doctors and hearing specialists said it was wax and he would probably grow out of it.”

Jerome said it was strange to have his full hearing back again. “I can hear much better now and I think I’ll be happier at school now my ear does not ache all the time,” Jerome said. “It’s great that people don’t have to shout to me and that I don’t have to turn my head all the time.”


British nurses leaving in droves

Thousands of nurses are leaving the NHS in search of better pay and working conditions abroad. More than 10,000 nurses and midwives left to work abroad in 2006-07, leaving the NHS just a few years from a staffing crisis, the country’s top nurse said. Nearly 35,000 nurses - enough to staff the entire health service in Wales – have emigrated in the past four years. During the past three years there has been a 75 per cent rise in the number of nurses leaving for Australia alone, data from the Nursing and Midwifery Council (NMC) suggests.

Despite an anticipated shortfall of 14,000 nurses by 2010, Clare Chapman, the Department of Health’s director-general of workforce, has said that the NHS no longer needs to increase overall numbers of nurses and doctors.

Peter Carter, general secretary of the Royal College of Nursing (RCN), told The Times that the Government was guilty of a “yo-yo approach” to workforce planning, exacerbating low morale. “We are just a few short years away from a crisis,” he added. “There is every sign that being short-staffed on overstretched wards puts patients at risk, yet an estimated 20,000 nursing posts have been cut in hospitals and surgeries across the country. “At the same time as they are offered a miserly pay deal, they are being bombarded with advertising for a better life abroad. When you are offered comparable salaries and a higher quality of life in Australia, the Cayman Islands or South Africa, is it any wonder that some might choose to kickstart their careers abroad?”

The average salary for an NHS nurse was 24,000 pounds, Dr Carter said, about 10,000 less than the average police officer or teacher, while a below-inflation pay rise of 0.6 per cent in real terms last year had been an insult.

In total, 33,513 nurses left the UK and registered to work abroad between 2003-04 and 2006-07, but this was likely to be a conservative estimate, Dr Carter said. Meanwhile, 6,144 nurses from abroad were registered to work in the UK last year, 4,624 of them from outside the EU.


Tuesday, January 29, 2008

Massachusetts Health Costs Balloon

(Boston, Massachusetts) As always, socialized medicine means massive unanticipated costs. In Massachusetts, the mandated health plan is like a huge vacuum cleaner sucking dollars out taxpayers' wallets.
According to recent reports, the cost of Massachusetts' health insurance mandate will rise 85 percent, or $400 million, in 2009. Former Massachusetts Gov. Mitt Romney (R), meanwhile, has been on the presidential campaign trail praising the program he put into place.

According to The Boston Globe, the cost increase is largely due to an increase in the number of people signing up for state-subsidized health insurance. State and federal taxpayers are likely to shoulder the cost increase.
Mark my words, Massachusetts' premier symbol of corruption and ineptitude, The Big Dig, will be considered a bargain basement deal when compared to the dollars ultimately confiscated from the public for the state's socialized health care system.

Remember, voters, Mass. HealthCare is Mitt Romney's baby.
How dreadful! Big drug firms launch cheap versions of their pills!

What right have they??!! A big whine below emanating from haters of the drug industry. Just the phrase "Big Pharma" warns you of Leftist bias ahead

Many of Big Pharma's biggest blockbusters will soon lose their patent protection. Deloitte, a consultancy, estimates that $55 billion of products will go off patent in 2009 and will then face competition. At the same time, pharma bosses are being asked to defend patents in costly legal battles against an increasingly confident and litigious generics industry. As generics firms evolve from mere copycats into innovators in their own right, many such firms—led by Israel's Teva, India's Ranbaxy and Dr Reddy's Laboratories—are vigorously challenging patents.....

Under American laws designed to encourage generic drugs, which save money for patients, the first generic maker to win regulatory approval for its version of any given branded drug is supposed to enjoy a six-month monopoly. This promised pot of gold was designed to support small generics firms—but Big Pharma has found a loophole. It is pre-emptively launching generic versions of its own branded pills, which wipes out those six months of monopoly profits and undermines the economics of generics firms.

Merck, a big American pharmaceuticals firm, is soon expected to launch an authorised generic version of Fosamax, an osteoporosis drug that is due to lose patent protection in February. A recent survey of global branded-drugs firms by Cutting Edge Information, a consultancy, found that a third of them had launched authorised generics between 2005 and 2007—and the number will grow to 44% between 2008 and 2010. Pfizer has set up an in-house division to handle such generics.

More here

Australia: Emergency wards facing crisis

The good ol' government "planning" again. This is a government that REDUCES the number of beds when it rebuilds a hospital! Despite steady and quite foreseeable population growth

A DRAMATIC increase in the number of patients turning up at public hospital emergency departments has stretched the system to its limit, says [Queensland] State Health Minister Stephen Robertson. He has called on Queenslanders to give overworked hospital doctors and nurses a break after a survey showed 75 per cent of those who go to public emergency rooms for treatment are there because they couldn't get access to a GP or didn't want to pay doctors' fees.

The number of people who sought treatment at Queensland hospital emergency departments last year increased 8.7 per cent from 2006 - nearly five times the usual annual increase, and four times the state's population growth for the period. The flu epidemic in August boosted the figures and the state's 23 largest public hospital emergency departments treated nearly 1 million patients in 2007. "This is what we have to try and deal with . . . we can't just keep forever expanding our emergency departments to cope with ever-increasing numbers," Mr Robertson said. "We have to find ways to deal with this very challenging, increasing demand."

The survey, commissioned by Australia's health ministers, revealed that one out of every three emergency room patients thought they actually needed hospital treatment. But about two out of three went to hospitals because their doctor was not on duty, or that doctor's clinic was closed. The overload has flowed through to add months to elective surgery waiting lists, hospital staff say.

Mr Robertson said new and refurbished emergency departments would be the priority in the Government's record $5 billion capital works spending in 2007-08. "But the problem is that emergency medicine is one of those specialties where there is a worldwide shortage," he said. Mr Robertson today will release the public hospitals' performance report for the December quarter. It will reveal that 929,093 people attended emergency departments in 2007, up from 854,550 in 2006. The 82,774 December total in emergency rooms was the highest in Queensland history.

Mr Robertson said the number of doctors in Queensland had increased from 8453 in 2001 to 9352 in 2006. But the number of GPs per 100,000 people had fallen from 238 to 227, and an increase in the number of female GPs and an ageing male sector had resulted in a decrease in doctor-patient hours.

AMA Queensland president Ross Cartmill disagreed with Mr Robertson that people attending hospital did not need treatment. He estimated that less than 5 per cent should have seen a GP first. "The fundamental issues in our Accidents and Emergencies are not enough staff and a lack of beds."


Monday, January 28, 2008

Cancer woman runs out of time in NHS battle

Yet another death from socialism -- and as deliberate and as heartless as anything Stalin did

A WOMAN suffering from breast cancer has run out of time to benefit from a potentially life-extending drug which the National Health Service (NHS) denied her, even though she was prepared to pay for it. Colette Mills has been told by doctors that in the four months since she asked for the drug the disease has taken such a hold in her body that the cancer will no longer respond to the treatment. She is the victim of a ruling which states that any patient who wants to pay for additional drugs not prescribed by the NHS should lose their entitlement to their basic NHS cancer care and pay for all their treatment. She was prepared to pay for the drug but not her whole treatment.

Mills, a 58-year-old former nurse, said: “I am just absolutely gutted. I just cannot believe people make these decisions about other people’s lives. “It wasn’t going to cost them. I was going to pay for it. How can they say this policy is far more important than somebody’s life? “The NHS has taken this opportunity away from me and, if they are doing it to me, they are doing it to a lot of other women as well.”

The government claims that to allow some patients to pay for additional drugs on top of their NHS treatment creates a two-tier system between those who can and cannot afford them.

Asked about her future prospects, Mills said: “They are not hopeful of halting it. They will give you no promises. I didn’t ask and he [the doctor] didn’t say. It is not something I want to know just yet.” Mills, a mother of two, launched a legal action to try to force the NHS to allow her to pay for the drug Avastin which she wanted to take alongside another medicine, Taxol, which is prescribed by the health service. But during her four-month battle with the NHS, the breast cancer has spread to other parts of her body and doctors have told Mills it is too late for her to benefit from the combination of Avastin and Taxol.

An American trial has shown that taking the drugs in combination doubles the chance of preventing the disease from spreading compared to taking Taxol on its own. Taking Avastin in addition to Taxol is also likely to keep the disease under control for almost twice as long. Leading oncologists say Avastin offers a small but significant advantage in treating breast cancer. Mills will now be prescribed an alternative medicine but does not know how successful this will be in stopping the cancer.

Several other cancer patients are also taking legal action to win the right to pay for medicines that are not available on the NHS. The patients’ lawyer, Melissa Worth, of the law firm Halliwells, said: “Colette has been told by her medical team that she may have missed her chance. If she had been given the opportunity to take the Avastin when she first contacted her medical team about it, then she would have had three months’ treatment by now. Months down the line, the policy will need to change but for those patients currently fighting their NHS trusts, it might be too late.”

Becoming an entirely private patient would have cost Mills, from near Stokesley, North Yorkshire, about 10,000 pounds a month instead of about 4,000 solely to pay for the Avastin and its administration. Although she could have tried to raise the funds such as finding a loan, she believes it is a fundamental principle that the NHS should continue to fund her basic care for which she has paid through her taxes.

The Department of Health, however, said top-up payments would “undermine” the “fundamental principle of the NHS, now supported by all the main political parties, that treatment should be free at the point of need”. Mills’s case has provoked a national debate about whether NHS patients should be allowed to pay for top-up treatments. NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the over-fifties, have all backed Mills and other patients in her situation since The Sunday Times highlighted their plight last year. A group of Conservative MPs, including former shadow health minister John Baron, are campaigning for co-payments to be allowed.


Australia: Big and dangerous hospital delays for ambulances in Victoria

HUNDREDS of ambulances are out of service each day -- stranded at Melbourne hospitals. Ambulances are stuck at hospitals for up to four hours despite government benchmarks that they be free to leave within 25 minutes. Paramedics are unable to respond to new emergencies because the hospitals are full, documents under Freedom Of Information laws reveal.

The Metropolitan Ambulance Service documents reveal alarming numbers of ambulances waiting at hospitals. On average, more than 29 ambulances across Melbourne wait daily at emergency departments for an hour or more. In the first six months of last year, more than 320 ambulances a day were stuck for longer than 25 minutes. The documents reveal:

AN AMBULANCE delivered its patient to the emergency department at the Austin Hospital in three minutes, but waited three hours because there was no bed.

153 AMBULANCES, almost five a day, spent an hour or longer at Royal Melbourne, Grattan St, in May last year.

40 AMBULANCES were stranded for more than an hour at Frankston Hospital in one week.

MORE than 100 ambulances were stuck for an hour or longer at The Alfred in January.

Ambulance Employees Union secretary Steve McGhie said the down time could cost lives. "The reason they're waiting so long is because they can't get their patients off the stretcher," he said. "There is no room for them at the hospitals and ambos have to wait until they find room. "Every minute they have to wait at a hospital is another minute another patient has to wait for an ambulance."

Opposition health spokeswoman Helen Shardey echoed Mr McGhie, saying the out-of-service time could mean the difference between life and death.


Sunday, January 27, 2008

The Collective Punishment Model

Remember how in grade school, the teacher would punish the whole class for the actions of just a few disruptive students? This is an early lesson in collective punishment, which is usually practiced during wartime or under martial law. Collective punishment has now arrived with compulsory medical insurance. Known as an "individual mandate," politicians of both major parties have supported it. Compulsory politically-defined insurance is law in Massachusetts, is up for consideration in California and Colorado, and Democratic presidential candidates endorse it nationally.

Politicians peddle compulsory insurance under the guise of "personal responsibility." The story is that the uninsured receive medical care without paying for it. Their freeloading passes costs onto the insured, which increases premium costs. Compulsory insurance, say its supporters, can remedy this problem by forcing both the insured and uninsured to purchase medical insurance - as defined by politicians.

This rationale is flawed. First, freeloading from the uninsured does not significantly increase insurance premiums. Paying the medical bills for the uninsured adds little to insurance premiums - and certainly less than Colorado's scheme for compulsory insurance. A study published in Health Affairs found that uncompensated care is "only 2.8 percent of total personal health care spending," of which our tax dollars - not increased premiums - fund at least 80 percent.

In Colorado, the Lewin Group found uncompensated care to be less than four percent of total medical spending. The portion of uncompensated care that can correspond to increased premiums is around $200 million annually. This is just $85 per privately-insured resident, or one percent of the average premium.

But the billion-dollar "cure" proposed by Colorado's Commission on Healthcare Reform would cost the insured more than $85. To encourage compliance with compulsory insurance, the Commission's plan includes tax-subsidized premiums and Medicaid expansion. Privately-insured Colorado resident, the tax increase would cost about $400.

Second, holding people responsible would mean punishing freeloaders themselves and allowing providers to prevent customers from skipping out on the bill. This is the exact opposite of compulsory insurance, which forces the innocent to purchase insurance policies determined by political interests, rather than their own needs. This is collective punishment. What if we applied the rationale for compulsory medical insurance to freeloaders who leave restaurants without paying the bill? This certainly increases prices, but forcing all citizens to purchase "diner's insurance" punishes the innocent.

Third, government controls already punish the innocent - insured and uninsured alike - by making medical care and insurance prohibitively expensive.

The federal tax exemption for employer-provided insurance coddles insurance companies by tying employees to their employer's plans, effectively discounting insurance, and shielding insurance companies from competition. It also drives demand for more comprehensive insurance than would otherwise be purchased. Insulated from medical costs, patients behave like business travelers on a company expense account, so medical providers need not compete on price. Shall we further pamper insurance companies by forcing everyone to purchase their products?

On the state level, medical providers and disease constituencies lobby to force insurance to include benefits that many customers do not need. For example, Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. These mandates increase Colorado premiums by 21 to 54 percent, which dwarfs the one percent increase attributable to the uninsured. Colorado's Chief Medical Officer states that 2,500 Coloradans lose insurance for every one percent increase in premiums. Nationally, the figure is 300,000 people. These controls also reduce wages and are responsible for up to twenty-five percent of America's uninsured.

Compulsory insurance further empowers politicians to determine what insurance is best for you. For example, the Boston Globe reports that under the Massachusetts plan, "more than 200,000 people with health insurance would have to buy additional coverage to meet proposed minimum standards under the state's new health insurance law."

When government policies increase insurance costs, the first to drop coverage are the young and healthy. Those remaining in the insurance pool are at higher risk to incur medical expenses, so premiums rise again, which again drives out the healthiest remaining customers. It takes some nerve to support policies that make insurance prohibitively expensive and then make it a crime not to purchase insurance.

Compulsory insurance is based on collective punishment, a perverted form of justice found where troops patrol the streets and spitballs go splat. It punishes both the insured and uninsured for the misdeeds of politicians. Legislators should stop scapegoating the uninsured for the mess they've perpetuated. They should repeal legislation that inhibits the free market from delivering affordable high-quality medical care.


Saturday, January 26, 2008

"Treat it like car insurance ."

In almost every cry for "nationalized healthcare" these days, there seem to be one of two basic mindsets advanced for such a program. One camp continues to advocate the "Medicare model," seeking to base an expansion of health insurance on this overblown and bloated methodology, which is already very near the point of bankruptcy or drastic cutback on services in order to continue to function at all. Enough has been said, both here and elsewhere, about how absurd this system is as prototype for broader "coverage."

However, even among those who recognize the serious faults in the present Medicare model, there are many who see health insurance as just another mismanaged program, which if only it were better regulated would answer all the problems it now presents. These folks point to the "automobile insurance" paradigm as something the healthcare industry should emulate. They also use the fact that mandatory auto insurance has become the rule rather than the exception, to indicate how easily health mandates could be applied across the board.

What they fail to consider is how different insuring an automobile is from the personal health and wellness realm. Herewith is an attempt to define some of those differences.

First, let's examine the "mandatory" aspects of auto insurance. Even in its most draconian implementations, this does not compel drivers to take on full coverage (including comprehensive/collision, maximum personal injury, car rental during a disabled vehicle, etc.). It only requires the driver to be insured for liability to others, at least to a minimum standard of coverage. The focus of the mandates is on your burden on innocent others, not on your personal well-being.

Second, the incidents covered by an auto insurance policy are restricted to the results of accidents and breakdowns, even under the most all-inclusive policies. There's no coverage for routine maintenance, oil changes, parts or labor for repairs, etc. All of this must be secured under a separate set of warranty coverage, none of which is mandatory in any state - nor is it likely to become so.

And finally, car insurance may currently be obtained through a much wider variety of insurance agents and companies, in many cases spanning state lines and boundaries. Although the rates themselves may be based on where you live and the actuarial statistics pertaining to that area, in most cases companies based far across the country can serve your requirements, competing with localized agencies.

Now compare all this with the health insurance model, if it mimicked the automotive one. If the only requirement was that you minimize your negative effects on others, a proper mandate might require you to avoid contact with others while afflicted with a communicable disease. During flu season, for example, one might wish to secure some policy that paid at least partial wages for time missed while staying home and recovering from a virus, rather than passing it to others by our presence in the workplace. No other coverage (except perhaps for the medicine to speed recovery?) would be then deemed mandatory, although one would be responsible for remaining isolated until the ailment had passed, at least through its communicable stages.

The limitations on personal-care coverage, even as voluntarily incurred, would also be pretty restrictive if we strictly adhered to the automotive model. Just for starters, physical exams, screenings and other supposedly "preventative" actions would not be covered by the policy; we don't object to paying out of pocket for an oil-change, or a new battery - or if we do, we've secured a repair and maintenance contract to limit those expenses beyond a certain level. (Note that one can now do something similar with healthcare, by taking out a high-deductible, catastrophic-only policy, with low premiums, while investing the remainder in a Health Savings Account to pay for those "maintenance" costs.)

Whatever the case, under this paradigm there would be no need for the massive amount of paperwork and bureaucracy we now must weather - in every doctor's office, clinic and hospital - processing all those claims and forms for routine examinations, screenings and treatments, for the mere security of detecting possible serious ailments before they become inoperable or incurable. Paying up front and at point of service would cut such administrative costs considerably, and any healer who failed to pass along those savings, with lowered fees, would not stay in business very long.

Only the big-ticket items, caused by "collisions" with other elements (in this case, chronic diseases, accidents and other catastrophic events, comparable to "other vehicles, physical barriers and tree-trunks," in the case of the autos), would be "covered" by insurance under such policies. If we chose to add "coverage" for either minor ("fender-bender"?) or health-maintenance events, we could do so, but this would not be mandatory under a consistent application of this paradigm.

Finally, if we were truly basing this process on the automotive model, we'd be offering a lot more options, and without the state-line boundaries that now exist. While some leeway among local providers does exist, there are so many mandated coverage provisions imposed by individual states, with no recourse to avoiding them in being "covered" within that state, that the cost of the policy is artificially increased just by that factor alone. Bottom line, the "car insurance model" might be a good starting point for serious healthcare reform . but only if one really means what is implied by that idea.


Australia: Woman's death in government hospital was preventable

A MELBOURNE woman who died after giving birth could have survived if her medical treatment had been more timely and organised, a coroner found today. Piyanat Siriwan, 33, died at 2.15pm on April 1, 2004, at the Monash Medical Centre from massive blood loss after giving birth to a healthy baby girl at 8am that morning at the South Eastern Private Hospital in Melbourne's outer east.

Delivering her finding today into the death, Coroner Paresa Spanos said with more competent medical management, including a more timely transfer from the South Eastern Private Hospital, Mrs Siriwan "had a reasonable chance of surviving''. "In that sense I find her death was preventable,'' Ms Spanos said. Saying Mrs Siriwan's transfer between the hospitals was "a study in chaos'', Ms Spanos was critical of Mrs Siriwan's obstetrician Maurice Lichter and anaesthetist Emlyn Williams in their handling of her case on the day of her death, and ordered them to front the Medical Practitioners Board of Victoria (MPBV). She recommended the MPBV take whatever "action it deems appropriate against the two doctors''.

Ms Spanos also made an adverse comment about South Eastern Private Hospital not having made Dr Lichter or Dr Williams aware there was an emergency supply of blood available which would have been used to help Mrs Siriwan. She recommended the hospital ensure all doctors were aware of such supplies being available in future cases.

However, Ms Spanos said she did not have any adverse comment to make in relation to the Metropolitan Ambulance Service or the nurses attending Mrs Siriwan on the day, adding that their concern and frustration had been evident. A lawyer for Mrs Siriwan's husband, Harrinat Siriwan, said outside the court that he was too upset on hearing his wife's death was preventable to speak publicly.


Friday, January 25, 2008

Wal-Mart Finally Wins Approval of Its Employee Health Plan: Retailer Says More Than 50 Percent of Staffers Have Signed Up for Benefits Package

Wal-Mart said this week that for the first time in its 45-year history more than half of its workers had enrolled in the company's health insurance plan, a potent milestone for a retailer long associated with unaffordable benefits. The discount retailer said that, after it introduced a revised health plan last fall, the number of workers who signed up reached 690,970, or 50.2 percent of its 1.4 million employees, the NY Times reports. The higher enrollment — which has risen from 45.5 percent of Wal-Mart's employees five years ago — is expected to help blunt criticism from unions and political groups that have focused, relentlessly, on the company's failure to insure fewer than half its workers.

After several years of research and discussion, including interviews with executives at companies known for generous healthcare, like Starbucks, Pitney Bowes and Microsoft, Wal-Mart last fall introduced what was considered its most flexible, and generous, health plan. A family can pay as little as $250 a year in premiums if it is willing to have a $4,000 deductible and be responsible for as much as $10,000 in medical bills, roughly the same plan that cost them $1,500 a few years ago, reports Times writer Michael Barbaro. "We can see that the improvements we've made are being embraced by our associates and their families," Linda Dillman, the head of benefits at Wal-Mart, which refers to its workers as associates, told the Times.

Critics still contend the plan is out of reach for many Wal-Mart workers, who earn, on average, less than $20,000 a year. But thousands of workers have enrolled. Wal-Mart said that 30,000 workers who enrolled for 2008 were previously uninsured. To date, Wal-Mart said, 92.7 percent of its workers have healthcare, it not through Wal-Mart, then through a spouses' or parents' employer, state Medicaid programs, the military or a previous job. The number of workers who are uninsured has fallen, to 7.3 percent in 2008 from 9.6 percent last year, the company said.

Dillman said Wal-Mart would commission a study to find out why those 7.3 percent of workers were not enrolled in a health plan. "We really want to understand what is the barrier preventing them from moving onto our plans," she told the Times.

In a statement, Wal-Mart Watch, a union-financed group critical of the retailer, said it was "surprised that Wal-Mart is proud to report that half its employees choose not to take Wal-Mart's health care plan, including 7.3 percent who think Wal-Mart's plan is worse than nothing at all."


Thursday, January 24, 2008

Dental alternatives

Recently I was having dinner at a local restaurant and bite into something hard that really shouldn’t have been there. My jaw felt sore but after a day or two it seemed fine. A few days later the pain really started. I called around the local dentists and found only one that would fit me in. He quoted a price of $160 for the appointment. With no other option I took it.

The dentist himself rarely appeared during the entire appointment. An assistant took an x-ray of my top left molars. The dentist put in a brief appearance to look at the tooth and the x-ray and tell me it was fractured. He then wanted to send me to a specialist for a root canal and then to come back to him for a crown. I have no idea what the cost would be since I didn’t have the cost of the specialist or the root canal. But just the first dentist alone, with the first visit, wanted $1,300+. Add in the root canal and this first useless visit and the cost most likely would have exceeded $2,000.

As for the severe pain the dentist suggested I buy some over the counter pain killer -- the very kind of pain killer that was already failing miserably. To be fair, I don’t blame the dentist for his refusal to prescribe a pain killer. The drug cops, in order to expand their field of operations, have been harassing doctors who dare to try to alleviate patient pain. The government wants you to suffer in order to protect you from yourself.

But what really pissed me off was that by the next day it was quite clear that they had diagnosed the wrong tooth. Originally I told them it was my left side but that it sometimes felt as if it was the top and sometimes the bottom. I couldn’t tell because the entire jaw was throbbing. But as it got worse it was more clearly the bottom jaw. Yet the tooth they diagnosed was on the top.

A conversation with someone reminded me that Tijuana is filled with dentists so I flew down that Sunday night to make an appointment on Monday morning. The dentist there fit me in his schedule a couple of hours after the call. He checked the teeth and said it looked like there was a small fracture in a lower molar. Then came my first surprise. To x-ray the tooth he used a small plastic device, which acts as the film, that was attached to his laptop. After the x-ray is taken the image appears instantly on the laptop. My U.S. dentist wasn’t this advanced.

From the x-ray it appeared that a root canal would be needed. My last experience with a root canal was very unpleasant -- lots of pain that the dentist kept telling me couldn’t be happening but was. The dentist assured me that it would be different. I went ahead with some reluctance.

The pain killer was injected and he waited and waited. He kept asking about how numb my lips were feeling. And when I told him they were numb to the center of my lip it was time to start. I can honestly say that there wasn’t any pain during the entire process. He did the root canal and packed the tooth scheduling me for a crown on Friday.

During this first session he spent over two hours working on my tooth. He was the only one who did the work. He didn’t bring in a second-stringer. There was no pain whatsoever. He warned me the jaw would be in pain when the shot wore off. It did. And when it got bad I called him and he suggested a pain killer which I can purchase over the counter -- you can’t get in the U.S.

I went back a few days later to have the crown fitted and then again the next day to have it attached. Only on the third visit did another dentist handle it because my original dentist had no appointments. This dentist constantly kept fitting the crown and filing away at it to make sure there was perfect fit. And then as a bonus I decided to have my teeth cleaned as well. That cost $30 extra.

There was nothing second rate about the care I received. I got prompt care directly from the dentist. It was accurate, pain-free and effective and it cost a fraction of what I was paying at home. Even with my flight the total cost was about half what I would have paid at home. So even the cost were relatively pain free. The most painful part of the experience was dealing with the travel Nazis at the airport and waiting in line with thousands of people trying to get permission to re-enter my own country on my way back to the airport.

Of course you can seek treatment in the United States if you wish. Or you can take a medical vacation in Mexico. What you’d save, depending on what needs to be done, can pay for the trip and still put extra money in your pocket. Of course, if you have third party payment for your care you may not worry about the costs -- and that’s one of the reasons that medical care in the U.S. is so expensive.


Wednesday, January 23, 2008

Britain: Nurses' low pay 'fatal in rich areas'

Lives are being lost because of the central negotiation of pay rates for nurses, a study has found. Hospitals in prosperous areas such as London and the South East find it harder to recruit and retain nurses than those in areas where local wage rates are lower. This is because regional differences in nurses' pay are not as big as regional differences in the wider labour market. As a result, hospitals in prosperous areas treat fewer patients and have worse results than those in poorer areas, says a team from Bristol and London in a report for the Centre for Economic Performance and the Centre for Market and Public Organisation.

A gap of 10 per cent between nurses' pay and that of women working locally in the private sector was said to raise the death rate among people admitted to hospital after a heart attack by 5 per cent. The NHS and the Royal College of Nursing (RCN) are wedded to the idea that nurses everywhere in the UK should be paid the same. There are some regional variations, say Professor John Van Reenan, of the London School of Economics, and colleagues, but they do not fully reflect differentials in the labour market. In inner London, for example, white-collar wages for women are 60 per cent greater than those of women in the North East. Allowances are paid to nurses who work in inner London, but they amount to only about 11 per cent more than the wages of their colleagues in the North East.

The new research by Emma Hall, Carol Propper and John Van Reenen tracked changes in wage rates and changes in performance in more than 100 English hospital trusts between 1995 and 2002. Hospitals in areas where the outside labour market is strong treat fewer patients per staff member. They have higher death rates among patients who are admitted after heart attacks.None of these effects is found in private sector nursing homes. Nor do they seem to arise from financial problems faced by hospitals in high-cost areas.

There is a 15 per cent increase in death rates between hospitals where outside wage rates are in the top 10 per cent and those in the bottom 10 per cent. Productivity varies by 18 per cent between the top 10 per cent and the bottom 10 per cent. The results have important implications for regulated labour markets, and the NHS, the report concludes. "Rather than focusing on across-the-board increases in national pay, which we found not to be cost effective, relaxing the regulatory system to allow local wages to reflect local market realities would improve productivity and save lives," it says.

Peter Carter, the general secretary of the RCN, said: "In the RCN's experience, poor hospital performance tends to be related to an absence of clinical leadership, inadequate resources and staffing levels or ineffective financial management. "The modelling in this study can lead to simplistic conclusions on very complex issues."


Australia: Call for inquiry into public hospital death at hands of a Saudi


The NSW Opposition has called for the parliamentary inquiry into Royal North Shore Hospital to be reopened to hear evidence from a senior anaesthetist who raised concerns about the hospital's practices with a coroner. Opposition health spokeswoman Jillian Skinner said she would push to reopen the inquiry after Deputy State Coroner Carl Milovanovich, who is investigating the death of teenage patient Vanessa Anderson, said it was not his role to canvass broader issues at the hospital.

Vanessa, 16, suffered a seizure and died two days after her skull was fractured by a stray golf ball in November 2005. The inquest has heard she received no anti-convulsant drugs and was prescribed Panadeine Forte and the painkiller Endone, a combination three medical experts described as inappropriate.

Mr Milovanovich was set to deliver his findings last July, but adjourned the inquest after senior anaesthetist Dr Stephen Barratt wrote to him raising concerns about Sanaa Ismail, the anaesthetics registrar who increased Vanessa's dose of Endone. As the inquest resumed yesterday, Michael Williams SC, for the Anderson family, also sought to question Dr Barratt about his wider concerns at the hospital, but Mr Milovanovich limited the doctor's evidence to matters relevant to Vanessa's treatment.

Dr Barratt told Westmead Coroner's Court that Saudi-trained Dr Ismail "unfortunately has an issue of needing to save face" and invented stories. While he backed down from his initial assertion that this was a "cultural issue", he said: "She will not admit to mistakes." Recalled as a witness, Dr Ismail - now a senior registrar at the hospital - repeated her evidence that she misread Vanessa's medication chart, not realising she was on high-strength Panadeine Forte rather than ordinary Panadeine.

Dr Barratt told the court that two incidents earlier in 2005 had triggered his concerns about Dr Ismail's performance when unsupervised. However, when cross-examined by Dr Ismail's barrister Stephen Barnes, Dr Barratt conceded there was "little or nothing" in either incident to raise safety concerns. He agreed that an internal investigation cleared her of mistakes in treating the first patient, who went into cardiac arrest while in labour.

The court heard Dr Barratt had been "impaired" by extreme anxiety when he contacted the coroner and was prescribed medication less than three weeks later. Outside court, Vanessa's father Warren Anderson said the six-month adjournment had been difficult: "We just want the truth about what happened to our daughter." Ms Skinner will move to reopen the parliamentary inquiry so Dr Barratt could testify "about all of the matters he wanted to canvass". Mr Milovanovich will hand down his findings on Thursday.


Tuesday, January 22, 2008

Surgical competition cuts costs

Warren and Wendy Miller would never have chosen India as a tourist destination. They thought it was too hot, too poor, too dirty and the food, well, "too Indian". But as they gazed up at the Taj Mahal, that most elaborate of monuments to a perished love, they knew they had done exactly the right thing. The Millers were medical tourists, escaping Queensland's long public health waiting lists and eschewing private specialists for the same reason.

The Innisfail couple flew to India in March 2006, so Warren, 67, could have his arthritic knee replaced at the world-renowned Fortis Hospital in New Delhi. While they were in the neighbourhood, they also decided to have laser surgery on their eyes.

The Millers aren't alone. Every year, hundreds of Australians are heading overseas for sun, sand - and surgery. While exact figures aren't known, travel industry specialists estimate that most of these travellers, more than 85 per cent, are heading offshore for Botox treatment, breast enhancement or reduction, and bottom lifts. Dubbed "nip-and-tuck tourists", they are paying in Thailand, Malaysia and the Philippines a fraction of what it would cost them at home to have cosmetic surgery, with the bonus of an overseas holiday thrown in. And an alibi. While daiquiris are being sipped and beaches are being walked, wounds are healing thousands of kilometres from home and the prying eyes of friends and family. Clients are returning home refreshed, rejuvenated and retouched while friends and family are none the wiser.

Dental treatment is also booming in South-East Asia - a trend that saw Brisbane psychologist Keith Owen bound for Bangkok last year. In the luxurious surrounds of the Dr Sunil Dental Clinic, Owen had 13 teeth crowned and two badly broken ones repaired. In Australia, the dental work would have cost about $35,000 with a conditional guarantee. In Bangkok, the final bill - including air fares, accommodation and trips to see the city's highlights - came in at less than $10,000. In addition, there's a 15-year guarantee if there are any problems, regardless of who is at fault. Sunil also provides limousine transport to and from the airport and the clinic, a service which is most definitely not available in Australia.

Owen's decision was reached on price alone. "It was absolutely horrendous, the cost over here, and that's why I went over there," he says. "I got treated really well... and the quality of work was really good."

The greatest potential, though, lies in the area of elective surgery. People like the Millers are exploring their surgical options because they are fed up with extensive waiting times in the public and private sectors in Australia. More and more people are getting out their passports and fetching their phrase books to have elective surgery, including heart operations and hip replacements, overseas. Singapore even offers organ transplants, including kidney and liver.

There are dozens of internet sites where potential patients can package their holidays, including flights, tours, transfers, accommodation and a trip to a specialist of their choice. Admittedly, most of these are geared to potential clients from the UK and the US, where not only are the waiting lists hellish but costs are extortionate. Many US companies now sign up employees to health insurance that stipulates all major surgery and dental work must be done outside the country.

In Australia, Thai Airways already has recognised the growing market for Australian health tourists by offering holiday packages to Thailand that include executive medical check-ups through Royal Orchid Holidays. One of the hospitals in the package is Bangkok's Bumrungrad Hospital, which The New York Times has described as having "carpeted wards, internet access, cable television, rooms with balconies and private bars". The foyer is of the standard of a five-star hotel, and there are apartments and suites with a pool and fitness facilities for post-operative recovery. Last year, the hospital catered for more than 450,000 overseas patients from almost 200 countries. Add on daily cleaning, room service meals, fluffy bathrobes and airport transfers - what's not to like about the place?

Both the Australian Medical Association and the Australian Dental Association say patients should be extremely cautious when investigating the overseas option for treatment, especially if the destination is a developing country. Infection rates, follow-up care and internet rip-off merchants preying on vulnerable people are all cited as reasons to stay at home. Recent media exposure about botched operations, especially cosmetic surgery, has made Australian travel agents offering medical tourism packages wary. At least two of the operators involved - Redcliffe-based International Medical Tours and Sabra Travel in Sydney - have had a rethink. A spokeswoman for Sabra said they'd stopped offering health tours about six months ago, while IMT is also planning to close that side of its operation.

The Millers, though, are a two-person fan club, and ready to sing the praises of their treatment option to anyone who'll sit still long enough. "The hospital itself was absolutely No. 1 - a great big multi-storey building," Miller says. He says the accommodation and treatment was first class - and there wasn't a speck of dirt in sight. And yes, they wouldn't hesitate if a second trip was in the offing. "I'd like to have my eyebrows lifted," Wendy Miller says - tongue firmly planted in her 63-year-old cheek. They even found a restaurant that served Chinese food the way they'd cook it at home themselves.


Monday, January 21, 2008

NHS kills thousands -- increased funding no help

Over 17,000 deaths a year could be saved if NHS performance improved, a new study claims today. The Taxpayers' Alliance claims the 34 billion pounds of extra spending on the NHS by Labour has made no difference to mortality rates. Its claims are based on an analysis of World Health Organisation data, comparing NHS performance to its European counterparts since 1981. This took into account how many deaths could plausibly have been averted by the NHS - a measure known as mortality amenable to healthcare. The calculations compare the UK performance to that of Germany, France, the Netherlands and Spain.

The Taxpayers' Alliance says if the UK were to achieve the same level of mortality amenable to healthcare as the average of the other European countries studied, there would have been 17,157 fewer deaths in 2004. This is over five times the total number of deaths in road accidents.

The campaigning group argues its findings show the government's extra NHS spending has failed to deliver results. Report author Matthew Sinclair said: "Thousands are dying every year thanks to Britain's health service not delivering the standards people expect and receive in other European countries. "Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality. This is a colossal waste of lives and money. "We need to learn lessons from European countries with healthcare systems that don't suffer from political management, monopolistic provision and centralisation."


How a superbug cost the NHS 5 million pounds

There is talk of a ski chalet in Verbier and they are drawing up plans to build a holiday home in Ibiza. A plot of land on the Mediterranean island has, it emerges, already been chosen. Leslie Ash and her husband Lee Chapman are certainly in a position to afford such luxuries now - even if they might not have been before.

Ever since the Chelsea and Westminster Hospital accepted liability - back in 2006 - for "shortcomings" in care that left Miss Ash, 47, battling a near-fatal superbug, the only question remaining was just how many "noughts" would be printed on her compensation cheque. The answer was finally made public on Wednesday: 5million. That's six "noughts", incidentally - and equal to the total of every payout made to every MRSA victim in Britain since 2002.

The award would pay for 250 specialist intensive care unit nurses for a year, or 70 consultants; or, indeed, any number of second homes in Switzerland or Spain, where the couple are thought to be about to buy land for their proposed new property. "We can then combine the peace and quiet over there, with the hustle and bustle of London," Miss Ash is quoted as saying.

Now, no one can begrudge former patients like Miss Ash, a mother of two teenage boys, and still best known for her role as Deborah in the 1990s sitcom Men Behaving Badly, some form of compensation, or her luxurious place in the sun. For a time she was left almost completely paralysed from the waist down. Offers of work dried up. Today, she cannot walk without a stick and is in considerable pain ("I'll always be in pain . . . my painkillers only take 50 per cent of it away," she has said.) ....

The deal signed by her lawyers is ten times the 500,000 pounds she was initially reported to have been awarded as a victim of a hospital superbug. Her injuries meant it was "unlikely she would ever be able to return to an active role as an actress", the writ stated. "The size of the payout is large because it takes into account her loss of earnings and future loss of earnings." Miss Ash has said holding the Health Service accountable - rather than making money - was the motivation behind her compensation claim. But we have learned that more than one offer to settle was made during the legal negotiations, including a substantial one in late November last year. Miss Ash insists she was at the "height of my career" when she became ill - hence the record damages. Even her most ardent fans might dispute this....


Sunday, January 20, 2008

Judicial Watch Finally Pries Open the Clinton Vault

Post below lifted from Suitably Flip about the health dictatorship America narrowly escaped in the 1990s

The Judicial Watch website is down at the moment (possibly due to a massive traffic flood) back up, but Captain Ed summarizes what the group found in the first collection of documents they managed to wrangle from the Clinton Library on the topic of Hillarycare circa 1993.  Specifically, some of the documents detail strategy deliberations that address how to deal with the First Lady's detractors.  And the tactics discussed (including the suggestion by a certain Democratic Senatorial elder that the Clintons "expose lifestyles, tactics and motives of lobbyists") are of a flavor that can best be described as Clintonian.

What's more, the memos seem to lay bare the fact that even the coziest Clintonistas weren't precisely bowled over by her radical plans to socialize American medicine.  More bluntly, it sounds like even Clinton campers realized the authoritarian utopia Hillary was cooking was enough to make George Orwell himself blush.
A June 18, 1993 internal Memorandum entitled, “A Critique of Our Plan,” authored by someone with the initials “P.S.,” makes the startling admission that critics of Hillary’s health care reform plan were correct: “I can think of parallels in wartime, but I have trouble coming up with a precedent in our peacetime history for such broad and centralized control over a sector of the economy…Is the public really ready for this?... none of us knows whether we can make it work well or at all…”

With the primary in high gear, this ought to shift the political discourse in interesting directions.  If the early glimpses are an indication of what's yet to come, we may have to start referring to a young Senator from Illinois as Mr. Inevitable.

Update:  I think I've cracked the cipher of the intials "P.S."
Paul Starr (born May 12, 1949) is a Pulitzer Prize-winning professor of sociology and public affairs at Princeton University.
In 1993, Starr was the senior advisor for President Bill Clinton's proposed health care reform plan.
As fate would have it, Starr recently wrote an article for The American Prospect (the liberal magazine he co-founded), entitled "Hillarycare Mythology: Did Hillary Threaten Democratic Senators?"  In the piece, he aims to disabuse us of the notion that the First Lady was so ominously proficient in the dark art of politics.
Writers love stories like this one because they seem to confirm a larger narrative about a public figure's inner qualities. Some stories are so good you wouldn't want to spoil them by finding out they never happened.

Well, we may be about to find out.

Update:  Judicial Watch is back up.  This is the page detailing the first round of documents and this is the memo "A Critique of Our Plan" (pdf) that I'm speculating was written by Paul Starr.

Here are a few more of his thoughts about Hillarycare.
We will inevitably be accused of creating a monstrously complicated proposal, and it will take an enormous effort to communicate the essentials in a simple way.

But the issue is not just communication.  There is more regulation in this plan that [sic] I expected to see, and I worry about the wisdom of much of it.  The spirit and some of the substance contradict the idea of flexibility for states and room for variety, innovation, and competition.
[T]he most heavy-handed part of the program is the budget, and we may not have any credible way of making it more palatable.
And a few more highlights from that Senate elder's smear cookbook (pdf).
Impeach the credibility of opponents:

  • Avoid partisan targeting.  Demonstrate that opponents are advocates of delay or inaction, regardless of party affiliation.  Moderate Republicans must be broken from conservative ranks.

  • Expose opponents as "professional lobbyists" with values and interests divorced from average Americans (document salaries, perks, ideological extremism, and provide all to the media.

  • Use classic opposition research to expose their selfish and short-sighted motivations, and obstructionist tactics (collect mailings, track ad campaigns, investigate expenditures, and provide to the media).
His punctuation here is comically revealing.
Apply pressure on undecided Congressional votes with intensive message delivery through their home state or home district media outlets.
Result:  Three-four days of saturation local coverage in all targeted states and/or districts, tied to national events with network coverage - all featuring "real" people with "real" stories.
At one point, the author (Jay Rockefeller of West Virginia, incidentally) lays out the pros and cons of waging an avowedly partisan grassroots campaign vs. a non-partisan campaign, in order to rally public support for Hillarycare.  If the modern day Clinton machine is aptly characterized as one of meticulous scripting, triangulation, and... lets face it, ham-fisted sock puppetry, Senator Rockefeller may deserve some credit for showing them the ropes.
Non-partisan:  The National Health Policy Council is the most obvious existing organization to be expanded for this purpose.


  • ... A high-profile announcement of the decision to take this "aggressively non-partisan approach" would be extremely helpful in building public confidence and support...

  • General public would recognize this as a clear attempt to break through partisan politics and gridlock.

NOTE: Just so you understand, I have been involved with NHPC, as honorary chair, for nearly two years.  I can attest to their effectiveness and their breadth both geographically and politically.  I have considered other existing organizations, but I believe NHPC would serve you needs best, in part because I know that the people involved are prepared to do anything you would ask of them.
All the goodwill of a "non-partisan" organization with all the control and ideological reliability of group of paid staffers?  Brilliant.  I wonder if Hillary ever tried to replicate that formula.

Update:  I reached out to Professor Starr at Princeton, who acknowledges it was his memo and offers a couple of additional points.
Dear Mr. Pidot,

Two points: 1) This memo, which I wrote, was a critique of a preliminary draft, not the final draft, of the 1993 Clinton health plan, and 2) none of the provisions to which I objected are in Senator Clinton's current proposal, which shows that she has fully absorbed the concerns I was raising.

If you use any of this short email, I presume that as an honorable journalist, you will quote it in full. 

Paul Starr

Saturday, January 19, 2008

British cancer patients let down on fertility

Cancer patients are being denied access to NHS fertility treatment, leading specialists say today. In spite of a recommendation in 2004 that patients facing chemotherapy should be given universal access to sperm, egg and embryo storage, there is no consistency and no national policy on funding such techniques. Patients who are treated for cancer can become infertile, so storing sperm, eggs or embryos can be their only hope of becoming parents later.

A new report by experts from the Royal Colleges of Physicians, Radiologists, and Obstetricians and Gynaecologists, recommends that the NHS funds these services, including setting up research-based centres for egg and ovarian tissue storage. About 11,000 patients aged between 15 and 40 are diagnosed with cancer each year in the UK - 4 per cent of the total. A separate survey for the charity Cancerbackup highlighted the "postcode lottery" in accessing procedures.

In 2004 the National Institute for Health and Clinical Excellence (Nice) said that cancer patients should be given universal access to sperm, egg and embryo storage. The Royal Colleges' working party found this was not happening. "There is currently no national policy for funding any of the techniques which aim to preserve fertility or treat the effects of gonadal damage, demand for which will always be very limited. "The working party strongly recommends that an agreed national policy and funded nationwide equity of access to resources be available."

The report says that sperm banking should be widely available and noted the success of embryo storage. The study also called for patients to be fully informed of the risks of treatment at the time of diagnosis.

Dr Michael Williams, Vice-President of the Royal College of Radiologists, said: "It is shocking that arguments over funding still limit patients' access to fertility-preserving treatments. Sperm freezing is well established, simple and effective."

The Cancerbackup survey of 84 out of 152 primary care trusts (PCTs) revealed that access to fertility services is patchy across England. The East of England was found to have the best provision, while PCTs in the South West failed to implement many of the Nice recommendations. About a third of men questioned by Cancerbackup said they had never been offered sperm storage. The survey also revealed that only half of the PCTs funded embryo storage.

Joanne Rule, the chief executive of Cancerbackup, said: "It is unacceptable that access to fertility services for cancer patients is dependent on where you live. Some PCTs are denying patients the option to preserve their fertility. All cancer patients should be informed of the potential impact of cancer treatment on their fertility before treatment starts."

A spokesman for the Department of Health said: "There are Nice guidance documents which recommend that cancer patients should have access to appropriate trained personnel at the time of diagnosis to discuss fertility issues. Implementation of Nice guidance is a standard which the NHS is expected to achieve over time."


Scotland: Great-grandmother sues over MRSA

A great-grandmother who contracted the MRSA superbug in hospital is suing NHS Greater Glasgow for 30,000 pounds, in a move that could pave the way for hundreds of other sufferers to claim millions of pounds in damages. Legal arguments began yesterday at the Court of Session in Edinburgh, where a judge is to decide whether the case brought by Elizabeth Miller, 71, should proceed to a full hearing.

Mrs Miller, who was not in court, told The Times last night that her life had been devastated by weakness and breathlessness since she acquired the infection after a heart operation in the Royal Infirmary, Glasgow, in 2001. The case is believed to be the first of its kind in Britain. Mrs Miller, from Kilsyth, near Glasgow, had MRSA diagnosed nine days after an operation to replace her aortic valve. Her legal team blames the infection on staff not washing their hands, a lack of soap and paper towels and faulty sinks and taps at the hospital. They say that a nasal swab taken from their client proves that she did not have MRSA before her operation.


Friday, January 18, 2008

Fruitless attempts to create equality in a complex world can have disastrous consequences

The instant I heard how the NHS was treating Colette Mills and Debbie Hirst, the image came to me. Here we go again, I thought.... They both have cancer. They wish to benefit from a relatively new drug called Avastin, but the drug has not been approved for use by the NHS. It does do some good, but it is not regarded as cost-effective. So the two women decided that they would buy the drug themselves. Fair enough? Apparently not. The two women have been told that if they pay for the drugs, NHS treatment will be denied to them. They have to pay for all their care privately, an impossibly large sum, or receive it all through the NHS. Alan Johnson, the Health Secretary, was firm on the subject. They cannot, he argued, "be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs".

But the reason he gave was not a medical one - that drugs needed to be administered together by the same doctor on NHS time. Or a practical one - that it would be a bureaucratic nighmare to have some drugs for sale and some not. It wasn't a legal one either: it isn't at all clear that the law prevents this mixture of the NHS and private treatment Instead he said this of the request by these gravely ill women: "That way lies the end of the founding principles of the NHS."

Now Mr Johnson is a compassionate man and an intelligent one, too. He's not, in my experience, generally dogmatic. So what on earth possesses him to deny cancer treatment to these terribly sick patients? Where could such an idea come from? Sootynomics.

Last year was the 50th anniversary of Tony Crosland's book, The Future of Socialism. While re-reading what was, when it was published, one of the most important books of social democratic thinking, I was struck by how dated it had become. Crosland spent half the book in earnest dispute with people advancing ideas that are, to the modern eye, completely ridiculous. He patiently explains, for instance, over an entire chapter, why guild socialism - a barely comprehensible scheme in which trade groups control industry - wouldn't be a bright idea.

What has changed over the past 50 years is this: we now appreciate, or at least have some inkling, how big and how complicated the world is. When there are staff employed in the occupational therapy unit of the IT centre of the people who make the dye that colours sliced bread packaging, how exactly does guild socialism work? The idea of a fully planned economy, painstakingly criticised by Crosland, now needs little effort to refute. It has simply fallen away.

Yet there remains an extraordinary amount of public policy confidently advanced without any idea of the massive contrast between the size and complexity of the world and the puny measure being proposed, without any understanding that the world rages on like the sea - unstoppable, uncontrollable. The absurd idea, for instance, that you can tackle obesity by banning food advertisements on children's television (an apt example of Sootynomics, come to think of it) or stop climate change by using fewer carrier bags at the supermarket. I remember one of my colleagues calling for a boycott of Tesco because it was killing the high street. The last time I looked, Tesco was still trading.

Alan Johnson's NHS ruling is a perfect example of the same syndrome. What is the fundamental principle whose end he fears? Not that care should be free at the point of use, since he already believes that to use Avastin, you must pay for it. No, the principle to which he clings is that all patients should receive the same care. There should be equality. Do you see what I mean when I say it would be comic if it wasn't a tragedy? Mr Johnson looks at the world with its vast disparities in wealth, with its teeming masses and its warzones and its starving slums and its clipped suburbs and thinks he can make the world more equal by preventing a couple of women buying Avastin.

Actually, never mind the starving slums and the warzones, there isn't even equality inside the NHS. There are cancer drugs you can have prescribed in Scotland that you can't have prescribed in England. You can pay for some dental services while receiving others on the NHS. You can receive two different but related treatments and pay for one of them as long as you don't have the treatments together in one place as one episode.

Alan Johnson is trying to hold a line that cannot be held. As more expensive drugs become available and are deemed "not cost-effective" the Mills and Hirsts will multiply. The offence against their rights will be seen increasingly as unacceptable and the pursuit of an elusive equality ever more obviously futile. You may as well stop planing down the tree now, Mr Johnson.


A good comment on the above from a "Times" reader:

This long-standing NHS policy is symbolic of the vicious logic of Britain's socialism. It is the politics of Iago: "If Cassio remain/ He hath a daily beauty in his life/ Which makes me ugly." Like the nasty kid in the playground, we will attack anyone who is better than us.

It is also tribal. The NHS treatment is "us". You are either with us, or outcast. It reminds me of the provincial museum official who denied entry to a public school group. "They're not us. They can't use our facilities." Thankfully that nasty piece of tribal nonsense was over-ruled by Tony Blair. In this more tragic case and many like it, the vicious 'if I can't have it, neither can you' policy of tribal doctrinaire socialist equality will continue.

British medical education bungle good for Australia

A BLUNDER in a jobs recruitment program in the UK will result in relief 19,000km away with hundreds of doctors set to migrate to Australia to help fill staff shortages in our ailing public hospitals system. More than 5000 British medics have found themselves unemployed after failing to get a training post at hospitals in the UK. Two years ago, with critical shortfalls in the number of doctors, the British government lifted the number of places available at training schools and centralised the recruitment system. But it failed to take into account how many places there were available in hospitals to provide internships or hands-on training for the medicos to complete their training.

The British Medical Association said yesterday the only winner would be Australia, with hundreds of young doctors applying to complete their training and fill critical staff shortages. Most of the doctors have applied to work in NSW and Queensland hospitals but a BMA spokesman said hospitals across all states could expect British applicants in the next few months when the true number of training posts available became clear. "It's just a ridiculous situation," a spokesman said. "They increased the medical school places but gave us a situation now where there are only between 8000 and 9000 places (in the UK) but about three times as many applicants. "Not being able to complete their training means they have to put their careers on hold, take a non-training job or practice abroad. The loss to the UK is a gain for countries like Australia and we know a number who are planning to head there."

Dr Robert Thomas spent a year at a NSW Central Coast hospital but was one of the few to find a place in the UK to complete his training. "I was lucky but a lot of my friends are still planning to travel to Australia to work in hospital accident and emergency wards," he said. "I think you will find most will go there for training but will stay there for good. The life is so much better."

An official inquiry into how thousands of doctors missed out on UK places last week concluded the government and Department of Health should be stripped of responsibility for the recruitment system.


Thursday, January 17, 2008


Four new reports below

Rudd flailing at the air over health

State health ministers have been ordered to design ways to admit fewer people [That's a great start!] to hospital and release patients only when they are ready to leave, in exchange for incentive payments to be rolled out by the Rudd Government. Federal Health Minister Nicola Roxon is preparing for a meeting with her state counterparts on January 31 in Melbourne to discuss how to implement the Government's $2 billion plan to fix the problems in the nation's health system over the next four years. The Rudd Government has warned it will consider a commonwealth takeover of public hospitals [Do the Feds REALLY want that monkey on their backs?] if the states have not begun implementing reforms by the middle of next year.

Ms Roxon's move came as retired appeals court judge Geoff Davies - who headed the 2005 commission of inquiry into Queensland health, prompted by the Jayant Patel malpractice scandal - called on governments to consider rationing services or restricting access to ensure safety and quality.

After health ministers and treasurers met in Brisbane on Monday to discuss the distribution of $150 million for an elective surgery blitz - a tiny proportion of Australia's $80billion-plus annual health spending - Mr Davies has used the opinion pages of The Australian today to criticise previous reform efforts. "It is possible that, in the end, the only realistic choice may be between, on the one hand, a system which can provide free hospital care and treatment of all kinds to all people, but only inadequately, seriously risking patient health and safety; and, on the other, one which can provide a safe and adequate system but not to all categories of people or not of all services presently promised," he writes. "But the possibility of that choice is one which politicians have, so far, refused to confront ... because they have assured us that we are all entitled to free healthcare, whatever that may mean."

Australian Health Policy Institute director Stephen Leeder questioned whether Mr Davies had been exposed to the "dark side of health" for too long, saying most patients were satisfied with the level and quality of care received in public hospitals. Professor Leeder said the public system had for more than a decade struggled to provide more essential operations with less funding, "relatively speaking", and that it was time for governments to respond. He said surveys had shown Australians were willing to pay more to improve the system, although not in the form of co-payments or direct funding, but "the people reluctant to do anything about it are the politicians".

But Jeremy Sammut, from the Centre for Independent Studies, said health costs would continue to rise and governments should look at more radical funding options. "If we shift to a self-funded model, we'll have more chance of having a sustainable health system in the long-term," Dr Sammut said. He said such models should go beyond the private health insurance reforms embraced by the Howard government and instead replicate the superannuation reforms of the early 1990s.

But Australian Healthcare Reform Alliance chair John Dwyer said he did not believe the public health system was unsustainable. "I do believe that a quality public health service, in which people will get quality of care in a timely manner based on need, not their own personal situation, is entirely achievable," he said.

Ms Roxon told The Australian there was an awareness that change was required. "We do understand that there is a legitimate claim for more money for hospital services, but we also need to be much smarter about how we provide a range of other services that could keep people out of hospital, that could make their transition in and out of hospital better." She said there was "a significant amount of sifting going on" of good ideas, not just within the federal Health Department and the states. "I'm asking the states and territories to give us some ideas. I'm absolutely adamant that we have to get both the entry and the exit end of the hospital working properly. "So we have to look at managing inappropriate and preventable hospital presentations and admissions, and we have to look at having proper discharge processes so that people who are frail or chronically ill don't leave hospital with everybody knowing they'll be back in two weeks."


Patients risk death in Australia's sick hospitals

We've all heard about the worrying inadequacies of our public hospitals. Shortages of hospital beds, shortages of doctors and shortages of experienced nurses are among the most serious. At least in one hospital, Bundaberg, these inadequacies have caused serious injury and death. Their revelation has caused public outrage. But such inadequacies are by no means confined to one hospital, or even to one state. On the contrary, there is convincing evidence that they are widespread throughout Australia. Public hospitals, generally, are not delivering all of the services promised by governments to all of the people to whom they are promised, at a level that ensures adequate patient health and safety.

Until recently, the solution of this problem has been mired in political point scoring and mutual criticism between the commonwealth and state governments. Because direct responsibility for health has been that of the states, the commonwealth health minister chose simply to blame the states for these inadequacies; and state leaders responded by blaming the commonwealth for failing to fund the education and training of sufficient doctors and, more generally, for failing to provide sufficient funds to enable the states to deliver adequate patient health and safety to all of those who sought it free of charge.

So it was heartening that then-Opposition leader Kevin Rudd not so long ago acknowledged - the first time by a commonwealth leader - that public health is not just a state problem, but one that must be solved co-operatively by the commonwealth and the states. And that acknowledgement has now resulted in commonwealth funding to ease elective surgery waiting lists. But it is one thing to recognise this; it is quite another to recognise and acknowledge the nature and extent of the problem; and yet another to solve it.

In consequence of the report of my commission of inquiry into Bundaberg and other public hospitals in Queensland, the Queensland Government acted promptly to attempt to remedy the inadequacies disclosed in that report. But it was hampered in what it could achieve by the terms of the Australian healthcare agreement, which it had made with the commonwealth, as had all other states.

By that agreement, the state was committed to continue to provide, at no cost to all who sought them, all of the services which it promised at the commencement of the agreement, whether or not it was capable of providing them adequately. And when the then premier, Peter Beattie, raised the possibility of co-payments for some services, the health minister, Tony Abbott, threatened legal action for breach of the agreement. The result was, and remains, that states, endeavouring to improve the quality of free hospital care, are confined to do that within the existing framework, whether or not that framework is capable of delivering adequate patient health and safety to all who seek it free of charge.

The Australian healthcare agreements are based on the assumption that all Australians, irrespective of their wealth, are entitled to free hospital care and treatment, including operative treatment; not just emergency care and treatment, but also elective procedures. What has not been considered, and what politicians have so far been reluctant to consider, is whether that assumption is a realistic one.

Can Australia afford to provide all of those services, free, to all Australians while maintaining an adequate standard of medical and hospital care and safety? For if there is one thing that we should never compromise, but unfortunately have, it is an adequate standard of care and safety. Unless that standard is achieved, there remains a serious risk that patients will continue to suffer both delay in treatment and inadequate treatment, either of which substantially increases the risk of injury or even death.

It is possible that, in the end, the only realistic choice may be between, on the one hand, a system that can provide free hospital care and treatment of all kinds to all people, but only inadequately, seriously risking patient health and safety; and, on the other, one which can provide a safe and adequate system but not to all categories of people or not of all services presently promised. But the possibility of that choice is one that politicians have, so far, refused to confront. Politicians have refused to confront this possibility because they have assured us that we are all entitled to free health care, whatever that may mean. To admit that they cannot provide, safely and adequately to all Australians, all of the services presently promised might risk public disapproval, even anger.

But Australian governments must together consider whether, in order to deliver a safe and adequate free public hospital system within realistic budget constraints, they must make a choice: either limit the services presently promised by that system or limit the categories of persons to whom they are presently promised.

Two realities compel this consideration. The first is that, without either such limitation, governments have consistently failed to provide a safe and adequate free public hospital system. And the second is that Australia's national real healthcare spending has been growing faster than the Australian economy every year since 1990. Taken together, these show that the possibility of public hospitals providing all of the services promised to all of the people to whom they are promised, at no cost and at a safe and adequate level, is becoming increasingly remote. Thus the first challenge for co-operative federalism in health: what kind of free hospital system can Australia realistically deliver without, in any way, compromising patient health or safety?

There is a second challenge. Who should deliver that system? Should it be delivered solely by public hospitals or should some part of it be delivered by the private sector under contract with government? The latter is already occurring in some states. And if universities in this country commence providing specialist surgical training, and to that end establish teaching hospitals, greater surgical expertise may, in the future, at least in some specialties, exist in those hospitals than in public hospitals.

Consequently, better quality surgical care and treatment may be obtained in some areas by using the private sector, funded by government, to provide it, rather than by providing it within government-run hospitals.

I do not presume to know the answers to these questions. My concern is to ensure that any reconsideration of the provision of free health care in Australia is not confined by the way in which it has been delivered so far. For if there is one certainty about the existing system, it is that it remains inadequate. A little safer now than it was, but still worryingly inadequate.


Ambulance absurdities in Victoria

Surprise! Something that is "free" will be abused

MELBOURNE'S $16 million-a-year ambulance dispatch system is forcing paramedics to race through streets to treat nose bleeds, apply sticking plaster and tend to compulsive hand-washers. Ambulance officers say a computer dispatch program that fails to distinguish between a heart attack and a stubbed toe sends them on thousands of unnecessary high-speed runs each year.

Ambulances have been sent to people with in-grown toenails and sprained ankles - at $860 a trip. Call-outs have jumped more than 25,000 in the past year but paramedics say that up to half of the code one jobs - the highest priority response - are for cuts and scratches, or less. Their union says ambulances are sent to most jobs to eliminate the risk of litigation. "I can't tell you how many Band-Aids I've put on this year," one paramedic said. "It's costing a massive amount of resources. "We can't get the response times down because we're going to everything."

Another said: "Everything's an emergency. Some of them are things that, when I was a kid, your mum would look after." Other "emergency" jobs include: a patient whose lip had been cut on a pizza crust, a man with a paper cut and a boy with a grazed knee.

Ambulance Employees Union secretary Steve McGhie said paramedics did not need the burden of treating minor complaints. "It is an American system based on (fear of) being sued. It's causing huge concerns for paramedics," Mr McGhie said. "It will get worse before it gets better."

MAS chief executive officer Greg Sassella said the same dispatch system was used around Australia and the world. Mr Sassella said it was "conservative" in rating the degree of emergency, but there was no better system. Victoria had tried to improve the system by introducing referrals to doctors or nurses, he said, weeding out more than 26,000 calls last year. Mr Sassella said referrals, which cost $61, will be expanded in coming years. "We've done more than any other service in Australia to reduce over-response," he said.

Paramedics believe some people call ambulances to avoid waiting at medical clinics. "They think they'll be seen quicker at a hospital (arriving by ambulance). There's a percentage ... who know how to play the game," Mr McGhie said.

The MAS annual report says the "community's expectation of ready access to health care" is a reason for a 9 per cent rise in call-outs in the past year. But one officer said the figure was misleading. "I can tell you, the number of sick people in Melbourne has not gone up 9 per cent in the past year," he said. "There is a proportion of society which uses us as a taxi service ... every day, you do an inappropriate job. We are being flogged, absolutely flogged." The officer said Victoria should run a public awareness campaign on when it was appropriate to seek emergency help, similar to one in the UK.

The MAS report said the increasing number of call-outs was partly due to reduced access to medical services and patients discharged early from hospital. An ageing population, greater rates of complex and chronic illness and more people living alone are also cited as factors. Ms Sassella said ambulance resuscitation rates for cardiac arrest had risen from 5 per cent to 55 per cent in the past decade.


Ambulance absurdities in Queensland

Surprise! Something that is "free" will be abused

The State Government will consider on-the-spot fines for Queenslanders misusing the Ambulance Service as paramedics become fed up with frivolous call-outs. Emergency Services Minister Neil Roberts will meet with his department next week to consider the introduction of infringement notices as the Ambulance Service shoulders a call-out rate 30 per cent above the national average. Paramedics have told The Courier-Mail of instances in which "patients" have faked injury to ensure a free ride to hospitals including:

* A man who faked an ankle injury to receive transport to the Gold Coast Hospital, where he was later seen walking freely. He then admitted to paramedics he had needed a lift to see his girlfriend in the maternity ward.

* A man complained of back pain but when the ambulance arrived he said he did not have money for a taxi and wanted a lift to a methadone clinic.

* A Gold Coast woman claimed she was sick and needed transport to hospital. When she arrived, she left the ambulance and headed for the shops. A paramedic said there was nothing they could do to stop the woman. "That happens all the time," the paramedic said. "They basically say we pay our ambulance community cover so shut up and take us. "We're absolutely flogged and everybody's sick of it. "Most of us are ready to give it away."

The ambulance service receives funding from an annual levy on Queenslanders of $97.99, collected through electricity bills. An audit into the service, ordered by Premier Anna Bligh, last month recommended the scrapping of the levy and reintroduction of the old subscriber/user pays system, or a retention of the levy and a new user co-payment regime. But Ms Bligh said a levy and co-payment system was "untenable" and the subscription system had previously resulted in people making a financial decision not to call an ambulance.

There is a provision in the Ambulance Service Act for fines of $3750 for people making "false calls" but acting Emergency Services Minister Andrew Fraser said "these offences must be dealt with summarily through the court and it has been rarely used". "The Government will examine enforcement and consider the introduction of infringement notices," Mr Fraser said. Queensland Ambulance Union State Organiser Jason Dutton said the union welcomed the fines and other steps being taken by the Government.