Monday, November 30, 2009

Quis custodiet ipsos custodes? Britain's hospitals may be bad but the regulators are worse

Another week, another hospital scandal. The story is beginning to be all too familiar: dozens of patients dying needlessly, in filthy conditions that would shame a Third World country.

It emerged on Thursday that inspectors making unannounced checks in October on Basildon and Thurrock University Hospitals NHS Foundation Trust discovered a collection of horrors: blood spattered on floors and curtains, mattresses soaked with foul-smelling stains, contaminated equipment, a high rate of pressure sores among the elderly, long waiting times in the accident and emergency department and, worst of all, poor nursing care, with old people deprived of food, attention and dignity. As a result, about 70 people in the care of the Basildon and Thurrock trust may have died needlessly: its mortality rate is a third higher than the national average.

Ministers and media expressed shock and horror, but within hours there was news of another scandal of just the same sort. On Friday the regulator Monitor, which supervises NHS foundation trust hospitals, announced it had sacked the chairman of the Colchester Hospital University NHS Foundation Trust: Colchester also has higher than average mortality rates. Monitor charges the trust with poor leadership, long waiting times, poor infection screening, poor children’s services and worsening patient satisfaction. It is not often that someone gets sacked these days — something must be really bad.

That makes three hospital horror stories this year, counting the reports in March about conditions at the Mid Staffordshire NHS Foundation Trust; 400 people died there needlessly. Monitor has concerns about a further eight trusts.

What on earth is going on? It is bad enough that we have some — perhaps many — dreadful hospitals, even though the NHS budget has tripled in the past decade. What is even worse is that it seems difficult to have any confidence in the many people and organisations responsible for overseeing hospitals and anticipating these problems — not just bad hospitals but bad supervision. Why has it taken so long for these bad practices and poor outcomes to be noticed? The mortality figures have been available for more than 10 years.

In the case of Basildon and Thurrock, the Care Quality Commission (CQC), the new independent regulator for all health and social care in England, was the body that inspected the trust and published the dreadful findings. Yet last month it posted on its website a glowing report on the trust, giving it 13 out of 14 for cleanliness and 5 out of 5 for keeping the public healthy. This report, astonishingly, is still there.

The CQC knew this information was wrong; it must have realised the report would be misleading to the public who went to the site to check hospitals’ performance. Yet it has left the report on its site. One can only wonder about the information on other hospitals. Why should one trust any of it?

Baroness Young, the chairwoman of the CQC, found herself in an impossible position last week, confronted with this inconsistency. Wriggle as she would under the probing of the Today programme, she could do no better than to say her organisation is only eight months old and the report on the website was done months ago under the previous regime — the Healthcare Commission — and things are going to be much better now. She failed to deal with the problem of public trust.

She also failed to inspire confidence in her strange attack on the methodology of hospital mortality figures provided by Dr Foster Intelligence, an organisation the public might actually be able to trust. It is a partnership between the NHS and the Dr Foster unit at Imperial College; it provides monthly and carefully adjusted mortality figures across the NHS, which are known for their reliability and which have directly prompted all the recent investigations into problem hospitals. Dr Foster now makes a point of writing to all NHS hospital chief executives to warn them when their mortality rates begin to rise.

I wonder what Baroness Young thinks is wrong with the figures or their methodology. The rest of the CQC seems to think they are all right and a useful tool for looking at hospital performance. In fact, everyone seems to accept the Dr Foster figures apart from a few ministers. On Saturday morning, for instance, Andy Burnham, the health secretary, called for an investigation to uncover high death rates across the NHS.

But that information exists already, in neat monthly packages from Dr Foster Intelligence; there can be no point in calling for it, other than wearisome politics.

Altogether this government’s NHS policies bring to mind an interfering child with attention deficit hyperactivity disorder. Since 1997 we have had six secretaries of state for health. That means an average of two years in post. It is impossible for anyone to understand the essentials of our byzantine health service in such short fits of attention.

As for the regulators, including the one Baroness Young seems to think was not up to snuff, we have had at least three upheavals of regulations under Labour — the Commission for Health Improvement, then the Healthcare Commission and now the CQC. Such constant change must be at odds with good management.

It is hardly surprising that the public has become so suspicious; there may not be many data about the death of trust in this country, but the anecdotal evidence is overwhelming. Who monitors the monitors? Not only hospital regulation is at issue.

All around us this question keeps emerging.

To the weary citizen, the Chilcot inquiry into the Iraq war looks just another attempt to avoid any awkward truths. No one is to be on trial; no one is to be blamed. No one has to appear, either, and Macavity Brown, to his shame, won’t be anywhere to be seen. Who is there to insist on what’s right?

The Ofsted report last week was deeply depressing for its cautiously expressed findings — failing schools, illiterate children and poor teaching. What’s worse is that Ofsted and its predecessors have been inspecting and reporting fairly cheerfully for decades, while standards have fallen lower and lower. The Walker inquiry into banking is yet another affront to an angry public. Who is there to insist on public probity? That is the question, sadly. Who will guard the guards themselves?


The most dangerous British hospitals

Twelve NHS hospital trusts have been identified as “significantly underperforming” on a range of safety measures according to new research which has ranked every general hospital in England.

The low performance conclusions came despite overall patient care at eight of these trusts rated as good or excellent last month by the Care Quality Commission (CQC), the health service regulator.

The critical research conducted by Dr Foster, a consultancy that collates independent league tables on NHS trusts, also identified 27 trusts with unusually high death rates involving the deaths of 5,000 more patients in the past year than had been expected. The new data are contained in The Dr Foster Hospital Guide 2009 which contains a league table of NHS trusts across England with their performances rated on patient safety.

Basildon and Thurrock University Hospitals NHS Foundation Trust, Scarborough and North East Yorkshire Healthcare NHS Trust and Lewisham Hospital NHS Trust in south London are identified as the poorest overall performers. Basildon and Thurrock, Royal Bolton Hospital NHS Foundation Trust and Tameside Hospital NHS Foundation Trust in Greater Manchester are also named by Dr Foster as having the highest mortality rates.

The report includes incidents of 209 foreign objects such as drill bits left inside patients after surgery; 82 incidents where the wrong part of the body was operated on; and 848 patients under the age of 65 admitted with low-risk conditions who subsequently died.

Barbara Young, who chairs the CQC, last night assured Andy Burnham, the health secretary, there was no evidence that direct intervention was needed in other hospital trusts, apart from Basildon, despite the Dr Foster data.

The NHS boss in charge of Basildon and Thurrock had received an 11% pay rise in the past year. Alan Whittle, chief executive of the trust, who was paid £150,000 during 2008-9, also saw the value of his pension pot increase by nearly £500,000 to £1.5m over the same period.

Details of Whittle’s pay emerged after a CQC report found that poor nursing, dirty wards and a lack of leadership had contributed to an estimated 400 avoidable deaths at the Basildon hospital last year.

A CQC spot check last month had uncovered soiled mattresses, poor clinical practices, mould growing in suction machines and out-of-date medical equipment.

Katherine Murphy, director of the Patients Association, a pressure group, criticised a culture of “rewards for failure” within the National Health Service. “Surgeons and doctors who fail patients can be struck off and the same should be true of NHS executives,” she said.

Michael Large, the trust’s chairman, said Whittle’s 11% pay rise reflected the hospital’s higher turnover and greater responsibilities for executives.

Yesterday it emerged that Whittle is having a relationship with Karen Bates, a hospital safety manager who also serves on the hospital’s board of governors.


British woman dies after cancer screening blunder at NHS hospital

And the blunder was covered up

One woman has died and hundreds of other cancer patients put at risk after a crucial machine used to test for the best way to treat the killer disease developed a fault that was not repaired for at least a month. The NHS hospital at the centre of the blunder failed to tell patients their results may have been wrong due to the broken equipment. It also did not report the incident to the medical authorities – an apparent breach of Department of Health rules designed to protect patients and alert doctors to problems.

Last month, mum Tracey Kindley, 43, died of breast cancer after learning her treatment had been based on inaccurate test results. She was being treated at a private hospital in North London after she discovered a suspicious lump in March 2005.

Her doctors performed a biopsy and sent it to a local NHS Trust’s pathology department, which confirmed her cancer. But one of the machines used at the Queen Elizabeth II Hospital, in Welwyn Garden City, crucial in assisting her doctors in deciding the best treatment for the cancer, was not working correctly. The machine – used to test hormone levels – gave a ‘false negative reading’ for oestrogen, meaning she was not prescribed certain life-saving drugs because it was thought they would have no effect on her cancer.

Her doctors spotted the error only when she failed to respond to treatment and the cancer spread. The doctors ordered new laboratory tests on the original biopsy and these results showed very high oestrogen levels in the cancer cells, alerting them to a major error. Health service managers at the Queen Elizabeth II ordered checks and discovered the machine had developed a fault around the time of the tests on Mrs Kindley.

A service report on the equipment shows a ‘critical repair’ was carried out on May 6, 2005. The managers claim the machine was ‘fixed within days’ of the problem being identified, but crucially Mrs Kindley’s tests were carried out on April 8 – almost a month before the fault was spotted. The East and North Herts NHS Trust, which oversees the hospital, re-examined the results of other patients whose samples were tested on days either side of Mrs Kindley’s.

However, an internal investigation concluded the incident was a ‘one-off’ and that despite testing hundreds of patients during the period, no other patients could have been affected. The conclusion meant patients tested when the machine is known to have been malfunctioning – a period of around four weeks – were never alerted that they, too, may have been given the wrong results.

In the weeks before her death, Mrs Kindley began a legal action against the hospital. Her lawyer Hugh Johnson, of Stewarts Law, believes that had she been given the right treatment, she would have had a 70 per cent chance of making a full recovery.

In his letter to the Trust, Dr Nihal Shah, Mrs Kindley’s consultant clinical oncologist, wrote that she ‘had concerns that a similar scenario does not arise for other patients’.

Mrs Kindley died on October 28. Yesterday, her husband said he blamed the test errors for his wife’s death. ‘I believe they robbed me of my wife. The right results would have opened up other forms of treatment and I believe she would be with me and her son Max now.’

Last night, the Trust acknowledged the tests carried out had given a ‘partial false negative result’ and it has apologised that this should have happened. It admitted that the problem had not been reported to the Medicines and Healthcare product Regulatory Agency. ‘That decision is now being reviewed.’


Australia: Government hospitals chase away the sick by long delays and then call them "treated"

The "DNW" racket. Australian government hospitals are clearly just as good as British ones at "fudging" their statistics, and that is saying something

ALMOST 70,000 sick or injured Queenslanders walked out of emergency departments at the state's largest public hospitals in the past year, mostly because they became fed up waiting to see overworked doctors. And they were not only people with runny noses or sore throats – thousands needing urgent attention also left.

A Right to Information (RTI) search by The Sunday Mail and The Courier-Mail has uncovered the numbers of "Did Not Waits" previously hidden by Queensland Health. The Did Not Waits registered upon arrival but left before they saw a doctor, mostly because of the exasperating wait in overstretched emergency departments.

More than 100 people classified as "emergency" – requiring attention within 10 minutes – left. Another 10,700 classified as "urgent" (within 30 minutes) did not wait. The figures came from the state's 27 largest hospitals.

The 69,800 people who did not wait in the past financial year were not mentioned in the quarterly hospital performance reports published by a department which Health Minister Paul Lucas has praised for its openness. Instead, they were included as "treated". [What a fraud!!] "Queensland reports more than 1800 (health) statistics every quarter – more than any other state," he said. "There are talks at a national level about how other states can implement similar reporting standards."

Doctors have told The Sunday Mail that they believe Queensland Health keeps quiet about the figures simply to make itself look better. The newspaper has been told about two recent occasions where doctors walked into crowded waiting rooms at major hospitals and told patients who were not critically ill that they would not been seen for at least six hours. One doctor, who asked for his name to be withheld, said he advised patients who thought they could hold off seeing a doctor that they should consider going home and taking with them any medication, such as Panadol, that might help them recover from their ailment.

One doctor conceded that, while most left because they were tired of waiting, there were some who took off for other reasons, including that they were scared that their injuries were part of a potentially criminal incident.

The RTI search was done as part of the Critical Condition series, which will continue this week in The Courier-Mail. It will look into public hospital bed numbers and the strain on emergency departments.


Mandating disaster

Will Americans be forced to buy health insurance?

ObamaCare has nothing going for it anymore. With unemployment touching double digits, its economic timing is bad; with polls showing tanking support in every group outside of the narrow sliver of die-hard liberal reformers, its political timing is bad; and with the Center for Medicare and Medicaid Services last week saying that it'll add billions to the already out-of-control deficit, its fiscal timing has gone from bad to awful.

So how are Comrades Pelosi, Reid, and Obama able to march ahead with their grand designs undeterred? One reason is that Republicans have done precious little to seize the moral high ground from them. By insisting on the removal of the public option—instead of the individual mandate—as the price of doing business, Republicans have missed a major opportunity to put Democrats on the defensive and change the terms of the debate.

Republicans threw down the gauntlet on the public option—a government-funded, Medicare-style insurance plan that will compete with private insurance—in a June letter to Obama. "Washington-run programs undermine market-based competition through their ability to impose price controls and shift costs to other purchasers," they said. "The end result would be a federal government takeover of our health care system, taking decisions out of the hands of doctors and patients and placing them in the hands of a Washington bureaucracy."

True. But the problem is that Democrats don't need the public option to engineer a "federal takeover of our health care system." All they need is the power to force Americans to purchase insurance.

A mandate will fundamentally alter the relationship between Americans and their government. Instead of the government being accountable to them, they will become accountable to their government. No less than the Congressional Budget Office—a non-partisan government agency—once admitted as much. "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action," it noted. "The government has never required people to buy any good or service as a condition of lawful residence in the United States."

If the government can force Americans to buy coverage on the threat of fines or even imprisonment—an option that Nancy Pelosi has pointedly refused to rule out—every other government diktat becomes small potatoes by contrast. In fact, it becomes necessary. If uninsured Americans must buy coverage, why shouldn't other Americans be taxed to subsidize them? Why shouldn't the insurance industry be required to sell them coverage? Why shouldn't government set insurance prices to ensure affordability? Why shouldn't doctors and hospitals be asked to charge only "reasonable" rates—or offer only government-sanctioned treatments? Nothing about ObamaCare fundamentally changes so long as the individual mandate remains intact.

Therefore, instead of wonkishly droning about the public option, Republicans should counter Democrats' grand appeals for "universal coverage for all" with equally grand appeals for "medical freedom for all." They should stand together on the Capitol steps and issue the health care equivalent of Reagan's Berlin Wall ultimatum: "Mr. President: Tear up this mandate."

During the campaign, Obama himself successfully stopped poor Hillary dead in her tracks by reminding voters at every turn of her tyrannical plans to force them to purchase coverage. So why aren't Republicans doing the same to Obama?

The main reason is that they themselves are deeply conflicted about the mandate. On the one hand, every Republican on the Senate Finance Committee voted against it—except, of course, for Maine's Sen. Olympia Wavering-Heart Snowe. On the other hand, many Republicans, led by their intellectual lights at the conservative Heritage Foundation, among others, have long accepted—no, championed—the notion that unless people are forced to carry insurance, freeloaders who land in emergency rooms will cripple the health care system. Legislate personal responsibility, in other words. It was a Heritage plan for forced coverage that formed the blueprint for the Massachusetts universal care debacle that the then Republican Gov. Mitt Romney enacted.

Thus Republicans have no leg to stand on now that Obama, pulling one of his many switcheroos, has embraced the individual mandate. Heritage folks are trying to pull their own switcheroo by opposing Obama's mandate, saying what they had originally proposed for Massachusetts was not really a mandate but actually a self-insurance scheme under which an uninsured person would have to post a personal bond before being treated in an emergency room.

But countering mandates with bonds doesn't exactly make for a rousing rallying cry. Indeed, both ideas are based on the mistaken diagnosis that the central cause of our health care woes is the cost of uncompensated care that the uninsured get. The fact of the matter is that this care accounts for no more than $40 billion of the country's $2.26 trillion health care bill—or less than 3 percent of total health care spending. This is less than what department stores lose to shoplifting every year. Several private hospitals that I visited in India last month make a fraction of the profits that American hospitals do but still reported treating up to 10 percent of their patients for free.

The mandate barring American hospitals from denying treatment to anyone who lands in emergency—the root of the supposed freeloader problem—certainly imposes a heavy burden on some hospitals, especially in inner cities. But it is far from clear that it forces American hospitals as a whole to provide more charitable care to the uninsured than what they would have without it. It would certainly be worthwhile at some point to consider policy options to replace this mandate with mechanisms to strengthen voluntary charity by hospitals and others. In the meantime, however, there is zero evidence to suggest that this mandate is imposing a crippling enough burden on hospitals to warrant mandates on everyone else as well.

The Republican strategy for defeating ObamaCare consists of notifying: seniors that they will face rationing and loss of private Medicare options; the uninsured that they will face fines and possibly jail; the young and healthy that they will have to subsidize the old and sick, etc. Alerting Americans to the personal dangers they will confront under ObamaCare is certainly a legitimate part of the political process.

However, the downside of a strategy based entirely on fear is that even if it succeeds now, it won't help to define the proper terms for a genuine solution in the future. For that, Republicans have to offer a principled critique of ObamaCare that delineates the sharp moral choices that Americans face. The current health care battle is the domestic policy equivalent of the Cold War. Democrats are on the side of command-and-control mandates that deprive individuals of choice. Republicans should position themselves on the side of market-based solutions that empower—not enchain—patients.


Why tragedy will be result of Dems rush to victory on health reform

House Speaker Nancy Pelosi begged, cajoled, and threatened health care legislation to a successful vote in her chamber, albeit by a razor thin margin of 220-215. The administration and House leadership touted this as a landmark vote, which it is, but only if you ignore the fact that the bill achieves almost none of President Obama's promised health reform goals. In fact, it is very likely to explode the deficit, drive up health care costs, and inflict massive new taxes on middle-class Americans.

Watching events unfold in Washington at first hand, it's become clear that health reform has become the Democrats version of "Moby Dick," as party leaders embrace the premise that they must pass something this year and declare victory, no matter how flawed the final product is. Unfortunately, they may sink the economy along the way.

If clearer heads prevailed, Congress would scrap these partisan bills and start over:

Both the House and Senate bills will cost well over $1 trillion over the next ten years. The CBO scores the Senate bill at $829 billion and the House bill at $1.055 trillion, but only because of the most transparent budget gimmicks. The Senate Budget Committee puts the fully-implemented price tag at roughly $2.5 trillion for the first decade - demolishing the president's promise that reforms would not cost more than $900 billion.

The cost curve for spending gets bent...up. The CBO says spending in both bills rises at 8 percent annually as far as the eye can see and CMS actuary Richard Foster says that national health spending gets worse, not better. So much for the president's repeated assurances that reform would slow the rate of health care inflation.

New entitlements plus cost growth equals taxes, and debt, debt, debt. The CBO only scores the bills as reducing the deficit because Democrats pretend that Medicare docs will get slashed by over 20 percent in two years. Reality says Congress will borrow about $240 billion for the "doc fix". Democrats pretend they will cut over $400 billion out of Medicare through more vigorous price controls - cuts that will never live to see the light of day. Get ready for a bubble in health entitlement debt.

What isn't borrowed in these plans is inflicted on drug companies, diagnostic companies, private health insurance companies, "Cadillac" health plans, and individuals and businesses that don't buy government mandated coverage. These taxes and fees, roughly 90 percent of which fall on families making under $200,000 a year, must grow even faster (10 percent annually) to keep up with the new spending spree.

Private insurance: expensive or off-limits. Taxes, fees and ill-conceived insurance reforms raise the specter of double-digit premium inflation for the majority of Americans with insurance. Millions will find their policies don't pass muster with the bill's insurance czar, driving them to more costly policies. The rest? Fifteen million will be thrust into Medicaid as eligibility rises to 150 percent of poverty.

It's not too late for moderates and conservatives in Congress to force Nancy Pelosi and Harry Reid to chart a safer, bipartisan course. Here are five fundamental, commonsense reforms that will cost less, improve health care quality, and expand coverage:

1. End the tax exclusion for health care and replace it with a standardized tax credit or tax deduction. Economists from (Obama adviser) Jason Furman to Martin Feldstein know that the tax exemption for employer-provided insurance is regressive (the rich benefit more), arbitrary (why tie insurance to employment?), and drives up health care inflation. End it - the largest tax break in the code - and use the proceeds to expand private insurance.

2. Expand existing state high-risk pools to address pre-existing conditions. Today, 35 states have high risk pools that they use to subsidize coverage for Americans who might go without coverage because they have pre-existing health conditions that make coverage very expensive or unavailable in the individual insurance market. Federal dollars should go to states that embrace model high risk pools offering affordable premiums and disease management plans that help keep beneficiaries in better health.

3. Create real interstate insurance competition through a transparent national market. The president and Congress talk a lot about competition. But forcing consumers to choose among three or four expensive government designed plans - bronze, silver, gold or platinum, stacking the deck in favor of public plans, and hamstringing private insurance isn't real competition. Could we limit consumers to four choices of cars, computers, or colleges and call it competition? Congress should allow interstate sale of insurance, but mandate transparency and standardized coverage descriptions so that consumers always know what they are buying and can easily compare different coverage options.

4. End waste fraud, and abuse in the Medicare and Medicaid program. Experts estimate that Medicare alone may lose up to $60 billion (about 10 percent of total spending) in fraud annually, but the government spends almost nothing on tracking and uncovering fraudulent schemes in federal health programs. Congress should switch to the best practices models use to detect fraud in the credit card industry by relying on real time algorithms to detect fraud at the point of service and stop it in its tracks.

5. Enact real tort reform that will end lawsuit abuse and reduce defensive medicine. Former DNC chairman Howard Dean admitted his party's allegiance to the plaintiff's bar precludes backing tort reform. So the president has acknowledged that lawsuits "may" drive up health care costs - but hasn't offered any serious solutions. Bipartisan malpractice reforms do exist - from expert health courts to a "safe harbor" for doctors who embrace best practices - that could reduce lawsuit abuse. The CBO estimates that tort reform could save $54 billion over ten years.

Republicans and Democrats agree that health care reform is a critical issue for the nation's future. But the Democrats have developed deeply flawed, partisan reforms that expand coverage without fixing any of the systems' underlying problems. Unless they chart a new, bipartisan course soon their rush to declare victory will result in a national tragedy.


Sunday, November 29, 2009

Investigation into NHS deaths after hospital scandals

An immediate investigation to uncover the true extent of death rates across the NHS has been ordered by the Health Secretary after scandals at two hospital trusts. Amid claims that patients are dying due to poor care in at least 27 hospitals around the country, Andy Burnham said that patient safety was paramount and must take precedence above all else.

His comments come after the head of a foundation trust in Colchester, Essex, was sacked over concerns about high death rates, leadership and waiting times. Failings in patient care had previously been linked to the deaths of between 70 and 400 patients at Basildon and Thurrock NHS Foundation Trust, also in Essex.

Mr Burnham used a speech at the Royal College of Midwives conference in Manchester to promise tougher action, saying that he had told the Care Quality Commission (CQC) to “establish immediately whether there are any other trusts at which similar issues demand immediate investigation”.

Monitor, which oversees NHS foundation trusts, removed Richard Bourne as chairman of Colchester Hospital University NHS Foundation Trust yesterday after the trust failed to meet waiting time targets for nine months. A taskforce of senior doctors and nurses was also sent to force improvements at Basildon and Thurrock after a damning report found poor hygiene and standards of care. The death rate at the trust was about a third higher than the national average, while at Colchester it was about 12 per cent higher.

Dozens of trusts could now be investigated by the CQC, which monitors data on mortality rates for all trusts in England. Overall, there have been 121 alerts on high death rates over the past two years that have required investigations. The alerts, based on information from the Dr Foster Unit at Imperial College London and the CQC, are triggered if numbers of deaths among hospital patients are significantly higher than expected.

The Conservatives claimed that at least 25 other hospital trusts had death rates higher than the national average last year, with at least 3,100 more deaths than would have been expected in 2007-08.

Cynthia Bower, the chief executive of the CQC, welcomed Mr Burnham’s request. She said: “We are constantly vigilant about safety on behalf of patients. This includes monitoring death rates across the NHS as well as other quality of care issues. “Statistics can raise questions but cannot always provide answers. You need to follow up by carrying out inspections, talking to staff and listening to people who use the services and that is what CQC does. We can and do act swiftly wherever we find reasons for concern.”

The Patients Association said that people had been appallingly let down by standards of care at the two trusts in Essex.

The Colchester trust, which serves about 370,000 people in northeast Essex, had slipped from “excellent” to “fair”, according to the CQC’s rating last year. Sir Peter Dixon has been appointed interim chairman of the trust.

At Basildon and Thurrock, CQC inspectors had found blood-splattered equipment and soiled mattresses. Equipment that should have been used once was being used repeatedly and resuscitation room equipment was past its use-by date.



Three current articles below

Only the market can make health system person-centred

Vouchers needed, says Dr Jeremy Sammut

According to the NHHRC, the most important health reform recommendations in the Bennett Report will make the health system person-centred by reorienting the system around stronger primary care. This will supposedly allow health consumers to have access to the services they need rather than only have access to the current mix of ‘hospital-centric’ health services that governments want to offer.

The idea of a person-centred rather than government-centred health system is borrowed from the market-based principles associated internationally with the consumer-directed health care movement. The aim of consumer-directed health care is to reform the old-fashioned ‘command-and-control’ arrangements that limit choice and prevent competition in the government sector of the health system.

Right now, the type, amount and mix of taxpayer-funded health services that are or are not provided to Australians are determined by federal and state governments, whose crucial yet often imperfect policy decisions frequently overlook the actual needs of patients.

Health departments allocate taxpayer subsidies in the form of population-based, capped global budgets to public hospitals and community health services, which are expected to deliver an unquantified and indeterminate amount of health services to the community. For consumers, this is well described as a ‘take what you’re given’ system.

Consumer-directed health care would improve the responsiveness of hospital and other health services by the application of quasi-market mechanisms. The key reform is to make funding flexible, responsive, and far more accountable. The taxpayer subsidy should be tied directly to the delivery of services and only be paid at the point at which each occasion of care is provided.

Funding should follow patients by means of a taxpayer-funded voucher, and patients, subject to clinical referral, should be allowed to purchase appropriate services from competing public or private providers.

In the long run, empowering consumers and tying funding to patients based on clinical need and choice of competing providers would reduce costs, while increasing access, quality, productivity, and allocative efficiency. Most importantly, governments would no longer centrally plan the type, amount and mix of health services as the supply would be set by the actual health needs of individual patients.

Market-based structural reform that promoted the efficient use of scarce resources would therefore establish a truly person-centred health system.

The above is a press release from the Centre for Independent Studies, dated November 27. Enquiries to Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.

Government health agency gets criticism of its incompetence censored

Another botched and dangerous attempt at computerization

The University of Sydney removed from its website an extremely critical essay about a new multimillion-dollar emergency department IT system after pressure from the NSW Health Department. Doctors, nurses and administrators at four area health services heavily criticised the system - which tracks patients - as posing an "unacceptably high risk" to patient safety because it was so slow, cumbersome and inefficient. Some hospitals have boycotted Cerner FirstNet and reverted to paper to record clinical notes because it is too difficult and too time-consuming to retrieve critical patient information from the system, the essay said. "In a number of cases we know senior clinicians have shut down the use of FirstNet within a few days of it coming online," it said.

This flies in the face of the recommendation last year from Peter Garling's inquiry into public hospitals for full electronic medical records to improve efficiency and patient safety.

The essay, by a medical IT professor, Jon Patrick, said several hospitals also reported it "doubled the delay" before emergency patients were first seen by a clinician. He also said the Cerner contract proposal suggested it was giving a "cheap price" on the proviso of a "speedy finalisation of the contract" which left NSW Health with such an "incredibly tight schedule" it stymied proper clinical consultation.

The essay was published late last month but NSW Health asked that it be removed, Professor Patrick said on his website. The university then published it again two weeks later. "I have been able to establish confidently that NSW Health phoned my head of department and asked him to remove the article without giving a specific complaint," Professor Patrick wrote on November 5. On Wednesday, he wrote: "The university has affirmed my right to publish my critical essay and the attempt to censor me has been mitigated."

The Deputy Director-General of NSW Health, Tim Smyth, told the Herald that the acting chief information officer, Craig Smith, contacted the university about the essay but did not ask for it to be removed. "That's entirely a matter for the university but my personal view having read the article is that I don't believe it's balanced, it's certainly not accurate and it certainly misrepresents reality," Dr Smyth said. The assertion of a cut-price deal was "just wrong", he said.

One doctor said: "I prefer looking at a paper result than the counter-intuitive waste of my time trolling [sic] through the system." Another said: "Every single user *hates* it with a passion … ENTERING the data is a pure nightmare."

Cerner FirstNet follows emergency patients and includes test results and statistics such as beds available. It is part of a massive three-year electronic records project due by June.

Professor Patrick has worked on IT projects with permission from area health services but was not asked to assess Cerner FirstNet.


Grim treatment of patients in government mental hospitals in Western Australia

A psychiatric patient claims to have been raped while in the care of WA's mental health system, according to a new report. The disturbing claim was contained in a report by the WA Council of Official Visitors, which includes allegations of serious breaches of mental health patients’ rights.

The patient claimed to have raped by a guest of another resident while staying at a mental health hostel. The Council of Official Visitors supported the rape allegation and the claim led to an upgrade of security at the hostel. The alleged victim has since left the hostel.

Other claims of neglect include allegations that some patients were being tied down and forced to spend the night soaked in their own urine. Food served in mental health facilities was often described as poor by patients. Meanwhile, parents of patients have complained that they are searched before they can see their children as if entering a jail. An elderly female patient said she was not allowed to keep personal belongings like a toothbrush. Some patients had been dumped in maximum security wards for up to six years when they should be cared for in the community.

According to the council, life for patients in these wards was grim. “They live in an artificial locked ward environment, not receiving the type of care which would best enhance their recovery potential,” the report said. “They don’t get to choose when to eat, how much coffee to drink, who to associate with, or if and when to smoke.”

Council of Official Visitors head Debora Colvin said some mental health patients were not given access to the toilet while they are "secured" in a locked ward. Patients are still being forced to travel in the back of a “paddy wagon” for long distances without a break. The report said there were major concerns that second opinions weren't being properly conducted throughout the WA mental health system.

Mental Health Minister Graham Jacobs said there was some good news in the report. Dr Jacobs said it was the first time in 11 years there was a 20 per cent reduction in the number of people who contacted the council to make a complaint. “The natural assumption is we’re doing a little better,” he said.

Dr Jacobs said there was a need for more community supported accommodation for people with a mental illness, which his Government was establishing. “Instead of large cluster homes on hospital grounds we want small home-like facilities in the community,” he said. Dr Jacobs said there had been improvements to secure wards at hospitals in Graylands and Joondalup.

A Mental Health Commissioner is also expected to appointed early next year for WA.


Family Health Care: A Giant Game of Chance

The House and Senate health care legislation resembles a game show more than deliberate exercise in public policy. As confusing and confused legislation language is translated into dollars and cents, how much Americans will find themselves paying for health care? It looks more and more like a giant game of chance.

Not only is Congress leaving the current inequities created by the federal tax treatment of health insurance in place, it is busy creating new ones.

Family Premiums. The Congressional Budget Office (CBO) estimates that under the House bill, the average premium in 2016 will be $15,000 and the average cost sharing will be $5,500 for a family policy or a total of $20,500. Under the Senate bill, the average premium will be $14,100 and the average cost sharing will be $5,000 for a family policy or a total of $19,100. Is the higher cost House plan better? How do we know? If the Senate can come in $1,400 lower than the House, could the price tag be lowered by another $1,400? If not, why not?

Under the House bill, a family of four with income of $30,000 will receive the $20,500 value for just $1,100, or less than $100 per month. The family will receive premium and cost sharing subsidies from their neighbors worth $19,400. Under the Senate bill, a family of four with income of $30,000 will receive premium and cost sharing subsidies worth $16,800, still quite generous. These subsidies are so generous in fact, that the House and Senate leaders don’t want millions of Americans to have them to buy private health insurance.

The Medicaid Solution. So, instead of providing these taxpayer subsidies, the House and Senate will put 15-20 million people into the Medicaid program where they are not eligible for the subsidies at all. It is “cheaper” for Congress to put people into Medicaid program, a welfare program, which pays doctors and hospitals at least 20-25 percent less than private health plans. Moreover, as the Chief Actuary of the Centers for Medicare and Medicaid Services warns, the cost will be lower under Medicaid because access to care will be more limited than under private coverage. Don’t expect the same level or quality of medical services.

New Inequities. Millions of low-income Americans who are insured through their employers will not be eligible for these new subsidies either. What do we suppose will happen when they find out that their neighbors- who make more money than they do- are receiving these huge taxpayer subsidies courtesy of Congress while they are locked into an employer plan with no choices and higher cost sharing?

For a family of four with income is above $78,000, the Senate bill, at least superficially, looks better. This family’s total premium and cost sharing will be $12,900 compared to $13,800 under the House bill. For a family of four with income of $90,100, the family’s costs under the Senate bill is $14,200 or $2,400 less than under the House bill.

Mass Dependency. If the Senate manages to pass its 2074 page bill, the House and Senate leadership will somehow split the differences behind closed doors. If this massive legislation passes both Houses again and becomes law, health policy becomes a powerful new political tool for the congressional redistribution of health care. In a few years, more than half of all Americans will be receiving direct subsidies from government through Medicare, Medicaid, and the new subsidies. Politicians will be able to add disposal income to a family’s budget by increasing the subsidies. By making more Americans dependent on government, the congressional champions of this style of governance are betting that this legislation will keep them in power for many years to come.

But they are also gambling on probability models to predict behavior. But, like all central planning schemes, people do not always behave the way the central planners expect. In fact, referring to the provisions of the House bill (H.R. 3962), the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) the patterns of behavior are “impossible to predict.” Costs will explode if CBO has underestimated the number of employers that will drop their private health coverage. If just one state figures out the windfalls that could be realized by dropping out of Medicaid, and saving itself billions by escaping the collateral federal mandates, others will surely follow. States Are already strapped with rising Medicaid costs, costs aggravated by the provisions of the House and Senate bills. A state-based Medicaid meltdown would shift more than a trillion dollars of cost to the federal taxpayers.

The health care legislation headed for the Senate floor next week is not sound public policy. It is a giant game of chance. Millions of Americans stand to lose. A lot.


Kill the Bills. Do Health Reform Right

by Charles Krauthammer

The United States has the best health care in the world -- but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes -- such as the 118 new boards, commissions and programs -- is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony. The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

-- You'll find mandates with financial penalties -- the amounts picked out of a hat.

-- You'll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third -- numbers picked out of a hat.

-- You'll find sliding scales for health-insurance subsidies -- percentages picked out of a hat -- that will radically raise marginal income tax rates for middle- class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool. Then do health care the right way -- one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

First, tort reform. This is money -- the low-end estimate is about half a trillion per decade -- wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.

The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits -- resources wasted on patients who don't need them and which could be redirected to the uninsured who really do.

In the 4,000-plus pages of the two bills, there is no tort reform. Indeed, the House bill actually penalizes states that dare "limit attorneys' fees or impose caps on damages." Why? Because, as Howard Dean has openly admitted, Democrats don't want "to take on the trial lawyers." What he didn't say -- he didn't need to -- is that they give millions to the Democrats for precisely this kind of protection.

Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines. Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn’t, oranges would be extremely expensive in Wisconsin, especially in winter. And the answer to the resulting high Wisconsin orange prices wouldn’t be the establishment of a public option -- a federally run orange-growing company in Wisconsin -- to introduce "competition." It would be to allow Wisconsin residents to buy Florida oranges.

But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need -- the excuse -- for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.

Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenues -- the largest tax break for individuals in the entire federal budget. This reform is the most difficult to enact, for two reasons. The unions oppose it. And the Obama campaign savaged the idea when John McCain proposed it during last year's election.

Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency. The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.


Saturday, November 28, 2009

Another catastrophic British hospital

A hospital trust’s “systemic failings” have led to neglect, poor nursing and deaths, regulators have found. Problems at Basildon and Thurrock University Hospitals NHS Foundation Trust, Essex, included patients being left on dirty trolleys, high rates of infection and bedsores caused by poor hygiene and a lack of basic nursing care. Those contributed to an estimated 71 extra deaths last year among accident and emergency patients.

The Care Quality Commission (CQC), an NHS watchdog, said that the trust had reported “persistently high mortality rates” which had not improved, despite warnings. The commission’s inspectors, who conducted unannounced visits to Basildon and Thurrock over the past year, noted blood on floors, curtains, equipment trays and a child’s blood-pressure cuff, mould on life-support machines and resuscitation room equipment that was out of date. The trust was also found to be making patients wait up to ten hours in its emergency department rather than the national target of four hours.

The mortality rate for emergency admissions was 6.1 per cent last year. The national average is 4.4 per cent. Based on about 4,200 patients seen in A&E at the trust last year, this would have led to 255 deaths, an increase of more than 71 deaths compared with what would be expected according to average mortality rates.

The high death rate prompted comparison with the larger Mid-Staffordshire NHS Foundation Trust, where an official report published in March found that appalling emergency care had led to between 400 and 1,200 patients dying needlessly.

Care at Basildon and Thurrock was rated as “good” by the commission in October. But it said that it had lost confidence in the ability of Basildon and Thurrock trust’s management to address the failings that it found on subsequent checks. It believes that the trust could be in breach of its foundation trust authorisation, and therefore has asked Monitor, the independent regulator of foundation trusts, to use its powers to take action. Monitor has the power to dismiss the board of the organisation or take further control.

Most of the inpatient care at the trust is provided at Basildon University Hospital, which has 777 beds. Outpatient care is provided at Orsett hospital.

The trust was one of the first in England to be granted foundation trust status in 2004, which affords it the freedom to manage its finances and a degree of independence from NHS control.

Cynthia Bower, the commission’s chief executive, said: “The trust has taken our concerns seriously but improvements are simply not happening fast enough.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “People have a right to know how on earth a hospital can be rated ‘good’ a few weeks before such serious failings come to light. “This Government has set up a labyrinth of bodies and inspectors which are meant to ensure high quality standards in our hospitals but it simply isn’t working. This is yet another case where a hospital has passed the test on paper but where real patient safety has clearly been compromised.”

Andrew Lansley, the Shadow Health Secretary, said: “It is unforgiveable if any lives have been needlessly lost. We need to know what happened after the Government found out about the tragedy at Stafford Hospital. Other hospitals with high mortality rates, such as Basildon and Thurrock, should have been looked at rapidly and effectively by regulators and ministers to ensure that patients were being treated safely.”

Mike O’Brien, a health minister, said that Monitor would rigorously oversee progress on the issues raised by the commission. “We expect these issues to be dealt with quickly and effectively to ensure high quality, safe care for patients,” he said. Michael Large, the trust chairman, said: “I want to reassure our local community that the safety and well-being of our patients is our highest priority. Monitor acknowledge that we have an effective programme in place to make further improvements.

“We welcome the opportunity to work with advisers to specifically focus on the areas where we need to make rapid changes. We have had expert independent clinical advice and nothing has pointed to a fundamental problem with clinical care.”


Maternity funding still not being delivered, British midwives claim

Millions of pounds of government funding intended to improve maternity care is still not reaching frontline services, midwives say. Despite a rising birthrate, nearly a fifth of the heads of midwifery said that their budget had been cut, and almost a third had been asked to reduce their budgets. Last year the Government promised £330 million of extra funding for maternity services, but this has not been ringfenced.

The results, from a survey across Britain by the Royal College of Midwives (RCM), come as the Health Secretary is due to speak at the union’s conference in Manchester. Andy Burnham will today announce a new “Start4life” campaign highlighting the importance of breastfeeding and healthy eating from infancy.

The RCM said that 5,000 more midwives were needed to provide safe and quality care to new mothers. Ann Keen, a health minister, said that it was up to NHS trusts how to invest the additional money. “Where funding is not reaching maternity services I call on Heads of Midwifery to challenge their PCTs,” she said. “We recognise there are concerns around staff morale and attrition rates and we are working with the Royal Colleges and the NHS to address these areas.”


Australia: Another man dies because of an incompetent government ambulance service

No funds for a GPS in each ambulance but plenty of money for a metastasizing bureaucracy

A NEW South Wales man suffering from a heart attack died before ambulance officers reached him because they got lost and did not have GPS, his wife says. The man's wife of 54 years, Velma McFadden, phoned emergency services from a property on the outskirts of the village of Cullen Bullen, near Lithgow west of Sydney, on September 28, she told Macquarie Radio. She waited for the ambulance to arrive, only to be told it was lost. "He was alive when I started CPR," Mrs McFadden said.

Mrs McFadden said a man waited at the local pub for the ambulance so he could direct it to Mrs McFadden's property, two kilometres from the pub. She received a call advising the ambulance was lost. "I was told they haven't got GPS in their ambulances," she said. "That they would have them up here in a couple of years time in the western area."

By the time the ambulance arrived Mrs McFadden's husband was dead.

In a separate incident in far northern NSW this week, an emergency services operator hung up on a man who needed help at a remote property near Boomi. Stuart Jamieson dialed triple zero to get help for a local man who had become seriously unwell after working in the heat. The call was terminated because Mr Jamieson was unable to provide a street number and the operator could not find his location on a map.

The incident followed an inquest earlier this year that found triple zero operators bungled their response to calls for help from Sydney schoolboy David Iredale because they did not have a street address. The 17-year-old died after he became separated from his two classmates on Mount Solitary during a three-day trek in 2006.


Australia: Man waits six years to see a public hospital doctor

TOWNSVILLE man Bill Edwards has waited six years to see a specialist at the Townsville Hospital. Mr Edwards was diagnosed with tinnitus, or ringing in the ears, by his family doctor on November 25, 2003 and was referred to see an ear, nose and throat specialist at Townsville Hospital. But on Wednesday, six years later to the day, Mr Edwards said he was more likely to win the lotto than see an ear specialist. "To me it's more ludicrous than upsetting," he said. "Waiting six years for an appointment is just ridiculous."

Townsville Health Service District executive director of medical services Dr Andrew Johnson yesterday said the six-year wait wasn't good enough. "Waiting six years for a specialist appointment is clearly not good enough and we apologise unreservedly for this regrettable delay," he said.

Mr Edwards, now 54, was diagnosed with tinnitus after taking the drug Zyban to help him stop smoking in 2003. The condition is a possible side-effect for a small portion of the population who take the drug. "I've still got ringing in the ears and it seems like I'm stuck with it," Mr Edwards said. "I just want to have it physically checked out and I need the advice of a specialist on how to proceed. "I'm fairly sure that once you've got it, you can't get rid of it but I would still like to know one way or the other."

Dr Johnson said the Townsville Hospital only had one full-time ear, nose and throat specialist on its staff, who saw around 15 patients a week. Another specialist was due to start in January. "We've had difficulty recruiting ear, nose and throat specialists as we're in competition on a global basis for skilled staff," Dr Johnson said. "Unfortunately, this has affected patients who need to see such specialists." He said the hospital had 1692 referrals for appointments with ear, nose and throat specialists so far this year.

Mr Edwards was admitted to Townsville Hospital twice since 2003, for a back operation in 2006 and for an eye problem in 2008. He said the staff were faultless. "It seems once you are in there it's fine but getting in there is the hard part," he said. "I'm on the lowest scale of urgency but ... even if they saw 10 patients a day - that's 50 a week - I'd have more chance of winning the lotto. "I'm on a disability pension and ... I am entitled to medical help."

Dr Johnson said the hospital had scheduled an appointment for Mr Edwards within the next three months. [Big of him!]

Opposition Health spokesman Mark McArdle said Queensland's hospital waiting lists were the worst in the country. "Queenslanders are putting themselves at risk when they place themselves at the mercy of a health system which is pathologically incapable of meeting their needs," Mr McArdle said.


Hiding Health Reform's Real Costs

Senate Democrats say their reform bill will cost $848 billion over 10 years. They're misleading the public by starting the count in 2010. The true cost would be $1.8 trillion over a decade. The $848 billion figure is based on a 10-year run beginning in 2010 when there will be little, if any, spending — even though the taxes that fund the new welfare state program will begin the next year. In fact, only 1% of the spending will come in the first four years of the 10 years the Democrats are counting, according to the Congressional Budget Office.

To understand the real 10-year cost, the clock needs to be started in 2014. It's the first true year of spending. After four years of minimal activity, almost $50 billion will be spent in 2014. The spending roughly doubles in the next year and jumps by about 50% in 2016. By 2023, the real 10th year of the program, the federal government will spend nearly $270 billion. Add up all 10 years, and the price tag is $1.5 trillion, nearly twice as costly as the Democrats' bogus estimate.

And that's a humble beginning. The five years after that, which are not shown on the accompanying chart, would cost an additional $1.7 trillion, says Jeffrey Anderson of the Pacific Research Institute. "Thus," Anderson wrote Monday in National Review Online, "the true first-15-year costs of the bill would be a cool $3.5 trillion -- according to the CBO's projections."

But let's not stop there. As long as we're discussing real costs, we should mention the estimate made by the Cato Institute's Michael Cannon. He projects that the House bill, passed Nov. 7, will cost $2.5 trillion over the decade that the Democrats are using for their estimate. His assessment includes the $250 billion that's been removed from the health care bill to be voted on in separate legislation. This is the "doctor fix" that's supposed to ensure that Medicare reimbursements for physicians won't be sharply cut.

Cannon also prices in the cost of the individual mandate -- the requirement that those who don't have health insurance buy it for themselves -- because the costs of the premiums are not included in the CBO's estimates.

Democrats did this because they learned from a previous mistake. The CBO included the cost of individual mandate premiums in the Clinton 1994 health care plan, and it was a primary reason why that legislation failed. This time, though, with the help of White House Budget Director Peter Orszag, who was CBO director in 2007 and 2008, they were able to hide the costs.

Supporters of health care reform simply haven't been honest about the cost of either bill. The Washington Post editorialized a week ago about "fantasy savings" in the Senate plan. Republican Sen. Kit Bond of Missouri says the entire reform effort is "a trillion-dollar scam." Cannon calls the House's muddying of the facts "the biggest fiscal obfuscation in the history of American politics." "The current leadership," he wrote in National Review Online the day before the Nov. 7 vote, "has rigged the legislation so that 60% of its total cost will not be made public by the CBO in advance of the House vote."

Though accurate, those are all mild descriptions of what the Democratic leadership is trying to do to the country. If it successfully forces its expensive agenda on an ostensibly free people, it will have committed an act that some will justifiably consider to be a crime.


Time for an Alternative to PelosiCare

As it becomes increasingly clear in the light of day that the bill passed by the U.S. House in the dark of night cannot find the necessary votes in the Senate, it is time for leaders to explore alternatives that have the support of the American people and will set us on a path to contain costs and achieve our goals without massive tax hikes and ever more spending.

Last month my firm surveyed 500 nationally representative registered voters about competing visions for health care reform. The results were clear: voters want a plan in line with what GOP leaders offered as their alternative on Saturday night. Voters preferred a comprehensive, step by step, common sense restructuring of the health care system over the massive, incredibly expensive, one size fits all, all at once plan offered by Speaker Pelosi. Voters were especially drawn to reforms which reduce the costs to consumers without adding to the deficit, create no new government agencies, and are less costly than the Democrat’s plan.

This should be welcome news to wary Legislators, especially those from red states and red districts. The public is not ready for a rapid and radical transformation of the health care system – they prefer a step by step solution to accomplish meaningful reforms. A strong plurality of voters believe that the President and Congress are trying to accomplish too much when it comes to healthcare and an overwhelming 63% of voters agree that “my health care is too important to risk on one gigantic piece of legislation rushed through Congress. I would rather see Congress take a more thoughtful step by step approach, focusing on common sense reforms.”

Support for this step by step approach grew as we added more components of the Republican and Democrat plans: support for the GOP plan soared when a “no new tax” pledge coupled with an incremental approach was tested against a comprehensive reform plan that includes tax increases. Indeed a clear consensus emerged from the data: Americans believe that if we make the right decisions, we can reform our health care system without raising taxes.

Our survey also shows that liberals are misreading the American public with their overwhelming emphasis on coverage, to the exclusion of cost reductions. Americans are indeed concerned about access to care (83% say “finding a way to provide health insurance coverage to most Americans” is an important part of health care reform), but there is greater concern and demand for solutions that lower costs. A nearly universal 97% deem “making insurance more affordable” an important part of reform, with 69% rating it extremely important.

Even when we asked voters to make direct tradeoffs between increasing coverage, lowering costs, and improving the quality of care, their preferences were clear. Respondents were asked what percentage of a health care reform plan should be focused on each of these three goals - 55% of voters assigned more weight to cost than they did coverage, and on average they assigned cost seven times the weight and importance they gave to coverage. The Democratic plan, with its myopic focus upon coverage while doing almost nothing to decrease health care premiums for most Americans, misses what Americans feel is the most crucial part of the debate.

Ultimately, when asked to choose between complete descriptions of the Republican and Democratic plans (without labeling them such), voters chose the GOP plan: 63% chose “a limited, incremental, step-by-step approach to reform, which has no new taxes. This plan would lower premiums; but would not do anything to address the number of uninsured Americans. This plan would go into effect immediately;” and only 37% preferred “one comprehensive reform bill that would include multiple tax increases, would minimally impact premiums, but would provide insurance to most Americans. This plan would not go into effect for three years, though the tax raises would occur immediately.”

We have worked closely with Congressman Dave Camp as he helped forge this alternative plan and it is clear to us, clear to Congressman Camp, clear to congressional Republicans, and clear to 39 moderate Democrats, America is ready for health care reform – just not a sweeping re-creation of the entire system. Far from acting as the party of “No”, Republicans are showing a way forward on this debate that fits the prescription required for our ills. We hope in the coming days that a majority of the US Senate will also come to understand this as well. If they do, we can achieve meaningful reforms that the American people can agree on, and take a stop toward restoring their confidence in the legislative process and their elected representatives.


Friday, November 27, 2009

British Meningitis victim wins £3.2m compensation after hospital turned him away for 'misusing emergency services'

Once again: "Diagnostic tests? Who needs 'em?"

The family of a man left severely brain damaged after being turned away from hospital were awarded £3.2million yesterday. Doctors failed to spot that a simple ear infection had spread to the brain of Mark Thomas when he was 12.

Antibiotics could have treated the illness, but they missed tell-tale signs of meningitis including a stiff neck and severe tiredness and sent him home. The blood test which flagged up the spread of the meningeal infection was only reviewed after Mr Thomas's parents took him back to the hospital the following week for a second opinion - by which time it had attacked his brain.

Before the eventual diagnosis, a nurse had lectured the family about ' inappropriate use of A&E services'.

Mr Thomas, now 20, has the mind of a child and virtually no short-term memory. He used to be a keen footballer, but now goes to fixtures and forgets the score within minutes of a match finishing. He suffered a stroke which damaged the right side of his body and will never be able to work, instead needing round-the-clock care from his parents Elaine, 49, and David, 51.

Mr Thomas, from Blakenhall, Walsall, suffered a series of ear infections which refused to clear up in the six weeks before contracting meningitis in February 2002. He saw his GP several times but by February 9 his condition deteriorated so much that his parents took him to Walsall Manor Hospital for a blood test. The schoolboy had the classic signs of meningitis, including a stiff neck, aversion to bright lights and extreme lethargy, which should have rung alarm bells for doctors. But he was sent home and the blood test results - which revealed the infection had spread to his brain - were not passed on to his parents.

Five days later his illness had worsened and his desperate parents took him back to A&E only to be told by a nurse his condition was not sufficiently serious and they were 'using emergency A&E servicesinappropriately'. But Mr and Mrs Thomas refused to take their son home and demanded a second opinion. It was only then that the blood test results from February 9 were reviewed and meningitis was finally diagnosed.

Bosses at Walsall NHS Hospital Trust admitted liability for the errors and a settlement was approved by the High Court in Birmingham yesterday. The £3.2million pay-out will fund a lifetime of future care for Mr Thomas.

Mrs Thomas, a housewife who cares full time for her son, said: 'My son had to learn to walk again, eat, it was just like having a baby again. If the doctors had done their job properly and acted more quickly, Mark would now be living a completely normal life.' Sue James, chief executive of the Trust, said: 'We wish to apologise again to Mark and deeply regret the delay in diagnosing his condition.'


Gifted Cambridge-bound student who died after two-year anorexia battle 'let down by NHS'

Anorexia is an OCD. She should have been given anti-psychotic drugs

A gifted teenager who died after suffering a severe eating disorder for two years was let down by health chiefs, an inquest heard today. Alice Rae, who scored 9 A*s in her GSCEs and had been offered a place at Cambridge University, was found dead in her bed by her mother on January 14. An inquest into the 18-year-old's death was told the 'highly intelligent and determined' college student was sent home from hospital within hours of her admission - and a chance to help her battle her condition was lost.

Her father, company director Peter Rae, told the coroner sitting at Winchester, Hants, that there were some occasions when his daughter 'simply ate and vomited all day every day.'

The inquest heard that just weeks before she died Alice, who suffered from anorexia and bulimia, had been admitted to hospital in December when her blood potassium levels were at life-threatening levels - she but was discharged within hours. The family turned to the NHS believing that experts would be able to help her out.

Mr Rae said: 'This was an obvious and clear point of possible intervention where the medical team saw that here was a girl with critically low life-threatening potassium levels. 'These were brought about by an illness and affecting behaviour. She was discharged in 20 hours and was given no advice other than to resume the treatment programme that clearly had not been working.' He added: 'We were told it would be quite some number of days (that she would be in there). We were surprised that she was discharged so quickly.'

Alice had repeatedly said she was unhappy with the treatment at the NHS Eastleigh Eating Disorder clinic and had made no progress in her recovery. He said that treatment at the Eastleigh clinic had been 'completely useless' in tackling her condition. She would gorge on meals and throw them straight back up - and at her weakest was able to walk no more than 50 yards.

Mr Rae added: '(Staff at) the meetings would usually ask 'have you vomited this week?' and she saw this as how they were failing to understand her condition.' Mr Rae said that his daughter was overcome by her condition and unable to help herself.

Alice was a keen debater and horserider who had two older brothers - William and Tom - and a younger sister Georgina. However, she had battled with the eating disorder since 2006, the inquest was told.

Dr Carol Ward, the GP who saw Alice in the weeks leading up to her death, said that her condition had improved after her hospital admission - but that she was a very ill young woman. 'She was extremely bright and extremely intelligent and could discuss her care in great detail but this is a condition that is so devastating that it does affect your ability to make decisions about your care,' she said. 'Young girls with this condition are very, very difficult to help.'

She added that she expected Alice to be kept in hospital longer following her December 29 admission. 'I was surprised she was discharged as early - I did ring late morning (on December 30) and speak to medical admissions and there were no plans for her discharge,' she said.

A post mortem examination on Alice's body revealed no obvious cause of death - but it was ruled that on the balance of probabilities, low potassium levels were the most likely factor.

Dr Neil Joughin, a private consultant psychiatrist based in Chichester, West Sussex, saw Alice in the days before her death - and said she had a new motivation to get better after winning a university place. He said: 'If Alice had gone back into a general hospital or been sent to an eating disorder unit she would likely be alive today.'

She did not tell him about her hospital admission - and he would have treated her differently if she realised her problems.

Low potassium levels can cause the heart to beat irregularly - and doctors at the Royal County Hospital had suggested fitting a pacemaker in the hours before her hasty discharge. She was seen at the Eastleigh clinic by treatment co-ordinator Dr Isabel Lewsey for seven months of cognitive behavioural therapy at the start of 2008 - before it was discontinued because it was not working.

Coroner Sarah Whitby, the Assistant Deputy Coroner for Hampshire, recorded a narrative verdict. She ruled: 'Alice Rae died from an unascertained cause on the night of the 13 to 14 of January 2009 at her home. 'She had been suffering from anorexia from at least May 2006 for which she had been receiving treatment.'


Australia: Will they ever learn? Another government ambulance bungle over lack of street address

How many people do they have to kill before they get their act together? These phone helplines where some know-nothing just sits in front of a computer screen are a disaster. They usually fail completely when something non-routine comes up. I have experienced it many times with Telstra and have only got action by writing a letter to the Telstra boss. But writing letters is no help in an emergency. Emergency services should have somebody with local knowledge that they can call on if their computer data is inadequate. With Telstra, I have had arrogant and ignorant operators hang up on me too. That's just how computer-driven helplines deal with non-routine problems

Six months after an inquest found NSW triple-0 operators bungled a series of calls from a dying schoolboy lost in the Blue Mountains, the service has been accused of failing another person in need of help. Stuart Jamieson called the emergency line from a remote property near Boomi in far northern NSW on Monday to get help for a man who had become seriously unwell after working in the heat. An operator ended the call because Mr Jamieson could not provide a street number.

"I gave the road that went past [the location]," Mr Jamieson told Fairfax Radio network today. "They said they wanted a house number. I said there's no house number." Asked what road his property was on, Mr Jamieson said: "The Boomi-Goondiwindi Road. They couldn't find Goondiwindi on a map because ... it's in Queensland. "They said they could not find the Boomi-Goondiwindi Road."

AAP found the road in seconds, with two clicks on Google. Because the operator could not locate Mr Jamieson on a map, she terminated the call. "We were quite prepared to meet the ambulance at the road," Mr Jamieson said. An ambulance eventually arrived after he contacted a local stock and station agent who found help by knocking on the door of the Goondiwindi ambulance service, he said.

The emergency services operator who disconnected his call has since been stood down, The Daily Telegraph reports.

The incident followed an inquest earlier this year into the death of Sydney schoolboy David Iredale. The 17-year-old became separated from his two classmates on Mount Solitary during a three-day trek in 2006. The inquest found three triple-0 operators bungled a series of calls for help he made to them before he died - because they did not have a street address.


Opposition to health care legislation dominant

As the debate over a health care bill enters a critical stage, a new USA TODAY/Gallup Poll finds Americans inclined to oppose congressional passage of the legislation this year. The survey, taken Friday through Sunday, finds 42% against a bill, 35% in support of it. Despite nearly a year of presidential speeches, congressional hearings and TV ad campaigns by interest groups, more than one in five still doesn't have a strong opinion.

When pressed about how they were leaning, 49% overall said they would urge their member of Congress to vote against a bill; 44% would urge a vote for it.

The findings underscore the difficult battle ahead as President Obama presses Congress to enact the legislation by the end of the year. The House passed its version this month, and Senate debate on its health care bill is slated to start in earnest next week. A sharp partisan divide in public opinion helps explain the mostly party-line votes in Congress.

Those Democrats surveyed were overwhelmingly in favor of a bill: 76% to 17%. By an even wider margin, 86% to 12%, Republicans were opposed. Independents were against it by 53% to 37%.

Obama has seen his approval rating on handling health care policy slide a bit since the summer. Now, 40% approve, 53% disapprove, down from a 44% approval rating in July.


Damn the deficit: Full speed ahead on health care

Double-digit. That hyphenated adjective has been used most often recently to describe October's 10.2 percent unemployment rate. But it can also be used to describe the federal budget deficit as a percentage of the gross domestic product. That precise number is not yet known, but it may turn out to have a more dire effect on our national life than October's unemployment rate.

In the fiscal year just ended, federal spending was nearly 25 percent of GDP while federal revenues slipped below 15 percent because of the financial crisis and recession. We have not seen a budget deficit of this magnitude since World War II, which surely was a greater challenge than recent economic troubles.

Apologists for the Obama administration argue that some 2009 spending, like that on financial bailouts, is nonrecurring. True, but as the Congressional Budget Office has reported, the trajectory of administration spending and revenue is pushing the annual deficit toward $1,000,000,000,000 -- that's $1 trillion -- for the next decade.

Congressional Democrats' health care bills threaten to add to that. The bill currently before the Senate is advertised as costing less than $1 trillion. But significant spending doesn't kick in till 2014 and over the ensuing 10 years adds up to $1.8 trillion, nearly double that.

Thanks to current low interest rates, servicing the debt costs the government only $200 billion this year. But the White House estimates that debt service will exceed $700 billion in 2019. "In a few years," the Economist editorializes, "the AAA rating of Treasury bonds, the world's most important security, could be in jeopardy."

It's not only Republicans who decry this prospect. Examining the Democrats' health care proposals, William Galston, domestic policy adviser in the Clinton White House, writes, "We're already facing an unsustainable fiscal future."

Looking further ahead, Scott Winship notes in the Progressive Policy Institute's blog that federal spending is on course to exceed 40 percent of GDP because of scheduled spending on entitlements -- Social Security, Medicare, Medicaid -- within the lifetime of today's children.

Yet the congressional Democrats who are pressing to expand federal health care spending do not seem much fazed by the prospect that, as Winship writes, "the level of taxation it would require to meet projected spending needs is far higher than anything the country has ever seen-slash-tolerated."

That suggests that, at least for some Democrats, huge looming budget deficits are not a bug but a feature.Just as Ronald Reagan hoped that cutting taxes would force politicians to cut spending, these Democrats hope that increasing spending will force politicians to increase taxes to levels common in Western Europe. Never mind that those economies have proved more sluggish and less creative than ours over the long haul.

The instrument they may have in mind is the value added tax, which operates as an invisible sales tax on goods and services. Back in May, Budget Director Peter Orszag's spokesman mentioned the VAT as a "credible idea" that he did not want to rule out. In June, House Ways and Means Chairman Charles Rangel suggested a VAT as "a point of discussion."

In September, John Podesta, head of the Obama transition team, spoke of how a VAT would "create a balance" with other economies, and White House adviser Paul Volcker cited a carbon tax and a VAT as ways to raise lots of revenue. In October, Speaker Nancy Pelosi said, "Somewhere along the way, a value added tax plays into this."

These statements are noteworthy, because American politicians are ordinarily skittish about saying we should imitate Europe's high-tax and high-spending policies. These policies seem more unpopular than ever 10 months into the Obama presidency. Pollster Scott Rasmussen reports that 53 percent of voters worry that the federal government will do too much in response to economic problems, while only 37 percent worry it will do too little.

That mirrors voters' current opposition to Democratic health care bills. Democratic leaders nonetheless want to jam one through before their current majorities are eroded, as they seem likely to be, in the 2010 elections. This is politically risky, but makes sense if your goal is to expand government.

So the battle over health care is not just about health care. It's about whether government will permanently gobble up more of the private-sector economy and slow it down in the process.


Will Medical Tourism Industry Realize Benefits From Passage of Government-Run Health Care Bill?

Bob McCarty is a touch cynical below

Recently, a friend shared a prediction that prompted me to wonder whether or not the medical tourism industry will experience a boom if government-run health care becomes a reality in the United States.

In case you’re not familiar with the concept of medical tourism, it typically involves people from one country traveling to an exotic foreign locale to have a medical procedure performed at a lower cost. The “medical tourist” label applies to those who opt to spend some of their procedure-related savings by incorporating sightseeing and leisure activities into post-operative travel plans.

Considering the possibilities, I conceived that the most likely ObamaCare-induced scenario would involve cruise ships that would otherwise have found themselves in dry dock as a result of Obama’s massive wealth-redistribution schemes pulling the plug on the domestic cruise industry.

Reconfigured as floating hospitals, the ships would cruise in international waters barely 12 miles off the coast of the United States. They would be staffed by skilled doctors, nurses and other professionals who see tremendous benefit in being able to make a decent living as health care professionals unencumbered by bureaucracy-choked government panels. Their patient rosters would be comprised of people hoping to realize both the financial benefits that stem from saving money and the psychological benefits that would result from avoiding an experience with a government-run health care system.

Seems simple enough until liberalism — or, more accurately, socialism — enters the picture. That’s when I concluded that it will not work — not for very long anyway — due to efforts the Obama Administration will launch to thwart their success. Those efforts will include the following:

* The Obama Administration will refuse cruise hospitals entry into U.S. territorial waters and, in turn, access to U.S. ports. Why? Because their operations do not comply with federal health care guidelines and regulations.

* The Department of Homeland Security will step up screenings of American citizens who attempt to travel outside of the United States while not in the best physical condition. I can just imagine Janet Napolitano saying, “We wouldn’t want to burden other nations with our sick or inform citizens.”

* Both the Coast Guard and the FAA will deny applications for operating permits made by land, air or sea transportation companies hoping to be able to ferry patients to or from cruise ships. Of course, President Barack Obama will describe the denials as being “part of a larger anti-terrorism effort about which I cannot offer more details.”

* Congress will raise the tax rate on income earned by medical professionals while working outside the United States to a level high enough to make it unprofitable for them to make a living. President Obama will describe this as “only fair to those who grew up poor and could not afford medical school.”

If the measures above fail to sink the niche cruise hospitals, I’m certain Obama Administration officials will seek international assistance — perhaps from the United Nations and/or the World Health Organization — to make them illegal and to make those behind them subject to prosecution from the International Criminal Court. Their justification: “Those ships are needed to serve as floating prisons to house the thousands of Americans who refuse to sign up for government health insurance.”


Thursday, November 26, 2009

Third of new mothers left alone after birth by over-stretched midwives in Britain

More than one in three mothers are left alone and worried during labour or shortly after giving birth, a poll shows today. Almost a third received no free antenatal classes on the NHS, while a quarter had very little help with breastfeeding despite it being a Government priority.

Critics say the Health Service is struggling to cope with a massive shortage of midwives because officials failed to foresee huge rises in birth rates.

Sushma Cherion, 37, said she was left alone in a delivery room for two hours after giving birth for the first time. Mrs Cherion, of Hemel Hempstead, Hertfordshire, gave birth to Leia-Rose, who is now two, at King George Goodmayes Hospital in Essex. The software test engineer, who is married to Gilles, 39, said: 'When I was transferred to a ward, I was not seen by a midwife until eight hours later. 'There were no midwives on the ward and I was not greeted by anyone. I was a first-time mum and did not know that I was supposed to wake up and feed my baby.

'There was no guidance from midwives about breastfeeding. 'I wanted my soiled sheets changed but I couldn't and started crying, so I ended up changing them myself.'

The Royal College of Midwives says there is a shortage of at least 5,000 midwives. It commissioned the survey of more than 3,500 women visiting the Netmums website, which found that 35 per cent of new mothers say they were left alone during labour or just after, at a time when they felt worried.

Sally Russell, of, said: 'This survey's results should demonstrate to the Government just how stretched maternity services are. 'Some mums have told us that the lack of postnatal care has led them to suffer with postnatal depression, which can have dramatic impacts on the whole family.'


Socialist Britain too poor to afford cancer research?

If they fired just one percent of their bureaucrats, they would have a mint to spend on research

Research into cancer and dementia will come under threat from government plans to fund social care, experts warned last night. Andy Burnham, the Health Secretary, told The Times that millions of pounds would be “reprioritised” from health research and development to pay the costs of the Social Care Bill, published today. Money will also be diverted from public health campaigns such as those on swine flu, sexually transmitted diseases and obesity.

The Bill, a key plank of Gordon Brown’s pre-election legislative agenda, has been condemned by Labour peers, scientists and health campaigners. It would guarantee free care at home or other support for up to 400,000 elderly and disabled people from next October, at a cost of £670 million a year.

Mr Burnham, disclosing for the first time how he planned to pay for the proposal, said that £60 million would be diverted from the health service’s research and development (R&D) budget and £50 million from public health promotions. Cutting spending on management consultants in the NHS would provide £60 million.

Further funds will be sought as part of a “major productivity drive”, he said. The NHS is expected to make up to £20 billion in efficiency savings over the next four years. Hospitals could see their income tied to levels of patient satisfaction on matters such as the quality of maternity care.

Scientists warned of the consequences of cutting research budgets, which help to support the clinical trials of new medicines. Nick Dusic, director of the Campaign for Science and Engineering, said: “This is extremely disturbing as the NHS budget was supposed to be ringfenced to protect long-term investment into the health needs of this country. In any department any raid on the R&D budget is supposed to be discussed first with the Government’s Chief Scientific Adviser. If they’ve breached this process it’s an extremely worrying development that needs to be looked into.”

Health ministers are expected to be interrogated in detail about which elements of the R&D budget should be cut to pay for social care as part of a continuing inquiry by the Lords Science and Technology Committee. Lord Warner of Brockley, the Labour peer and former Health Minister who last week described the social care proposals as “totally misjudged”, said: “I will be looking at the Bill very carefully to see if my worst fears are confirmed and whether the figures really do add up.”

Mr Burnham defended the Bill from claims that it amounted to “an admiral firing an Exocet into his own flagship”. He denied that any cuts would affect patient care or compromise major research projects. “I’m not saying [the Social Care Bill] is perfect, but in the interim it makes the system a bit fairer now,” he said.

Asked to account for the reallocation of funds, he said: “It’s always a question of priorities. I’m not cutting into vital projects. I’m moving stuff out of lower-priority, backroom spend towards direct public benefit. All I want to say is we are being tough about that. I’m interested in really squeezing so that we get as much benefit directly to the public as quickly as we can. “I’ve got to be ruthless about that and I will be ruthless about that. We will spell it out when the Bill comes to Parliament.” He added: “I don’t think anyone can accuse us of underfunding R&D.”

The NHS research budget for 2010-11 is more than £1 billion. It funds a multitude of projects ranging from the diagnosis of brain tumours in children to reasons why patients’ immune systems are lowered after kidney transplants. Academics and research scientists expressed concern that funding to find cures for conditions such as cancer or Alzheimer’s disease could be hampered in the case of longer-term cuts to training and research.

Peter Dangerfield, co-chair of the BMA medical academic staff committee, said that budget cuts were already becoming commonplace in medical schools and that in some cases research and teaching posts were not being filled as staff retired. “There are worries and concerns here,” he said. “Research, training and education budgets are usually the among the first to go when the health service is asked to make savings. We do fear that patients could suffer quite a hard hit in the long term, missing the benefits of new medicines and expertise.”

Harpal Kumar, chief executive of Cancer Research UK, said: “The NHS research and development budget funds vital infrastructure that supports cancer clinical trials. These trials have been instrumental in driving the improvements in cancer outcomes we have seen over the past 20 or 30 years. We would be very concerned to see cuts that affected these budgets given that they are an integral part of improving health outcomes for patients. This government investment ultimately benefits everyone.”

Andrew Lansley, the Shadow Health Secretary, said that Labour’s sums did not add up. “The amount of money they are cutting from the NHS budget doesn’t even begin to cover what they claim the cost of the policy will be, which most experts agree is already a gross underestimate.

Anna Dixon, director of policy at the King’s Fund, said: “Ministers should think hard about the likely impact of reducing budgets for research and development at a time when we are asking the NHS to step up and find projects and solutions to make efficiency savings. The suggestions in the Social Care Bill are rather short-term and what we need is a more substantial and long-term solution to social care funding that will be accessible to everyone who needs it.”

Norman Lamb, the Liberal Democrat health spokesman said: “The Government’s plans are so vague as to be incredible. It’s fantasy politics and the full costing of this has to be revealed.”


Senate healthcare bill: The five paragraphs you must read

Buried in the Senate's 2,074-page health reform bill are provisions that undermine your health freedom and privacy

"There is no such thing as a little freedom," said Walter Cronkite. "Either you are all free, or you are not free."

Whether you're for or against federal efforts to help people buy health insurance, you should know that the reform bill before the Senate would mandate a healthcare system that is definitely "not free."

What most of us know about the Democratic bill is that it requires nearly all Americans to have health insurance. What most of us don't know is that it requires us to buy a minimum level of insurance approved by the federal government, and forces health plans and providers to share our personal health information with the federal government and other entities.

If this bill becomes law, we could each be assigned a national beneficiary ID number or card (possibly an electronic device). And our personal health information will flow electronically to the US secretary of Health and Human Services (HHS) – and many others – without our consent.

Sound farfetched? Buried in the Senate bill's 2,074 pages are provisions that actually permit and foster such things. Freedom and privacy are often lost in the fine print – which is why we've been studying the Senate bill since it was released Nov. 19 to help uncover the facts. Here are five highly invasive provisions Americans should know:

1. Mandatory insurance

Bill text: "Sec. 1501. Requirement to Maintain Minimum Essential Coverage.... An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month."

Translation: Uncle Sam will now serve as your national insurance agent and force you to buy "minimum essential coverage" – or else you'll have to pay an annual fine. However, what Congress considers "minimum essential coverage" and "essential health benefits requirements" includes comprehensive coverage that many neither need nor want. Plus, those who prefer to carry catastrophic-only coverage won't have a free range of options for such coverage.

Bottom line: In a free society, the government should not force citizens to buy any product nor should the government mandate citizens' level of health-insurance coverage. Rather than imposing penalties to coerce people into government-sanctioned health insurance, Congress should offer incentives to help those who wish to buy insurance but find it unaffordable.

Congress could allow everyone to deduct the full cost of health insurance (and provide tax credits for those with no tax liability), while offering assistance to those who can't afford insurance and subsidize high-risk pools for those with preexisting conditions.

Helping those in need is a much better way to reform our nation's healthcare system than overhauling the entire system and putting Big Brother in charge of deciding what is acceptable coverage for nearly every American.

2. Electronic data exchanges

Bill text: "Sec. 1104. Administrative Simplification…. (h) Compliance. – (1) Health Plan Certification. – (A) Eligibility for a Health Plan, Health Claim Status, Electronic Funds Transfers, Health Care Payment and Remittance Advice. – Not later than December 31, 2013, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards (as described under paragraph (7) of section 1171) and associated operating rules (as described under paragraph (9) of such section) for electronic funds transfers, eligibility for a health plan, health claim status, and health care payment and remittance advice, respectively."

Translation: Requiring everyone to buy federally sanctioned health insurance, and then forcing qualified plans to comply with Administrative Simplification requirements, provides the government and health industry with power they would not be able to exercise in a free market.

Administrative Simplification rules are a product of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. They lay the foundation for a nationally linked database of personal health information. A federal "Nationwide Health Information Network" (NHIN) is well under way in the United States, without assurances that individuals will control their personal health data.

Bottom line: Americans should be able to contract privately with the insurance companies of their choice. Patients should be able to decide whether to have electronic or paper medical records, and not have the government require electronic records, which are then included in a nationally linked database.

3. Real-time health and financial data

Bill text: "Sec. 1104. Administrative Simplification…. (4) Requirements for Financial and Administrative Transactions. – (A) In General. – The standards and associated operating rules adopted by the Secretary shall – (i) to the extent feasible and appropriate, enable determination of an individual's eligibility and financial responsibility for specific services prior to or at the point of care.... (i) Eligibility for a Health Plan and Health Claims Status. – The set of operating rules for eligibility for a health plan and health claim status transactions shall be adopted not later than July 1, 2011, in a manner ensuring that such operating rules are effective not later than January 1, 2013, and may allow for the use of a machine readable identification card."

Translation: Administrative Simplification rules are being expanded to gather real-time financial and health data on individuals through a tracking ID, possibly a "machine readable" ID card (electronic device).

Bottom line: Moving forward with real-time data collection without an ethical patient consent provision means everyone loses their health-privacy rights. Congress needs to enact strong patient consent provisions for all health data, especially data collected "real-time."

4. Health data network

Bill text: "Sec. 6301. Patient-Centered Outcomes Research.… (f) Building Data for Research. – The Secretary shall provide for the coordination of relevant Federal health programs to build data capacity for comparative clinical effectiveness research, including the development and use of clinical registries and health outcomes research data networks, in order to develop and maintain a comprehensive, interoperable data network to collect, link, and analyze data on outcomes and effectiveness from multiple sources, including electronic health records."

Translation: Your personal health information may soon be studied by government scientists. Washington is creating a new research center that plans to use patients' electronic health records for conducting research and creating disease registries. The data network is comprehensive and includes use of electronic health records.

Bottom line: Federal funds should not be used to collect data electronically and conduct research on patients' personal health information without their consent.

5. Personal health information

Bill text: "Sec. 6301. Patient-Centered Outcomes Research…. (B) Use of Data. – The [Patient-Centered Outcomes Research] Institute shall only use data provided to the Institute under subparagraph (A) in accordance with laws and regulations governing the release and use of such data, including applicable confidentiality and privacy standards."

Translation: Think your health privacy is protected? It's not. This language refers to "applicable confidentiality and privacy standards," but HIPAA's so-called privacy law permits individuals' personal health information to be exchanged – for many broad purposes – without patients' consent (See 45 CFR Subtitle A, Subpart E – Privacy of Individually Identifiable Health Information; section 164.502(a)(1)(ii) "Permitted uses and disclosures").

Bottom line: Trust is a must for ensuring quality healthcare. Thus, as stated above, Congress needs to pass a strong, ethical patient consent law that ensures patients have control over the flow of their personal health information. What about the consent of the governed?

All told, the national mandatory health-insurance bill puts the federal government in charge of individuals' insurance choices and data privacy. This philosophy of governing is the opposite of America's founding principle: consent of the governed. Without health freedom and privacy rights, Congress is opening the door for many wrongs to be committed – all in the name of covering the uninsured.


Medicare Cuts Oxygen under new rules‏

First Mammograms and now oxygen

New Medicare rules designed to reduce waste and fraud in medical-equipment reimbursements are driving some home-oxygen suppliers out of business and leaving patients scrambling to find new providers. The new payment rules, effective Jan. 1, affect the more than one million people who rely on Medicare to pay for oxygen services, which relieve the symptoms of conditions such as emphysema and chronic obstructive pulmonary disease.

"It's totally penny-wise and pound-foolish," says Barbara Renzullo, a nurse and case manager at Massachusetts General Hospital in Boston. Some patients, unable to find a new supplier because their reimbursement rate has fallen so far, "wind up in the hospital."

Under the new rules, Medicare pays suppliers at the prevailing rate —an average of $200 a month, paid 80% by Medicare, 20% by patients—for the first three years after a patient begins coverage. Suppliers are then required to continue providing oxygen services to patients for an additional two years, but at a sharply reduced payment rate. After that, patients are entitled to receive new equipment, and Medicare will resume paying suppliers at the higher rate.

The changes are part of broader efforts by Congress and the Centers for Medicare and Medicaid Services, or CMS, which oversees the federal insurance programs, to address waste and fraud in reimbursements for so-called durable medical equipment, which includes things like home-oxygen machines, wheelchairs and walkers. CMS says it expects to save about $220 million in the fiscal year that began last month. The agency says it had been paying too much for oxygen equipment, and that payments for the first three years should cover service costs for the two-year gap.

Suppliers say those calculations don't account for how much it actually costs to provide services, such as delivering oxygen tanks. Some are balking at accepting new patients who are near or have already reached the three-year limit on full payments. The companies would have to provide oxygen services for the next two years while getting minimal payments for follow-up visits and other services.

Ms. Renzullo, at Massachusetts General, said she has seen patients forgo using oxygen when their suppliers closed and no other company would take them. In January, one terminally ill patient wanted to move to Virginia to live with her daughter, Ms. Renzullo says. But the patient had reached the three-year oxygen payment cap, and no supplier in Virginia would accept her. The patient spent extra days in the hospital while Ms. Renzullo tried to sort out the situation. Ultimately, a Massachusetts supplier mailed an oxygen concentrator to Virginia.

Some smaller, independent oxygen providers, which account for much of the industry's business, say they are being driven out by separate Medicare rules that took effect Oct. 1 and require durable medical-equipment suppliers to be accredited and to post a surety bond.

The changes are supported by many in the industry, but some small suppliers say they can't afford them. It costs $2,500 to $3,500 for a company to go through an accreditation survey, says Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers. But a supplier may spend tens of thousands of dollars to comply with the stringent requirements.

Respiratory therapist Bob Sherman is job hunting after his company, Family Pharmacy and Valley Medical Supply in Stevensville, Mont., decided to exit the durable medical-equipment business. The costs for accreditation and a surety bond, coupled with lower reimbursements, cut too far into profits, he says.

A CMS spokesman said the agency has heard of one supplier filing for bankruptcy recently, but is unsure whether it was caused by the new rules. He also said the amount paid to suppliers to maintain equipment was increased last month.


Obamacare: Big State Tax Hikes

Anxious to avoid raising taxes too much to pay for their health care proposals, the Obama administration and its congressional allies hit on a great new idea: Make the states raise their taxes to fund the program, instead.

Both the House and the Senate bills require that states cover a larger percentage of their people under Medicaid -- a joint state and federally funded program. The idea was to force states to raise their taxes to cover a big part of the health care bill for treating poor people. Since the Feds can simply charge any increase in spending to their already overdrawn bank account, but the states have to balance their budgets, the increased state spending for Medicaid will cause sharp increases in state taxes. And the governors will get the blame, not Obama and not the Congress.

The House bill requires states to give Medicaid to those whose incomes are less than 150 percent of the poverty level, while the Senate will settle for only 125 percent. For most states, this is a hefty increase.

In some states, like New York, where Medicaid covers everyone making 150 percent of the poverty level already, there will not be any extra required spending. But not so in California, which only covers 100 percent of the poverty level. Were the House bill to pass, the already fiscally beleaguered state would have to increase its Medicaid spending on poor people by 50 percent, at least an extra $2 billion a year and perhaps more.

In many Southern states, the Medicaid program only covers a portion of those living below the poverty level. For these states, the requirement to cover all those in poverty and then 50 percent more will cause enormous increases in taxes. In Arkansas and Louisiana, where swing-Senators Pryor, Lincoln and Landrieu come from, the cost could exceed $1 billion for each state each year.

Unfunded mandates for state spending imposed from on high in Washington have always rankled governors. The senators and congressmen in Washington get the credit for spreading largesse, but the governors in the states get the blame for the taxes that are needed to pay for it. Since Democrats currently control the vast majority of governorships, this process of making their own party members take the rap for raising taxes is politically self-destructive in the extreme. But Obama is so desperate to pass his health care legislation that he doesn't care what havoc in his party he reaps in the process.

The question now is whether the governors of the 50 states, particularly the Democrats, are going to sit idly by and let their budgets be destroyed by the health care bill.

When the Republicans in Congress insisted on tacking big cuts in aid to legal immigrant benefits for disability and other areas onto the welfare reform bill, it was the Republican governors who forced them to repeal the pernicious cuts the very next year. They did not want to have to raise taxes to make up for the withdrawal of federal funding.

Now, the Democratic governors face the same situation. If Obamacare passes with its expansion of Medicaid benefits -- but with no federal funding of the extra spending -- it is these Democrats and their legislatures that will have to bite the bullet and pass new taxes to pay for it.

Since states are already facing mammoth financial problems as a result of dwindling revenues and swelling expenditures in the recession, these additional burdens could be politically fatal. Unless Democratic governors want to avoid the fate of one of their late brethren, former Gov. Jon Corzine of New Jersey, whose political career was ended in a blaze of new taxes, they might want to call their buddies in Congress and ask them to lay off the unfunded mandates, particularly during this recession.


A budget-buster in the making

The article below is by respected journalist, David S. Broder, writing in a Left-leaning paper

It's simply not true that America is ambivalent about everything when it comes to the Obama health plan. The day after the Congressional Budget Office (CBO) gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results. This poll may not be as famous as some others, but I know the care and professionalism of the people who run it, and one question was particularly interesting to me.

It read: "President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?"

The answer: Less than one-fifth of the voters -- 19 percent of the sample -- think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely. That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.

I have been writing for months that the acid test for this effort lies less in the publicized fight over the public option or the issue of abortion coverage than in the plausibility of its claim to be fiscally responsible. This is obviously turning out to be the case. While the CBO said that both the House-passed bill and the one Reid has drafted meet Obama's test by being budget-neutral, every expert I have talked to says that the public has it right. These bills, as they stand, are budget-busters.

Here, for example, is what Robert Bixby, the executive director of the Concord Coalition, a bipartisan group of budget watchdogs, told me: "The Senate bill is better than the House version, but there's not much reform in this bill. As of now, it's basically a big entitlement expansion, plus tax increases."

Here's another expert, Maya MacGuineas, the president of the bipartisan Committee for a Responsible Federal Budget: "While this bill does a better job than the House version at reducing the deficit and controlling costs, it still doesn't do enough. Given the political system's aversion to tax increases and spending cuts, I worry about what the final bill will look like."

These are nonpartisan sources, but Republican budget experts such as former CBO director Douglas Holtz-Eakin amplify the point with specific examples and biting language. Holtz-Eakin cites a long list of Democratic-sponsored "budget gimmicks" that made it possible for the CBO to estimate that Reid's bill would reduce federal deficits by $130 billion by 2019.

Perhaps the biggest of those maneuvers was Reid's decision to postpone the start of subsidies to help the uninsured buy policies from mid-2013 to January 2014 -- long after taxes and fees levied by the bill would have begun.

Even with that change, there is plenty in the CBO report to suggest that the promised budget savings may not materialize. If you read deep enough, you will find that under the Senate bill, "federal outlays for health care would increase during the 2010-2019 period" -- not decline. The gross increase would be almost $1 trillion -- $848 billion, to be exact, mainly to subsidize the uninsured. The net increase would be $160 billion.

But this depends on two big gambles. Will future Congresses actually impose the assumed $420 billion in cuts to Medicare, Medicaid and other federal health programs? They never have. And will this Congress enact the excise tax on high-premium insurance policies (the so-called Cadillac plans) in Reid's bill? Obama has never endorsed them, and House Democrats -- reacting to union pressure -- turned them down in favor of a surtax on millionaires' income.

The challenge to Congress -- and to Obama -- remains the same: Make the promised savings real, and don't pass along unfunded programs to our children and grandchildren.