Sunday, January 31, 2010

More Britons die as lone NHS GPs cover thousands after hours

SOME parts of Britain are relying on just one out-of-hours GP at night to serve more than 240,000 residents. An investigation by The Sunday Times into the inadequacy of round-the-clock cover has established two further deaths, including that of a three-year-old boy, after failures in the system.

Brighton, Bolton and Wigan are among the areas where a lone doctor is responsible for dealing with late-night emergencies. The news follows revelations last weekend that just two GPs provide cover for Suffolk and its 600,000-strong population on some nights.

Mark Simmonds, the Tory health spokesman, said repeated warnings about out-of-hours cover had gone unheeded by ministers: “It’s disgraceful that the government hasn’t taken action over this before.”

Brighton and Hove primary care trust (PCT) has one GP to cover an area with 248,000 residents on most nights. It claimed the doctor can receive as few as 10 calls each evening. However, in one case involving the trust, a three-year-old boy from Hove died from blood poisoning after the failure of the out-of-hours service. The frantic parents of Joseph Seevaraj phoned the duty doctor at 11pm on a Sunday and asked whether they should take their son to hospital because he was vomiting and suffering from diarrhoea. Joseph was already taking antibiotics for tonsillitis and the doctor advised his parents, Jean and Nicola, to wait for those to take effect. They watched over the toddler closely, but he died a few hours later.

A consultant in paediatric intensive care later said she believed the child would have survived if his parents had received proper advice from the out-of-hours service. “He needed basic medical attention,” said Veronica Hamilton-Deeley, the coroner, at the inquest. “The failure to provide it was gross failure.” South East Health, which provides round-the-clock services for Brighton and Hove PCT, said it had learnt from the incident in January 2008.

This weekend it emerged that only one GP serves 310,000 residents in the Wigan area on most nights, while 270,000 residents in the Bolton area also have to routinely rely on a single out-of-hours doctor. In North Somerset there is just one GP for 200,000 residents on a week night. Cambridgeshire has three GPs at night, Norfolk has four and Cumbria has six.

Such skeleton cover was introduced when GPs negotiated new contracts in 2004, boosting their average salary to more than £100,000 and allowing them to opt out of providing round-the-clock care.

This week a coroner is expected to conclude the inquest into the death of David Gray, a 70-year-old from Manea, Cambridgeshire. Gray died in February 2008 after being given a massive overdose of diamorphine by Daniel Ubani, a locum doctor from Germany who had flown in for his first out-of-hours shift.

While some PCTs say that just one or two GPs can adequately cover a population of more than 250,000, others have more doctors available for home visits. Under South Birmingham PCT there are 11 doctors on overnight duty, each covering an average population of about 35,000. Hampshire has 13 GPs on duty at night and Devon has eight, working at medical centres across the county.

Patients are often unaware if their local service is in crisis because most trusts do not publish performance reports. NHS Bristol said last week that a report on the quality of its out-of-hours GPs’ service was “confidential” and “commercially sensitive”.

Most round-the-clock services struggle to fill shifts with local GPs. Instead they use doctors from other parts of the country or foreign GPs who fly in for their shifts. A parliamentary debate was told last week of a case in Cornwall in which a patient had been confronted with a foreign doctor who used “an electronic word converter” to communicate. Other patients have complained of waiting eight hours for a doctor to arrive.

There have also been complaints that out-of-hours GPs do not have access to patient notes and sometimes fail to diagnose serious conditions. In one case, a doctor working as a duty GP in West Yorkshire was suspended from the General Medical Council register after he failed to examine an elderly patient properly. She died the next day. Dr Krzysztof Robak, 62, commuted more than 175 miles from Surrey, where he worked for a diet clinic, to his Yorkshire employer, Local Care Direct. When he visited the 86-year-old patient, he failed to check her blood pressure or take her temperature and did not consider her seriously ill.

Robak said yesterday that he had drunk two bottles of wine four days earlier and was suffering from the medication he took for his gout. He told the family of the woman: “Look what two bottles of wine can do to you” — a comment they considered inappropriate. Robak said he had told his employer he had been feeling unwell. “I felt guilty because I failed this woman,” said Robak. “I did not refer her to the hospital because she appeared to be over the crisis.”

He said he felt he had been treated harshly over the mistake and plans to appeal against his suspension. Local Care Direct, a nonprofit organisation which provides out-of-hours care services for 2.5m people in Yorkshire, said it had vetted Robak rigorously before employing him. It said it did not consider that he had contributed to the patient’s death in July 2007, but it had raised concerns about his conduct.


Australia: Patients in Queensland government hospitals malnourished

Just like government hospitals in Britain. And the solution is very British too: More bureaucracy. That it's more nurses that are needed to help feed the elderly is beyond their tramtrack socialist comprehension

ONE in three patients in Queensland public hospitals is suffering from malnutrition, according to a State Government report. The Queensland Health briefing paper says malnutrition is "highly prevalent" in hospital patients and residents in aged care facilities. It said malnutrition could be costing Queensland more than $13 million a year. It was blamed for extended hospital stays, causing illness and disease, and exposed the department to legal action.

Liberal National Party health spokesman Mark McArdle said he was concerned that the Government had slashed health budgets by cutting patient food services. Health sources said hot meals in some hospitals had been reduced from three to one per day. "This is Third World . . . this is seriously affecting patients' recovery and ultimately tying up desperately needed hospital beds," Mr McArdle said.

In documents obtained by the Opposition under Right to Information laws, it was revealed that Queensland Health first examined the problem in 2003, but did nothing about it until 2008. A July 2009 report for Director-General Mick Reid warned of the dangers of malnutrition. "Due to the emphasis placed on the high and increasing prevalence of obesity and related disorders, there is little awareness of the existence and extent of the other extreme, malnutrition," the report said.

Queensland Health's Patient Safety Centre conducted a six-month investigation in 2008. It found that 30 per cent of hospital patients and 50 per cent of aged care facility residents suffered from malnutrition. It was estimated to have cost taxpayers $13 million in 2002-03.

The centre recommended the establishment of a malnutrition prevention manager within Queensland Health, to be paid $120,000 a year.


Congress’ New Secret Plan to Pass ObamaCare – The Nuclear Option

Leaders in the House and Senate have a new secret plan to pass President Barack Obama’s sweeping health care plan using strong arm tactics and no transparency.

I wrote back in September that Congress had a plan to ram through ObamaCare by the end of the year, but the American people stopped that plan. Public outrage was amplified by Rush Limbaugh and others in the media who took up the cause to educate Americans about Congress’ plan to railroad the unpopular bill through Congress with little debate and no opportunity for dissent. Cooler heads prevailed and Congress stopped efforts to sneak the bill through Congress.

On January 19, the proponents of ObamaCare suffered a big setback. When little-known State Senator Scott Brown scored a shocking upset in a special election for Senate in Massachusetts campaigning as an opponent to ObamaCare, moderates in the Senate and House put the brakes on ObamaCare. The left had to retool their strategy, because there was no will in the Senate to take up and pass ObamaCare again. The only way proponents of Obamacare can win now is if they change the way the game is played, and liberals seem to be prepared to change the traditional rules of the Senate by triggering a legislative Nuclear Option in an effort to pass Obamacare by the end of February.

This is a Nuclear Option, because the left is preparing a strategy to obliterate the filibuster rule — the rule that requires 60 votes to shut off debate on legislation, for the purposes of passing multiple pieces of legislation that add up to ObamaCare. They will either use reconciliation to pull an end around the filibuster rule or they may be bold enough to merely use a simple majority of Senators to exterminate the filibuster rule from the Senate rule book.

Sources on Capitol Hill tell me that liberals in the House and Senate are a handful of votes away from a scenario where they can get ObamaCare to the President’s desk by the end of February. Here is the way it works. According to The Hill, “House Democrats are readying a series of smaller ‘sidebar’ healthcare provisions to introduce by mid-February even as they push for using reconciliation rules to move a broader healthcare package, according to leadership aides.” So the plan is to try to pass a few smaller issues and to prepare a so called “reconciliation measure” to make changes to the Senate passed ObamaCare bill awaiting action in the House.

The reconciliation plan would be done by “using budget reconciliation rules to pass parts of the healthcare package (and) would require only 51 votes in the Senate. But those rules can only be used to move provisions affecting the federal budget.” If they can pass smaller portions of ObamaCare with Republican support, then they jam a reconciliation measure through the Senate with only 51 votes containing ObamaCare tax provisions. Next the House would take up and pass the Senate passed 2,700 page ObamaCare monstrosity. If that happens, then the game is over and the will of the American people will be ignored again.

President Obama declared at the State of the Union, “here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let’s get it done. Let’s get it done.” This is a message from the President to Congressional liberals that he will support their efforts to ram through ObamaCare with all means at their disposal. The President showed his complete disconnect from the feelings of average Americans when he called for Congress to pass his health care proposal that has been rejected by the voters of liberal Massachusetts. Real Clear Politics has the President’s plan with the approval of an average of 37.4% and an opposition of 54.4% – that is an average poll deficit of 17% for ObamaCare, yet the President forges forward.

Liberals can use the Nuclear Option to pass at least some part of ObamaCare and it allows them to deal with the tax or revenue aspects of health care reform. Then they will pull the trigger and force the House to pass the 2,700 page ObamaCare bill which is one House floor vote away from a Presidential signing ceremony. This is a multi-bill strategy. The reason why House members may vote for the Senate ObamaCare bill is because they may have their concerns addressed with the small bills and reconciliation measures that will have passed before this historic vote. This scenario also provides cover for moderate Democrats in the Senate who can vote against the reconciliation measure and claim to constituents that they were, in the end, against ObamaCare.

This procedure is an indication that Congress understands that even the people of liberal Massachusetts hate ObamaCare, so they need to pass this bill as fast as possible and with little transparency to try to minimize the participation of the American people in this process. A rational politician would see the terrible polling numbers for ObamaCare and the results in Massachusetts as a sign that the bill should be scrapped. The problem today is that the American people are dealing with an elite class of politicians in Washington that don’t care what the American people think about ObamaCare.

These elites make fun of people who participate in Tea Parties. They have distain for those that show up at Town Halls to voice opposition to the bill. They denigrate protesters who come to Washington, D.C. to demonstrate against a government takeover of health care. They laugh at all the poll numbers that indicate they are going in the wrong direction. They are ignoring the voters and their own constituents to further the cause of President Obama’s vision of a de facto government run health care system.

This is one of those unique moments in history where a minority number of Members of Congress are protecting the will of a majority of the American people – the big question is who will win?


Saturday, January 30, 2010


Four current horror stories from Britain below

Is this the worst diagnosis and treatment of all time? NHS told dying woman she was lying and locked her up in a mental hospital!

I had chronic fatigue syndrome once but luckily I have a very good immune system and it only lasted a month. It was a very real debility, though -- JR

As Criona Wilson knelt beside her dying daughter’s bedside, she promised her that her death would not be in vain. Before the frail body of 32-year-old Sophia finally succumbed to the medical complications and ravages of ME, she replied in a whisper: “Then it’s all worth it.” In the years that followed, Mrs Wilson, 66, a former midwife, dedicated her life to proving that her daughter’s condition was not a figment of imagination, nor one that merited her youngest child’s incarceration in a mental hospital.

Her battle saw her take on the medical profession and accepted thinking about the diagnosis and treatment of ME, also known as chronic fatigue syndrome. Eventually, in 2006, a coroner ruled that Sophia’s death was the result of myalgic encephalomyelitis — the first such ruling at an English inquest.

The fierce debate over ME has been highlighted once again by the case of Kay Gilderdale, who admitted assisting her daughter, Lynn, to kill herself after suffering from ME for 17 years. When she walked free from Lewes Crown Court on Monday, having been cleared of murder, Mrs Wilson was among those cheering her from the public gallery. “I had to be there,” said Mrs Wilson yesterday. “It was such an important case. And the verdict was a vote for common sense in a trial that highlighted what people suffering ME and their carers have to face.”

Her daughter, Sophia Mirza, was a talented and popular arts graduate living with her mother in Brighton in 1999 when she contracted ME at the age of 25. She became confined to her bedroom and, just as Miss Gilderdale had, needed round-the-clock care. In 2003 she was visited by a psychiatrist, even though Miss Mirza complained only of physical discomfort. The psychiatrist told her that she was making up her symptoms and if she continued to pretend to be ill he would section her under the Mental Health Act. Mrs Wilson said: “I knew my daughter. There was no way she was mentally ill or pretending.”

When the dread knock on her door finally came in 2003, there was little she could do. A policeman forced the door open and the psychiatrist and a social worker locked themselves into Miss Mirza’s room to prepare her for her trip to a psychiatric ward. Her condition took a dramatic turn for the worse. After 13 days she was released and taken back to the care of her mother. “That spell in a mental hospital set her back terribly. We lost all faith in medical professionals. We were alone,” said Mrs Wilson.

In 2005 Miss Mirza could barely muster the energy to speak, eat or drink. She and her mother had already agreed that no doctors should be called in case she would be sectioned again. On November 25, 2005, Miss Mirza died in her bed at home.

Wiping tears from her eyes, Mrs Wilson said: “We did everything we could.” Determined to get to the bottom of why her daughter’s treatment had been so bad, she got hold of her medical records. After being contacted by the 25 Per Cent ME Group, which campaigns for those with the most acute form of ME, she agreed to her daughter’s body being examined.

At the inquest the next year a neuropathologist told the court that Miss Mirza’s spinal cord was inflamed and three quarters of her sensory cells had abnormalities. It was, the court heard, a clear physical manifestation of ME. The coroner ruled that she had died from “acute renal failures as a result of chronic fatigue syndrome”.

A year later, the National Institute of Clinical Excellence (NICE) issued its first guidelines on the diagnosis and treatment of the illness, describing it as “relatively common”, affecting up to 193,000 people in Britain. At the heart of that guidance is the need to take into account the opinions of the patients. Mrs Wilson is campaigning to get the Government to fund research into ME. “It’s not over yet.”


NHS doctors can kill people but that's OK

A doctor who prescribed “potentially hazardous” levels of painkillers to elderly patients who died has escaped being struck off the medical register. Jane Barton will be allowed to continue working as a doctor, despite being found guilty of serious professional misconduct, a fitness to practise panel ruled.

She was accused of a series of serious failings in her care of 12 elderly patients at Gosport War Memorial Hospital, in Hampshire, in the 1990s. These included prescribing prescription drugs at “excessive” and “inappropriate” levels, a hearing at the General Medical Council (GMC) was told.

The fitness to practise panel found that Dr Barton was guilty of putting patients at risk of premature death at the hospital between January 1996 and November 1999. She was found to have prescribed diamorphine, the opiate painkiller, at varying levels “and created a situation whereby drugs could be administered which were excessive to the patients’ needs” the panel found. However, it said that it had taken into account her ten years of safe practice as a GP in Gosport and 200 letters of support and ruled that she could continue working under certain conditions.

Relatives of the patients who had died reacted furiously to the verdict and walked out of the hearing in central London today. Iain Wilson, the son of Robert Wilson, one of the patients who died, shouted at the panel: “You should hang your head in shame.”

The GMC, which regulates the work of 150,000 doctors in Britain, had recommended that Dr Barton be struck off and also criticised the decision. Niall Dickson, the council’s chief executive, said: “We are surprised by the decision to apply conditions in this case. “Our view was the doctor’s name should have been erased from the medical register following the panel’s finding of serious professional misconduct. “We will be carefully reviewing the decision before deciding what further action, if any, may be necessary.”

The case will now be reviewed by the Council for Healthcare Regulatory Excellence, an ombudsman of misconduct cases. If found to be unduly lenient the decision could be referred to the High Court and possibly overturned.

In April last year a jury inquest at Portsmouth Coroner’s Court ruled that at least five elderly patients who died at a hospital in Hampshire were overprescribed strong painkillers that hastened their deaths.

In the cases of patients Robert Wilson, 74, Geoffrey Packman, 66, and Elsie Devine, 88, the use of painkillers was found to have been inappropriate for their conditions. Arthur Cunningham, 79, and Elsie Lavender, 83, were prescribed medication appropriate for their condition but in doses that contributed to their deaths, the jury found.

Dr Barton, who worked as a clinical assistant at the hospital, was the only individual to be investigated by police in connection with the deaths but was not charged with any offence.


Grandmother disgusted at filthy NHS hospital nursed and bathed other patients on her ward

A grandmother was so disgusted by the filthy conditions and neglect on a hospital ward that she bathed and cared for the patients herself. Janet Halsall, 74, was admitted to Hinchingbrooke Hospital in Huntingdon, Cambridgeshire, for three days to have a scan on her liver, when she was shocked to see staff repeatedly ignore pleas for help and leave fellow elderly patients to ‘fend for themselves’. The kind-hearted pensioner was so appalled by the conditions in the hospital that she bathed, washed and tucked in the frail elderly patients herself.

The grandmother-of-seven said fellow patients were distressed after being left without water, and when she went to the pantry to clean their glasses, she found it in a ‘disgusting state’. When one elderly lady got no help after repeatedly complaining to staff she was cold, Mrs Halsall was moved to search a store cupboard for a blanket. The former hairdresser even washed and bathed one lady who needed help to clean herself and took another pensioner to the toilet after staff continually ignored her requests because they were ‘too busy’. When she was discharged on Monday afternoon, her fellow patients cheered and clapped her - branding her their 'guardian angel'.

Speaking from her home in Little Staughton, Beds., she said: ‘I was absolutely disgusted when I entered the ward. ‘At 7pm I arrived in the ward and was appalled to find the bed was unmade and the water jug and glass were on the floor. ‘There was no locker or table to put my things on or bag to dispose of rubbish. ‘The patient in the next bed to me kept asking staff if she could go to the bathroom to have a wash and clean her teeth before breakfast. The reply was always “in a minute”. ‘She was really upset so I found her a bowl and washed her from head to toe and made her feel better. She was so grateful.

‘Never before have I seen so many people rushing around, working so hard but achieving nothing.’

Mrs Halsall, whose partner Eric died five years ago, blames the shoddy treatment on a shortage of staff. She added: ‘There simply weren't enough staff looking after the ward. People were asking for help and it was falling on deaf ears. ‘The poor nurse was running around and didn't have time to help everyone. I couldn't just sit there and watch so, being quite agile, I got up and helped them myself. ‘When I left the ward on Monday they all cheered me out and said I was their guardian angel.’

Mrs Halsall was referred to the Hinchingbrooke Hospital at around 11am on Friday amid fears she was suffering a liver complaint. She was told she could not have the scan until Monday and was later transferred to the Appletree Ward for the weekend. But within minutes of arriving, she became angry after spotting a number of patients who were not being cared for. Pensioner Joyce Bates, who was also on the Appletree Ward as she underwent physiotherapy for rheumatoid arthritis in her legs, hailed Janet a 'heroine'. Widower Mrs Bates, from March, Cambs., said: ‘I don't know what we would have done without Janet. The place was an absolute disgrace and our treatment was even worse. ‘I've stayed in hospital 38 times and I've never watched as a patient is forced to give another a bed bath because the nurses won't. ‘She truly was magnificent in what was a nightmare situation.’

Director of the Patients Association Katherine Murphy said: ‘Unfortunately we hear far too many examples of the kinds of things described by Janet Halsall. ‘It is completely unacceptable for patients not to be treated with dignity and respect and not to receive the help they need with things like personal hygiene. ‘That should be fundamental to NHS care-whenever it's not it's an appalling indictment of our treatment of some of the most vulnerable users of our health services.’

A spokesman for Hinchingbrooke said: ‘Hinchingbrooke Health Care NHS Trust takes all complaints extremely seriously. ‘We would ask Mrs Halsall to contact us directly so that a full investigation can be conducted into her experience on the ward. ‘Until we can look into these incidents in more detail it would be inappropriate to comment further at this time.’ [Blah, blah, blah!]


Don't fall sick out of hours in Britain: GPs refusing to work nights and weekends claimed boy's life

Like so many proud parents, Jean and Nicola Seevaraj meticulously recorded the milestones in the life of their first child, Joseph. He smiled when he was a month old, stood up on his own four days before his first birthday and loved the movie Madagascar. And there was so much more to look forward to - his first day at school, learning to read and to ride a bike. Instead, at the age of three years, one month and 19 days, Joseph was dead. 'I remember checking on him around 4am,' says Mr Seevaraj, 33, a church minister from Hove, East Sussex.

'I went back to bed and the next thing I knew it was 7.30am and my wife was screaming. She was absolutely frantic and I knew something terrible had happened. She was next to Joseph's bed. His eyes were open, but he wasn't responding to anything she did or said. 'It was the worst moment of my life. We called 999 and they told us to try to resuscitate him, but I knew inside myself that it was too late. He'd already passed away. 'The paramedics arrived and rushed him to hospital, but it was hopeless. And that was the beginning of our nightmare.'

It was a nightmare that would be made all the more ghastly because of the fact that Joseph's death had been avoidable. His parents had sought medical help for their son, who had tonsillitis. Joseph was prescribed antibiotics, but when he started to vomit and had diarrhoea, Mr Seevaraj phoned for further help. Because it was a Sunday, he could not talk to the family doctor. Instead, he was connected to the out-of-hours service and was put through to a German-trained medic. The locum doctor, who Mr Seevaraj claims struggled to understand what was being said to him, told him there was nothing to worry about and that, no, it wasn't necessary to bring in the child for further treatment.

Mr Seevaraj followed that advice - and the following morning woke to find that his son was dead. An inquest would later hear that had Joseph been taken to hospital, then the septicaemia that claimed his life could have been treated. 'He needed basic medical attention,' the coroner said, ruling that neglect had contributed to Joseph's death. 'The failure to provide it was gross failure.'

Mr Seevaraj says: 'If we had been able to speak to our family GP that weekend, I believe Joseph would still be alive. There are lots of holes in the out-of-hours system - it needs to be sorted out.'

And he is not alone in that view. New figures show that serious complaints about out-of-hours care have shot up by 50 per cent in just two years. The Medical Defence Union, the leading insurance company that covers most GPs, reported a sharp rise in the number of grievances against doctors following deaths, misdiagnoses and negligence. In 2007 and 2008, there were 517 complaints related to consultations at evenings and weekends - up from 337 over the previous two years. Seventeen insurance claims followed the deaths of patients.

And then there is the shocking case of David Gray, a 70-year-old kidney patient, who died in February 2008 after being injected accidentally with ten times the maximum recommended dose of morphine. It was administered by Dr Daniel Ubani, a locum who had travelled to Britain from Germany and had slept for just three hours before going on his first out-of-hours weekend shift in Cambridgeshire. As well as giving the fatal injection to Mr Gray, an 86-year-old woman died of a heart attack after the Nigerian-born Dr Ubani failed to send her to hospital.

While the deaths of Mr Gray and young Joseph may differ in their circumstances, both serve to shine a spotlight on the growing scandal of British doctors' refusal to work nights and weekends, with their places too often being filled by doctors from abroad, some of whom speak poor English.

All this, of course, is the result of one of the Government's most disastrous pieces of meddling, which allowed British doctors to opt out of out- of-hours duties - and meant they were no longer responsible for the care of their patients 24 hours a day, seven days a week.

That's why, six years on, Suffolk - a county of 600,000 people - has just two British doctors on call overnight and at weekends. Similarly poor coverage is offered elsewhere, as sick patients are fobbed off with telephone assessments or forced to make their own way to overloaded Accident & Emergency hospital departments.

Before the introduction of the new contracts in 2004, GPs were responsible for providing out-of-hours care to their patients. Since then, however, the responsibility for in-hours and out-of-hours care was split, so that primary care trusts took on responsibility for patients at nights and on weekends. As a result, despite the fact that British GPs are the highest-paid in the developed world - average earnings are £106,000 - they earn their crust during office hours.

Under pressure to return profits and cut costs, primary care trusts introduced ways of dealing with patients that reduced the need for time- consuming home visits while looking for 'cheaper' doctors from elsewhere. Though precise figures are not available, research by the Daily Mail suggests that a third of primary care trusts are flying in GPs to fill these posts. The doctors come from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland, and are attracted by the comparatively good rates of pay.

While the NHS has a long history of employing foreign doctors, their presence on the front-line of healthcare has raised specific concerns. Top of these are question marks over the foreign medics' qualifications and language skills.

It's something that 66-year- old Renee Forrow discovered when her husband Derek died at their Suffolk home two years ago after a longterm illness. It was a Saturday evening and, with her GP surgery closed, she called the out-of-hours service - Suffolk Doctors on Call (Sufdoc) - to request that a doctor be sent to certify the death. But what should have been a dignified process quickly degenerated into what Mrs Forrow describes as a 'Monty Python farce'. First, the Polish doctor and his driver could not find the house and took two hours to arrive.

When he did arrive, there were no sympathetic words. Instead, the doctor asked the stunned widow to fill in a form with her husband's name, address and other details. 'When he came in, he didn't say anything to anybody,' she says. 'He just scuttled in, pointed at my husband on the bed and said: "Accident?" 'He then examined him, gave me a form and said: "You say, you do. You fill in. I don't understand." I felt it was wrong that I had to fill in the details myself, but it was impossible to have a proper conversation with him. He simply could not converse in English adequately.'

As if that was not distressing enough, the doctor then pointed at her husband's morphine pills and asked: 'How many you give him?' Mrs Forrow said: 'It sounded insensitive because it almost suggested that he could have overdosed. It was almost as if I had done my husband in.' Just minutes after his arrival, the Polish doctor left. Shocked by what had happened, Mrs Forrow decided to speak out. She is concerned by what might have happened had the doctor been called to treat a complicated case.

'Suppose he visited an ill, old lady and was trying to pick up the nuances of what she was saying,' she says. 'Communication is half of diagnosis and he was like a little scared rabbit caught in the headlights.' A letter of apology subsequently arrived from Sufdoc. It stated: 'There is no question about his (the doctor's) competence as a clinician. It is just an issue about communication.'

It is these twin issues - competence and communication - that are at the heart of concerns over the role being played by foreign doctors in the out-of-hours service. While concerns over the competency of foreign doctors are pressing-there is a growing belief that the way to address them is by a fundamental overhaul of the outofhours system that would make their presence unnecessary.

This would be achieved by handing back responsibility for roundthe- clock care to family GPs. In this way, continuity of care between patient and doctor would be ensured, as would direct accountability. Perhaps unsurprisingly, doctors' leaders oppose these suggestions, saying that it would be 'unsafe' to make GPs work longer hours.

It is not an argument that cuts much ice with the likes of Dr Frank Newton, who worked as a GP for 25 years in rural Northamptonshire before retiring in 1989. 'When I started, there were two of us and we covered 200 square miles with about 4,500 patients,' the 80-year-old told me. 'I worked every hour the other guy didn't work. We took it in turns during the week for the nights, and in turns for the weekends. 'We took a fortnight's holiday each, so if the other guy was away you would be on for two weeks in his absence and he would do the same when you took your fortnight. 'I can tell you that we weren't on our knees with exhaustion and we were not unsafe - we were used to it. We wanted to be involved because we were part of the community and that is what the job was about. 'I find it very sad the way things have gone today, because I think that the people who are missing out are the practitioners themselves as well as the patients. What pleasure can you get from doing only half a job?'

So, should GPs be involved in arranging out-of-hours care for their own patients? As providers or commissioners of this care, they would not necessarily be obliged to return to outofhours work themselves, but they would be obliged to organise it (experts predict that if this happened, more local doctors and nurses would get involved). Even the NHS Alliance - an independent body that represents NHS professionals working outside hospitals, including some GPs - is calling for doctors to take back at least some of the responsibilities they cast off in 2004.

Many patients who have experienced the shortcomings of the system - such as negotiating complex phone systems or being forced to take a sick child to a dropin centre in the middle of the night - would go further and demand that, in return for their increased salaries, doctors would be available when they were most needed.

As Katherine Murphy, director of the Patients Association, points out, ill-health can strike at any time. 'There should be no less emphasis put on the out-of-hours care than there is on the care on offer between 9am and 6pm,' she says. 'No one decides when they get ill, so the same importance should be given to the provision of care whatever the time of day.'


Democrats shelve health care overhaul

Democratic leaders on Thursday shelved plans to push through a major health care overhaul, casting aside President Obama's top legislative goal, which has bedeviled congressional Democrats for more than a year.

Senate Democrats put a positive spin on it, arguing that they're sidelining it until later this year - possibly until the summer - so they could deal immediately with Mr. Obama's State of the Union call to address the economy and job creation. But House Speaker Nancy Pelosi, who said a comprehensive bill is still a priority, already has plans to pursue small, targeted health bills, such as a repeal of insurance companies' antitrust protection.

Rank-and-file Democrats aren't optimistic about the fate of a comprehensive overhaul. Sen. Mary L. Landrieu, Louisiana Democrat, classified the legislation as on "life-support" and with a pulse, but warned that resuscitating the legislation would take a lot of work. "Can we come out of the dugout in the second half and fight and come back and win in the second half of the game?" she said. "Yes. But it's going to take some serious strategic excellence ... and absolutely extraordinary communication and coordination to do that."

Mr. Obama said Wednesday that he still wanted a health care reform bill - an uphill legislative effort that headlined his first year in office - but suggested that lawmakers take a step back before renewing their work. "As temperatures cool, I want everyone to take another look at the plan we've proposed," Mr. Obama said in his address. "But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here's what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close."

But Democrats on Capitol Hill, eager to prove to voters that they're listening to their concerns about the hobbled economy and the job market, are ready to move a jobs bill. "The president made it clear that our No. 1 focus this year is putting Americans back to work," said Senate Majority Leader Harry Reid, Nevada Democrat. "And we couldn't agree more."

Democrats plan to release a jobs package, possibly next week, that could include a mix of funding for infrastructure projects, targeted tax cuts and small-business loans. The plan could include a "cash for caulkers" program or even forgiving some payroll taxes for companies that hire unemployed workers, said Sen. Richard J. Durbin, Illinois Democrat and majority whip.

Leaders stressed that health care reform legislation is still important and is still going to get done. "We're going to do health care reform this year," Mr. Reid said. "The question is, at this stage procedurally, how do we get where we need to go."

The yearlong effort to push reform legislation through five congressional committees and both chambers of Congress dominated Mr. Obama's first year in office. Presidents had tried for decades to pursue a universal health bill, but never got nearly as far as Democrats did last year.

The debate over a public insurance plan, federal funding of abortion, costs and other issues divided the public. Mr. Obama said Wednesday that he holds himself responsible for never clearly explaining what he wanted the bill to do. Republicans seized on the opportunity to label the plan over the summer, telling voters that the bill would lead to a government takeover of the health care system, tax hikes and even at one point to the infamous "death panels."

The public's distrust of the effort came to a head in Massachusetts when Republican state Sen. Scott Brown on Jan. 19 won the seat long held by Sen. Edward M. Kennedy, shocking Democrats and giving Republicans enough votes to sustain a filibuster of the bill. Mr. Brown won in the traditionally blue state by promising to vote against it.

Mrs. Pelosi is already planning on pursuing small pieces of the Democrats' health bill - an indication that House Democrats are anxious to take action and declare a small victory. She said she would and wait to see how the Senate pursues obtaining a comprehensive bill now that Democrats no longer have a supermajority. Legislation to repeal insurance companies' antitrust protections could be introduced as soon as next week. "We will move on many fronts, any front we can," she said. "But we are going to get health care reform passed for the American people for their own personal health and economic security and for the important role that it will play in reducing the deficit."


Friday, January 29, 2010

British bureaucracy and the baby

By Meegan Cornforth

Why do British politicians think that their National Health System is so wonderful? Braving the snow and icy conditions one recent afternoon on Christmas holidays in London, I visited a doctor’s surgery near my sister’s home to make an appointment for her newborn baby. Rather than being a simple endeavour of securing the next available timeslot, it was an annoyingly bureaucratic experience.

It began with a stern lecture from the receptionist for not following the rules. The NHS requires patients to be formally registered with the practice before the doctor sees them. Appointments must be made in the morning for the same day only. In addition, you cannot make phone appointments but must visit the surgery in person. This particular rule appears to have been established by the practice itself to sidestep confusion with the Appointments Line – an NHS telephone booking system so complicated that it requires an 18-page user guide!

The complexity of NHS regulations means that everyone is confused about procedure – patients and practices alike. And although many British surgeries are over-burdened, the NHS prevents patients from visiting GPs outside their designated catchment zone. In effect, the NHS would rather keep you in a crowded waiting room than let you see an available doctor.

In the world of the NHS, the patient is treated like an errant child whose punishment is to wade through a quagmire of bureaucracy to receive treatment. Fortunately in my case, the receptionist decided that given my colonial ignorance and argumentativeness, it was easier for her to break the rules ‘just this once, mind’ and give my little niece an appointment that very evening. A cherished victory of common sense over bureaucracy.

In an increasingly authoritarian Britain, the ill-functioning NHS is just one example of the difficulties imposed on the lives of citizens by too much regulation and government involvement.

At the forthcoming UK elections, Conservative Party leader David Cameron looks set to oust embattled Prime Minister Gordon Brown from 10 Downing Street. But don’t hold your breath for a Conservative victory to loosen the state’s bureaucratic grip over the country. Although Cameron has occasionally mused on leading Britain into a new ‘post-bureaucratic age,’ this supposed big government sceptic has just plastered Britain with campaign posters promising: ‘I’ll cut the deficit, not the NHS.’

Any British child could tell him that there is plenty of NHS red tape waiting to be cut.

The above is a press release from the Centre for Independent Studies, dated January 29. Enquiries to Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.

Last week, the voters sent a message to Washington. Last night, Obama made clear he will not listen

The key passage in the State of the Union Address last night was this:
So, no, I will not give up on trying to change the tone of our politics. I know it's an election year. And after last week, it's clear that campaign fever has come even earlier than usual. But we still need to govern.

To Democrats, I would remind you that we still have the largest majority in decades, and the people expect us to solve problems, not run for the hills. And if the Republican leadership is going to insist that 60 votes in the Senate are required to do any business at all in this town--a supermajority--then the responsibility to govern is now yours as well. Just saying no to everything may be good short-term politics, but it's not leadership. We were sent here to serve our citizens, not our ambitions. So let's show the American people that we can do it together.

The nub of it was the statement explaining away the election result by analogy to a disease: "After last week, it's clear that campaign fever has come even earlier than usual." If the voters of Massachusetts sent a message, President Obama refuses to listen.

In a moment of faux humility, he said of ObamaCare's failure: "I take my share of the blame for not explaining it more clearly to the American people." He will not listen to us; he expects us to listen to him as he explains this monstrosity again, "more clearly" this time, he promises.

On his personal blog, Robert George of the New York Post offers an astute and somewhat charitable analysis:
I didn't have time to pour [pore?] through all SOTUs given, but I can't remember when a POTUS explicitly reminded his side of the size of its majority and the other side the price that comes with asserting that 60 votes are necessary for passage of major bills.

He was, at that moment warning that Democrats risked being labeled cowards and Republicans obstructionists if his agenda wasn't pushed through. Was that serious ass-covering ("If this all falls apart, it's your fault, not mine!")? Maybe, but it's not a completely unfair reading of the current political reality. . . .

Barack Obama is daring Democrats to walk away from him on health care--now that each chamber has passed a bill. A party legislative dream of decades is tantalizingly close. November may prove that Massachusetts was the warning sign that Republicans and many independents believe it to be. But Obama has put down the gauntlet to declare that he deserves to have half his first term play out before the post-mortems of his presidency are carved in stone--regardless of how unpopular health care is at this moment.

In short, Obama is faced with the perpetual tug in politics--does an elected leader stick to the inner compass or does he follow what the polls (and one special election) tell him?

Obama seems willing to bet his congressional majority on the former. That's why this was a give-no-inch political speech.

This seems unlikely to work as an electoral strategy--which is to say that many Democrats seem likely to lose their seats if they follow Obama's urging and support widely hated initiatives like ObamaCare. That would seem to be the clear political message of Massachusetts, and surely enough Democrats received it to make Obama's approach unlikely to succeed as a legislative strategy.

Putting together the slim House majority and Senate supermajority for ObamaCare was an arduous enough task for Harry Pelosi and Nancy Reid. The results of their work were thrown into disarray by the election in Massachusetts, and reassembling the majorities (or even just the House majority) will be even harder than assembling them in the first place. Rather than study the "legal implications of Einstein's theory of relativity," Obama should have examined the political implications of the second law of thermodynamics.

Obama did not deliver what many observers expected: a show of humility, and a scaling back of his vast ideological ambitions, à la Bill Clinton after the 1994 elections. George argues that this expectation was unreasonable:
Huh!!! Really?

Losing Ted Kennedy's Senate seat is the political equivalent of losing both chambers of Congress--including the Democratic House for the first time in 40 years! Conservatives really want to make that comparison? Obama appears to be making the bet that a president gets two years before the inevitable midterm correction delivered by the voters. To toss aside all plans now would be the mark of someone with absolutely NO backbone.

We look at it differently. The special election in Massachusetts was a gift for Obama and the Democrats--an early warning that the country strongly rejects their priorities. By plowing ahead with those priorities anyway, Obama is squandering an opportunity to bring his ambitions into line with the views of the electorate--a chance President Clinton did not have until his party had already lost its majority.

Our surmise is that Obama's approach reflects a defect of character more than a carefully wrought strategy. We may be proved wrong about this--the real test will come in 2011 and 2012, assuming the Republicans do make big gains this November--but our preliminary reading is that the president combines the worst traits of his two predecessors. He is ideologically overambitious, to an even greater extent than Clinton was in his first term. And he is as arrogant and inflexible as George W. Bush's harshest critics accused him of being.


Obama: I know better than you

The American people simply do not matter to Barack Obama. He said so himself last night as he attempted his first State of the Union Address, declaring, "[W]hen I ran for president, I promised I wouldn't just do what was popular -- I would do what was necessary." This was a nice way of saying he had heard the overwhelming opposition to his Big Government agenda — and he has decided to plow ahead anyway.

"I will not walk away" from the government health care takeover, he said, and "neither should the people in this chamber." This, in spite of devastating resistance to the scheme that would ration care, raise premiums, drive people off of their insurance, cut benefits, and bankrupt the treasury with over $1.5 trillion in costs over ten years once fully implemented.

All told, 58 percent oppose the plan in Scott Rasmussen's last weekly poll on the subject. His tracking has been way ahead of the curve on opposition to the health care takeover. While apologists were claiming majority support for plans like the "public option," Rasmussen has polled clear opposition for most of 2009.

Barack Obama doesn't care. With only an occasional glance at the glaring reality that the American people really are not in favor of his plans, Obama's State of the Union was mostly a "stay the course" campaign rally, coupled with blind assertions as to the correctness of his position. Not to mention his bull-headed insistence that the Democrats get it done and "not run for the hills."

For example, he came close to prevaricating (to put it kindly) about losses from the Troubled Asset Relief Program: "[W]e have recovered most of the money we spent on the banks. To recover the rest, I have proposed a fee on the biggest banks." Only, the biggest banks are the ones who have paid TARP back in full, with interest.

Most of the $120 billion in losses have arisen under loans to AIG (not a bank), GM (not a bank), and Chrysler (not a bank). It was Obama's own Treasury secretary, Timothy Geithner who testified to Congress, "There is a significant likelihood that we will not be repaid for the full value of our investments in AIG, GM and Chrysler."

But not to worry, Obama says, "I am not interested in punishing banks." Only, he is. He asserted that "Our most urgent task upon taking office was to shore up the same banks that helped cause this crisis." By that, he means, take over, regulate, and monopolize. You know, punish.

Despite all of his bald distortions, Barack Obama's greatest transgression in this speech was more a sin of omission than commission in his historical account of what actually happened. In fact, the only entities Obama is not interested in targeting are those most directly responsible for the mess.

Obama had positively nothing to say about Fannie Mae, Freddie Mac, and the Federal Reserve (government-created entities all), whose errant policies of loose lending and easy money coupled together to incentivize borrowing on an unprecedented level, inflate the housing bubble, sell worthless securities worldwide, and bring the economy to brink of ruin. Not one word.

Even as George Bush was attempting to justify the unprecedented bailouts his Administration ushered in, he at least acknowledged the role played by, for example, too-low interest rates. Instead, Obama presented a bizarre, disjointed address that was almost completely disconnected from reality, save for the touch of icy indifference to the express will of the American people not to proceed on this course.

But then, by now, that is what the American people have come to expect from the imperial, impervious president.


Health reform: Where to go from here

The Scott Brown political earthquake has had more far-reaching implications than anyone anticipated. With the public admission of Nancy Pelosi that she does not have the votes in the House to pass the Senate health bill, President Obama's government takeover of health care appears to have stalled out, at least for now.

What this means is that Republicans and conservatives now have the first real opportunity to be heard on alternative health reform ideas. To prevent the return of socialized medicine to center stage, we should move aggressively with reforms that will solve what the public is really concerned about.

Cover the Uninsured

The well-kept secret of health policy over the past year is that the uninsured can be covered for little additional net cost, without the government takeover of health care, rationing, new health care bureaucracies, or any of the other central components of Obamacare.

No one wants to see anyone suffer or worse because they can't get essential health care. The lack of a clear safety net for the uninsured is what gives Democrats the political lift to keep coming back for socialized medicine. Reform now should focus on the modest changes necessary to establish a true safety net that will ensure that no one will be denied essential health care. Only that will permanently protect the health care of the American people from government takeover and control.

Real health reform should begin with Medicaid, which already spends over $400 billion a year providing substandard health care coverage for 50 million poor Americans. Congress should transform Medicaid to provide assistance to purchase private health insurance for all those who otherwise could not afford coverage, ideally with health insurance vouchers. This one step would enormously benefit the poor already on Medicaid. The program today pays doctors and hospitals only 60% of costs for their health care services for the poor. As a result, close to half of all doctors and hospitals won't take Medicaid patients. This is already a form of rationing, as Medicaid patients find obtaining health care increasingly difficult, and studies show they suffer worse health outcomes as a result. Health insurance vouchers would free the poor from this Medicaid ghetto, enabling them to obtain the same health care as the middle class, because they would be able to buy the same health insurance in the market.

Ideally this would be done by reforming Medicaid financing to provide the federal assistance to the states for the program through finite block grants, which do not vary by matching increased state Medicaid spending as under the current system. With finite block grants, states that innovate to reduce costs can keep the savings. States that operate programs with continued runaway costs would pay those additional costs themselves. Such reforms worked spectacularly to stop the runaway costs of the old AFDC program when Congress adopted welfare reform in 1996.

Give states the incentive to embrace such reform with a block grant formula that would provide states with increased funding sufficient to provide assistance to all those who truly cannot afford health insurance, counting continued state Medicaid funding, along with broad flexibility to redesign their Medicaid programs. The voters of each state can then decide how much assistance for the purchase of health insurance to provide each family at different income levels. This would rightly vary with the different income and cost levels of each state.

This would not cost much because only about 12 million Americans arguably cannot afford health insurance without some public assistance. Out of the 47 million uninsured we keep hearing about, 9.7 million are already eligible for current government programs like Medicaid or SCHIP but haven't signed up. Another 6 million are eligible for employer sponsored insurance but have not signed up for that either. Another 9 million are in families earning more than $75,000 per year. Another 10.2 million are immigrants, legal or illegal, and not U.S. citizens.

Just give the assistance necessary, counting what they can reasonably pay based on their income, to that 12 million to buy private health insurance. That is the key to avoiding a multitrillion-dollar new entitlement involving government rationing, which would trash the best health care in the world the American people now enjoy. With broader welfare reforms involving positive incentives, we could end up with less total government spending than today.

Completing the Safety Net

But a second step is necessary as well to ensure a complete safety net. Federal funding should also be provided to help each state set up an uninsurable risk pool. Those uninsured who become too sick to purchase health insurance in the market for the first time, perhaps because they have contracted cancer or heart disease, for example, would be assured of guaranteed coverage through the risk pool. They would be charged a premium for this coverage based on their ability to pay, ensuring that they will not be asked to pay more than they could afford. Federal and state funding would cover remaining costs.

Such risk pools already exist in over 30 states, and for the most part they work well at relatively little cost to the taxpayers because few people actually become truly uninsurable. This works far better than forcing insurers to cover everyone regardless of pre-existing conditions, or regulation such as guaranteed issue (forcing insurers to cover everyone who applies regardless of health condition) or community rating (forcing insurers to charge the same or nearly the same to all regardless of health condition). Such regulation has been proven beyond dispute to cause health insurance premiums to soar. That is because it is like requiring insurers to provide fire insurance for houses that are already on fire. With the above reforms, those cost increases are completely avoided, while ensuring that everyone has someplace to go to get essential coverage and care.

The law already provides that insurers cannot cut off already existing policyholders, or impose discriminatory rate increases, because they become sick while covered. That would be like allowing fire insurers to cut off coverage for houses once they catch on fire. If this law needs to be modernized, it should be.

With these reforms, those who have insurance can keep it, those who can't afford it are given help to buy it, and those who nevertheless remain uninsured and then become too sick to buy it have a back up safety net in the risk pools. Notice that this completely solves the problem of the uninsured without any individual or employer mandate, which are unnecessary gateways to enormous trouble. Once the government adopts such mandates, it is inexorably led down the path to socialized medicine.

Controlling Costs

A few, simple, additional reforms would help greatly to reduce health costs as well. Insurers should be allowed to sell health policies nationwide across state lines, subject to the regulation of their home states. This would reduce costs through increased competition, as well as greatly expand consumer choice.

Medical malpractice reform would also reduce costs. Non-economic damages, such as compensation for pain and suffering, should be sharply limited. Punitive damages should apply only in criminal proceedings, not in civil trials. Traditional tort standards for medical liability should be strictly enforced. Doctors and hospitals should be responsible only for damages for which they were the proximate cause.

Health Savings Accounts (HSAs) involve health insurance with high deductibles in the range of $2,000 to $6,000 per year, which reduces the cost of such insurance by 25% to 40%. These cost savings are kept in the HSA to pay health expenses below the deductible, growing beyond the deductible amount in a year or so. This gives patients incentives to control costs, as they keep unspent funds in their accounts for future uses, such as health care, retirement income, or others. With this new patient interest in controlling costs, which they don't have with traditional health insurance that pays for almost everything, doctors and hospitals would increasingly compete to control costs in serving patients.

The American Academy of Actuaries released a report last year on experience with consumer driven health care plans, such as HSAs or the quite similar Health Reimbursement Arrangements (HRAs). It showed that these are the only plans that are controlling and even reducing health care costs, and that patients with such coverage are using more chronic and preventive care. That's why employers and health insurers are increasingly turning to these products.

Greg Scandlen provides more detail in a new study from the Heartland Institute, "Ten Ways Consumer-Driven Health Care Is a Proven Success." He reports that experience with HSAs and HRAs shows:

Once people have control of their own money and are able to make their own choices, they suddenly become very interested in seeking out information about costs and quality. They are more likely to listen to their doctor and look for ways to lower their own costs. They are more likely to change their lifestyles because it is their money on the line, not an insurance company's.

He adds that those covered with these plans choose lower cost health options, sharply reduce visits to hospital emergency rooms, and are more likely to participate in wellness programs and to use preventative services.

Scandlen further reports the powerful effect of the incentives in such plans in slashing the growth of costs, saying:

The Mercer Company found that the annual rate of increase for consumer-driven health plans was about half that for PPOs and HMOs. Wellpoint looked at the experience of 8,000 of its group accounts in 2008, and found that PPO and HMO rates rose between 7 percent and 10 percent from the previous year while rates for its consumer-driven plans actually dropped from 2007 to 2008….[S]imilar programs offered by the Postal Workers Union and the Government Employees Health Association had no increase in premiums for four years running.

Finally, Scandlen explains that these plans provide patients with more power and control over their own health care, saying:

Traditional health insurance means the insurance company picks and chooses what providers it will recognize. These providers may be very good for the insurance company, by accepting lower fees, but not so good for the patient. With a consumer-driven plan, and especially with an HSA, patients may go to any health provider they choose so long as the provider is duly licensed and providing a service recognized as a health care expense by the IRS.

Federal and state governments should consequently promote such HSAs as much as possible. HSA options should be allowed for the above Medicaid vouchers. Seniors should be allowed an HSA option in Medicare Advantage. And consumers should be allowed to contribute at least as much to their HSA savings account each year as the deductible on their health insurance.

The Medicaid vouchers discussed above would also reduce the cost of health insurance by transferring Medicaid patients to the private insurance market, ending the cost-shifting to private insurance that currently results from the steep underpayment of doctors and hospitals under Medicaid. In other words, you will see your health insurance premiums go down under such reform because part of what you are paying today is being used to cover the services provided to Medicaid patients, which the government is not paying for despite its promises.

No Rationing

Republicans should move quickly to join together behind this common sense reform package, and communicate it to the public. They should aggressively seek to join with moderate Democrats who want to solve problems rather than promote government power. Conservative and grassroots activists should support such Republicans and Democrats in truly bipartisan collaboration, and help to communicate the message of real, constructive reform.

But Republicans and these new Democrat reformers must stay away from any reform component of any kind providing for health care rationing. These include fixed health care budgets, accountable care organizations, pay for performance, comparative effectiveness dictates, or "cost effectiveness" regulations, among others. This was the main source of grassroots revolt over health reform, and any new reform proposals will be closely monitored by grassroots watchdogs to raise a new angry revolt if they continue to be included. Republicans in particular are vulnerable to third party challengers if they cross the grassroots over this.

Instead, government policy should seek to maximize incentives for investment to maintain the most advanced, cutting edge, high-tech health care system in the world. Americans rightly want access to the latest possible miracle cure drugs and medical technology. Policymakers should tend carefully to maximizing incentives for health care innovation and breakthroughs, taking maximum advantage of rapidly advancing modern medical science. This is a central component of the high standard of living Americans expect, and demand.


California Senate okays single-payer healthcare

The California Senate approved creating a government-run health care system for the nation's most populous state on Thursday, ignoring a veto threat from Gov. Arnold Schwarzenegger. Supporters said it is time for state legislatures to take up the debate as the Obama Administration's national health care proposal falters in Congress. "If it's not to be done at the national level, let us take the lead," said state Sen. Christine Kehoe, D-San Diego.

The move in California comes after Massachusetts voters changed the calculus in Congress by electing a Republican to the Senate who opposes the pending plan.

Democrats are the majority in both houses of the California Legislature. The 40-member state Senate passed the single-payer plan on a 22-14 vote, sending it to the Assembly. One Democrat voted against the measure.

Schwarzenegger promised to veto the proposal, as he has two similar plans that previously reached his desk. Spokeswoman Rachel Arrezola cited the state's massive budget cuts and looming $20 billion deficit in arguing the state cannot afford to shift to a single-payer health care system. "Any elected official who thinks it's a good idea to strap the state with tens of billions of dollars from a government-run health care system is clearly not in touch with what voters need and deserve," Arrezola said.

The proposal by Sen. Mark Leno, D-San Francisco, authorizes $1 million to establish a commission that would decide how to pay for the system. The funding plan would ultimately have to be approved by voters. Leno argued the state-run plan would replace the $200 billion Californians already pay for their health care while eliminating insurance companies' share. He previously said the system could use existing state and federal money and a payroll tax, coupled with increased efficiencies from a government-run system. "We are spending $200 billion currently," Leno said. "It is the same $200 billion used in a more efficient, cost-effective fashion."

Republicans derided the timing of the vote, saying Democrats are ignoring the lesson in Massachusetts at their political peril. "This plan is to the left and radical of what couldn't get out of Washington," said Sen. George Runner, R-Lancaster.

Senate President Pro Tem Darrell Steinberg said Republicans refused to support even a $14.7 billion health care reform bill that Schwarzenegger, a Republican, negotiated with Democratic leaders two years ago. "Not a single Republican vote — so what are you for?" asked Steinberg, a Democrat from Sacramento who usually strikes a conciliatory bipartisan tone. "The demagoguery needs to be answered and addressed."

Schwarzenegger's proposal actually was undone by Democrat Don Perata, Steinberg's predecessor in the Senate, when he ordered a financial review that found the plan would be billions of dollars out of balance within a few years.


Australian public health spending on course to disaster

KEVIN Rudd has declared 2010 a year of "major health reform", warning that health spending alone will outstrip state tax revenues within two decades. In the latest in a series of speeches in the lead-up to Australia Day, the Prime Minister yesterday warned that Australia faced the choice of cutting pensions, health services and aged care; running massive deficits; or, his preferred option, boosting productivity as the population aged to help lift tax revenues.

Mr Rudd told a reception in Sydney that the states' health spending was already growing at 11 per cent a year compared with revenue growth of 3 to 4 per cent a year. "Rapidly rising health costs create a real risk (that), absent major policy change, state governments will be overwhelmed by their rising health-spending obligations," he warned. "If current spending and revenue trends continue, Treasury projects that the total health spending of all states will exceed 100 per cent of their tax revenues, excluding the GST, by around 2045-46, and possibly earlier in some states. That is why 2010 must be and will be a year of major health reform."

The big-ticket item remains a new carve-up of commonwealth and state responsibilities to fund and run the nation's public hospitals, with pressure on the federal government to act at next month's Council of Australian Governments meeting. The Rudd government promised during the last election campaign to take over hospitals if the states failed to lift their game by this year. The Prime Minister must now decide whether to embrace a single-funder model for hospitals, with the commonwealth to fund health facilities, but the states to run them.

Mr Rudd said growing health-spending pressures would account for two-thirds of the total projected increase in government spending over the next 40 years. "Forty years ago, Australian government spending on health equated to 1.2 per cent of gross domestic product," Mr Rudd said. "In 2010, Australian government health spending equates to 4 per cent of GDP. And the Intergenerational Report projects that it will rise to 7.1 per cent in 2050. "In dollar terms, that's an increase of over $200 billion by 2050 and equates to an increase in average Australian government health spending per person in real terms from $2290 today to $7210 in 2050."

Australian Medical Association president Andrew Pesce said a single funder would help stop some of the blame game between the states and the commonwealth. "When things go wrong, the states blame the commonwealth," Dr Pesce said. "If there's a single funder, at least you know who is responsible for the money. The commonwealth would be the insurer or purchaser of healthcare and the states would run hospitals."

Mr Rudd surprised and angered health groups by failing to deliver a new agenda on health reform at last month's COAG meeting in Brisbane, but the issue is expected to take centrestage when premiers hold their next meeting, next month. Beyond the central issue of who funds and runs public hospitals, other items to be discussed include primary care and who, other than doctors, should have access to Medicare payments -- such as nurses. There is also a push by aged- care providers again to introduce some form of high-care nursing home bonds and reforms to help fund new infrastructure needs as the population ages.

Health groups have recently complained their patience is wearing thin as the government fails to act on promised reform. But senior Rudd government sources argue the Prime Minister was deliberately taking his time to get the policy right.

In the short term, the rising costs will make for another tough budget for Health Minister Nicola Roxon, who must deliver new spending cuts after targeting private health insurance rebates, IVF and cataract surgery in the last budget.


Thursday, January 28, 2010

British centrist party calls for tighter rules on foreign doctors

The Liberal Democrats have launched new proposals to tighten rules on the employment of foreign doctors after the death of a 70-year-old man treated by a doctor from Germany. Norman Lamb, the party's health spokesman, called for a series of reforms including a national language and competency test for every doctor wishing to work in Britain.

The demand comes after David Gray, from Manea, Cambridgeshire, died after he was given more than 10 times the recommended daily dose of diamorphine by Daniel Ubani, a locum doctor from Germany. Dr Ubani, 67, had been on his first shift working for an out-of-hours medical service when the overdose was administered on February 16, 2008, an inquest into Mr Gray's death has heard.

The Liberal Democrats said the reforms should include making sure that a suspension in one country is effective across the European Economic Area - covering the European Union, Iceland, Liechtenstein and Norway.

There should also be a criminal offence created for a primary care trust to allow a doctor to operate without ensuring compliance with regulations, the Liberal Democrats said. Mr Lamb said: "The tragic death of David Gray raises serious concerns about the safety of out-of-hours care in this country. "We cannot allow a situation to continue where we are reliant on tired, overworked foreign doctors to cover out-of-hours care.

"Patients' lives are being put at risk because standards across Europe are not uniformly good and foreign doctors can practice in the NHS without a test of competence and language. "Ministers have known for some time that the safeguards in place were not adequate but they have completely failed to take action. "These proposals will ensure that every doctor working in this country can speak English, is familiar with our health service and is well trained."

The General Medical Council (GMC) currently applies a test for English language proficiency and clinical skills to doctors from outside the European Economic Area before granting registration to work in the UK. But it cannot apply the same set of tests to doctors from within the EEA - a situation described as "profoundly unsatisfactory" by Niall Dickson, chief executive of the GMC.


It still won’t work

In the wake of Scott Brown's astounding win last week in Massachusetts, President Obama has been backpedaling faster than Darrelle Revis on health-care reform, telling reporters that Congress should "move quickly to coalesce around" parts of the health-care bill that both parties can agree on, "core elements" such as insurance reform. That might be more popular politically, but it still won't work.

Take one "core element": prohibiting insurers from turning down customers with "pre-existing conditions" or charging more to customers who become sick. A bill to simply ban such practices might attract support from such GOP moderates as Maine's Olympia Snowe and Susan Collins. But the "reform" would wind up pushing millions of people off the insurance rolls — and New York state provides the proof.

The term "pre-existing condition" simply means people who are already sick. But if you can wait to buy insurance after you get sick, who'd ever buy insurance while they're healthy?

Requiring insurers to charge the same premiums to the sick and the healthy compounds the problem: Premiums would fall for older and sicker customers — but rise for the young and the healthy. Knowing that they could always buy a policy after falling ill, many young people would drop out of the insurance market. (Indeed, these "young invincibles" already make up the largest part of the uninsured.)

New York provides an object lesson: It enacted precisely these "reforms" in 1993. The next year, roughly 500,000 people canceled their insurance, according to a study by the actuarial firm of Milliman & Robertson.

With the young and healthy dropping out of the insurance pool, premiums will have to rise to cover the now-sicker insured population. That, in turn, will encourage more healthy people to drop out, raising premiums still further — and so on, in what's known as the "adverse-selection death spiral." The only solution would be to mandate that everyone buy insurance. But, as the last year's debate has shown, that creates all sorts of problems:

* To mandate that people buy insurance, the government has to define what insurance is. (I'm pretty sure my policy with the $1 million deductible won't qualify.) This opens the door to all manner of special interests demanding to be part of the required benefits. People would be unable to keep their current plans, but would have to buy new, probably more expensive, policies that met government specifications.

* If the government is going to force people to buy insurance, it'll have to subsidize insurance for those who can't afford it. Covering those costs means new or higher taxes for someone. And subsidies without cost controls will break the bank (as they're doing now in Massachusetts) — so the government will have to impose price controls or restrictions on care.

Before you know it, "mini-me" ObamaCare has morphed back into the full-blown version.

Democrats have boxed themselves into a corner. The public has rejected their plans for a government takeover of the health-care system — but giving up would mean admitting that they just wasted a year on a bill that didn't even pass. They'll be tempted to try to pass something — anything.

Alas, "anything" so far doesn't include the type of free-market reforms that could actually solve some of these problems. For example, if Democrats really wanted to deal with the problem of pre-existing conditions, they'd support expanded state high-risk pools. Better yet, they'd offer the same tax break to people who buy their own insurance as we give to employer-provided insurance. Moving to personal, portable insurance means that people who lose their jobs would no longer automatically lose their insurance — so pre-existing conditions would be far less of an issue.

And, if Democrats want to create an incentive for the young and healthy to buy insurance, they could eliminate costly mandated benefits that makes insurance a poor deal for the young.

But Democrats seem determined to prolong the agony — trying to force through some version of their top-down, command and control, government-directed approach no matter how often Americans say "No!" We can only hope that sooner or later they'll get the message — and start over with something that will actually work.


Why ObamaCare Isn't Flying

This is the sound of President Obama's health-care reform bill crashing to earth: Senate Majority Leader Harry Reid on Tuesday: "We're not on health care now. We talked a lot about it in the past." Democratic Sen. Dianne Feinstein: "It's a time out."

The bill's advocates can't believe this is happening. They elected a popular and charismatic Democratic president. With him came a filibuster-proof congressional majority. Done deal. Write the bill, vote it into everlasting life, and burn votive candles to Franklin Roosevelt's unfinished national entitlement legacy.

After seven nonstop months ObamaCare is failing, just as ClintonCare failed after a year's effort in 1994. It's clear there is something inherently wrong in what the Democrats have been trying to do here. What is it? The answer lies in the often-repeated phrase that they are trying to reform "16% of the American economy." Why would anyone think it possible in 2010—as politics, economics or mere practical feasibility—to reorder 16% of a $14 trillion economy of 300 million people living in 50 separate states whose geography is 16 times larger than France?

The Obama reformers are driven by the idea that their bill would fulfill a dream running back 70 years to 1939, when FDR failed to win passage of a universal health-care bill. But this isn't 1939. It's not even 1994. American health care, whatever its defects, is today unimaginably complex. What the Democrats are trying to do isn't just difficult. It's impossible.

According to data compiled by Hoover's business research from the U.S. Census, the health-care industry consists of 340,650 separate establishments employing 5,508,926 people. I leave it to a mathematician to calculate the number of possible economic relationships this would produce every day, much less annually . We have 512,000 physicians and surgeons, 2.2 million registered nurses and a galaxy of different jobs orbiting around them. Some 36% of these are in individual physicians' offices.

One of the jewels of this collection of professionals, which the politicians say is "failing" us, is the U.S. medical-device industry. It has come a long way since the days of "The Clinic of Dr. Gross" in Thomas Eakins's famous painting. There are 8,616 separate medical-device companies in the U.S., employing 359,065 people. Within the device industry, its two largest categories are electronic and precision equipment and surgical appliances. These are the wizards of American medicine.

The president says the special interests oppose his bill. But to pay for the bill, Congress would levy a $2 billion annual tax on the medical-device industry, which ardently opposes the legislation. Let's pick a state. How about suddenly famous Massachusetts. The Massachusetts Medical Device Industry Council lists more than 220 companies as primary members. They have weird names like Aeris, ExtruMed, Bioxcell and WunderThink. Yet the Democrats are agog that Massachusetts voted Scott Brown into the Senate.

Harvard Medical School Dean Jeffrey Flier said of the health-care bill in these pages recently that "our capacity to innovate and develop new therapies would suffer most of all." And that's the high-minded criticism of the bill. Down at the level of simple retail politics what you see are tens of thousands of separate health and medical interests that understandably are in motion because of this bill's determination to change everything in American health care.

The president and his health-care advisers are giving philosopher kings a bad name. Only people who have reduced American health care to rows and columns of data in academic studies would think it possible to remake this incredibly sophisticated organism as easily as rebooting a spreadsheet. You can't do it.

Meanwhile, press reports this week also noted that Mr. Obama's "comprehensive climate bill" is being down-sized to something that can pass Congress. Same problem.

Barack Obama is 48 years old, a "young" president. But in a sense, he is an old 48-year-old. The House leadership, the committee chairmen leading his agenda, are old guys from the 1960s and '70s. The so-called progressive Democrats who make up his core base are essentially a labor movement stuck in a one-size-fits everything industrial model from the 1930s.

It is a revealing irony that the other big story this week is the phenomenal steady success of Apple's iPhone, the result of a basic platform opening itself to a zillion application companies. Probably 90% of those tiny app firms voted for Barack Obama, whose idea of how the world actually works could not be less like their own.

Senate Minority Leader Mitch McConnell's suggestion that Mr. Obama start over is better advice than he knows. Refashioning America's terrific health-care industry from basic platforms might even be exciting. That won't happen. The Democrats will ride their, and Mr. Obama's, 70-year-old national-entitlement dream straight to November, and over the cliff.


Can we have “universal” medical care without coercion?

The recent loss of what supposedly was a “secure” U.S. Senate seat by Democrats in Massachusetts has triggered a firestorm of speculation about the future of the Democrats’ “health care” bill. For the current legislative season, so-called ObamaCare looks to be dead or at least dormant.

“Politically dead” is a temporal term, however, and there is no doubt that President Obama and his congressional allies are going to formulate an alternative strategy and then try once again to ram “universal care” through the legislative process. In this piece, I don’t deal with the politics of universal care, but rather with the larger collectivist and coercive reasoning that accompanies its implementation.

Ever since the Progressive Era, Americans have been told that there is a difference between “good government” and “bad government.” “Good government” provides all sorts of services that poor people cannot afford, such as medical care, transportation, housing, education, and even food. (“Bad government” arrests, imprisons, and generally acts like an occupier.)

Obviously, “universal care” falls under the “good government” label, and when conservatives or libertarians complain about “government on our backs,” the “Progressives” are quick to reply that government “gives” us all sorts of goodies that we never would have unless there were intervention by the State. While this sounds good, I remind readers that government provides nothing without coercion, so when someone speaks of “good government,” that person really is claiming there is “good coercion.”

What comprises “good coercion”? It is the application of force that supposedly serves a “greater public good,” the “greater good” being medical insurance for those who did not have insurance before. Clearly, a philosophical issue is before us. Should government force someone not only to pay for health insurance for someone else (through taxation), but also to purchase a government-approved health insurance policy for himself?

Advocates of such coercive measures are quick to accuse private enterprise of being “exploitative and oppressive.” (Listen to a speech by Ralph Nader or read the latest issue of The Nation or the editorial page of the New York Times.) Something does not quite make sense, however.

No one has forced me to purchase the vast amount of things that I own and use. Instead, I choose to purchase them, and that includes health insurance. (I would prefer that the health system not be dominated at all by third-party payments, so I could purchase insurance for potential catastrophic events, but nonetheless I do purchase my insurance voluntarily.)

Contrast what I just have described to the purchase of government-produced goods. As a taxpayer I am forced to pay (on pain of arrest and imprisonment) for products that other people use, from roads (which, at least, I use myself), public schools, Social Security and Medicare, and, of course, “national defense.” It does not matter if I wish to use those products or support them; I have no choice but to help pay for them.

Thus it is with “universal” medical care. The plan is for the government to force everyone to purchase an “insurance plan” and pay for others to purchase such plans as well. No one is permitted to opt out (unless one is part of an old-order Amish sect).

Proponents of such a policy claim that unless everyone is forced to participate, the system will not provide “equal care,” and therein is the lynchpin of the whole system. From taxation of “Cadillac” plans to forcing everyone, regardless of health, to purchase policies, the government is attempting to enforce an egalitarianism that is in the best interests of no one but the political classes.

There is no way that the plan can make everyone better off. Instead, like so many other tax-and-spend schemes, it seeks to make some people better off by making a lot of other people worse off, and such a plan can be put into place only with brute force. It is a truism in economics that people won’t deliberately and knowingly make themselves worse off. The political classes know it, and perhaps maybe others are beginning to understand.


Speech therapy

The Left-leaning writer below is not buying the Democrat excuses for failure

"Communications failure" is the phrase being used by the White House and assorted commentators to explain the collapse of health care reform and other parts of President Obama's agenda. According to this reasoning, Obama hasn't pursued the wrong goals. He has simply failed to articulate them. And tonight's State of the Union could somehow change that.

There are two problems with this theory. First, it's not as if the administration has failed to articulate its message. Second, even if it has, it's unlikely the State of the Union will make a difference.

Obama himself seems to subscribe to the notion that no one is listening. "What I haven't always been successful at doing is breaking through the noise and speaking directly to the American people in a way that during the campaign you could do," Obama told ABC's George Stephanopoulos after Republican Scott Brown's win in Massachusetts last week. Spokesman Robert Gibbs, meanwhile, argued on Tuesday that the administration was out-communicated by its opponents. Health care reform "became a caricature of its component parts," Gibbs said.

In one sense Gibbs is right: Ever since the inauguration, and especially since the health care debate began in earnest in the fall, the Obama administration has done nothing but communicate. Between the town halls, the weekly presidential addresses on YouTube, the prime-time speech on health care to a joint session of Congress, and the constant hawking of the administration's line on cable news—all of which drew charges that Obama was "overexposed"—it's hard to say that the White House hasn't done enough talking. Yet certain memes—"death panels," anyone?—took hold despite the administration's efforts.

So "communications failure" seems too pat an explanation for the collapse of the administration's plans for health care reform. It's an easy political fall-back. When something doesn't go your way, it's not because of a flaw in the policy. It's not because you failed to organize your supporters. It's because you failed to articulate your goals and why they're important. In the spectrum of political failings, it's the least blameworthy, since it leaves open the possibility that people just don't get it.

There are more plausible—and just as easy!—explanations. One of the best is that the administration has simply been battered by a series of unfortunate events. If Ted Kennedy had not died when he did, there would be no talk right now of a "communications failure." Same if Martha Coakley had run a better campaign. Or if Senate Democrats had not spent so long trying to court Republican votes that never materialized. If these events hadn't played out the way they did, we'd be talking about Obama's patience, Rahm Emanuel's diplomacy, and the White House's shrewd communications strategy.

What must be frustrating to the administration is that its talking points are hardly unique. Most independent experts, including the Congressional Budget Office, say that both the House and Senate versions of health care reform would reduce the deficit. The White House has repeated this numerous times. Yet 68 percent of Americans believe it would increase the deficit. The CBO says that reform would be fully paid for, be it through taxes on the wealthy or a tax on so-called "Cadillac" plans. Obama mentions this often. Yet more than 75 percent of Americans think it would lead to higher taxes for the middle class. Perhaps the most telling contradiction is that while many Americans believe that reform would improve care, costs, and access for the country as a whole, they think it would hurt them personally—a logical conundrum, if not an impossibility. The White House may be suffering from a communications failure, but it's not for lack of talking.

An alternate theory, of course, is that Americans hear quite well what Obama is saying, thank you—they just don't believe him. If that's the case, then he may need more than a single speech to turn sentiment around.


Wednesday, January 27, 2010

Congress slows down on health care

Congressional leaders are taking health care legislation off the fast track as rank-and-file Democrats, wary of unhappy midterm election voters, look to President Barack Obama for guidance in his State of the Union address. House and Senate leaders said Tuesday they need time to determine the best way forward on health care in the wake of last week's special election loss in Massachusetts, which cost Democrats their filibuster-proof Senate majority.

Obama is not expected to offer a specific prescription in Wednesday night's speech, but Democrats want to hear him renew his commitment to the health care overhaul he's spent the past year promoting as his top domestic priority. It is now badly adrift, and lawmakers want to stop talking about the divisive topic and move on to jobs and the economy, the issues they say preoccupy their constituents.

"The president effectively will hit the reset button (Wednesday) night, after which we'll have a matter of weeks, not months to get this right," said Rep. Anthony Weiner, D-N.Y. "We're reaching the point where our momentum is clearly stopped already," Weiner said. "If we're going to do this, I think we have to do this soon."

Not so, according to Senate Majority Leader Harry Reid, D-Nev. "We're going to find out how to proceed," Reid told reporters Tuesday. "But there is no rush."

The House and Senate separately passed 10-year, nearly $1 trillion bills last year to remake the nation's medical system with new requirements for nearly everyone to carry health insurance and new regulations on insurers' practices. Negotiators were in the final stages of reconciling the differences between the two measures before last week's GOP upset in the race for the Senate seat long held by the late Edward M. Kennedy. Democrats acknowledge that opposition to the health care remake in Washington helped spark the Massachusetts revolution.

Democrats now have four options for moving forward, said House Majority Leader Steny Hoyer: no bill; a scaled-back measure designed to attract some Republican support; the House passing the Senate bill; or the House passing the Senate bill, with both chambers making changes to bridge their differences.

House Speaker Nancy Pelosi has ruled out passing the Senate bill with no changes, and no Democrats are publicly advocating abandoning the effort altogether, though Rep. Stephanie Herseth Sandlin of South Dakota, a leader of conservative House Democrats, said some conservative Democrats would prefer to do just that.

The option attracting the most attention is for the House to pass the Senate bill with changes. Rep. Jim Clyburn of South Carolina, the No. 3 Democrat, told reporters Tuesday he thinks the House could do so if lawmakers get rid of provisions like special Medicaid deals for Louisiana and Nebraska and dial back a tax on high-cost insurance plans opposed by labor unions.

But two centrist senators threw up a roadblock to the approach, because it would require using a special budget-related procedure to go around Republican opponents in the Senate, a calculated risk sure to inflame critics on the political right. Sens. Evan Bayh, D-Ind., and Blanche Lincoln, D-Ark., who both face re-election this year in Republican-leaning states, said they would oppose taking that step.

The strategy requires only 51 votes to advance, but Senate leaders may not be able to round up the support. Even if they do, final action could stretch into late next month or beyond. And a number of Democrats sounded Tuesday like health care was the last thing they wanted to be dealing with. "If someone's losing their house, lost their job, the last thing they care about is their next door neighbor's health care," said Rep. Shelley Berkley, D-Nev. "Health care isn't the No. 1 issue on their minds. If it's not the No. 1 issue on my constituents' minds, it's not the No. 1 issue on my mind."


Obamacare: CNN Poll Shows Only 38% Support

I’ve long said that the magic number to kill Obamacare was %35. But with the election in Massachusetts, I think %38 will do. From the story:
Only three in ten Americans say they want Congress to pass legislation similar to the health care reform bills that have already been approved by the House and Senate, according to a new national poll. A CNN/Opinion Research Corporation survey also indicates that nearly half the public, 48 percent, would like federal lawmakers to start work on an entirely new bill, and 21 percent feel Congress should stop working an any bills that would change the country’s health care system.

Devastating. What a debacle. Why? Because they made the same stupid blunder as Hillary Clinton did in 1993. Unbelievable.

For the good of the country, it is time for President Obama, Speaker Pelosi, and Leader Reid to pull the plug on this monstrosity and start anew with a more targeted reform. Or, they can tear the country apart–and destroy their own political fortunes–by forging arrogantly ahead in total disregard of public opinion. Politically, I’d rather they did the latter. But too many people need help, so I am rooting that they finally gain wisdom and pursue the former course.


Why Obamacare Is Doomed -- The Hollywood Version

Whereas the Obamans want us to have less health care, the movie “Extraordinary Measures” wants us to have more medicine, more cures

Here’s a paradox of liberalism: Hollywood hurts the Obama health care plan more than it helps. Hurts it a lot more. But how could that be, one might ask, when everyone knows that studio moguls, as well as actors and writers, are solidly “blue” in their politics--and in their campaign contributions? The answer is this: Yes, Hollywoodites think liberal, but when it comes to making movies, they think a bit more conservatively. More precisely, they think in terms of what real people will want to see, and that pushes in a center-right direction, which is where the country is.

Oh sure, they might give a few thousand dollars to chic liberal Democrats every couple of years, but when it comes to spending tens of millions on a movie--in hopes of making a lot more than that in return--they are a good deal more, well, conservative. A case in point is the new film, “Extraordinary Measures,” starring Brendan Fraser and Harrison Ford. The movie is an out-and-out tribute to science, family values, and, yes, entrepreneurial capitalism. Obamacare, with its emphasis on bureaucratic rationing and government control, is nowhere to be seen.

If the Obamans had stopped to think about the implications of such a movie being made in 2010--released by CBS Films, no less--they would have realized that their fundamental approach to healthcare is wrongheaded, at odds with the way that Americans think about health issues. Whereas the Obamans want us to have less health care, “Extraordinary Measures” wants us to have more medicine, more cures.

“Measures” tells the mostly true story of John Crowley, a business executive whose two children were diagnosed with Pompe Disease, a degenerative neuromuscular disease that paralyzes, then kills, its victims, usually before their 10th birthday. In other words, it is a horrible disease, fully worthy of a massive effort to cure it; “I wish we had a drug to treat Pompe,” one character says early on--“but we don’t.” And so the issue of health insurance, while important, is not as important as the issue of cures. If there’s no cure for Pompe Disease, children die a painful death--and an expensive death, involving lots of time in hospitals, lots of expensive therapy equipment. But if here is a cure, the children can grow up to become productive citizens.

As for John Crowley, he did something truly daring and capitalistically heroic--right out of an Ayn Rand novel. Starting with $100,000 of his own money, he quit his job and started a company to make the cure for Pompe and so save his children. And it worked--let’s hear it for capitalism and freedom. Fictional composites aside, this is basically a true story, as recorded by a Wall Street Journal reporter, Geeta Anand, in her 2006 book, "The Cure: How a Father Raised $100 Million--And Bucked the Medical Establishment--In a Quest to Save His Children."

And so yes, it’s an inspiring story of family love and duty--although, of course, Hollywood has made many movies in the past out of similar stories. “Magnificent Obsession,” about a man who goes to medical school to restore the sight of the woman he loves, has been made and remade--although, to be sure, most medical dramas coming out of Hollywood go to TV, where for half a century, dramas ranging from “Dr. Kildare” to “Marcus Welby” to “ER” to “House” have emphasized heroic doctors, practicing heroic medicine. Indeed, the currently running “House,” about a crazy-brilliant doctor who breaks all the rules in his determination to cure his patients, is rated as the most popular television show in the world.

So if people love medical drama, focusing on cures, then Hollywood loves medical drama, focusing on cures. Show business is, after all, a business.

But politics is a business, too, and so one would think that politicians would know what they are doing. But maybe not. Obamacare, like Clintoncare before it, is bureaucratic and boring. And that’s on a good day. Last August, The Nation’s Chris Hayes, a liberal-leftist supporter of Obama, perfectly described what the Obamans had done to the health care issue:
In its health care messaging, the White House has taken an issue more intimate and immediate than perhaps any other in a voter’s life and transformed it into an abstract, technical argument about long-term actuarial projections. It’s a peculiar kind of reverse political alchemy: transforming gold into lead.

Turning gold into lead--not at all what Hollywood is about. If there’s one thing Hollywood prides itself on, it’s getting bottoms into seats, and eyeballs onto screens. And if that takes drama and excitement, so be it: The show must go on.

One might think that at one of those posh L.A. fundraisers, some Tinseltown type would have taken Obama aside and said, “Look, your whole campaign is about ‘hope.’ Hollywood movies are about hope; 98 percent of the time, the picture ends happily. So enough with the bureaucrats and the ‘death panels’--give the folks some reason to hope! Talk about cures! A cure for breast cancer. A cure for Alzheimer’s. For Parkinson’s. A cure for spinal cord injuries and paralysis--that would play with families of war veterans. Pick one of those; trust me, it’ll play well in Peoria, especially if we get Michael J. Fox involved. And then, once you have the trust and confidence of the folks, you can pile on with the rationers and price controls!” In other words, the mogul might have said, turn Obamacare into a movie with a happy ending--not a sorry and scary show starring Kafka-esque bureaucrats.

But if anything like that conversation occurred, the Obamans didn’t listen. Like the Clintonites two decades ago, they charged ahead with a health care plan that bombed.

Now as it happens, “Extraordinary Measures” has received mostly weak critical reviews, and is not doing particular well at the box office. Perhaps the disease, Pompe, is too obscure. Perhaps, as noted, TV has absorbed the huge market for “true med” stories. So there might not ever be a sequel to “Measures.” But here’s a safe bet: No matter how much they might love Obama, Hollywood execs will never greenlight “Obamacare: The Movie.”


The Obamacare War is Over

In the days since the Massachusetts vote, liberal columnists and bloggers urge Democrats to fight one last battle to save Obamacare. In his Friday column, economist Paul Krugman writes in the New York Times that House Democrats must recognize their “moment of truth.” He implores them to vote for the Senate healthcare bill and “do the right thing.”

47 health policy experts endorsed this position, writing an open letter to the President. In The New Republic, Prof. Harold Pollack of the University of Chicago, one of the letter signers, notes that: “we are so close to enacting a historic reform.”

Former Democratic speechwriter Michael Cohen, writing in the New York Daily News, implores Democrats to act now. He recognizes that they will need to “swallow their pride and vote for the health-care bill that passed the Senate without much change” but suggests it’s all worth it.

These arguments have been echoed across the blogosphere.

As I noted last Tuesday, there are still options on paper to pass Obamacare this year. The most plausible one: to get the House to drop conference negotiations with the Senate, and simply pass the Senate bill. Krugman, Pollock, and Cohen all endorse this approach. It seems that the White House is at least flirting with a variant of the idea. The reality, however, is that the war is over. Obamacare was lost the moment that the Democrats managed to lose even Massachusetts.

Democrats are still in a state of shock. They shouldn’t be. They spent 2009 crafting bad legislation.

The White House’s determination to swiftly pass health reform, and to pass it along partisan lines, meant that all meaningful policies were abandoned in the process. Health reform was supposed to be about reducing premiums for working Americans; every CBO estimate has suggested that premiums would in fact rise with the proposed legislation. President Obama has spoken time and again about the need to “bend the curve of rising health costs.” The White House half-heartedly embraced ideas that would rein in rising health costs, and then quietly negotiated away these provisions in the different drafts before Congress. Even a federal agency estimated that costs would increase under Obamacare. The promises of greater competition? By the time the Senate finally got around to passing its bill, the national health insurance exchange (modeled after the health benefits enjoyed by members of Congress) was whittled down to 50 unworkable state exchanges.

It should never have gotten to this point. The surprise wasn’t that the people of Massachusetts rejected this problematic legislation – it’s that the White House didn’t put the brakes on the process earlier.

In the coming days, we can expect Democrats to do little. They will blame others for their loss in Massachusetts; they will scheme about the possibility of passing some legislation this year; they will fantasize about a shift in public opinion. Ultimately, the White House will need to make a decision. Either they abandon all efforts or they reach across the aisle.

In 2009, the President worked with Democrats in order to craft popular and needed legislation to reform American healthcare. By this January, he couldn’t even persuade the people of Massachusetts as to the value of his efforts – in a state where registered Democrats outnumber Republicans 3.5 to 1, in a state that he himself won by more than 26% just over a year ago. In other words, while working with his allies, he didn’t achieve anything close to success.

A bipartisan effort, however, won’t give him everything he wants, but it may give him some sensible legislation. On Wednesday, when he delivers his State of the Union address, we’ll get a first taste of the post-January 19 presidency. Will he be feisty but irrelevant? Or will we enter into a period of post-partisanship, as he’s promised before?