New Medicare Benefit Will Outspend Projections

The new cost projections for the upcoming Medicare prescription drug entitlement are slightly higher this year than last year. Democrats are making hay, while the Bush administration claims the projections are “virtually unchanged.” What’s being ignored is that the actual cost of this new entitlement will likely exceed all current projections. Medicare and other entitlements have a history of spending more than projected. It’s in their nature.

When Medicare was enacted in 1965, official government projections foresaw hospital spending — the program’s largest component — reaching only $9 billion in 1990. Actual Medicare spending on hospital care in that year was $66 billion, or over seven times as high. One result is that Medicare’s payroll tax is now nearly double what its sponsors said would be necessary (having been raised most recently in 1994), and Congress increasingly relies on other revenue sources to meet Medicare’s obligations.

There are three principal reasons why we can expect this new entitlement to cost more than the government predicts.

Reason 1: Politicians don’t like to reveal how much of your money they are spending.

A politician who hides the true cost of his proposal can give away more of your goodies without you taking notice (or at least not until it’s too late). A 2002 study in the Journal of the American Planning Association examining 258 transportation infrastructure projects found that politicians underestimated costs nine times out of 10, and that cost overruns averaged 28 percent. “Cost underestimation cannot be explained by error,” the authors concluded, “and seems to be best explained by strategic misrepresentation, i.e., lying.”

One way to underestimate costs is with overly optimistic economic assumptions, which have a long pedigree under Medicare. President Lyndon Johnson’s administration was accused of hiding the true cost of Medicare by using rosy economic scenarios. Today, Medicare’s actuaries assume that health care costs will grow only one percentage point faster than GDP, even though the gap has historically been over twice as large.

Another way of low-balling costs is by “inflating the denominator.” In 2003, Congress and the president agreed to create a drug benefit that cost no more than $400 billion over 10 years. Most understood this to mean an average of $40 billion per year. But pushing the entitlement’s start date back to 2006 effectively spread an eight-year cost estimate over ten years, and made the projected cost appear 20 percent smaller.

There’s also what we might call “the Nixonian way.” During five months of legislative debate, the Bush administration concealed its own projections that the legislation would actually cost between $500 billion and $600 billion. At the same time senior administration officials claimed – on television and in newspapers – that the program would cost only $400 billion, one such official threatened to fire Medicare’s chief actuary if the actuary went public with the higher cost estimate.

Reason 2: People alter their behavior to maximize their entitlement.

Medicare spending exceeded initial projections because seniors consumed more care when they bore less of the cost. Once taxpayers subsidize seniors’ consumption of prescription drugs, seniors will consume more drugs than they did before.

Many will drop the drug coverage they already have to take advantage of the new entitlement. The Congressional Budget Office estimates that every fourth participant in the new entitlement would have had private drug coverage anyway. Congress was so worried that employers will drop their retirees into the new program that it will begin bribing employers not to do so — to the tune of about $5 billion per year.

Actual spending on employer subsidies will probably be larger, as employer groups manufacture ways to qualify for the subsidy. These behavioral changes will leave taxpayers paying for costs that someone else was already paying voluntarily.

Reason 3: Congress often expands the entitlement.

Cost projections cannot predict future changes in legislation. Once a program is in place, beneficiaries lobby Congress to expand it. The Medicare drug benefit came about under political pressure from Medicare beneficiaries for greater subsidies. The same has happened with Social Security. Once the drug benefit takes effect, expect to hear pleas from seniors for further subsidies to fill in the infamous “doughnut hole.”

Just how expensive the new Medicare prescription drug entitlement will be is impossible to say. Jagadeesh Gokhale of the Cato Institute and Joe Antos of the American Enterprise Institute posit that the actual cost could be over twice as high as current projections. They may be wrong, but if history is any guide, they’re definitely in the right neighborhood.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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DEADLY PUBLIC MEDICINE

BBC News broadcasts today are leading on the story that 'ministers think they have turned the corner in tackling the antibiotic-resistant superbug MRSA' that is rife in Britain's state-run hospitals. 'The number of infected patients, we are told, 'is lower than at any time since records began.'

Let us ignore the point that records only began in 2001, when the superbug was already tearing through the National Health Service. In April to September 2001, some 3,598 NHS patients were infected with MRSA. In the equivalent April-September period 2004, on which all this hype is based, the number was 3,519. Not much of a difference. Especially if you are one of the 3,519.

True, that number is down by 421 cases on the previous six months. But the fact is that each year, around 5,000 NHS patients die from infections they picked up in hospital. About 1,000 of those die from MRSA. And how many patients die from MRSA in the private sector? None.

(Post lifted from the Adam Smith blog)

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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RISK-AVERSE BUREAUCRACY AND PUFFED-UP DO-GOODERS HURT MS SUFFERERS

Now they have no drug to help them. How many of them were asked if they were willing to take a small risk to get help for their suffering?

Anna Peabody's dreams of motherhood and marriage -- and merely walking upright -- came alive with the arrival of Tysabri.

Multiple sclerosis patients such as she had waited years for the drug, the first promising treatment in nearly a decade. Early last year, Cambridge biotech giant Biogen Idec Inc. said Tysabri warded off MS more powerfully than even the most optimistic predictions. Peabody, 19, thought the drug ''would change everything."

Just one year of data from test patients was enough to wow federal regulators. They approved Tysabri a year ahead of schedule, without public discussion or debate, and before planned clinical tests were completed. But there were concerns: Some scientists thought the drug would leave patients vulnerable to deadly infections. At the time, Biogen Idec's vice president of medical research, Al Sandrock, declared: ''No multiple sclerosis drug currently on the market has been approved with less than two years worth of data."

But in a tragic flash, it all unraveled. Two test patients contracted a rare infection. One died. Last week, Biogen Idec and its partner, Elan Corp., pulled the drug from the market.

Tysabri's precipitous rise and fall has called into question the FDA's decision to quickly and quietly approve a potentially risky drug, criticism that comes on the heels of recent controversies over its handling of painkillers and antidepressant drugs.

''They should take as much time as they need to make sure the drugs are safe and effective," said Arthur Levin, director of the Center for Medical Consumers, an advocacy group. Quick approval, he said, ''increases the risk that we're going to discover really serious threats to the public health later on after a drug has been approved."

What I would really LOVE now is for the complacent Mr Levin to get MS

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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Public hospitals never have enough funding. Those bureaucrats are expensive: "Australia's quality of medical training was being eroded because of the downgrading of public hospitals, the Australian Medical Association (AMA) said today. AMA president Dr Bill Glasson told a Sydney medical training conference Australia's great public hospitals - which had been icons of medical training - were being destroyed because of a funding shortage. Private hospitals were now carrying out 50 per cent of surgery across the country, Dr Glasson said. Public hospitals no longer had enough positions for junior doctors and due to the emphasis on service delivery did not spend as much time training students. "As our public hospitals become downgraded, we are able to provide less and less services to most public hospitals and therefore less teaching opportunities," Dr Glasson told reporters. Training would have to be delivered in public and private hospitals, Dr Glasson said.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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LYING WITH STATISTICS

Here's how to think about the numbers presented in a recent L.A. Times story - an exercise in "Yes, but what would the numbers be if ...?" The February 9, 2005 edition of the L.A. Times has a story on U.S. health-care costs derived from a new study by researchers at Boston University School of Public Health. Major points include:

* Rising health-care costs are absorbing nearly one-fourth of all economic growth. The statistics cited to support this fact are that spending for health care this year will be $1.7 trillion, which is up $621 billion from 2000. That $621 billion increase represents 24 percent of the total GDP growth between 2000 and 2005. By contrast, increased spending for military defense during that same period accounted for only 10 percent of GDP growth. The growth in medical spending during this period was three times the growth rate in educational spending.
* U.S. health-care spending per person in the U.S. is double that in Canada, France, Germany, Italy and Britain. The study researchers argue that the $1.7 trillion annual cost of health care in the U.S. would be adequate to provide coverage for everyone if proper controls on medical costs were in place.
* Doctors receive or control 87 percent of all health-care spending. This is broken down as 21 percent in doctors' fees and 66 percent in doctors' orders for drugs, diagnostic tests, hospitalization and other prescribed services such as physical therapy. The L.A. Times story offers no explanation for what the remaining 13 percent of medical costs are. Presumably, a large part of it is administrative costs.
* The researchers conclude that the only way to manage health-care costs is to force everyone into a socialized medicine scheme.

"Yes, BUT WHAT WOULD THE NUMBERS BE IF ...?"

The story fails to reach the level of detail required to understand what's really going on. For instance:

* If doctor fees represent 21 percent of total costs ($357 billion annually), what percentage of those fees represent the cost of purchasing medical malpractice insurance, and is that insurance cost rising faster or slower than the aggregate rate of growth in medical costs?
* What percentage of total medical costs result from the practice of defensive medicine, which incurs unnecessary medical costs for the sole purpose of reducing vulnerability to unjustified or frivolous malpractice claims?
* Is it the assumption of the researchers that a socialized medicine solution in the U.S. would somehow magically eliminate all medical malpractice suits?
* What percentage of total medical costs are prescription drugs, and are those costs rising faster or slower than the aggregate rate of growth in medical costs?
* What percentage of total medical costs is incurred for acute hospital care, and are those costs rising faster or slower than the aggregate rate of growth in medical costs?
* What percentage of total medical costs is incurred in nursing home care, and are those costs rising faster or slower than the aggregate rate of growth in medical costs?
* Is the rate of growth in Medicare costs rising faster or slower than the rate of increase in the number of covered persons after factoring out the new prescription drug benefit?
* Medicare is a form of socialized medicine, somewhat comparable to that which exists in Canada, France, Germany, Italy and Britain. However, Medicare, unlike those European plans, does not cover all medical costs. Also, U.S. retirees pay a monthly Medicare Part B premium of $54.00 (about $650/year, deducted out of their Social Security checks. Consequently, the government-paid Medicare cost per retiree should be substantially less than the cost per retiree in those European nations. But if the annual Medicare-paid portion of medical coverage (less the $54/month premium) per retiree is comparable to or higher than the government-paid cost in those European nations, doesn't that eviscerate the argument that a socialized medicine approach for everyone would result in substantially reduced medical costs?
* The Bush plan for controlling medical costs proposes that many consumers should become managers of their own health care by a combination of tax-sheltered health savings accounts and high-deductible catastrophic health insurance. But the Boston University study argues that the sickest individuals are not competent to make their own decisions about medical treatment, and thus the Bush plan won't work.

The L.A. Times story does not offer any kind of objective proof that a socialized medicine solution, where medical decisions are influenced or dictated by a mindless bureaucracy, would produce superior overall outcomes.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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ANOTHER EXAMPLE OF SPENDING MORE MONEY TO GET WORSE RESULTS

When will people realize that governments shouldn't be running hospitals? This story is about the public hospital system in my home State of Queensland in Australia. Fortunately we also have an excellent private hospital system with minimal waiting times -- and affordable health insurance

Queenslanders are continuing to languish on hospital waiting lists with official figures showing more people are waiting longer for urgent operations despite State Government claims it is beating the problem. The increase in numbers waiting for urgent and semi-urgent operations is contained in the latest Elective Surgery Waiting List Report. A spokesman for Health Minister Gordon Nuttall said $110 million had been allocated over three and a half years to cut elective surgery waiting times, as well as a further $20 million last month. This is included as part of Queensland Health's annual budget, which over the past four years has increased from $4 billion in 2001-02 to $5.1 billion in 2004-05.

During this period, an analysis of elective surgery waiting list reports shows the extra money bought Queensland only 231 extra admissions to hospitals during the December quarter 2004 compared with December 2001. Brisbane hospitals admitted 101 fewer patients when statistics were compared between the December quarter 2001-02 (13,221 admissions) and the December quarter 2004-05 (13,120). The waiting list data also shows more people are waiting for urgent and semi-urgent operations over the four years, while the non-urgent has dropped considerably.

In the most urgent Category 1 for operations, as at January 1 this year, 77 people had waited more than 30 days for urgent operations, which was up from April 1, 2002, when 72 had waited more than 30 days. An independent audit of Queensland hospital waiting lists was promised by the current government during last year's state election, but this is yet to happen.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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AND YOU THOUGHT ENGLAND WAS BAD

The NHS in Scotland gets lots more money but produces much worse results. The perfect demonstration that it is bureaucracy, not money that is the problem

Chronic mismanagement of the Scottish NHS has resulted in treatment rates falling behind England for the first time despite billions of pounds of extra investment, a damning new report by a leading health expert reveals. The report has concluded that the English health system has powered ahead of its Scottish counterpart in many vital hospital services, seeing more patients, despite costing less and having fewer doctors. Dr Matthew Dunnigan, senior research fellow at the University of Glasgow, said last night: "The difference is in NHS management. If you speak to English doctors they tell you that although it is not perfect, there is a drive and initiative and coherence which is lacking in Scotland."

His findings reveal that England is now out-performing Scotland for the first time on new outpatient procedures, hospital visits in which patients are seen by hospital consultants for initial treatment. It also shows that the number of cases seen in all stages of the hospital service - from the GP’s door right through to hospital inpatient treatment - has dropped since 1999, following devolution. Yet over the same period, the number of cases seen in outpatients and inpatients in English hospitals has soared.

Scotland on Sunday can also reveal that there are now 1,000 fewer acute hospital beds in Scotland compared with 1999. Doctors warned last night that the reduction had already led to further waits for those on the list, and an increased risk of MRSA infections due to over-crowding on wards. The new revelations come after damning waiting list figures emerged last week, showing that 113,000 people are on the inpatient waiting list - the highest figure ever. A further 240,371 Scots are currently awaiting outpatient treatment, 45,000 of whom have been waiting for more than six months.

By contrast, the number of patients awaiting treatment for more than 6 months in England - with a population 10 times Scotland - is a mere 2,452. In total there were only 64,466 patients waiting for their first outpatient appointment across the whole of England at the end of 2004.

Dunnigan’s study used the Scottish Executive’s own figures and comparable statistics from the Department of Health in London to provide a like-for-like comparison. In 1990, Scottish outpatient clinics saw 212 Scots per 1,000 head of population for new acute appointments. That compared with only 157 per 1,000 in England - reflecting the fact that Scotland has long had greater health needs. However, by 2003, while the Scottish figure had risen slightly to 241, England had soared ahead to 251. The turnaround means that from seeing 35% more new patients in 1990, outpatient clinics now see 4% fewer today than in England.

England’s improvement has been achieved despite the fact that English taxpayers pay around £200 less per person for the NHS than do Scots. The English also have only 2.1 doctors per 1000 people, compared to Scotland’s 2.5. Dunnigan said the figures showed the English system had advanced rapidly in giving more patients access to consultants - while Scotland had stayed the same, despite its massive extra investment. "Despite having more cash, we are only achieving parity with England. That is a major failure. England has caught up with us and now passed us," he said.....

Nanette Milne, health spokeswoman for the Scottish Conservatives, said: "There is clearly something wrong with the Scottish system, if you are getting 22% more per head of population compared to England yet it is not coming out the other end."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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VISITING YOUR DOCTOR VIA EMAIL

"In a move to improve efficiency and control costs, health plans and medical groups around the country are now beginning to pay doctors to reply by e-mail, just as they pay for office visits. While some computer-literate doctors have been using e-mail to communicate informally with patients for years, most have never been paid for that service.

Brian Settlemoir, 39, an accountant in Folsom, Calif., recently sent an e-mail message to his doctor at the Creekside Medical Group to ask if it was time to reduce the dosage of a medicine after his cholesterol level dropped. The prompt answer was "not yet." "I'm sitting at work," Mr. Settlemoir said. "I've got e-mail open anyway. It's much easier than calling and getting voice-mail prompts and sitting on hold. It's very valuable to me."

Blue Shield of California pays his doctor $25 for each online exchange, the same as it pays for an office visit. Some insurers pay a bit less for e-mailing, and patients in some health plans are charged a $5 or $10 co-payment that is billed to their credit card and relayed to the doctor.

For doctors, the convenience of online exchanges can be considerable. They say they can offer advice about postsurgical care, diet, changing a medication and other topics that can be handled safely and promptly without an office visit or a frustrating round of telephone tag. And surveys have shown that e-mail, by reducing the number of daily office visits, gives physicians more time to spend with patients who need to be seen face to face.

For patients, e-mail allows them to send their medical questions from home in the evening, without missing work and spending time in a doctor's waiting room. In fact, many say exchanges in the more relaxed, conversational realm of e-mail make them feel closer to their doctors.

The patients can also use the e-mail connections, which they reach through secure Web sites, to get X-ray and test results and request prescription renewals. Doctors are not paid for these services, except in time saved in the office.

This shift toward online doctor-patient communication is important for another reason. Physicians and health care technology specialists say they believe that it could help spur the changeover to electronic health care information systems, which government officials and industry leaders say is needed to reduce medical errors and promote better care. Doctors at the clinics of the University of California, Davis, grew accustomed to using e-mail for clinical purposes before the clinics introduced electronic medical records, said Dr. Eric Liederman, medical director of clinical information systems at Davis. The messaging "gave them some comfort and facility with using the computer," he said.

Early research at clinics at the university found that using e-mail improved the productivity of physicians, decreased overhead costs and improved access to doctors for patients, including those who still telephoned. "There was a huge reduction in the number of calls," said Dr. Liederman, who is a big fan of e-mail exchanges.

Doctors and insurers say online consultations can be especially useful for patients who have chronic conditions like diabetes, asthma and heart problems. They have been frequent users and being in touch can help them to comply with regimens to cope with their diseases. "Patients love this stuff; I love this stuff; the staff loves this stuff," said Dr. Barbara Walters, a senior medical director at Dartmouth-Hitchcock Medical Center in New Hampshire......

Kaiser Permanente, the nation's largest nonprofit managed care company, has tested patient-physician messaging in the Pacific Northwest and is starting the program this year in Hawaii and Colorado as part of Kaiser's $3 billion information technology program. Kaiser's salaried doctors get credits for messaging, adding to their pay......

A bill introduced in the House on Feb. 11 by Charles A. Gonzalez, a Democrat from Texas, and John M. McHugh, a Republican from New York, for the first time included a provision to authorize Medicare to make "bonus payments" to doctors for e-mail consultations."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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AMERICAN MEDICAL SYSTEM FAR BETTER FOR YOU THAN THE SOCIALIZED BRITISH VERSION

The British National Health Service is one of the oldest of its kind so shows how such services end up

"In "Die in Britain, survive in U.S.," the cover article of the February 2005 issue of The Spectator, a British magazine, James Bartholomew details the downside of Britain's universal health care system. Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. "Britain has one of worst survival rates in the advanced world," writes Bartholomew, "and America has the best." If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent. Again, reports Bartholomew, "Britain is at the bottom of the class and America is at the top."

Explains Bartolomew: "That is why those who are rich enough often go to America, leaving behind even private British health care." The reason isn't that we sue more in America and scare doctors into efficiency, or that our medical schools are better. It's more simple than that. "In America, you are more likely to be treated," writes Bartholomew, "and going back a stage further, you are more likely to get the diagnostic tests which lead to better treatment."

More specifically, three-quarters of Americans who've had a heart attack are given beta-blocker drugs, compared to fewer than a third in Britain. Similarly, American patients are more likely than British patients to have a heart condition diagnosed with an angiogram, more likely to have an artery widened with angioplasty, and more likely to get back on their feet by way of a bypass.

On the availability of equipment, explains Bartholomew, Britain has only half as many CT scanners per million people as the United States, and half as many MRI scanners. With lithotripsy units for treating kidney stones, the United States has more than seven times the availability per million of population than Britain. Not only is the British equipment in short supply, but much of what's there should be loaded up and carted off to the nearest scrap dump. An audit by the World Health Organization, for instance, found that over half of Britain's X-ray machines were past their recommended safe time limit, and more than half the machines in anesthesiology required replacing. "Even the majority of operating tables were over 20 years old -- double their life span," reports Bartholomew.

Taken as a whole, Britain's universal health care system has evolved into a ramshackle structure where tests are underperformed, equipment is undersupplied, operations are underdone, and medical personnel are overworked, underpaid and overly tied down in red tape. In other words, your chances of coming out of the American medical system alive are dramatically better than in Britain. "Having a diagnosis test beyond an X-ray in Britain tends to be regarded as a rare, extravagant event, only done in cases of obvious, if not desperate, need," writes Bartholomew. "In Britain, 36 percent of patients have to wait more than four months for non-emergency surgery. In the U.S., 5 percent do. In Britain, 40 percent of cancer patients do not see a cancer specialist."

On how things worked in an individual case, Bartholomew writes of Peggy, an American radiologist, who went to Britain to meet her English boyfriend's family. While she was there, her boyfriend's father found blood in his urine and went to a local National Health Service hospital in which no CT scans or cystoscopy tests were done. The patient had asthma and laid in his hospital bed with breathing difficulties but still didn't see a specialist. He was told it would take six weeks. Short of the six weeks, he was discharged from the hospital. Back home, before his appointment with a consultant came up, he died of an asthma attack.

As a footnote on Canada, the average wait for a simple MRI is three months. In Manitoba, the median wait for neurosurgery is 15.2 months. For chemotherapy in Saskatchewan, patients can expect to be in line for 10 weeks. At last report, 10,000 breast cancer patients who waited an average of two months for post-operation radiation treatments have filed a class action lawsuit against Quebec's hospitals."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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THE "WHO CARES?" BRITISH SYSTEM

Michael Howard provoked a row yesterday by raising the case of a woman still waiting for surgery after seven cancellations. He highlighted the plight of Margaret Dixon, 69, whose operation to repair a broken shoulder was repeatedly postponed because of a shortage of high-dependency beds. Mr Howard said that her experience represented the "real world" in the National Health Service where extra money being spent was not reaching front-line services. Tony Blair said that such an experience was unacceptable but was exceptional.

The row was the first time that Mr Howard had raised the case of an individual patient at Prime Minister's Questions since he misrepresented the facts concerning a breast cancer patient from his constituency last June. He claimed that she would have to wait 20 months for radiation treatment, rather than 20 weeks. Mr Howard said that Mrs Dixon, who lives in Penketh, near Warrington, Cheshire, and has osteoarthritis, was told that she might not survive surgery and on each occasion said goodbye to her family in case she did not. Hers was not an isolated case, the Tory leader said, and 67,000 people had NHS operations cancelled last year, 10,000 more than five years ago.

The Prime Minister snapped back that the Conservatives had faxed him information on Mrs Dixon's case seven or eight minutes before he entered the chamber and he could not know all the facts of her case, but most NHS patients were well treated. Extra money being spent on the NHS, which the Conservatives opposed, could be seen in more nurses, extra wards, new hospitals and the fact that cancer deaths were down by 30,000 under this Government and cardiac deaths are down 25,000 a year, Mr Blair said.

The row heightened as Mr Howard said that extra money was being spent on bureaucrats in primary care trusts and managers in the NHS, whose numbers were rising at three times the rate of doctors and nurses while average waiting times had risen in the past four years. "Mrs Dixon and the 67,000 patients who have had their operations cancelled represent the real world and the real NHS and you are living in an entirely different universe," the Conservative leader said. Mr Howard said the reality of the NHS under Labour was that 250,000 people without medical insurance paid for private care because they would not get the treatment they wanted under the NHS, a threefold rise.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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COX-2 DRUGS OVERSOLD BUT STILL IMPORTANT

All drugs have side-effects

Last week, the New England Journal of Medicine took the unusual step of pre-releasing three articles showing that the increased risk of heart and other vascular disease that had caused Merck to withdraw Vioxx from the market is in fact not limited to Vioxx but instead is a ''class effect,'' meaning that all of the so-called COX-2 inhibitors lead to an increased risk of heart disease. Editorialists called this the ''final nail in the coffin'' for all of these drugs, and depending on the report of the FDA advisory panel, they may well be right.

To a bewildered public, this is understandably confusing, but the issues here are fairly simple. They are a combination of good science, poor FDA oversight and greed. All of these drugs have two actions. Even at low doses they are very effective pain relievers, which is why one or two aspirin will relieve your headache. At higher doses, they also have anti-inflammatory properties, decreasing the heat, swelling and tenderness accompanying diseases such as rheumatoid arthritis.

People with rheumatoid arthritis have to decide daily whether the risks outweigh the benefits. They know that the drugs they take have side effects, but without them they might literally be bedridden. For them, the risk of ulcers, or even a heart attack, might well be worth taking.

However, only about 1% of the population has rheumatoid arthritis, while a huge percentage have other causes of chronic pain such as back problems, neck pain, etc. So, rather than a limited approach directed at people who might need and benefit from these drugs, the makers of the new COX-2 inhibitors spent hundreds of millions of dollars advertising them directly to consumers, creating an enormous demand and reaping billions in profits. And now they are paying the piper.

So what should you do about your lumbago, or whatever? If you don't have rheumatoid arthritis or a similar disease, try simple pain relievers such as acetaminophen first. In doses up to 2,000-3,000 mgs. per day, these drugs are remarkably effective, although the higher doses should be avoided in heavy drinkers. If they aren't effective, try ibuprofen. It is inexpensive and relatively short-acting. Most people have few stomach problems, although if you have a history of stomach disorders you might add a stomach protective agent like ranitidine or omeprazole.

When all of this shakes out, there will still probably be a small group of people with diseases such as rheumatoid arthritis who will do best on the COX-2 inhibitors, and I hope they are kept on the market for those people.....

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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ANOTHER FARCE FROM BRITAIN

A grandmother who waited three years to see a consultant finally got her appointment, and found that the doctor had died two years earlier. Janet Warnes, 68, was first referred to Iain Fraser, an ear surgeon, in 2002. She received a letter from Leeds General Infirmary last year asking if she still needed the appointment.

An examination was fixed for last month, but when she arrived at the hospital with her appointment card, Mrs Warnes said the receptionist told her that the doctor had been dead for two years. Mrs Warnes, of Leeds, said yesterday: "I was starting to think I might be dead before I finally saw a doctor, but I never expected him to be."

When Mrs Warnes was seen by another doctor, she was told that she could now go on the waiting list for a hearing aid, but that it might now take another two years.

Leeds Teaching Hospitals NHS Trust, which runs Leeds General Infirmary, apologised to Mrs Warnes but said that her experience had been caused by a "one-off computer system error".

Source






How medical boards nationalized health care: "Besides paying some of the highest prices for health care, we have the dubious distinction of having the most heavily regulated healthcare system in the world. In no other country on earth are doctors and hospitals subjected to as many oversight and enforcement agencies, bureaus and commissions. Rules, regulations, and laws are duplicated, redundant, multiplied, magnified, and contradictory. Laws and regulations covering doctors and hospitals plus all the other parts of our healthcare system now account for over half of all the words, sentences, and paragraphs in our entire body of law. If regulations could make a healthcare system work better, ours would surely be perfect. In fact, the opposite has occurred."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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COMPREHENSIVE HEALTH INSURANCE PRODUCES HUGE WASTE

The biggest problem is too much insurance rather than too little

If preventative, first-dollar health plans work, why isn't the cost of health care going down instead of up? We know that hospitals and health providers are merging into ever-larger firms, presumably to achieve economy of scale, but premiums aren't going down. We know that doctors and clinics are working harder and making less money, so where is all that money going? The answer, as I described yesterday, is administration... paper-shuffling. Where health care was once a matter between a doctor and a patient, that relationship is now divided by a mountain of clerical workers, managers (almost 4 of them for each doctor), and paperwork ... in clinics, companies who manage health plans, and insurance companies. Doctors and patients are now as isolated from each other as farmers are from grocery shoppers.

There are about 44 million Americans who aren't covered by a health care plan. In 2002, 17.3% of non-elderly people were uninsured. That's up from 13.7% in 1987. The "problem" is getting worse. There is an abnormal percentage of racial minorities, especially Hispanics. About 20% are children. 83% are under 35 years of age, and 34% are ages 21-24. 80% of uninsured people are part of working families. They're employed heavily in service jobs and blue-collar jobs. Over half of the uninsured adults who are working are working full-time. National surveys consistently show that the high cost of health insurance is the primary reason people are uninsured.

Statistically, uninsured people go longer between recommended tests, such as Pap smears, mammograms, and prostate exams. I would wager that they have much lower rates of unnecessary surgery too.

Uninsured people do become hospitalized and accumulate costs they can't pay, and a substantial part of that will end up being reimbursed by the federal government. About $41 billion won't be paid for, and the feds will pick up about 2/3 of that. I don't know why they will, but I imagine it's for the benefit of the providers.

Those who raise a fuss about the uninsured imply that being insured reduces total health care cost. Even forgetting that costs have ballooned, that argument doesn't hold water: Even counting the $41 billion in uncompensated care, uninsured people STILL spend 45% less than insured people do. To me, that's an indication of just how wasteful and ineffective health care plans really are... or does it mean that uninsured people are just healthier?

Well... mandatory insurance is often touted as the solution. We'll just force everyone to have insurance, and there won't be any more uninsured folks. All employers, presumably including self-employed people, would have to purchase a plan. Another case of "magic money"; where is the money employers have to spend on health care plans going to come from? From reducing the employees' pay? From laying off some people? Mandatory insurance would undoubtedly put some firms out of business immediately, and it would have a chilling effect on new business startups.

Of course, it would also mean that total health care costs will go even higher, health care providers will get bigger still, the health care industry will expand even more, providing even more unneeded services at still higher rates. At least we'll all be in the SAME sinking ship. There is a place for insurance in covering health care costs, but it isn't in the sort of plans that have become common. Insurance should be used to cover catastrophic losses, not routine expenditures, which are no more than a way to put more money into the coffers of providers.

Americans must realize that money an employer puts into a health plan is money that would otherwise go into their paychecks. From your paycheck, it can be used for a variety of things, depending on circumstances. When it's going down the health care toilet, you're forced to "use" it or lose it, so you tend to use it, even if you don't need to. The incentives lead to overuse and waste. The average cost of single coverage is $3,695/year. For family coverage it's $9,950. If an average family needs that much expenditure in health care, then we've become a very sickly society.

The California Chamber of Commerce produced an ANALYSIS OF THE ECONOMIC IMPACTS OF MANDATORY HEALTH COVERAGE IN CALIFORNIA (pdf) and reached these conclusions:

"Research suggests that mandated employer-provided health insurance does not curb the upward spiral of health-care spending and insurance premiums. In fact, it may have the opposite effect because it does little to inhibit administrative overhead or unnecessary tests and utilization of services. Research also suggests that mandated employer-provided health insurance programs are not necessarily an efficient, targeted vehicle for insuring the uninsured. Nor do such programs necessarily help the most disadvantaged and vulnerable workers."

Like all other plans based on the use of force, mandatory health care coverage is not only immoral, but it won't work, and it will have many negative consequences. There ARE some good ideas around that CAN solve the problems in health care, but they don't use force, so they're not political solutions. Mandates are force, and when force is used, other, better solutions are simply eliminated. The recent history of American health care is filled with forceful measures that have changed the best health care system in the world into one that has become nothing but a monstrous money vacuum. Despite ever-increasing technology, ever-increasing expenditures, and widespread "preventative" health care, we don't seem to be healthier. Obesity is up, asthma is up, and none of the other problems have disappeared. Somebody's getting rich from health care, but it damned sure isn't American workers.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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CANCER CAN WAIT IN ENGLAND

A fifth of patients with suspected cancer wait more than a month to be seen by a specialist in England, a report showed on Friday. The National Audit Office (NAO) survey of more than 4,000 cancer patients found widespread improvement in care provided by the National Health Service since the last survey in 2000. But the research also showed that large numbers were waiting weeks or months before being seen by a cancer specialist after visiting their doctor with symptoms. The survey, which includes both patients referred urgently and those not referred urgently, found 58 percent of patients were seen by a specialist within two weeks in 2004 - up from 46 percent in 2000. A further 22 percent of patients were seen by between two weeks and one month, while 20 percent waited longer than one month. A government target states that all patients with suspected cancer referred urgently by their doctor should be seen by a specialist in two weeks.

The report looked at the experience of patients from going to their doctor to support in the community after being discharged from hospital. Patients with the four cancers that account for the greatest number of deaths -- lung, breast, bowel and prostate -- were asked how long they had to wait before being seen by a specialist. Breast cancer patients were most likely to be seen within two weeks -- at 70 percent -- followed by lung cancer patients at 68 percent. Only 51 percent of bowel cancer patients and 32 percent of prostate cancer patients were seen within two weeks, though these were up on the 2000 figures.

Source




GOVERNMENT MEDI-MUDDLING HURTS AMERICAN BUSINESS

American manufacturers are losing their ability to compete in the global marketplace in large measure because of the crushing burden of health care costs, General Motors Corp. chairman and chief executive G. Richard Wagoner Jr. said yesterday as he called on corporate and government leaders to find "some serious medicine" for the nation's ailing health system. In a speech at the Economic Club of Chicago, the auto executive, who is responsible for providing health insurance for more people than any other private employer in the nation, graphically detailed how rising medical bills are eating into his company's bottom line and ultimately threatening the viability of most U.S. firms. "Failing to address the health care crisis would be the worst kind of procrastination," Wagoner said, "the kind that places our children and our grandchildren at risk and threatens the health and global competitiveness of our nation's economy."

After spending several years on the health policy sidelines, Wagoner is launching a mini media blitz, hoping the competitiveness argument will be the one that finally prompts lawmakers to take on an increasingly expensive system rife with inefficiencies and inequities. Wagoner said he intends to press his case personally in Washington and with the nation's governors. Though self-interest may be at the heart of Wagoner's crusade, he and a range of corporate leaders and policy analysts warned that GM's woes are a harbinger of what lies ahead. "GM is the canary in the coal mine for Medicare and everyone else," said Sean P. McAlinden, chief economist at the nonprofit Center for Automotive Research. "There are many, many more companies out there in trouble because of health care costs than just the auto, steel and airline industries."

McAlinden, a labor expert sympathetic to union views, said many in Washington have mistakenly concluded that GM and other carmakers are simply whining about costly union contracts. "GM and the United Auto Workers didn't cause this double-digit inflation in health care," he said. And if GM pushed for sharp reductions in health benefits, the powerful union would likely strike and send the company into Chapter 11 bankruptcy protection, he predicted.

Last year the automaker, known for its innovative approach to health care, spent $5.2 billion to cover 1.1 million retirees, employees and their families. Prescription drugs cost GM $1.9 billion, and the company projects overall medical spending will increase by $400 million this year. That could be offset by a provision in the Medicare drug benefit to pick up a portion of firms' retiree drug costs. But the figure that prompted Wagoner to raise his voice is $1,500. That is the amount of money added to the price of every single vehicle to cover health care, a cost that his foreign competitors do not bear. "The cost of health care in the U.S. is making American businesses extremely uncompetitive versus our global counterparts," he said....

Yesterday, Wagoner broke his silence on an idea proposed by Sen. John F. Kerry (D-Mass.) in the 2004 presidential campaign, saying he supports some type of national catastrophic reinsurance program. Senate Majority Leader Bill Frist (R-Tenn.) has also endorsed the concept of a separate government-backed insurance pool to cover the most expensive medical cases. "If we can create a comprehensive insurance model to better share these catastrophic costs among all consumers, then we can take a big step toward providing affordable health care coverage for all our citizens," Wagoner said.

Wagoner and fellow executives find much to be frustrated with in the health care system. "It's simply not acceptable for over 45 million Americans to be without health care coverage," he said, echoing a point made recently by Jack O. Bovender Jr., chief executive of health care giant HCA Inc. "And it's unfair for those of us who do provide health care benefits to have to pay higher bills to cover the costs of the uninsured.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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A SOCIALIZED MEDICINE DISGRACE

The b*******s just don't care. A little girl had to go to America to get a false British diagnosis overturned

From the time Tilly Merrell was a year old, doctors told her family she would never have a normal life -- or even a normal meal. British doctors found that the food she swallowed went into her lungs instead of her stomach, causing devastating lung infections. They said she had isolated bulbar palsy, and their solution was to feed her through a stomach tube. Forever. But having a backpack with a food pump wired to her stomach wasn't much of a life for a girl whose favorite smell is bacon frying -- a girl who once broke through a locked kitchen door in an effort to sneak some cheese. So her family got help from their community of Warndon, about 120 miles north of London, raising enough money to take Tilly, now 8, on a 5,000-mile journey they hoped might change her life, a journey to Lucile Salter Packard Children's Hospital at Stanford University.

Doctors at Packard were intrigued that she had no neurological symptoms often associated with the palsy. In all other ways, she was a normal child with a mischievous smile and a truckload of energy. After seeing her Feb. 7, they ran three tests and found out what was wrong with her. Nothing. She had infections, certainly, but they were long gone. And when she swallowed something, it went into her stomach, not her lungs.

Until this month, Tilly often had to go off into another room with her PlayStation during family meals. She would always try to sneak morsels of food, not fully understanding the British doctors' warnings about how much harm they could cause. "Christmastime was the worst," said Tilly's grandmother, Sonia Merrell. "She couldn't eat or drink with us. She used to think we were horrible." Having Tilly go through that for the rest of her life wasn't something that her grandmother was ready to accept. After five years of searching the Internet, Sonia Merrell found a story about how a girl with a similar condition was trying to get treated at Packard....

So Tilly, 13-year-old sister Megan, Amelia, Sonia and grandfather Trevor Merrell got on a plane Feb. 5. Two days later, they were seeing Dr. Kenneth Cox, Packard's chief medical officer and its chief of pediatric gastroenterology. "I felt a little bit of anxiousness when they arrived," he said. "I wondered if there was something I didn't know."

After all, England is not exactly a backward nation when it comes to medicine. Tilly had several cases of severe pneumonia as a baby, and her mother said that doctors in the socialized British system clung to the palsy diagnosis....

Once he met with the family, Cox arranged three tests. Dr. Peter Koltai examined the back of Tilly's throat, looking for evidence that she couldn't swallow properly. Dr. Jin Hahn checked to see if she had any neurological problems. Tilly also needed a modified barium swallow, which allowed occupational therapist Marianna Thorn to track whether food was going into her stomach or lungs. "It showed that Tilly had some very enlarged tonsils," Thorn said, "but nothing that told us she would aspirate on food."

More here. (This post also appears on Blogger News)

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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AN UNHEALTHY HEALTH ORGANIZATION

Unfortunately, like most U.N. agencies, the WHO's activities have long been captive to a highly political agenda. For instance, earlier this year the organization claimed that a third of childhood deaths in Europe were due to environmental causes. It's a preposterous claim. European analysts Jaap Hanekamp and Julian Morris observe: "few of these deaths were actually caused by problems generally associated with 'the environment.' Out of 100,000 total deaths, 75,000 were caused by accidents -- e.g. drowning, fires, falls and other hazards of childhood. Of the remaining 25,000 deaths, nearly all of them in poor countries such as Turkey and Russia, most were caused by a combination of dirty water, poor sanitation, malaria and indoor air pollution."

But the facts didn't stop the WHO. It was particularly upset about the presumed threat of global warming, which, it claimed, would result in "more widespread and severe" deaths due to diarrhea, floods, malaria, and nutritional problems. Yet, Hanekamp and Morris archly observe, "No scientific evidence was offered to support these claims -- perhaps because none exists."

Nevertheless, the World Health organization is advancing its so-called Children's Environment and Health Action Plan for Europe which, naturally, advocated more regulations over technology, such as fossil fuels, pesticides, and plastics. The result will be to make us all poorer, yet wealth is one of the most important determinants of health. Wealthier societies are better able to care for those who are most vulnerable to illness.

For instance, the pesticide DDT is one of the most effective mechanisms to kill mosquitoes, which spread malaria. Cheaper energy lowers the cost of producing food. Important medical devices are made from plastics. Under the guise of promoting the "precautionary principle," the WHO is ignoring problems that today kill millions while fretting over worst-case scenarios for the future that are unlikely ever to occur. Simply providing clean water and improving sanitation would do more to help Third World peoples than do most of the WHO's highly publicized initiatives.

The WHO has organized the "Roll Back Malaria" program, along with UNICEF, the World Bank, and the U.S. Agency for International Development. Unlike global warming, malaria actually does kill. Yet the WHO has been spending scarce resources on two drugs which have been found to be no longer effective in Africa. Other choices are available, but so far the WHO bureaucracy hasn't bothered to adjust.

Moreover, complain Robert Bate and Richard Tren, respectively a British and a South African health care analyst, "Roll Back Malaria partners are unwilling to fund interventions that work but upset environmentalists, such as indoor insecticide spraying." Although widespread outdoor use of DDT years ago did have adverse environmental consequences, poor nations throughout Africa and South Asia are literally begging for assistance in undertaking carefully targeted indoor spraying.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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MEDICARE WILL BANKRUPT THE STATE GOVERNMENTS

Texas Gov. Rick Perry last week became the umpteenth -- if not the umpty-umpteenth -- state official to warn of the financial catastrophe awaiting us in the absence of conscientious attempts to overhaul federally subsidized health care. "We are experiencing a government takeover of health care," said the governor. That's no prissy, finger-wagging ideological declaration. The state-federal Medicaid program presently gobbles up a quarter of' Texas' budget. From 1994 to 2003, the state's share of Medicaid costs nearly doubled; the total state budget, by contrast, grew 65 percent. Medicaid now pays for half of all Texas births.

How sweet and compassionate, you say? That's only if we view the subsidizing of health care as the primary function of state government. "If these trends continue," said Perry, addressing the Texas Hospital Association, "and if federal leaders do not make reform of Medicaid a top priority, subsidized health care is going to one day bankrupt the states."

A troublesome law of life asserts itself: You can't spend money you haven't got. All around the country, the warning sirens have been howling. In 2003, Tennessee overran its Medicare budget by $966 million, New Jersey by $236 billion, New York by $1.7 billion, California by $723 billion. Reform proposals are sprouting this winter like golden daffodils. Out in California, Arnold Schwarzenegger talks of moving some Medicaid beneficiaries to managed care. New York Gov. George Pataki seeks $1.1 billion in Medicaid cuts. Tennessee's Democratic governor, Phil Bredesen, says 323,000 people must be excised from the rolls of TennCare, the state's extravagantly generous alternative to Medicaid. Into the program, the state presently pours fully a third of its budget.

In Florida, where Medicaid spending has grown an average 13 percent a year for the past six years, an especially dramatic reform program is in the works. At the center is customer choice. Gov. Jeb Bush would empower Medicaid clients to purchase specific services from managed-care organizations, using state-supplied premiums. Those who lead healthy lives would receive even larger grants. The Bush plan also contemplates private flexible spending accounts, where the owners could park tax-deductible money for future medical expenses. "Our proposals," Gov. Bush said, "put the focus back on the patient by encouraging strong patient-doctor relationships and allowing competition in the market to drive access and quality of care." Florida's Republican-controlled legislature can be expected to give the governor most of what he seeks. (The federal government must likewise provide some waivers.) The alternative: a Medicaid obligation projected at three-fifths of state spending in just 10 years.

The Social Security shout fest ("It's going bankrupt!" -- "No, it's not, you liar!") might have prepared us for the grueling challenge we confront with federal medical programs. The United States is beginning to pay the price, not for the 1933-41 New Deal, rather for the post-New Deal obsession with converting relatively modest measures of government-paid relief into costly programs of permanent social insurance. For nakedly political reasons (voters more handsomely reward lawmakers who give them money than they do those who withhold it), Social Security changed from a fallback, minimal-guarantee system into a full-fledged pension program, based on entitlement. Benefits, and the taxes to support them, soared higher than the Capitol dome. Came the '60s. Lyndon Johnson turned health care into a federal entitlement.

Our appetites proved in the end larger than the resources required to support them. Politicians taught us -- and, oh, what eager pupils we proved! -- to see the provision of daily needs as a basic function of government, never mind what our tougher, pricklier forebears had asserted to the contrary. The day of reckoning is at hand, and the sight isn't pretty. Who can wonder at that? Not the growing numbers who listen anxiously to political leaders telling us what we should have known all along: There ain't no such thing as a free lunch.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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FEISTY AUSTRALIAN PROFESSOR TELLS IT LIKE IT IS

A leading hospital's director of surgery has resigned in disgust, saying it is ethically, "if not criminally", wrong to force cancer patients to wait up to six months for an operation. Professor David Morris, who stepped down as divisional director at St George Hospital last month, but continues to operate, said: "I am aware of two patients that have died waiting and others whose cancer has progressed, and I do not think that is appropriate."

As senior doctors prepare to overhaul the state's surgical services in an attempt to fix lengthy waiting times, a fight has broken out at the hospital over delays in potentially life-saving surgery for cancer patients. Trauma surgery at the hospital is also under enormous pressure, while waiting lists continue to deteriorate, according to Professor Morris. He said 732 people had waited more than a year for an operation and 185 of those classed as most urgent had waited more than the recommended one month. "We have two theatres empty every day, and that is purely funding, not staffing," Professor Morris said, blaming "lethargic" hospital administrators. "In fact, 56 per cent of [the most urgent cases] did not get their surgery within one month - these figures are likely to deteriorate further because the only administrative approach to budget overruns is to cut elective surgery."

But the head of South East and Illawarra Area Health Service, Deborah Picone, said the hospital had no record of patients dying while on the waiting list and that many patients classed as urgent were often wrongly classified by doctors who either did not understand the categories or were eager to push their patient up the list. People waiting for carpal tunnel and varicose vein operations as well as haemorrhoidectomies were on the most current urgent list, she said, but would be removed when they were properly classified as less urgent. "From time to time the list blows out and we have to put in a concerted effort to bring it in," Professor Picone said. "We are doing the same amount of surgery as we were doing this time last year ... and we are going to move to do additional lists over the Easter period."

A dispute over funding for specialist surgery known as a peritonectomy, for metastatic colorectal cancer, is fuelling the debate over St George waiting times. Professor Morris told the Herald he was "struggling" to get funding from the state and federal governments to develop his new surgical program. Other experts, such as the head of the NSW Cancer Institute, Jim Bishop, have called for more evidence before the procedure receives further funding.

The chairman of the NSW Government's surgical services task force and the director of surgery for Wentworth Area Health Service, Patrick Cregan, said that while there were "enormous problems with waiting lists" it was a unique situation to have people dying while waiting for surgery. "This is not the universal experience," Dr Cregan said. "The big problems are in the less urgent categories." The task force was examining ways of improving the system to ensure patients' conditions were correctly classified and that their social situation was considered. "The current classification system ... is a fairly crude implement," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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BABIES, BATHWATER AND MEDICINES

Modern life is a risky business--and medicine is no different. We accept peril on a daily basis without even thinking about it. For the convenience of being able to zip from place to place, we drive possibly dangerous, gasoline-guzzling contraptions called cars. In return for the gift of flight, we accept not only the danger of plane crashes but also a potential heightened risk of cancer for frequent flyers, who spend more time close to the sun and its gene-mutating radiation.

Then there's the tremendous risk you take every time you swallow a pill--and the tough job facing a panel of academics called by the U.S. Food And Drug Administration to examine the safety of popular pain pills.

Medicines are chemicals that alter the way the body works. "Give me a drug without a side effect," a drug researcher once said, "and I'll show you a drug that doesn't work." This is true for most life-saving medicines. Chemotherapy kills cancer, but sometimes it will also kill the patient, perhaps by lowering white blood cell counts so much that infection is a risk. Cholesterol drugs such as Pfizer's Lipitor or Merck's Zocor cut the odds of heart attack or stroke in high-risk patients by a third, but they also can cause side effects that destroy muscle tissue and, eventually, the liver.

Coumadin, a Bristol-Myers Squibb blood thinner, prevents strokes but also increases the risk of bleeding and interacts with everything from other drugs to broccoli and spinach. The allergy pill Allegra, from Aventis, might stop your runny nose but it can also give you a backache.

Patients are often more than willing to take big risks. Amgen faced a chorus of protest from patients and doctors after it stopped developing a medicine for Parkinson's disease because of its onerous side effects. When GlaxoSmithKline recalled an irritable bowel syndrome drug, patient groups made such a clamor that the medicine went back on the market. (Heavy restrictions were placed on its use.)

What we need is a way of balancing risk against benefit better, because for some medicines, the dangers will never justify the gains. Vioxx, for instance, got on the market with one proven advantage--it reduced the risk of ulcers. For the vast majority of patients, a heart attack risk might very well outweigh any benefit from the drug.

Now, many are increasingly convinced that Celebrex and Bextra have similar risks, especially after the publication last night of the full studies implicating the drugs, and two blistering editorials, in The New England Journal of Medicine.

Australia's medical regulators have already slapped warnings on both drugs. By Friday, the panel of academics will give its opinion, and the FDA is likely to follow its recommendations as to whether the drugs stay on the market--and in what form.

But an even more difficult task lies ahead. The FDA needs to be fixed. But how do we avoid throwing out the baby with the bathwater? It's estimated that 100,000 Americans die each year because of adverse drug reactions, but that's no reason to dump the medicine box down the toilet. Some 100,000 U.S. patients also die each year from medical errors, but we keep doctors and nurses around for the simple reason that, as a society, we're better off with them than without them.

The same is true of medicines--at least by and large. Like everything else in life, pill popping is an odds game. The challenge is to make sure that the odds are in our favor.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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The next great battle between socialism and capitalism will be waged over human health

By Harvard economist Kenneth Rogoff. He recognizes that existing socialized medicine systems are already disastrous but still thinks the U.S. needs more socialism. What a nut! The best way to control costs is to get government OUT of the picture, not to get it more involved

"US healthcare costs have already reached 15 percent of annual national income and could exceed 30 percent by the middle of this century – and other industrialized nations are not far behind. Certainly, an aging population is part of the story. But if economic productivity keeps growing at its current extraordinary pace, Europeans, Japanese, and Americans could triple their current income per person by 2050. Inevitably, we will spend a lot of that income on improving and maintaining our health.

Which brings us to Marx. When the price of medical care takes up just a small percentage of national income, it is hard to argue with the notion that everyone should enjoy similar medical treatment. Sure, critics may gripe that the higher taxes needed to pay for universal health coverage may cut into economic growth a bit, but so what? A little redistribution won't suddenly transform the United States into a failed, Soviet-style "workers' paradise." But as health costs creep up to, say, 25 percent of national income, things get more complicated. Americans would see their tax bills more than double, while total taxes could reach 75 percent of many Europeans' income. With oppressive tax burdens and heavy state intervention in health – already the largest sector of the economy – socialism would have crept in through the back door.

Of course, smug Europeans, Canadians, or Japanese may think that exploding healthcare costs are a purely US problem. Certainly, the British and Canadian governments successfully wield their monopolies over healthcare to hold down both doctors' incomes and prescription drug prices. And part of the rise in US healthcare costs stems from the breakdown of the checks and balances that more centralized systems provide. (For example, Americans are several times more likely to receive heart bypass surgery than Canadians, where the procedure is reserved for extreme cases. Yet several studies suggest that patients are no worse off in Canada than in the United States). And even the most fanatical free marketers recognize that healthcare is different from other markets, and that the standard supply-and-demand principles don't necessarily apply. Consumers have poor information, and there is an obvious case for greater government involvement than in other markets.

But if all countries squeezed profits in the health sector the way Europe and Canada do, there would be much less global innovation in medical technology. Today, the whole world benefits freely from advances in health technology that are driven largely by the allure of the profitable US market. If the United States joins other nations in having more socialized medicine, the current pace of technology improvements might well grind to a halt. Even as the status quo persists, I wonder how content Europeans and Canadians will remain as their healthcare needs become more expensive and diverse. There are already signs of growing dissatisfaction with the quality of all but the most basic services. In Canada, the horrific delays for elective surgery remind one of waiting for a car in the old Soviet bloc. And despite British Chancellor Gordon Brown's determined efforts to rebuild the country's scandalously dilapidated public hospital system, anyone who can afford to go elsewhere usually does. With public healthcare systems fraying at the edges, many countries outside the United States increasingly face the need to allow a greater play of market forces.

During the next few decades, modern societies will wrestle with very tough questions and tradeoffs: What, exactly, are people's basic health needs in an era where medical technology relentlessly advances the frontiers of the possible? How do we help people while still giving them the incentive to economize on their use of scarce healthcare resources? And who plays God – the bureaucrats, the doctors, or the forces of the market?

Ultimately, the case for some government intervention and regulation in health care is compelling on the grounds of efficiency (because costs are out of control) and moral justice (because our societies rightly take a more egalitarian view of health than of material possessions). The issue is precisely how much redistribution of income and government intervention is warranted. With the health sector on track to make up almost a third of economic activity later this century, the next great battle between capitalism and socialism is already underway".

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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

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