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31 January, 2007

GOING BLIND? WHO CARES? THE NHS DOESN'T!

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

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

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

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

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

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

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

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

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

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

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

Source



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

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

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

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

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

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

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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30 January, 2007

INSANE WORKING HOURS FOR AUSTRALIAN PUBLIC HOSPITAL SURGEONS

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

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

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

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

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

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

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

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

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



NHS patients need to buy organs from Third World to survive

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

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

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

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

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

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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29 January, 2007

TENNESSEE: LESSON FOR CALIFORNIA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source



NHS managers "incompetent"

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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28 January, 2007

America's Next Great Debate: Health Care

Post lifted from MedGadget

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

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

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

By Mark Steyn:

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

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

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

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

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

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



BRITISH TORIES CLUELESS ABOUT FIXING BRITISH HEALTH CARE

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

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

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

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

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

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

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

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

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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27 January, 2007

Universal Health Care: A lesson from Japan

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

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

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

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

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

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

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

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

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

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

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

Source



NHS cash crisis could cost diabetic children limbs

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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26 January, 2007

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

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

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

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

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

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

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

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

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

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

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

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

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

Source



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

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

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

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

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

Source



THE CASTRO IRONY

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

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

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

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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25 January, 2007

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

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

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

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

The governor claims a mandate is necessary because the uninsureds medical costs get shifted to everyone else; a mandate would ensure that all Californians have coverage. Yet the governor vastly overstates the free-rider problem, which is dwarfed by the amount of waste in our health-care system. And requiring people to purchase insurance doesnt mean theyll do it. California requires drivers to purchase auto insurance, yet one in four California drivers are uninsured.

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

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

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

Schwarzenegger would expand government programs for the poor, including Californias version of Medicaid i.e., Medi-Cal. In fact, he would expand these programs so much that they would cover many Californians who arent poor at all. Families of four making $60,000 per year including illegal immigrants would be eligible.

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

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

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

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

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

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

Source



Mother gives birth in toilet

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



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

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

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

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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24 January, 2007

COMMENT FROM CALIFORNIA ON THEIR MEDI-MADNESS

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

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

The cost squeeze

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

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

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

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

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

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

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

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

Violating federal and state mandates

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

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

The doctor and hospital tax

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

Paying for more care

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

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

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

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

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

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

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

Source



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

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

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

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

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

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

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

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

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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23 January, 2007

A NASTY BRITISH HEALTH BUREAUCRACY

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



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

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

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

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

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

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

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

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

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

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

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

Source



Behind the IVF ‘trial by television’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now, answering that question would make a good documentary.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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22 January, 2007

Schwarzenegger putting his case

Gov. Arnold Schwarzenegger hit the road Friday to sell his health care plan, telling Los Angeles business leaders he thinks the state will approve a plan to cover 6.5 million uninsured Californians this year and that medical costs could drop as soon as next summer. In a discussion with the Los Angeles Area Chamber of Commerce, Schwarzenegger framed the health care plan as a way to reduce costs for businesses that already offer health care to workers. The Republican governor said existing policyholders bear the costs of expensive medical attention already given to the uninsured, which he called a "hidden tax." "Even though you are insured, don't think that you should not care about this issue," Schwarzenegger said. "Because you should be caring about this issue especially if you're insured because you are paying a 'hidden tax.' And that 'hidden tax' is a lot of money and we can eliminate that and reduce it down if we have everyone insured."

Schwarzenegger's plan would raise $12 billion, including $5.5 billion in federal funds, to extend health coverage to 6.5 million uninsured Californians. Employers with at least 10 workers and who do not provide health care would have to pay 4 percent of payroll to the state, while physicians and hospitals would also have to pay a percentage of revenues. Some Republican lawmakers criticized the proposal last week for placing new mandates on companies and health care providers. They called it a tax, a charge the governor denies.

The Los Angeles Area Chamber of Commerce has been one of the more receptive business groups in response to the governor's plan. The chamber's board president, David Fleming, said his organization supports the governor's efforts. "I think this plan represents a logical solution to a growing and major problem in this state," Fleming said by telephone. "We're the only nation in the world where health care is paid for by businesses, which puts American businesses at a disadvantage with those in other nations. With health care premiums going up every year, it's time to address the problem."

Scott Hauge, president of Small Business California, said employers are open to contributing to health care as long as the state also focuses on driving down specific costs. He said the health care plan should focus on preventive medicine, reducing technology costs and chronic disease management, in addition to examining how to pay for the uninsured.

The governor likened his proposed requirement that all Californians obtain health insurance to existing law requiring all drivers to have auto coverage. "When we say everyone has to have car insurance, there are still some people that don't, but if they get caught, then there will be some penalties," he said.

Schwarzenegger opened the meeting to reporters and broadcast his appearance online after visiting privately with chamber members for about 30 minutes. Besides addressing his health care plan, the governor talked about a legislative proposal to ban parents from spanking a child younger than 4 years old. "I have not looked at it yet," Schwarzenegger said. "I just think that one ought to address that issue. ... We are very fortunate that in America we are in a country where that is not a popular thing. Where I grew up, in Austria -- of course, 40, 50 years ago -- it was a much more common thing. Everyone got smacked, everyone got whacked with the yardstick, in school, by their teacher, by their parents, so it was just a much more cultural thing then."

Source



British referral management schemes damage patients' interests

Bureaucrats second-guessing a doctor's referrals and sending the patient somewhere else instead??

Referral management schemes pose a serious threat to patients' interests, argues Peter Lapsley, Chief Executive of the Skin Care Campaign, in this week's BMJ.

Referral management schemes are springing up across the NHS as a means of reducing primary care trusts' spending on secondary care services. The justification given for the introduction of the schemes is that they bring services "closer to home" - a mantra repeated often by the government at present. But trust managers admit privately that the true purpose of the schemes is to reduce costs in the face of the budget deficits so many of them are confronting, he says.

Typically, such schemes require that 80% of GPs' referral letters be reviewed in primary care and that 60% of cases should be retained within the trust. In many cases GPs are being offered financial incentives to participate in the schemes. Lapsley firmly believes that these schemes pose a serious threat to patients' interests. They introduce an extra step in the patient's journey, delaying the diagnosis and treatment of often complex and difficult diseases, he writes.

What is more alarming is that some primary care trusts now deliberately delay outpatient appointments, refusing to fund routine paper referrals seen within eight weeks of the date of the referral letter. In contrast, patients who can be booked into clinics directly through the Choose and Book electronic booking service can be seen within two to three weeks, no matter what their complaint. The schemes also remove any vestige of "patient choice," another government mantra, he adds.

In the case of dermatology, about 15% of GPs' consultations in Britain relate to skin disorders, yet the average undergraduate curriculum has only six days of dermatology, and only 20% of GP vocational training schemes include a dermatological component. Practice nurses receive no such training.

Referral management schemes therefore create a real risk that patients with skin diseases will be seen by clinicians who lack the necessary training and experience, greatly reducing the likelihood of prompt and accurate diagnosis, not least in respect of skin cancer, he argues.

The schemes are also insulting to GPs, second guessing their decisions. They undermine the viability of secondary care dermatology, and they remove any incentive for secondary care specialists to support or develop the role of the GP with a special interest in dermatology. The schemes may provide a short term solution to a short term financial problem. The risk, though, is that they will do lasting damage, he concludes.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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21 January, 2007

EVEN CASTRO CAN'T GET GOOD SOCIALIZED MERDICINE

Cuban leader Fidel Castro has long prided himself on Cuba's doctors and free public health care system, but that system seems to have let him down after he fell ill in July , U.S.-based doctors said on Tuesday. Based on a report in Tuesday's edition of Spain's El Pais newspaper, the doctors -- who have no first-hand knowledge of Castro's condition -- said Castro had received questionable or even botched care at the hands of health experts on his communist-ruled island. "It's not a good story. Too bad they didn't send him to Miami for surgery," said Dr. Charles Gerson, a clinical professor of medicine in the gastroenterology division of New York's Mt. Sinai School of Medicine.

According to two medical sources cited by El Pais, the veteran revolutionary was in "very serious" condition after three failed operations on his large intestine for diverticulitis, or pouch-like bulges in the intestine, complicated by infection. The sources in El Pais were from the same Madrid hospital where a surgeon who visited the 80-year-old Castro in late December works. The Spanish surgeon, Jose Luis Garcia Sabrido, had not changed his opinion that Castro was slowly recovering after stomach surgery for an undisclosed ailment, his secretary said. But El Pais said Castro was being fed intravenously and his outlook was bleak. If confirmed, the newspaper's account was the first with details of Castro's clinical history since he first underwent surgery six months ago. His condition is considered a state secret inside Cuba

Gerson and Dr. Meyer Solny, a veteran gastrointestinal expert at New York Presbyterian Hospital and the Weill Cornell College of Medicine, said Castro's doctors erred by seeking to avoid a colostomy -- or opening in the abdomen to get rid of stool -- after an initial operation to remove part of his large intestine. "They took a chance, which was probably not the best judgment under the circumstances," Gerson said. "It sounds like they tried to spare him the colostomy, which would have been the safer and more conservative approach, and what they did was to try to establish continuity of the bowel by sewing the colon to the rectum, and for one reason or another it sounds like that didn't work. And now there are troubles," said Solny.

Gerson said the Cuban doctors appeared to have suffered one problem after another. "What you're into is multiple operations with complications and infection in someone his age, you know, the wear and tear is going to start wearing him down, and he's going to get weaker," he said.

U.S. medical experts were also puzzled by El Pais' report that Castro had undergone a third operation to implant a Korean-made prosthesis, possibly an artificial stretch of bowel, after a second failed operation to clean and drain an infected area and perform a colostomy. "I would say that that would likely be a very risky situation because of the nature of the large intestine, which is a sewage line," said Dr. Stephen Hanauer, chief of gastroenterology at the University of Chicago. He said the use of a prosthesis in such cases was "experimental" at best and unheard of in the United States. "I think the prognosis is very grave at this point," said Dr. Roshini Rajapaksa, a gastroenterologist at NYU Medical center and assistant professor at the NYU School of Medicine. "For an elderly person to undergo major abdominal surgery three times, especially when they're unsuccessful, is a very serious situation."

Source



Australia: More stupid medical bureaucracy

If you are a Pakistani doctor killing people regularly that is fine but if you just take a break for once you are negligent! And a bureaucracy that fails to consider the impact of its decisions is CLEARLY negligent. These dummies wouldn't know malpractice if they fell over it

Eight Kingaroy doctors have labelled the Medical Board of Queensland's suspension of a colleague as "absolutely disgusting". Patrick Lip, who has practised in the nearby South Burnett town of Wondai for 36 years, was suspended last month after allegations that his response to an emergency had contributed to a patient's death from a drug overdose.

A letter to Dr Lip, signed by the eight general practitioners and faxed to Health Minister Stephen Robertson, said other doctors in the region were finding it hard to cope with the extra workload resulting from his suspension. "For this to happen three days before Christmas was badly timed and is absolutely disgusting," the letter said. "There must be thousands of patients dependent on the very devoted medical services you have offered over the past 30-odd years. "Our real concern is for these patients now having to find another GP in an area that is totally short of doctors in any case."

The doctors said their Kingaroy surgeries had been swamped by requests from Dr Lip's patients to join their practices. "Unfortunately, most are already very busy working 12 hours on a daily basis, and many of your patients are turned away," they wrote. "The situation is intolerable and the future looks dismal."

Wondai Mayor David Carter said he knew of at least one patient who had travelled 90 minutes to Gympie to see a GP since Dr Lip's suspension. He said the suspension had created great angst in the town. Cr Carter said Dr Lip was the type of doctor who still made house calls. "I've been that ill myself, my wife has called and he came straight round," Cr Carter said.

Dr Lip, who has appealed his suspension, has declined to comment on legal advice. A Queensland Health spokeswoman said the department was very committed to maintaining GP services in rural and remote areas. But she said it also had a duty of care to ensure patient safety. The Medical Board of Queensland said it was working hard to resolve the matter as quickly as possible.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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20 January, 2007

Shades of Grey: Arnold Schwarzenegger and the road to national health care

Ted Kennedy, the nation's most persistent backer of nationalized health care, must be smiling at the irony. Almost four decades after he first proposed the idea, Gov. Arnold Schwarzenegger, a Kennedy relative by marriage, is touting his own version of universal coverage, and, if adopted, the idea could go nationwide quickly. It's no wonder critics are already dubbing the ostensibly Republican chief executive "Schwarzenkennedy."

This isn't the first time Mr. Kennedy has found a Republican to carry water for him. In 1971, after Medicare spending had increased by more than 70% in five years (although the number of people enrolled grew by only 6%), Richard Nixon declared a "health-care cost crisis" and worked with Mr. Kennedy to propose mandatory employer-provided health insurance. The idea foundered, but a modified version now has been revived by Mr. Schwarzenegger, who wants to require that every person buy health insurance, or be covered by an employer or the government. Massachusetts has a more modest law in place, and an adviser to Mitt Romney helped Schwarzenegger aides on their plan.

Liberals are overjoyed at the about-face by a governor who in 2005 vetoed a Democratic bill that would have merely expanded the state's coverage of children, saying the $300 million price tag was too high. Assembly Speaker Fabian Nunez praises the governor's new proposal: "This is a plan Assembly Democrats could have written."

Indeed, they already have--and Mr. Schwarzenegger fiercely opposed it at the time. In 2003, then-Gov. Gray Davis, fighting to stave off his recall, signed a law mandating employers with 20 or more employees provide health coverage or pay into a state fund that would provide it. After Mr. Davis was recalled, Mr. Schwarzenegger helped lead an effort to repeal what he called a "job-killing health-care tax." In 2004, 51% of voters agreed and repealed universal coverage in the same election in which George W. Bush lost the state by 10 percentage points and the highly liberal Sen. Barbara Boxer was re-elected by 20 points.

But the next year, Mr. Schwarzenegger suffered a stinging defeat as public employee unions spent $130 million in a special election to defeat four reform initiatives he supported. A chastened governator swung left by hiring as top aides Susan Kennedy and Daniel Zingale, two former deputy chiefs of staff to the recalled Mr. Davis; Jason Kinney, a Davis speechwriter, joked that he had decided "to finish the second term of Gray Davis." No one is laughing now. The behind-the-scenes architects of much of the governor's plan were Ms. Kennedy and Mr. Zingale, who also served as Mr. Davis's director of managed health care.

Last November, Gov. Schwarzenegger won landslide re-election in part by winning 91% of Republicans with an ironclad pledge not to raise taxes. He pounded Phil Angelides, his Democratic opponent, for wanting to raise taxes by $7 billion to pay for universal health care. But now the estimated cost of the Schwarzenegger plan to cover California's uninsured, including two million illegal aliens, is $12 billion. State subsidies for people to buy insurance will extend to those earning up to $50,000 a year, more than California's median income. "He's creating a welfare state where more than half the people are in the wagon being pulled than outside the wagon pulling," says one health-care analyst.

As bad as the policy implications are, the governor's plan may be fatally flawed, politically. He insists it doesn't raise taxes, despite billions in new charges on doctors, hospitals and employers. He prefers to call the new revenue "in-lieu fees" and "coverage dividends." "He excoriated Phil Angelides, rightly, for proposing the same tax increases he has put on the table," says GOP state Sen. Tom McClintock. "He is now pushing the second largest tax increase in California history. I won't be able to trust anything he says."

Whether the new revenue is a tax or not is important, because if it is a tax the plan must garner a very difficult two-thirds vote in both legislative houses. Barring that, the California Supreme Court will have trouble with the concept. A fee on employers who don't offer health insurance probably requires only a majority vote. However, the imposition of a levy on the gross revenues of doctors and hospitals is almost certainly a tax that would require two-thirds approval.

Then there are the feds. The $5 billion a year in extra federal Medicaid money, which the governor is banking on, is shaky. An even greater barrier is Erisa, the 1974 federal pension law that preempts all state laws that regulate employee benefits. Last summer, a federal judge threw out Maryland's so-called "Wal-Mart law" requiring large firms to spend 8% of their payroll on health care because "state laws which impose health or welfare mandates on employers are invalid under Erisa." Just yesterday a federal appeals court upheld the ruling voiding the Maryland law.

Rather than pursue a legally dubious universal coverage proposal, Mr. Schwarzenegger should have pursued the universal access he used to tout. He could sign up more of the nearly one million Californians eligible for current health programs but not yet enrolled. The 49 coverage mandates that make insurance so expensive (Idaho has only 13) could be reduced and residents allowed to buy coverage from other states. Nurse practitioners could be allowed to set up their own clinics. Instead, the governor's plan piles on a new mandate that bars insurers from turning down anyone based on health status or age. When New Jersey instituted a similar rule in 1993, premiums jumped 500%.

Mr. Schwarzenegger insists he is pursuing a centrist course that borrows from both the right and left. But more realistically, he is imitating Richard Nixon's old strategy of throwing rhetorical bones to his right while attempting to appease the left with liberal programs. Emmet John Hughes, an Eisenhower speechwriter who knew Nixon well, once said he "judged any declaration of speech not by its content but by its impact." That explains Nixon's dramatic lurches into or toward wage price controls, a guaranteed annual income and mandatory employer health insurance.

Arnold Schwarzenegger used to claim he admired Ronald Reagan most "because he stuck by his principles when others wouldn't." But with his Rube Goldberg health plan Mr. Schwarzenegger has demonstrated that at his core he prefers roles more suited to Tricky Dick than the Gipper. Should he succeed, the long-term dream of nationalized health care held by Ted Kennedy, and Hillary Clinton, will be closer to reality than ever.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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19 January, 2007

NHS CAN'T HANDLE EMERGENCIES

So they lie instead

Doctors are struggling to meet Government accident and emergency waiting time targets because the NHS cash crisis is resulting in a shortage of beds, doctors' leaders warned today. A survey for the British Medical Association (BMA) found that a shortage of hospital beds was delaying the admission of patients from A&E in England. A third of those questioned said that figures were manipulated in order to meet the access targets. A total of 503 members of staff at all grades working in emergency departments responded to the survey. The Government target is that 98 per cent of patients should wait no more than four hours from arrival at A&E to admission, transfer or discharge.

The survey questioned UK staff from the British Association for Emergency Medicine (BAEM), with 86 per cent of the responses received from those working in England. Eighty-seven per cent of doctors in England said that the lack of in-patient beds was the main reason for not meeting Government targets. Staff shortages and patients attending A&E with minor problems were also blamed. Two-thirds of those in England said that patients were moved to inappropriate areas or wards to help meet the target, while 58 per cent said patients were being discharged from A&E to inappropriate areas or wards before they had been properly assessed.

Just over half of those in England said that their department was meeting the A&E target. But 49 per cent said their department had received extra cash to help them meet the target, and 53 per cent said agency workers and staff on short-term contracts had been brought in to help. Almost all of those who replied to the survey in England said that their workload had increased in the past 12 months, with most blaming the transfer of out-of-hours care from GPs to primary care trusts.

Today's survey also revealed that departments are at risk of being downgraded or closed altogether.It found that 48 units in the UK (42 of them in England) were at risk of being downgraded and 23 in the UK (19 of them in England) were at risk of closure.

Don MacKechnie, chairman of the BMA's Emergency Medicine Committee, said: "Many hospitals have cut bed numbers as part of their financial recovery plans and attempts to balance their books. "This means that there are fewer available beds for patients coming through A&E who need to be transferred within four hours to a hospital ward from the emergency department to meet the Government's access target. "The report finds that doctors and other staff are working exceptionally hard and putting in extra hours to meet access targets. Working towards the four-hour target on A&E waiting times has been a fantastic achievement, it has proved good news for patients and the extremely long waits seen in the last decade are now very rare. "However, respondents tell us that despite this success, the level of performance in many departments is proving unsustainable and these departments are finding it difficult to cope on a daily basis."

Martin Shalley, president of the BAEM, said: "Attendances at urban A&E departments continue to rise and pressure on beds remains a significant factor for achieving the four-hour target. "It is vitally important to separate acute and elective facilities so that each can perform efficiently and improve the patient journey." Government figures show that 98.2 per cent of patients were seen and treated within four hours in 2005/06.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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18 January, 2007

LEFTIST HATRED OF A SUCCESSFUL PRIVATE ALTERNATIVE TO THE CRUMBLING NHS EMPIRE

The bureaucrats are trying to justify their existence -- and how better to show your wisdom than by persecuting success? In a non-envious world they would be bending over backwards to help this guy rather than trying to trip him up with paperwork.

Two IVF clinics run by Britains most successful fertility doctor were raided yesterday by regulators and police following allegations that he treated patients without a valid licence. Inspection teams from the Human Fertilisation and Embryology Authority (HFEA) were granted a warrant to search the two London clinics run by Mohammed Taranissi to determine whether he has committed a criminal offence.

Mr Taranissi, whose personal wealth is estimated at 38 million pounds, operates the Assisted Reproduction and Gynaecology Centre (ARGC) and the Reproductive Genetics Institute (RGI). The ARGC has long topped league tables for IVF success rates and has an active licence. The licence held by RGI has expired. If there is evidence that he treated patients illegally he could become the first doctor to be prosecuted. The teams are also investigating allegations about the types of therapy he recommends and the information given to patients.

Mr Taranissi vigorously denied any wrongdoing and said that he had co-operated fully with the inspections. He accused the HFEA of changing its procedures to refuse the RGI a licence. The only patients treated since its application for renewal was turned down were seen with the authoritys knowledge and approval, he said.

Angela McNab, chief executive of the HFEA, said: Since January 2006, the RGI has not had a licence. Providing treatment in a centre which does not have a licence is potentially a criminal act. The HFEA needed a warrant because the RGIs licence had run out and the regulator did not have an automatic right to inspect it. The RGIs licence expired in December 2005, but for the first six months of 2006 it operated under special directions from the HFEA.

In June, Mr Taranissi was offered a three-year licence, on condition that he transfer no more than two embryos to patients aged over 40. He accepted the offer, but indicated that he wished to make representations about the condition. The HFEA interpreted this as a refusal of the licence. The offer was then withdrawn.

Mr Taranissi said that he then stopped taking new patients at RGI and finished treating patients whose cycles had begun. This was done with the knowledge and approval of the HFEA, he said. He told The Times: It is very odd the way they have portrayed the licence situation. All of a sudden, they said to me because you have made representations, you have effectively refused the licence. There is no issue of patient safety here, it is about the interpretation of a signed paper. It is different from a backstreet clinic, where there is a very serious issue of patient safety.

The HFEA said that its action was taken independently of allegations made against Mr Taranissi by the BBC One Panorama programme last night. It claimed that a young undercover reporter had been offered IVF at the ARGC even though neither she nor her partner had a history of infertility. Mr Taranissi said that the BBC failed to report visits by three other reporters who were given appropriate advice, and that the 26-year-old reporter had been seen by a junior doctor no longer with the clinic. He said that her notes indicated that the doctor had discussed options including natural conception with the woman and that his comments had been taken out of context.

Source

More background:

The charity Infertility Network UK was due to spend yesterday compiling a report for the Department of Health into the inconsistent availability of in vitro fertilisation (IVF) treatment on the NHS. Instead, it spent the day handling a torrent of calls from worried patients who had seen a BBC Panorama programme questioning the propriety of the man said to be the most successful IVF technician in Britain, the private practitioner Mohammed Taranissi.

Which is a shame, because the muddle of treatment on the NHS is a far greater scandal than the continued operation by Mr Taranissi of a private clinic whose licence was under review. And under review not because he had done anything wrong, but because the Human Fertilisation and Embryology Authority (HFEA), the regulatory body for IVF clinics, had suddenly reduced the number of embryos Mr Taranissi was allowed to transplant, and he had ed.

Women over 40 are allowed to have three embryos transplanted during IVF; the HFEA wanted Mr Taranissi to transfer no more than two. Because twins and triplets are far more likely to have health problems than lone babies, the HFEA wants to encourage people away from multiple embryo transfers. About one in four IVF pregnancies produces twins, more than ten times the rate for natural conceptions. Half are born prematurely, with low birth weight, and subsequently run a much higher risk of cerebral palsy (18 times as high in the case of triplets). Neonatal and first-year care for twins and triplets is expensive for the NHS.

There is a public policy issue worth debating here, but the HFEA has not had that debate publicly, and it isn't official policy yet, so what right it had abruptly to curtail Mr Taranissi's freedom to operate is unclear. Those who know a lot more about the sector than I do say that the HFEA is suspicious of Mr Taranissi's success rates and have long suspected him of fiddling his figures or some such. The surgeon's friends insist his success rate is due to his absolute dedication and in particular his willingness to implant embryos at precisely the correct moment, whether that be 3am or Christmas Day.

The other allegation against Mr Taranissi's clinic is that IVF was inappropriately offered to a 26-year-old who had tried for only a year to conceive. The clinic says the doctor's comments were taken out of context by the BBC, which has refused to show them unedited tapes. It cannot be pure coincidence that the HFEA raided Mr Taranissi's clinics on the day that Panorama was due to broadcast its allegations. The HFEA was pandering to the cameras; sick behaviour from an unelected regulatory authority that appears to be out of its depth.

I could argue at length about the costs of private IVF treatment, success rates (23.6 per cent for women of 35-37, just 10.6 per cent at 40-42), proper regulation and the social engineering it represents - babies on a plate for people wealthy enough to afford them - but that would be missing the point here. The real scandal is in NHS units up and down the country. Three years ago the Government said that all infertile couples where the woman is under 40 would be offered one cycle of IVF within a year, as a first step towards implementing official guidelines that stated that three cycles of treatment should be offered. Research by the National Institute for Health and Clinical Excellence (NICE), which drew up the guidelines, showed that the cost per live birth of IVF rises from 12,000 when the woman is 24 years old to 13,000 pounds if she is 35, just over 20,000 at 39 but 38,000 at 42. Hence the age 40 cut-off.

But, surprise surprise, what the Government promised hasn't happened. Local health managers have interpreted the guidelines in wildly different ways. A year ago a survey by NICE found that only 40 per cent of primary care trusts would confirm that they even offer IVF treatment. Those that do offer it have waits of up to five years and a bewildering array of conditions that the patient must meet.

Research carried out by Infertility Network UK two years ago, and now being updated by them for the Department of Health, found, for instance, that in Durham you must wait four or five years, have a body mass index not greater than 30 and have no surviving children in your current relationship, before you are allowed IVF treatment on the NHS. Thames Valley will not treat a woman unless she is 36 and has never paid for any IVF treatment privately. In Norwich you have to have a body mass index no more than 34, no children from a previous relationship and must be a couple who have lived in Norfolk for at least two years. In Southampton City there are no social eligibility criteria; in North Dorset you must have been in a stable relationship for at least three years. In Rowley Regis and Tipton there must be no children on the maternal side; in Mendip there must be no children living with the couple and "no access to children from previous relationship". And in Cherwell Vale the couple must be non-smokers.

There is an astonishing degree of social manipulation going on in a complicated postcode lottery five years after the Prime Minister promised couples could expect "the same level of high-quality services" for IVF wherever they lived. Some services are being cut: Luton has stopped funding new fertility treatment for now, and York is considering doing the same.

And then, of course, if you do get your treatment paid for, there are all the pitfalls of sloppy NHS service to negotiate: lost X-rays, long queues, rude receptionists, dismissive doctors. It must be particularly painful to be treated to the NHS's special brand of production-line treatment when you are in the sensitive process of trying to get your own little production line moving. So the popularity of Mr Taranissi's and all the other private IVF clinics is easily explained. But what a pity Panorama couldn't find the time to investigate that

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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17 January, 2007

Walk-in health care in California

Free-enterprise facilities offer quick, not-too-costly help -- way ahead of the government mess

While state and national leaders debate a cure for a broken health care system, a band of entrepreneurs has been quietly responding with a stab at the problem: establishing walk-in, storefront clinics. These clinics, often tucked into pharmacies, keep retail hours and offer a menu of services: diagnosis and treatment of routine ailments like sore throats, pinkeye and swimmer's ear, vaccinations and health screenings. The Sacramento region already has three retail-based clinics, with four more scheduled to open soon. They are part of a nationwide trend in health care delivery: easy-access medical services for customers willing to pay for the convenience. Backers say they cater to people who want health care that is uncomplicated, quick and not too costly.

That de ion fits Wendy Holmquist, a 36-year-old mother of two with a full-time sales management job and little patience for long waits at doctors' offices. "I feel like hell," Holmquist told a nurse practitioner recently inside a one-room clinic at the back of a Natomas Rite Aid pharmacy. "I can't even bend over because of the pain in my face." A half-hour later, Holmquist left the clinic with everything she needed: a diagnosis of a sinus infection, an antibiotic and decongestant, and nurse's orders for steamy showers and liquids. For Holmquist, who lives north of Sacramento but whose regular doctor's office is in east Sacramento, the clinic's slogan -- "Real Health Care, Real Quick" -- proved to be prophetic.

"Obviously, consumers are driving this," said Tine Hansen-Turton, executive director of the Convenient Care Association, a nationwide trade group formed to support and establish guidelines for the fledgling industry. "There are 46 million uninsured in this country and many complaints about bad experiences with the health care system," Hansen-Turton said. "Consumers say, 'This is a model we like because the clinics are available when we need them and on our terms.' That's different." Health care consultant Mary Kate Scott calls it an "irreversible trend," citing rapid growth -- from 62 clinics nationwide at the start of 2006 to 235 by year's end -- and projections for at least 500 more this year and another 700 in 2008.

Besides the Natomas site, Sutter Express Care now operates clinics at Rite Aids in Rancho Cordova and Elk Grove. Another, on Florin Road, will open Thursday, followed in late February or March by Rite-Aid-based clinics in Folsom and Roseville.

Later this month, Sacramento internist and KCRA television health correspondent Dr. Thomas Hopkins will open his own business, Medi-Stop, a routine-care clinic in a 1,200-square-foot space at a Natomas strip mall. A chronic shortage of primary care doctors, an aging population and higher out-of-pocket costs for insured patients fuel the movement, Scott said. The trend attracts consumers too busy or tired of waiting on the phone with their HMO's on-call nurse for an appointment that may not come anytime soon. "As consumers start to pay more and more, they get more discerning and play a more active role," said Scott. "They are really responding to increased access and the cost-effective approach."

The retail clinics may appeal to people with high deductibles, those who can't get insurance or opt not to purchase it, or people who otherwise may go to emergency rooms. But they are also popular with insured patients who simply seek convenience. Sutter Express Care, for example, accepts most types of health insurance, including Medicare for seniors. That meant that Holmquist, who was prepared to pay the standard $59 fee for the visit, was charged only a $15 insurance co-payment.

The model won't work for everyone, though. Fifty-year-old Phyllis Owens, whose chronic health problems prevent her from working, relies on Medi-Cal, the state's insurance program for the poor and disabled, for her care. Neither Sutter Express Care nor Medi-Stop are set up to bill Medi-Cal for services. "Sixty dollars is a lot of money," said Owens, who complained of an aching back while standing outside an Oak Park grocery store. "It would be wonderful if it cost $10."

Nationally, supermarket chains such as Piggly Wiggly, and big box outlets such as Wal-Mart and Target also offer clinics. In the Bay Area, Farmacia Remedios, a small chain with in-store clinics, caters to Spanish-speaking customers. "Over the past three or four years, access to basic health care has become a big problem," said Hopkins, whose Medi-Stop clinic is sandwiched between Carvel Ice Cream and and Computer Renaissance. "We want you to come in, get what you need, and get follow-up somewhere else if you need to."

A Harris Interactive poll reported high satisfaction from those who used the clinics, but a majority surveyed also worried that serious medical problems might not be accurately diagnosed. The medical establishment has similar concerns, since retail-clinic physicians only serve in supervisory roles and typically are not on-site. The American Medical Association has outlined nine principles it says will ensure that patients of the clinics get the best possible care. It recommends, for example, that clinics limit the scope of their services and that patients are informed they will be seen not by a licensed physician but a specially trained nurse or physician assistant. "There is more to it than simply patient satisfaction," said Dr. William A. Hazel Jr., an AMA board trustee. "The value will depend on being able to demonstrate they delivered quality care in a safe and effective fashion."

Although the California Medical Association has not officially weighed in on the phenomenon, CMA President Dr. Anmol S. Mahal worries that expanded use of the clinics could damage the "sacrosanct" doctor-patient relationship. "In primary care, our physicians don't just treat the earache that day, but they know the person," said Mahal, a Fremont gastroenterologist. Dr. Thomas Atkins, a family physician and the medical director for Sutter Express Care, said the clinics are not trying to offer a substitute for regular primary care. The retail-based clinics also work as referral services, turning away patients with head trauma, serious lacerations or complications from chronic diseases.

At Sutter Express Care, nurse practitioner Lynn Denham-Martin keeps a file with names of community doctors accepting new patients, as well as s of other types of clinics, including Planned Parenthood for obstetrics, gynecology and primary care, and Med 7 Urgent Care, a stand-alone center equipped with a lab and X-ray and staffed with physicians who can address broken bones and many serious illnesses. At the Sutter Express Care clinics, and at the soon-to-open Medi-Stop, patients choose from a "menu of services," a list of easily treated ailments from seasonal allergies and strep throat to sprains and sunburn.

Rite Aid spokeswoman Jody H. Cook said that, in an era when the traditional pharmacy has a small profit margin, clinics can bring more customers -- and dollars -- into the drugstore. That formula worked with clinic patient Lynn Davis of Sacramento. While waiting for a decongestant prescribed by Denham-Martin, she hunted the aisles for soda for her husband and food for her cat before heading home. "It's awesome," Davis said. "Convenience. That's the key."

Source



Australian man dead for 10 months given surgery date

It's getting as bad as Canada!

A man who has been dead for almost a year was scheduled for surgery today at Queensland's biggest hospital. The blunder has stunned grieving mother Ann Heath, 66, who says her son Michael Trindall, 45, should never have been on a public waiting list.

Mrs Heath was bracing herself for the first anniversary of her son's death when the Royal Brisbane and Women's Hospital sent a letter in December to advise the date of his surgery. "What can anyone else to do me? I have lost my son and I have to put up with this garbage," Mrs Heath said.

The revelation comes just weeks after Premier Peter Beattie announced the Government would tender for a broker to manage its public hospital elective surgery waiting lists and a short time before the latest waiting list surgery data is released. It's also nine months since Mr Beattie claimed the state's health system had "turned a corner".

Mrs Heath, who received the letter four days before Christmas, said she was overcome by anger. She said it was ironic that as thousands of people wait for public surgery, Queensland Health booked a time for her dead son, who died at the Gold Coast's John Flynn Private Hospital last February.

A spokesman for Health Minister Stephen Robertson said Mr Trindall was due for his annual check-up with a urologist. But Mrs Heath said her son had private health insurance and although he received chemotherapy for his pancreatic cancer at the RBWH, all other procedures were done at private hospitals. "And besides, he had pancreatic cancer, he didn't have anything wrong (for which he would need to see a urologist), and he was already dead. There's no excuse," Mrs Heath said.

In a statement to The Courier-Mail, a Queensland Health spokeswoman said: "This is an extremely regrettable but unavoidable situation. "(The) RBWH was not notified of the patient's death (and) it is simply not possible to track all patients, including those treated in private facilities. "In this instance, Queensland Health had no way of knowing of the patient's death. "A letter of apology and an explanation will be sent to Mrs Heath."

Mrs Heath has accused the Government of incompetence and insensitivity and has asked her local Liberal MP Jan Stuckey to get some answers. Mrs Stuckey, a former nurse and wife of a GP, said the case highlighted how shambolic the public system still was. "She wants to know why Michael's name appeared on the waiting list when he had passed away 10 months prior," Mrs Stuckey said. "Mismanagement and incompetency of our public health system is both legendary and shameful. "Patients hope they live long enough to get on to the waiting list, and then it could easily be the wrong patient."

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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16 January, 2007

We've seen Arnold's health-care movie before

California Governor Arnold Schwarzenegger once extolled "the power of the market" in Milton Friedman's "Free to Choose" PBS series. So it's probably just as well that the late, great economist won't see the regulated mess that his admirer is proposing to make of California's health insurance market. As speaker of the state assembly Fabian Nunes remarked, "This is a plan assembly Democrats could have written."

In fact, they already have--in 2003, when Democrat Gray Davis was Governor. Candidate Schwarzenegger campaigned against that measure, which was less onerous than his own new proposal mandating that business provide health insurance to all employees. Arnold even helped to gather signatures for a 2004 state referendum in which voters overturned that bill. But now he's taking on a new political acting challenge, this time playing Gray Davis as apparently channeled through his chief of staff Susan Kennedy (who used to work for Mr. Davis).

Or perhaps the GOP Governor is trying to replicate the media hosannas that former Massachusetts Governor Mitt Romney garnered last year with his "universal" coverage law. As with the Romney plan, Governor Schwarzenegger builds his proposal around an "individual mandate" that would require people to buy health insurance or face penalties such as garnishment of wages. This compulsion is supposedly justified on grounds that treating "free riders" in emergency rooms is a significant driver of overall health costs. But studies have shown that the cost of this problem is less than 3% of overall health-care spending.

Far worse are Mr. Schwarzenegger's proposals for California's employment and insurance markets. The Governor is proposing that businesses with 10 or more employees be required to provide insurance, or else pay 4% of their taxable Social Security wages into a fund to subsidize insurance for the working uninsured. The likely reaction of many California businesses to this new and costly mandate: outsourcing to Nevada, or India.

Mr. Schwarzenegger goes far beyond the Romney plan in proposing to help pay for his scheme by taxing hospitals 4% and doctors 2% of their gross revenues. That's right, institutions operating at or near a loss would have to pay the tax. So California doctors could soon be spending more time with their accountants than with patients--assuming they can afford to keep their practices running at all.

Yes, we know, the Governor calls it a "fee" or "dividend," rather than a tax. This is no doubt because the California constitution requires that any new "tax" pass both houses of the legislature with two-thirds majorities. So call the elephant in the room a hippo and hope the public buys it. We trust this Hollywood action stunt will be tested in court, if not in another referendum.

Like all such political schemes, Mr. Schwarzenegger's plan also works at cross-purposes. It includes new subsidies to help the uninsured obtain coverage, but at the same time it would impose new coverage mandates that would make insurance a lot more expensive. Two rules in particular have all but ruined the market for individually owned coverage in every other state where they've been tried.

The first is called "guaranteed issue," which means insurers are required to write you a policy even if you wait until you're sick to ask for it. It is precisely this "guarantee" that many people use as an excuse to remain "uninsured." Why not buy a new car rather than health insurance when you're healthy if you know you can always buy insurance if you get cancer?

The second rule is "community rating," which means insurance premiums cannot vary based on age or health status. This is akin to telling auto insurers that they can't charge higher premiums to 18-year-old males with a history of speeding tickets than they do 45-year-old mothers. Both rules raise the cost of insurance for everyone.

This is all especially regrettable because California has had more market-friendly insurance regulations than most other large states. And this has meant lower insurance premiums. According to eHealthinsurance.com, a single 35-year-old man in Beverly Hills can buy decent coverage for as little as $69 a month. But Arnold's plan would move those rates in the direction of community-rated New York, where that same man would pay $416 for any coverage at all.

Like Mr. Romney before him, Mr. Schwarzenegger is playing on the political appeal of allegedly "universal" coverage. Mr. Romney hopes to ride it to the GOP Presidential nomination, and Arnold is basking in new media admiration. About the best we can say for their plans is that these state policy experiments will show other states what not to do. But they are also providing cover for the proponents of greater government control of health care. Right on cue, Hillary Rodham Clinton endorsed "universal" coverage this week too.

The better alternative, as Milton Friedman understood, is to expand tax-advantaged health savings accounts and to improve access and affordability by creating a national market for private health insurance. Consumers in California and Massachusetts, especially, are going to need that safety valve when the bill comes due for their Governors' attention-seeking but poorly considered plans.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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15 January, 2007

Future Prime Minister Gordon Brown can’t cure Britain's paralysed NHS, so he plans to privatise it

The former Granada boss Sir Gerry Robinson recently spent six months trying to reform Rotherham general hospital. The result was shown in three hours of fly-on-the-wall television on BBC2 last week. It was rightly put after the watershed: as politics it was certificate 18. At the end of each day Robinson could be seen slumped in the back of his car, his face buried in his hands. A tycoon sobbing in a limousine is the perfect icon of Labour’s health service.

So die all who try to reform the National Health Service. They have been doing so since a despairing Margaret Thatcher appointed Roy Griffiths, boss of Sainsbury’s, to the task in 1983. The NHS is the North-West Frontier of the public sector. If the health union Tajiks don’t get you, the Pashtun consultants will. You can throw as many men into the Khyber Pass as you like but they never return.

The one laugh in the programme was Robinson’s conclusion that the NHS was “unmanaged”. Yet each frame was crammed with managers falling over each other, with clipboards, pagers, consultancy reports and meeting agendas. There were nursing managers, surgical managers, recovery managers, manager managers, chief executive managers. The one thing they did not do was manage but that, of course, was not their fault.

Through this jungle wandered a charismatic megaspecies, the consultants, whom everyone agreed were “unmanageable”. They were like the weather, an immutable constant. It did not matter what the NHS or its patients wanted, the consultants ruled, which enabled everyone else to be equally obtuse. They seemed to regard their first duty as to the heraldic privileges of their specialist tribe, be it paediatrician, anaesthetist or ophthalmologist.

We watched the consultants, often in league with “health and safety”, blocking rationalisation of a system that had some of them doing three operations a morning and some seven. They demanded their own anaesthetists, who in turn demanded their own schedules. Surgeons wandered in and out of their private practices as waiting lists stretched over the horizon. NHS productivity would not improve because the fruit machine never yielded oranges in a row. There was always a lemon in the way — unless you were lucky enough to have Robinson and a television camera to move it.

The message of Robinson’s inquiry was devastating and explains the ostensibly terminal chaos enveloping the NHS under Patricia Hewitt. The central arm of government, the Treasury, has clearly given up on NHS reform. No government, Labour or Tory, has the guts to break the consultants’ restrictive practices, the GPs’ “lifestyle” demands or the healthcare unions. The Treasury itself capitulated to the unions by rubber-stamping the ridiculously expensive 2004 NHS pay deal, depriving Britons for the first time of proper out-of-hours GP cover.

After a quarter century of seeing money piling up in the upper echelons of the NHS, and being wasted on management consultants and useless computers, the paymasters have had enough. While Thatcher hoped for reform by shoving the private sector into the NHS, Gordon Brown is shoving the NHS into the private sector. If Rotherham hospital can do only half a dozen cataracts a session when it has capacity for 20 or 30, why not give the job to a bunch of South Africans in a caravan in the car park? Outsource routine operations. Switch a few regional general hospitals to accident and acute care and let the public drive to find them. Hence the decision to subcontract 40% of NHS operations to something called a “partners’ network” (Blairism for the private sector). We can hear a muffled cheer rising over the Thatcher home in Chester Square.

Treasury loss of faith in the corporate NHS has all but collapsed public investment in the hospital service, switching some £12 billion of it to private finance. This will be astronomically expensive, consuming reserves that would previously have gone on healthcare. The new Woolwich hospital must find £100m a year from its revenue budget and the Royal London and Barts £120m to service private loans forced on them by the Treasury in the fond belief that private money is more “efficient”.

More alarming is that internal pricing and payment-per-treatment will leave these mastodons financially exposed through loss of business to the private sector. In an attempt to favour this sector, the Treasury and Hewitt are refusing to allow NHS hospitals to cut tariffs to compete. Small wonder James Johnson, the British Medical Association chairman, parodied Blair’s 1997 battle cry, “24 hours to save the NHS” by saying there was now “one year to save the NHS”.

Many hospital trusts are building up large deficits that they cannot possibly cover; 29 are contemplating some 60 “reconfigurations”, code for closures, at a time when Hewitt is also talking of somehow building 50 cottage hospitals. She must also now contend with 11 of her ministerial colleagues declared to be in open opposition. Meanwhile manpower planning is in disarray, with hiring cuts or freezes almost everywhere and a reported surplus of 3,200 expensively trained NHS consultants by 2010.

How this has been achieved despite five years of 7% annual real rises in health spending is no mystery. A lethal coalition of medical staff and private financiers is walking away with the money. Few demoralised managers will bother to imitate Robinson’s efforts at Rotherham when the lead from Whitehall is to capitulate. Since many trusts are supposedly free-standing — which means bankruptable — it is possible that swathes of the NHS will end the decade in the notional ownership of City banks. Yet even this, for Brown, is preferable to the existing NHS.

The Robinson programme showed what amounted to the collapse of the “public service ethos” in Britain. The government would ideally like to privatise not just the bulk of the NHS but the Post Office, the probation service, the jobcentre network and, it was reported last week, most care of the elderly.

It has clearly lost confidence in the capacity of public officials to administer services (as opposed to regulate and form policy in Whitehall). That this should be the work of a Labour government is ironic since the purpose is to circumvent those classic legacies of socialism: trade unions and the risk aversion of large organisations.

Nothing better illustrates this than the shambles at the Home Office where privatisation is of limited application. Its capacity to administer a service, be it immigration, drug treatment or prisons, has all but failed. Its boss, John Reid, has rewritten the rulebook of corporate accountability. He will take no collective responsibility for the actions of his forebears as home secretary, though he sat in the same cabinet as them. Nor will he take blame for any decision if he can prove he was “not told about it”. Bang goes the theory of corporate negligence.

The catalogue of Whitehall organisations no longer fit for purpose is lengthening by the week. It embraces the farm payments agency, the child support agency, the immigration service and the criminal assets recovery agency.

In the old days such fiascos would have led to parliamentary uproar and heads rolling. Nowadays they are part of the tragic Whitehall soap opera, cause for rejoicing only among civil servants leaving to join management consultancies and parastatals such as Capita and Serco.

It is hard to imagine what morale must be like among officials in the Home Office or health department. Perhaps the public service ethos is out of date, irretrievably polluted by trade unionism and bureaucratic protectionism. Perhaps it is true that only the hope of personal gain will induce Britons to help their fellow men and women.

Source



Australia: A government aged-care hospital at work

Melbourne is at the moment in the middle of one of their notoriously hot summers. But no airconditioning or other coooling for you if you are old and poor and sick there

Airconditioning, lights and radios have been switched off and windows locked with curtains drawn to slash power use at Melbourne's biggest rehab and aged-care hospital. The bans at the 400-resident Kingston Centre were introduced on January 4, as the outside temperature rose to 39C [102 degrees F], a Sunday Herald Sun investigation has revealed.

Kettles, toasters and microwaves also have been unplugged at the sprawling, dilapidated century-old Cheltenham hospital while patients and elderly residents sweltered in the dark. And tougher restrictions -- yet to be triggered under the power-saving regimen -- will see all non-clinical computers switched off, laundry and machinery operation scaled back, out-patients' service closed and at-risk residents sent home or to other facilities. A plan to replace hot meals with sandwiches has been mooted, prompting fears that patients who have difficulty swallowing could be at risk of choking. Staff have told how they found it difficult to find door locks with their keys in the darkness. And patients reportedly stumbled and almost fell in the gloom.

The draconian regimen was exposed after the Sunday Herald Sun saw a directive from centre bosses to department and ward managers, which was sent on January 4, ordering "Stage 1" actions. The directive read: "All managers, please note we are currently at 80 per cent usage of power on site due to the hot weather . . . " Southern Health spokesman Kim Minett confirmed restrictions, but said there were limits to how much electricity use the old building could cope with

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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14 January, 2007

Health Care Expert Condemns New Liberal Report on Medicare Drug Prices

Research used in a new report by the left-of-center group Families USA, apparently meant to bolster House Speaker Nancy Pelosi's effort to give government employees the power to "negotiate" drug prices under Medicare Part D, is being called deceptive by a health care expert from the National Center for Public Policy Research. "The Families USA report proves the wisdom behind Mark Twain's quip 'There are lies, damned lies and statistics,'" said National Center senior policy analyst David Hogberg, Ph.D.

Families USA's "No Bargain: Medicare Drug Plans Deliver High Prices" purports to compare the drug prices paid by the insurance plans that administer Medicare Part D to those paid by the Veteran's Administration. It claims that drug prices paid under Medicare Part D are much higher than those paid by the VA, in some cases, over 1,000 percent higher.

However, says Hogberg, the report draws its Medicare drug price data from nonrepresentative sources. As an example of the flawed nature of the Families USA report, Hogberg notes that the Medicare drug price data used in the report to compare Medicare drug costs to the VA's drug costs come from only two counties - Montgomery County, Maryland and Hamilton County, Ohio. Based on median household income, both counties are above the national average. Montgomery County, for instance, is the fourth-richest county in the nation. Since wealthier areas, on average, tend to pay higher prices, Families USA's use of these counties as the source of their sample data all but guarantees that the Medicare drug prices data in their study will be exaggeratedly high.

"I call that cooking the data, pure and simple," Hogberg said. "You also have to dig deep into the Families USA study to learn the VA doesn't 'negotiate' drug prices. The VA pays only 76 percent of the nonfederal average manufacturer price of a drug. That's not a 'negotiation,' that's a price control. So, Families USA has skewed its results by using Medicare data only from wealthy counties and comparing it to prices obtained nationally by the VA, which was imposing price controls." "I trust that sensible members of Congress and the media will dismiss this study for the nonsense that it is," Hogberg said.

In conclusion, Hogberg added, "In 2003, President George W. Bush signed into law a pre ion drug program for Medicare, known now as Medicare Part D, that is administered by private drug companies. It bans Medicare from 'negotiating' directly with pharmaceutical companies. Proponents of government-run health care have long sought to remove this prohibition, but supporters of the ban believe that such 'negotiations' are akin to imposing government price controls, which all-but-inevitably lead to rationing, shortages, and a decline in health care quality."

Source



DANISH HEALTHCARE

"It is entirely possible to have a large welfare state, with generous benefits, without choking the economy," says Jonathan Cohn of the New Republic in a new series of articles, glorifying the Danish economic model.....

Finally, there are the "generous" non-cash social benefits of the Danish welfare state to consider, primarily the health care system, which all Danes can use free of charge. "Danish health care is no worse than the US version," Cohn states, "Yet we Americans pay far more for our system, because it's riddled with inefficiencies as insurance companies compete with one another to enroll healthy beneficiaries, rather than finance good care."

In fact, US healthcare is better than the Danish version, exactly because Americans spend more on healthcare than the Danes. As in most government-run healthcare systems, Danish patients face significant waiting times for many types of treatment that Americans can get immediately. The United States is also ahead of Denmark when it comes to employing modern technology. For instance, America has 62.1 DTX scanners (for osteoporosis) per 1 million people compared to 8.0 in Denmark. The ratio for MRI scanners is 27 to 10 in America's favor, and the ratio for CT scanners is 32 to 14.6, again in America's favor.

Furthermore, Americans have better access to many preventive drugs than Danes, who often have difficulties getting pre ions until they show serious medical complications. Competition between insurance companies is exactly what causes this American superiority in access to drugs. Since the insurance companies work for profit, they have an interest in minimizing expenditures for hospitalizations and expensive treatment by encouraging their beneficiaries to stay healthy through preventive drugs and a healthy lifestyle. By contrast, the Danish health system is governed by narrow-minded bureaucratic interests that jealously guard their individual budgets and slow down the strategic shift from treatment to prevention that has taken place in the United States.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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13 January, 2007

NHS CLUELESS ABOUT SUPERBUGS

And all this is after a huge increase in funding

The NHS will miss its target of halving superbug infections by 2008 and may never be able to control the problem effectively, the Government has admitted secretly. A leaked Department of Health memo has revealed that officials believe that government pledges to cut cases of MRSA substantially are not achievable, while the even more deadly Clostridium difficile is now "endemic throughout the health service".

More embarrassing still, much of the memo is devoted to "spinning" the failure to meet the targets so as to minimise its public impact. The memo was sent last October by Liz Woodeson, director of health protection at the Department of Health, to ministers. Politicians and health campaigners said that it deepened the sense that ministers and department officials were more interested in spin than substance.

The memo, leaked to Health Service Journal, states that the target to cut cases of the superbug methicillin-resistant Staphylococcus aureus (MRSA) by 50 per cent by April 2008, set by the former health secretary John Reid in November 2004, is unlikely to be met. There were more than 7,000 cases of MRSA in patients' blood-streams recorded in 2004, since when the number has dropped only slightly. "Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable," the memo said. "The opinion of infection experts is that we will succeed in reducing MRSA bloodstream infections by a third rather than half - and that, even if we had a longer period of time, it may not be possible to get it down to half." The memo adds that C. diff is now endemic throughout the health service, and poses an even greater threat to patient health. It gives warning that it is harder to tackle than MRSA, and that some techniques used to cut MRSA, such as alcohol rubs, do not work for C. diff.

The leaked memo sets out six ways of handling the failure to meet the MRSA target, including driving at the target as it is and face the consequences (a policy favoured by Downing Street), extending the target or accepting that it is unworkable and dropping it completely. Another tactic suggested is to enlarge the target to include C. diff, or even all hospital-acquired infections without specifying which ones.

Ms Woodeson admits in the memo that the battle to combat MRSA "doesn't seem to be having much impact on C. difficile, which is a far bigger problem". The note quotes figures from 2004 showing that while MRSA caused 360 deaths, C. diff was responsible for an estimated 1,300.

A Department of Health spokesman said of the memo: "We deplore this leak. This paper confirms that from the Prime Minister and Health Secretary downwards, the Government is determined that the NHS should get on top of the problem of MRSA and other infections." He admitted that progress had been slower than anticipated and that faster progress is needed to meet the target. "We have always said the target is challenging; that is why we set it. We remain committed to this target."

The memo is the second damaging leak to the HSJ from the department in successive weeks, suggesting that there are disgruntled civil servants prepared to risk their jobs to reveal what is going on. Andrew Lansley, the Shadow Health Secretary, said: "The Government needs to get a grip. Gordon Brown's target culture has increased costs with little improvement in care."

[And now for examples of the famous British "fudge"]

Six ways to fudge a target

* Keep it as it is, and drive as hard as we can to meet it - the policy favoured by the No 10 Delivery Unit. But Liz Woodeson, director of health protection at the Department of Health, admits: "We will be criticised if we fail to meet the target"

* Drop the target altogether, but this would be hard to get past No 10, and handling would be "extremely tricky" given media interest. "Dropping the target would probably provoke more criticism than failing to meet it in 2008," she says

* Extend the target to 2009. That would give more time, but would be open to charges of fiddling, and it may still be missed "because a certain level of MRSA infection is unavoidable"

* Extend the target, adding something on C. diff. That would be welcomed by people and might make hospitals take C. diff seriously, "as we suspect some simply see it as unavoidable". But there are many other hospital-acquired infections. It would be absurd to set a target for each, she said

* Change the target to hospital-acquired infections generally. That could not be done as mandatory reporting covers only five infections and there are "dozens of others"

* Switch to locally set targets. That would have the advantage of including C. diff, but "would be presented by the media as a cop-out because we knew we weren't going to hit the national target"

Source



NHS: NON-PAYING HEALTH TOURISTS SQUEEZE OUT BRITS WHO HAVE PAID FOR THEIR CARE

Health tourists are receiving free National Health Service kidney treatment worth about 30,000 a year, and potentially competing with British patients for scarce transplants, according to new data. The information, released under the Freedom of Information Act, shows that one hospital is spending up to a million pounds a year on dialysis for nearly 40 non-British residents; another has placed two asylum seekers on its waiting list for transplants and a third has recovered only 2% of its costs from overseas patients.

Doctors and patient groups say the NHS is struggling to provide kidney dialysis for British patients and is ill-equipped to cope with the extra demand. They warned of an acute moral dilemma as doctors balance their overriding responsibility to help those in greatest need with the fact that the patient may not be legally entitled to treatment.

There are fears some foreign patients, so-called "health tourists", may travel to Britain to take advantage of free NHS care. Dr Jonathan Kwan, head of renal services at Epsom and St Helier hospitals trust in Surrey, said: "Non-UK residents are putting pressure on the system, which is already under too much pressure." Kwan said British patients risked losing out to those from overseas who needed treatment more urgently. "Patients waiting for dialysis may be displaced by a clinically urgent case. Doctors try to prioritise the urgent cases irrespective of residency status."

There are a record 6,000 patients on the kidney transplant waiting list, with about 400 dying each year in Britain before an organ becomes available. Patient groups say some British sufferers are forced by a lack of dialysis machines to receive treatment at night. While most health tourists seek one-off operations, patients suffering from kidney failure require dialysis three times a week for life unless given a transplant.

According to the figures, Barts and The London NHS Trust, which covers two of the largest hospitals in the capital, is providing 37 non-UK residents and an extra 14 asylum seekers with dialysis. Two asylum seekers are on the kidney transplant waiting list at the Royal Berkshire NHS Foundation Trust in Reading.

Although trusts may try to invoice non-UK residents for treatment, they usually recover only a fraction of the cost. Asylum seekers are entitled to free treatment while their case is being considered. In the last financial year St George's hospital in south London spent about 100,000 on dialysis for overseas patients but has recovered only 2,100.

Timothy Statham, chief executive of The National Kidney Federation, said: "Capacity is at breaking point," he said. "We have very ill British patients needing to dialyse through the night because there is not sufficient capacity. Some patients may come from abroad because dialysis was not available in their country. We seem to be offering a world health service."

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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12 January, 2007

Gov. Schwarzenegger writes a pre ion for disaster

On Monday, Arnold Schwarzenegger presented his proposal for reducing the number of Californians who lack health insurance. His proposal is almost indistinguishable--except in details--from that of the Democrats who dominate the California Assembly and Senate.

The Democrats tend to favor solutions involving regulations, government spending and taxes, and Senate President Pro Tem Don Perata's proposal--the main contending Democrat plan--hits the trifecta. It would require employers to provide health insurance; give them the option of paying a tax instead of providing health insurance; and increase spending by expanding both the Medi-Cal and Healthy Families programs, which provide care to low-income children--including children of illegal immigrants and the disabled.

Mr. Schwarzenegger's solution hits the trifecta also. He would require employers with 10 or more workers to provide health insurance or pay a 4% tax on all wages covered by Social Security: Look for employers with 10 to 12 employees to get creative about outsourcing. And look as well, as Harvard economist Jonathan Gruber has documented, for wages to fall in firms that offer health insurance because of the mandate. Gov. Schwarzenegger would throw in a 2% tax on doctors and a 4% tax on hospitals to help fund Medi-Cal, California's name for Medicaid. And he would expand Medi-Cal to adults earning as much as 100% above the poverty line and to children, even those here illegally, in poor and middle-income families. He hopes, by doing this, to shift $5 billion of Medi-Cal's annual cost to the federal government.

There are two problems with such solutions. First, they infringe on economic freedom, preventing, in Robert Nozick's phrase, "capitalist acts between consenting adults." Second, government solutions rarely work.

Why doesn't increased government power tend to solve the problem of the uninsured? There are two main reasons. First, when government provides health insurance, many people who take advantage of it drop their own privately provided health insurance. In a 1996 article in the Quarterly Journal of Economics, Harvard economists David M. Cutler and Jonathan Gruber found a 50% "crowding-out effect." As the federal Medicaid program expanded, for every two people who gained insurance through Medicaid, one dropped private health insurance. Although this is a net addition of one, the costs to taxpayers are much higher than expected because now half of the newly covered, instead of paying their own way as they previously did, become wards of the state.

Second, of the 46 million or so people without health insurance at any given time, about 45% will have health insurance within four months. This is one of the main findings of a 2003 study by the Congressional Budget Office, "How Many People Lack Health Insurance and for How Long?" That shouldn't be surprising in a country where most private health insurance is employer-provided and most unemployment spells last 11 weeks or less. Solutions that involve government mandates on employers or employees will, therefore, miss connecting with about half of the people who are uninsured at a given point in time.

But what if the governor could solve some of the problem by making health insurance cheaper? He can--not by regulating more, but by deregulating. Let me explain. In the last few decades, state governments, the main regulators of health insurance in the individual and small-group markets, have mandated coverages for many kinds of health care. According to the Council for Affordable Health Insurance (CAHI), a pro-market association of insurance carriers, there were 1,843 state mandates in 2006. Among the most common, and most expensive, mandates are chiropractic care, treatment for alcoholism and drug abuse, and mental health benefits. California's government mandates coverage for all of the above, as well as for many other benefits, including, for example, infertility treatment--a very expensive benefit.

Abolishing these mandates would allow people who don't want to be covered for these things to buy cheaper insurance, while still allowing those who want them to buy and pay for them. Would such an approach work? That's like asking whether, if the government currently required new cars to have CD players, eliminating that requirement would lower the price of a car. Of course it would work.

It is important, though, not to overstate its benefits. The gain to Californians from abolishing these mandates would not be huge. CAHI compiled data from America's Health Insurance plan and eHealthInsurance for the individual market and from the federal government for the small-group market and found that in 2003, although California had more mandated coverages than all but six other states, it had among the lowest insurance rates for individual health insurance policies ($1,885 versus a top rate of $6,048 for New Jersey.)

The reason, explains CAHI, is that in other ways California is much less regulatory than many other states. It does not, for example, require guaranteed issue on individual policies--which drives up premiums by forcing insurance companies to supply policies to all comers, regardless of health status. Yet the governor's proposal would reverse this somewhat and prevent insurance companies from saying no because of age and health.

California should not, contra Gov. Schwarzenegger, do new regulatory harm; rather it should repeal existing regulations that cause harm--so as to make health insurance even more affordable.

There is one other way to deregulate: The California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.

If a version of Gov. Schwarzenegger's plan passes, the only thing certain is that there will be more regulation, more government spending and more taxes. A better path would be to deregulate, and thus achieve some increase in the number of insured--without new spending or taxes or regulation

Source



EU FORCES BRITISH AMBULANCES TO WAIT FOR TEA

Ambulance crews in Brighouse could be forced to finish their tea breaks before turning out on an emergency call thanks to new EU rules. Staff working at ambulance stations in West Yorkshire are among those who will be affected by the changes which staff have described as 'madness'.

If paramedics receive a call to a road traffic accident or someone taken ill at their home the new rules mean they are officially supposed to complete their meal break before responding to the emergency call. Paramedics in other parts of the country where the new ruling has been adopted have warned lives will be lost.

In some parts of the country ambulance services have opted out of the European Working Time Directive that enforces breaks. If a major accident happened outside an ambulance station and staff were on the first part of their meal break it would technically mean they could not be asked to help.

Operations director for Yorkshire Ambulance Service, John Darley, said a letter was sent out to all front line staff at the beginning of December informing them of changes to rotas and meal breaks. 'These changes are aimed at unifying the staff in North, East, South and West Yorkshire who joined together on July 1, 2006 when Yorkshire Ambulance Service - YAS was formed. 'Only West and South Yorkshire staff will be affected by the rota or meal break changes - with a protected meal break being introduced for the first time in West Yorkshire. Staff in North and East Yorkshire will continue with their current rota and meal break arrangements,' he said.

But John Durkin, GMB branch secretary for YAS, said the aim of the ambulance service was to save lives and he felt professionalism would outweigh the new ruling. 'Brighouse is very fortunate to have professional staff whose main aim is to help people,' said Mr Durkin. He said the meal break issue was among other changes currently being discussed.

Just days before Christmas hundreds of ambulance workers were warned of possible redundancies in the Yorkshire area. Around 400 staff working for YAS were told of changes that were being made to ensure a more efficient service. But Mr Durkin said the changes would have a knock on effect on patient care. He criticised the service for its 'insensitive' handling of the situation which he said had been done without any consultation. 'The staff who are affected back up the front line workers. It will affect patient care,' 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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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11 January, 2007

Rx For Your Health

Post lifted from Democracy Project

Most directly put, would your personal and financial health and that of your relatives be better directed by yourself or by government bureaucrats? The new Democrat congressional majority is determined to wrest control of your pre ion choices away from you, and in the process place taxpayers even deeper in debt.

One of the first orders of business for them will be to undermine the successful free-enterprise foundation under the Medicare Part D pre ion drug program. Despite its enrollment, coverage and cost successes - and, indeed, because it thereby challenges so many existing government-run programs by being for the most part privately managed - the highest priority for congressional Democrats is to destroy it.

If you care at all, you must read this short and straight-forward publication prepared by a consortium of leading experts from leading think tanks: "The Facts: Medicare Part D and Pre ion Drug Prices.

This joint fact sheet was jointly prepared by health policy experts from the American Enterprise Institute, the Center for Medicine in the Public Interest, the Galen Institute, The Heritage Foundation, the Institute for Policy Innovation, the Institute for Research on the Economics of Taxation, the National Center for Policy Analysis, and the Pacific Research Institute."

THEN, please send a copy to your congressperson and senator, and ask them to read it. You can easily access their email address at this site. All you need to do is enter your zip code. Then let your fingers do the talking to your representatives



Friedrich Hayek on universal health care

As the 110th Congress prepares to convene and the run for the '08 presidential nominations begins in earnest, we're seeing far more appeals from the left, both from politicians, bloggers and opinion makers to address the supposed "health care problem".

The appeals range from governmentally run universal health care to single-payer (again government) health insurance. The reasons given are also varied from the emotional "for the children" rhetoric favored by some to the technical "it would be more efficient and less costly" sobriquet.

Reading through Friedrich Hayek's monumental "The Constitution of Liberty" again over the holidays, I revisited his discussion of the topic. And, willing to risk boring you out of you skull I thought I'd share it with you. Fair warning: Long post follows.

One of the most important thoughts he has on the subject gets to the crux of designing a system which would supposedly provide equal care to all. Health care cannot really be quantified and thereby presents peculiar problems which must be understood:

"They result from the fact that the problem of "need" cannot be treated as though it were the same for all who satisfy certain ive criteria, such as age: each case of need raises problems of urgency and importance which have to be balanced against the cost of meeting it, problems which must be decided either by the individual or for him by somebody else."

And therein lies the great dilemma and the greatest threat to liberty. Because in a state run scheme it is the latter which will, indeed must, prevail. He approaches the topic of health insurance and "free health care" by saying:

"But there are strong arguments against a single scheme of state insurance; and there seems to be an overwhelming case against free health service for all. From what we have seen of such schemes, it is probable that their inexpediency will become evident in the countries that have adopted them, although political circumstances make it unlikely that they can ever be abandoned, not that they have been adopted. One of the strongest arguments against them is, indeed, that their introduction is the kind of politically irrevocable measure that will have to be continued, whether it proves a mistake or not."

That line is one of the most important points about this entire debate and one of the major reasons that many, especially among libertarians and fiscal and small government conservatives, resist the implementation of such a plan. Witness Medicare, Medicaid and Social Security. Once it is in place there is no turning back even if it is an outrageous mistake. Fine, you say, but other than resisting it, to this point, because it may turn into an expensive and inefficient debacle, what can you offer to at least lend credence to an argument against such a system? Fair question. And for that, I offer Hayek's argument, an argument that is well reasoned, not emotional, and provides some unique insights. He begins his critique by pointing out that the case for free health service is based on two fundamental misconceptions:

"They are, first, the belief that medical needs are usually of an ively ascertainable character and as such that they can and ought to be fully met in every case without regard to economic considerations, and, second, that this is economically possible because an improved medical service normally results in a restoration of economic effectiveness or earning power and so pays for itself."

But, as he argues, both miss the mark because they mistake the nature of the problem involved in decisions concerning "the preservation of health and life":

"There is no ive standard for judging how much care and effort are required in a particular case; also, as medicine advances, it becomes more and more clear that there is no limit to the amount that might profitably be spent in order to do all that is ively possible."

Now make sure you're clear on his point here. He's not claiming it is profitable (or rational) to spend what is necessary to do all that is ively possible. He's arguing that if you agree that even marginal improvement, no matter how small, is "good" ("no ive standard") then there is no limit as to how much you can spend for marginal improvement. Without an ive standard for making judgments as to how much care and effort are enough care and effort, the want is infinite. He continues:

"Moreover, it is also not true that, in our individual valuation, all that might yet be done to secure health and life has absolute priority over other needs. As in all other decisions in which we have to deal not with certainties but with probabilities and chances. We constantly take risks and decide on the basis of economic considerations whether a particular precaution is worthwhile, i.e., by balancing the risk against other needs. Even the richest man will normally not do all that medical knowledge makes possible to preserve his health, perhaps because other concerns compete for his time and energy. Somebody must always decide whether an additional effort and additional outlay of resources are called for. The real issue is whether the individual concerned is to have a say and be able, by an additional sacrifice, to get more attention or whether this decision is to be made for him by somebody else. Though we all dislike the fact that we have to balance immaterial values like health and life against material advantages and wish that the choice were unnecessary, we all do have to make the choice because of facts we cannot alter."

The fundamental issue he confronts here is the right of individual choice and the attack on that right which programs such as "free health care" pose. In essence individual choice is, at some point, overruled by collective choice. As Hayek implies in his discussion of " ive standards" and the real lack of them in judgments of how much care and effort are required in a particular case, those sorts of standards must be part and parcel to any "free health service". Infinite need/want meets finite fiscal and physical resources in such a system, and consequently some method of defining the limits of "health care" within those fiscal and physical constraints must, of necessity, be made. Individual choice then is reduced to those standards and the freedom to pursue "additional sacrifice" in terms of spending more on your health is removed from your array of choices. Even when such " ive determinably standards" are outlined, they prove not to be well considered or, as Hayek says, have any "relation to reality:"

The conception that there is a an ively determinable standard of medical services which can and ought to be provided for all, a conception which underlies the Beveridge scheme and the whole British National Health Service, has no relation to reality. In a field that is undergoing as rapid change as medicine is today, it can, at most, be the bad average standard of service that can be provided equally for all.. But since in every progressive field what is ively possible to provide for all depends on what has already been provided for some, the effect of making it too expensive foremost to get better than average service, must, before long, be that this average will be lower than it otherwise would be."

Why the US continues to be the gold-standard for the most progressive and best medical care available instead of the British National Health Service is to be found in that paragraph. When their health is involved, people will rarely, if ever, chose the "bad average standard of service" over one which provides them the opportunity to access the best and most progressive. Health care, as provided by any universal scheme can, at best, only offer that "bad average standard of service".

Much 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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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10 January, 2007

NHS STARVES OLD LADY TO DEATH

An elderly stroke victim begged for a beetroot sandwich and macaroni cheese in hospital but no attempt was made to feed her, an inquest was told yesterday. Olive Nockels, 91, a former school matron, died after surviving for nearly a month on a subcutaneous drip that delivered only a quarter of the calorie intake specified by the World Health Organisation (WHO) as a short-term starvation diet. Even that was stopped for four days when the hospital claimed that she was suffering from excess fluid.

Relatives told the inquest that doctors and the Norfolk & Norwich Hospital had no interest in treating Mrs Nockels after she was admitted in September 2003. Her grandson, Christopher West, told William Armstrong, the Coroner, at the inquest in Norwich: "The only thing that was said most of the time, as the weeks went on, was that she hadn't died yet. "Immediately after her admission it became clear it was their intention not to treat her."

Mr West, 34, obtained a High Court ex parte injunction on October 6, 2003, forcing doctors to reinstate artificial nutrition and hydration, but the next day Mr Justice Forbes varied the order on an application by David Maisey, a consultant. In the amended version, nutrition and hydration were to be reinstated only "as far as medically possible".

Mrs Nockels died on October 10, 2003 - three days after the amendments were made. Mr West said that doctors told him that the quality of life of his grandmother would be so poor that "it would be in her best interests not to intervene and let her die". He said: "You don't just let someone die because you think it's best for them. It's inhuman. I would class it as starvation, actually."

Mrs Nockels's daughter, Ivy West, told the coroner that her mother's hearing aid and dentures had been removed - for reasons given to her as comfort and safety. She denied that her mother, from Holt, Norfolk, was incapable of responding when she visited. "I talked to her every day," she said. "She would tell me she was cold and that she wanted something to eat. She told me she wanted a beetroot sandwich and some macaroni cheese. She could make decisions for herself."

Michael Heath, a consultant pathologist who carried out a post-mortem examination, gave the cause of death as a stroke. Questioned by James Dingemans, QC, counsel for Mrs West, he agreed that the lack of fluids was also a possible cause of death. Brian Payne, a retired consultant geriatrician, said that he had been asked by Dr Maisey to give a second opinion, and examined Mrs Nockels on September 30, 2003. He said that she gave no response to questions that he asked about her having a stomach feeding tube fitted, nor to whether she wished or was ready to die. He felt that it was "highly probable" that she would die.

Between September 14 and September 30, Mrs Nockels had received a daily intake of 140 calories from a subcutaneous infusion consisting of five per cent dextrose - a quarter of the 600 calories adequate for short-term starvation according to the WHO. From October 2 to 6 all artificial hydration of fluids was withdrawn. The hospital says that it twice sought to give Mrs Nockels a nasal gastro tube but this had been impossible to insert.

Dr Payne was asked by Mr Dingemans: "If someone says, `I would like a beetroot sandwich', does it help you decide on whether they need nutrition?" Dr Payne replied: "It probably means they are hungry." If a patient has lost the swallowing reflex as the result of a stroke he or she is in danger of aspirating, and so at risk of pneumonia, 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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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9 January, 2007

News media misreport health survey

If you saw ABC News or USA Today during the week of October 16, 2006, you probably got the impression Americans want government health care and oppose health savings accounts (HSAs). But data from the survey the news was reporting do not support those claims.

According to the ABC News/Kaiser Family Foundation/USA Today Health Care in America 2006 Survey, 44 percent of respondents were satisfied with the quality of health care in the country, but just 18 percent were satisfied with its cost.

However, 89 percent were satisfied with their own health care quality and 57 percent with their personal costs. Losing insurance is a concern for 56 percent of respondents with private care, and 60 percent of those with any form of health coverage worried about their ability to afford insurance over the next few years.

The three organizations jointly developed the questionnaire for the nationally representative survey of 1,201 adults, conducted by TNS of Horsham, Pennsylvania between September 7 and September 12, 2006. The survey had a margin of error for the total sample of plus or minus three percentage points.

Misleading Reports

Despite the increasing popularity of HSAs--more than 3 million are now open--and the amount of scholarly research dedicated to them, the survey all but ignored them.

The poll focused primarily on how people feel about the nation's health care situation, whether they are satisfied with their own coverage, who's to blame for high costs, and what they consider effective remedies. "We didn't ask specifically about HSAs on this survey," said Mollyann Brodie, Kaiser Family Foundation's vice president and director of public opinion and media research, "But what the survey does show is that people don't like the idea of bearing their own [financial] risk in their health care."

Brodie's simple message, however, did not get through to the ABC News reporters. An October 16 story on the ABC News Web site stated: "Making more consumers more aware of the cost of care is a motivating force behind proposals such as 'health savings accounts.' This poll finds that two-thirds oppose the idea, including as many conservatives as liberals, and six in 10 Republicans along with 73 percent of Democrats."

ABC then mentioned some of the benefits that define HSAs, but which were not asked about in the survey questionnaire: tax breaks, lower premiums, and the ability to roll unspent funds over from year to year and job to job. "Still," ABC reported, "the risk associated with these arrangements appears to be a significant hurdle for consumer-driven health plans to overcome."

Skewed Question

"The KFF survey question on HSAs is designed to get a negative response," said Greg Scandlen, president and CEO of Consumers for Health Care Choices, a membership group based in Maryland. "It is awkward, complicated, and is an inaccurate de ion of HSAs. There is no mention that HSA funds are tax-free, or that they can roll over and build up over time, or that they always belong to the consumer." Despite this, 79 percent of respondents said allowing consumers to shop around would be an effective way to control health care costs--more than the 62 percent who thought government regulations or the current system would be effective.

'Universal' Health Care

Although two-thirds of respondents said providing health care for all Americans is more important than holding down taxes, support slipped to 56 percent when a choice between the current employer-based system and a government-run universal health insurance program was presented, even without asking about a consumer-based system.

Support for universal government-provided coverage fell further when the survey suggested the possibility of higher costs or taxes (35 percent), waiting lists (33 percent), limited choice of doctors (28 percent), or loss of coverage for some treatments (18 percent). ABC News' coverage did not call any of these a "significant hurdle" for supporters of universal coverage to overcome.

But trying to set policy based on surveys is a problem in itself. "In most survey research, people agree on the goals for public policy, but not the methods," Brodie explained. "Each individual item may get a majority on its own, but when you try to force a choice, you often end up splitting the group roughly evenly--halves, thirds, quarters--based on the number of choices available."

Limited Advantages Seen

A larger hurdle that supporters of universal coverage face is the limited advantage respondents expected from it. "People don't necessarily see benefits of universal coverage for themselves and their family personally," Brodie said. Roughly half of the survey's respondents expected no change in cost, quality, availability, or choice of doctors under a government-run universal health care system, but 30 percent expected their family's quality of care to worsen, 31 percent thought they would have less health care available, and 36 percent thought they would lose their choice of doctors. Respondents split evenly on whether government-run universal health care would lessen the cost of care--26 percent thought it would, 26 percent disagreed.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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8 January, 2007

Some Truths About "Single Payer"

Post lifted from David Frum

From the horse's mouth: Tom Campbell had the experience of actually trying to run a "single-payer" system. As deputy minister of health in the province of Ontario (a civil service not a political position), Campbell had absolute operational control of the healthcare services available to nearly 10 million people. He decided what doctors would be paid, what procedures would be made available, where hospitals could be built and where they must be shut. And here is what he had to say about his experience as a healthcare sultan:

"[O]ur system could be much better. It lags behind the best international standards in waiting times and availability of new technology and drugs. Our medical staff are overworked and stressed. We seem to lurch from crisis to crisis with constant government attempts at micromanagement, punctuated with cutbacks and bailouts.

It is time for a different approach: less government, not more. Our current problems are caused by the failure of a rigid, centralized control system that inevitably follows from single-source funding. In the absence of economic user fees, paid directly to service providers, central funding leads to shortages and rationing as a means of cost control. We see the results in unacceptable waiting times and lack of adequate services. The current shortage of trained medical staff is the result of botched government decisions in the name of cost control. As a result, a significant number of people do not have a family doctor.

The way we fund health care rules out any market forces or signals that might improve efficiency. We provide free coverage for minor services to all, including the most affluent, so we don't have enough funds for timely cancer treatments and catastrophic drug plans. This creates the ultimate two-tier system where the more affluent can pay for drugs and travel to the United States, while those of more modest means are denied service.

Campbell has written a detailed paper proposed solutions to these problems, and any congressperson who is contemplating a government monopoly for the United States would be well advised to read it. (I'll append some highlights below.) Better yet: invite Campbell down to testify to Congress before experimenting with any "reforms" that would further reduce competition, choice, and accountability in a US system that already suffers from too little of these basics of rational decision-making, not too much. Here is what we should do.

1. Freeze existing levels of funding as a percentage of G.D.P. Take distribution out of the hands of politicians and put it in the hands of an independent, arms-length health commission overseen by a non-partisan board of outstanding citizens.

2. Create new funding through reasonable patient cost-sharing directly at the point of service rather than indirectly through taxes and government. Make patients responsible for the first dollar costs up to the average per-capita system cost. Through tax credits, set the maximum net cost for those in the highest tax bracket at $2,500 per annum, with provision for inflation. This would taper to zero for those with incomes under $25,000. Children under age 18 and students would be exempt.

3. Give service providers a share of the new money collected at point of service, as an incentive. Now hospitals have no incentive to service more patients and every incentive to ration them through long wait times. All services would become significant revenue generators, bringing about a different way of thinking about the way hospitals are run. There would now be a powerful incentive to provide more and timely service rather than to ration it.

4. Deregulate enrolments and fees in all medical training schools so they can accept all qualified candidates. One of the scandals of our time is the way that our health system has come to depend on draining trained medical people from poorer countries with more severe shortages than us. This is unethical and should stop. Government control has brought about continuing staff shortages in almost all health disciplines, while large numbers of our qualified young people have been denied career opportunities because of restrictive enrolments in our medical training institutions.

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Under this plan, the government would have a reduced but still important role. It would get out of day-to-day micromanagement of the system. Its role would be to establish the necessary legislative and tax framework on the advice of the independent health commission. Within this framework, a decentralized, democratic and all-inclusive health system could flourish.

Australia: Another unused government medical facility

A private business that acted like this would quickly go broke

An operating theatre in one of Queensland's busiest hospitals sits idle four years after being built, while waiting lists for surgery grow. The purpose-built "E1" theatre has never been used since the new Princess Alexandra Hospital in Brisbane was rebuilt in 2002.

The State Government is considering a bid from the Australian Medical Association Queensland to set up a brokerage system to cut waiting lists by arranging for patients to have publicly-funded surgery at private hospitals. Meanwhile, the operating theatre on the fourth floor of the hospital in Woolloongabba continues to gather dust.

After being contacted by The Sunday Mail, a Princess Alexandra spokesman said the "E1" operating theatre would be brought into use next month. But Opposition health spokesman John-Paul Langbroek said it was "a travesty" that it had taken so long to begin operations in the theatre while thousands of people were on waiting lists. "It seems to be a recurring theme with certain areas within Queensland Health that there's inefficient use of expensive resources," he said. "This is a classic example. There are people writing to my office and contacting me - people whose parents have had operations cancelled three or four times."

The latest available figures for the June to September 2006 quarter showed the number of people waiting for elective surgery had grown in 12 months from 34,641 to 35,665. Those needing urgent operations had blown out 45 per cent and the list for semi-urgent surgery grew by 65 per cent. Health Minister Stephen Robertson argued that the system was more efficient than in the past and that any growth in waiting lists was due to the large number of people moving to Queensland.

The Sunday Mail first revealed 17 months ago that the "E1" operating theatre was being used as a storeroom. Hospital officials said at the time it was not needed. After being contacted by The Sunday Mail last week, a hospital spokesman said: "The theatre is due to have cases put through it in February this year. "It will be used mainly for liver surgery." The spokesman said it was the last operating theatre to be brought into commission and any further growth would require the construction of new facilities.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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7 January, 2007

NHS: NO MONEY FOR NEW SENIOR DOCTORS

Thousands of doctors qualified to become consultants could face unemployment instead, the NHS says. A leaked copy of the Government's pay and workforce strategy reveals that by 2011 there will be 3,200 more consultants than there are jobs. It suggests that they will be employed in more junior roles at lower salaries, a move bitterly opposed by the British Medical Association. The document, leaked to the Health Service Journal (HSJ), also suggests that by 2011 there will be a shortage of 14,000 nurses and 1,200 GPs, while there will be a surplus of 16,200 physiotherapists, healthcare scientists and technicians.

The document, discussed by the NHS board at its meeting last month, indicates that training programmes and actual demand for staff are seriously out of kilter. It suggests that the era of guaranteed jobs for doctors is over, with a new, fluid market emerging and unemployment being used to drive down salaries. Cuts in the clinical excellence awards given to the best consultants are also suggested as a way of saving money.

The BMA reacted with anger to the proposals. Jonathan Fielden, the chairman of the BMA consultants' committee, said: "It is absurd to suggest that the NHS in England needs fewer hospital consultants. NHS consultants have driven the massive cuts in waiting times and continue to deliver real improvements in patient care. To suggest that there should be fewer consultants, and of a lower grade, will destroy the gold standard of specialist care that patients rightly deserve."

Workforce planning is one of the toughest tasks that the NHS faces. It takes at least 11 years to train a doctor to the level of consultant, which is marked by a certificate of completion of specialist training (CCST). Doctors with a CCST can apply for consultant jobs.

The document says that by 2011 there will be 3,200 doctors with CCSTs that the NHS "cannot afford to employ". Increasing numbers now midway through their training will not be matched by a similar increase in posts. Today there are 31,600 consultants, 200 more than the 31,400 posts. But the gap will swiftly widen. By 2010-11, demand is expected to be 32,700, while the supply will have reached 35,900. By then there will be a shortage of junior and staff-grade hospital doctors amounting to 1,100, and 1,200 too few GPs. Overall there will be enough doctors, but they will be trained in the wrong ways for the jobs available.

In a free market, doctors would move to where the work was, or the excess supply of consultants would drive down salaries, enabling more to be employed. But the NHS is dominated by centrally negotiated contracts that allow little such flexibility. In particular, the suggestion of a new "sub-consultant" grade is a red rag to the BMA. "Patients deserve the best possible care, not a dumbed-down service based around a sub- consultant grade," Dr Fielden said. "Workforce planning in the NHS has for many years been woefully inadequate. The BMA has repeatedly tried to suggest improvements in workforce predictions to the Department of Health and NHS employers."

The Government has already started to try to force down costs by proposing a below- inflation 1.5 per cent increase in pay and salaries to all NHS staff for next year. In another paper leaked to the HSJ, a senior offical wrote of "a real danger of industrial unrest" if the rise were set below 2 per cent.

A spokesman for the Department of Health said: "Over the next few years the NHS needs to consolidate improvements in patient care, reduce waiting times to a maximum of 18 weeks, respond to patient demand for care closer to home and to become more efficient in its use of resources...it is therefore only sensible to analyse what the workforce make-up should be to meet those challenges." He added: "This work is at an early stage and the ideas in the paper are very much what any health expert would be expecting the department to be considering."

Source



AUSTRALIA BENEFITS FROM BRITISH HEALTH CHAOS

Some lucky British nurses discover the wonders of tropical Cairns. Brits from North of Watford generally settle well in Australia



The first of more than 70 nurses from the English town of Stoke-on-Trent have reported for work in tropical north Queensland. The group of medical staff lost their jobs in a round of health spending cuts last year and were due to start 2007 on the dole. But when managers at Cairns Base Hospital heard about their plight they flew to Britain to offer them jobs.

The first of the Stoke nurses are on the wards in Cairns and enjoying the laid-back Queensland lifestyle. Katey Kitchen, 22, migrated with her boyfriend at the end of last year. "I had only been working as a nurse in Stoke for a year before I was made redundant," she said. "I was really upset. I didn't know what I was going to do. "Now I'm so glad I applied to come to Cairns. The atmosphere at the hospital is great and I love the weather. "We've booked a dive course for February and can't wait to get out on the reef. Life's brilliant here."

As well as the Stoke contingent, Cairns Base Hospital has a hired a further 80 nurses from hospitals across Britain. Most are due to arrive in the next few months but Katie Hollis, 31, arrived from Birmingham three weeks ago. "I'm married to a Cairns guy and we were looking to move here anyway, so it was a real stroke of luck when I heard about the recruitment drive here," she said. "Now I smile to myself every time I walk out into the sunshine after my shift."

The 150 British nurses - who are bringing about 250 partners and children with them -will solve the hospital's staffing problems and take the nursing roster to 700. Director of nursing Glynda Summers said she was thrilled with her recruits. "They are very well-trained nurses and they hit the ground running when they arrived here," she said. "They're settling in very well and they loved spending Christmas in Cairns."

Cairns businesses have offered jobs to the nurses' husbands and wives and local developers have agreed to reserve three new unit complexes exclusively for their families. The hospital has even devised a "tropical chums" scheme to help the newcomers settle in, matching Australian members of staff with the new recruits.

The Cairns nurses are part of an influx of foreign health professionals into Queensland. No statewide figures are available for the numbers of overseas staff recruited directly by individual hospitals, but Queensland Health's "Work For Us" recruitment drive has so far brought 98 overseas doctors, 53 nurses, 46 allied health staff and seven dentists to Queensland. Another 648 applications are being processed.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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6 January, 2007

Operations cancelled as NHS runs out of money

Despite a huge but obviously mismanaged increase in funding, patients are being told to wait for routine treatment and casualty staff are being asked to turn people away

Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year, The Times can reveal. NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A&E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended.

In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under eight weeks. Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff.

The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24 million this year.

A letter from its chief executive, Janet Soo-Chung says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.

No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.

The trust also announced the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others. “We fully appreciate the difficulties that the introduction of these measures entail," Dr Soo-Chung's letter says. "However, the financial position of the PCT is such that there is absolutely no alternative to this programme if we are to avoid even more difficult decisions in the near future."

Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeks — expected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, told hospitals to work out how many patients could be deferred until next financial year, and said that the trust would not pay for elective operations on smokers until they had attended smoking clinics.

Andrew Lansley, the Conservative health spokesman, said: “The Labour project has proved utterly incapable of running our NHS. Centrally imposed initiatives and costly targets have plunged the NHS into a record deficit. The NHS needs greater freedoms at a local level to return it on a stable and sustainable financial footing.”

In a report published this week, the think-tank Reform said that NHS deficits were deepening. It called for a one-off repayment of debt followed by a more rigorous financial regime and immediate administration for failing trusts. But the idea was rejected by the Department of Health. On the delays to appointments and operations, a spokesman said it was a matter for the local NHS, provided that national targets were not breached. However, the department has not left it all to local managers but has introduced fines for hospitals that operate too fast. These can amount to millions of pounds.

Last year the NHS returned a net deficit of £512 million, a fraction of the total budget. But the scale of the problems was concealed by strategic health authorities saving large amounts of money largely by cutting education and training budgets.

Source



37,000 job cuts needed to pay NHS salary bill

Office-workers are not separated out below but the last three categories below would contain at a guess up to half a million of them. Compare that with less than 70,000 doctors. How many sick people have office workers ever helped?



The Government is looking for ways of cutting the huge NHS salary bill to bring the service back into financial balance. Tens of thousands of job cuts and a three-year pay deal, starting with a low or zero increase for 2008-09, are strong possibilities, as the Department of Health wrestles with booming staff numbers and mismanaged pay deals.

Consultants, GPs, nurses and other NHS staff have all had pay increases, some huge, while a rise in staff numbers greatly exceeds that envisaged in the NHS Plan of July 2000.

Documents leaked to the Health Service Journal predict a sharp reduction in the workforce this year, cutting staff by 2.7 per cent, or 37,000 jobs.

Kevin Coyne, of the Amicus union, which represents many NHS staff, said: “This leaked document appears to confirm all of our worst fears. The report of job cuts runs counter to all of the Government’s claims about their commitment to the future of the National Health Service.”

NHS staff numbers have risen hugely in recent months. Patricia Hewitt, the Health Secretary, told the Commons Health Committee last year: “The NHS target for hospital doctors was to get to 74,590 by 2007. By 2004 the NHS was already employing over 78,000 hospital doctors and by 2005 over 82,000.”

Professor Nick Bosanquet, of the think-tank Reform, said: “For an organisation with a problem of financial balance and a pressing need to invest in new services, the recruitment of an additional 270,000 staff since 1999 represents a significant policy failure.”

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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5 January, 2007

What's Making Us Sick Is an Epidemic of Diagnoses

You might think this is because doctors make mistakes (we do make mistakes). But you can't be a victim of medical error if you are not in the system. The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses.

Americans live longer than ever, yet more of us are told we are sick. How can this be? One reason is that we devote more resources to medical care than any other country. Some of this investment is productive, curing disease and alleviating suffering. But it also leads to more diagnoses, a trend that has become an epidemic.

This epidemic is a threat to your health. It has two distinct sources. One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don't like, and in the past, this was considered a part of life. Increasingly, however, such sensations are considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction.

Perhaps most worrisome is the medicalization of childhood. If children cough after exercising, they have asthma; if they have trouble reading, they are dyslexic; if they are unhappy, they are depressed; and if they alternate between unhappiness and liveliness, they have bipolar disorder. While these diagnoses may benefit the few with severe symptoms, one has to wonder about the effect on the many whose symptoms are mild, intermittent or transient.

The other source is the drive to find disease early. While diagnoses used to be reserved for serious illness, we now diagnose illness in people who have no symptoms at all, those with so-called predisease or those "at risk."

Two developments accelerate this process. First, advanced technology allows doctors to look really hard for things to be wrong. We can detect trace molecules in the blood. We can direct fiber-optic devices into every orifice. And CT scans, ultrasounds, M.R.I. and PET scans let doctors define subtle structural defects deep inside the body. These technologies make it possible to give a diagnosis to just about everybody: arthritis in people without joint pain, stomach damage in people without heartburn and prostate cancer in over a million people who, but for testing, would have lived as long without being a cancer patient.

Second, the rules are changing. Expert panels constantly expand what constitutes disease: thresholds for diagnosing diabetes, hypertension, osteoporosis and obesity have all fallen in the last few years. The criterion for normal cholesterol has dropped multiple times. With these changes, disease can now be diagnosed in more than half the population.

Most of us assume that all this additional diagnosis can only be beneficial. And some of it is. But at the extreme, the logic of early detection is absurd. If more than half of us are sick, what does it mean to be normal? Many more of us harbor "pre-disease" than will ever get disease, and all of us are "at risk." The medicalization of everyday life is no less problematic. Exactly what are we doing to our children when 40 percent of summer campers are on one or more chronic pre ion medications?

No one should take the process of making people into patients lightly. There are real drawbacks. Simply labeling people as diseased can make them feel anxious and vulnerable - a particular concern in children.

But the real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms. Sometimes the harms are known, but often the harms of new therapies take years to emerge - after many have been exposed. For the severely ill, these harms generally pale relative to the potential benefits. But for those experiencing mild symptoms, the harms become much more relevant. And for the many labeled as having predisease or as being "at risk" but destined to remain healthy, treatment can only cause harm.

The epidemic of diagnoses has many causes. More diagnoses mean more money for drug manufacturers, hospitals, physicians and disease advocacy groups. Researchers, and even the disease-based organization of the National Institutes of Health, secure their stature (and financing) by promoting the detection of "their" disease. Medico-legal concerns also drive the epidemic. While failing to make a diagnosis can result in lawsuits, there are no corresponding penalties for overdiagnosis. Thus, the path of least resistance for clinicians is to diagnose liberally - even when we wonder if doing so really helps our patients.

As more of us are being told we are sick, fewer of us are being told we are well. People need to think hard about the benefits and risks of increased diagnosis: the fundamental question they face is whether or not to become a patient. And doctors need to remember the value of reassuring people that they are not sick. Perhaps someone should start monitoring a new health metric: the proportion of the population not requiring medical care. And the National Institutes of Health could propose a new goal for medical researchers: reduce the need for medical services, not increase it.

Source



Another waste of health dollars by government

A MULTIMILLION-dollar hyperbaric chamber built at the Royal Brisbane and Women's Hospital more than four years ago has never been used. Although demand for hyperbaric medicine has soared in Queensland in recent years, the chamber is unlikely to treat its first patient until next year. The Government yesterday defended its decision to refer public patients requiring decompression treatment to the Wesley Private Hospital as a better use of taxpayers' money.

Health Minister Stephen Robertson's spokesman said to commission and then operate the RBWH chamber for a year would cost $1.7 million. The Wesley Hospital provided the service last year for less than $1 million. "Until now, it's been cheaper to go through the Wesley . . . than to commission the one at the RBWH," [An interesting confession!] he said. "We're actually saving taxpayers' money." The Wesley has treated Queensland Health patients recommended for decompression treatment since 1998.

When asked why the Beattie Government had decided to build the RBWH hyperbaric chamber in the first place, Mr Robertson's spokesman replied: "I've got no idea." The chamber was built when Wendy Edmond, who has since retired from politics, was health minister.

The number of public patients treated in the Wesley hyperbaric chamber has almost doubled in three years, from 1083 in 2002-02 to 2097 last year. In 2002-03, the hospital treated 1083 public patients in its chamber but by last financial year, that had swelled to 2097.

Decompression chambers are used to treat a variety of patients, not just divers suffering from the bends. Patients who have had surgery on blood vessels are sometimes put in a hyperbaric chamber to assist in the repair of oxygen-starved tissue. Decompression treatment is also covered by Medicare in cases of difficult-to-heal wounds.

The Opposition and the Australian Medical Association Queensland both condemned the Government for building the chamber and then failing to use it. "It's crazy," said AMAQ president Zelle Hodge. "You'd have to ask why didn't someone do an appropriate cost analysis before this was built." [He's joking. Governments don't do that if it seems good for a self-inflating press-release at the time] Opposition health spokesman John-Paul Lanbroek accused the Government of mismanagement. "We've got this hyperbaric chamber that's supposedly the best in the southern hemisphere. What do we have to do to get it up and running as it should be for Queensland patients?" he said.

Mr Robertson's spokesman said the Minister last month had signed approval for Queensland Health to explore the possibility of running the RBWH hyperbaric chamber as a public/private partnership with a view to have it operational by 2008.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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4 January, 2007

Congressional Liberals' Plans For Medicare Will Make Private Health Insurance More Expensive

Letting Medicare Negotiate Drug Prices Also Likely to Increase Number of Uninsured. Price controls by any other name will achieve the opposite of their intent

The incoming 110th Congress will make health insurance more expensive if it lets Medicare "negotiate" pre ion drugs, says National Center for Public Policy Research Senior Policy Analyst David Hogberg, Ph.D. "The liberal plan to reform Medicare is designed in a way that givse drug companies greater incentive to raise drug prices. Higher drug prices means higher prices for health insurance. And that means more people will be unable to afford health insurance," Hogberg said.

As Hogberg points out in his new National Policy Analysis paper, "Letting Medicare "Negotiate" Drug Prices: Myths vs. Reality," Congressional liberals and their special interest allies are trying to hoodwink the American public into thinking that by "negotiating" with drug companies, Medicare will actually be bargaining over drug prices. "Nothing could be further from the truth," stated Hogberg. "Medicare doesn't negotiate prices. It sets them."

Medicare is a fee-for-service program that sets the prices it pays to medical providers. If medical providers are unwilling to accept the Medicare price, then Medicare does not reimburse them. To see how Medicare will deal with drug prices, Hogberg points to the operation of Medicare Part B, which pays for outpatient services. For drugs such as a tetanus shot that have to be administered by a doctor, Medicare only pays the "average" private sector price of the drug.

"That's surely how Medicare will pay for pre ion drugs under the Part D pre ion drug program should liberals succeed in removing the non-negotiation clause from the Medicare Pre ion Drug Act," said Hogberg. "Once that happens, drug companies will have all the incentive to push their prices higher in the private sector, since higher prices in the private sector means a higher 'average price' and, hence, bigger reimbursements from Medicare."

To prove his point, Hogberg points to research conducted by economists Mark Duggan and Fiona M. Scott Morton of the National Bureau of Economic Research. They examined the effect Medicaid, the government health insurance program for the poor, had on the price of pre ion drugs. Like Medicare Part B, Medicaid only pays the average private sector price for a drug. Duggan and Morton found that Medicaid's drug reimbursement practices resulted in a seven to 10 percent increase in the average price of a pre ion drug.

"With higher drug prices in the private sector," Hogberg says, "insurance companies will have to charge higher premiums to cover the costs of those drugs. Higher health insurance costs mean that it will be harder for employers and individuals to afford health insurance, and a higher number of uninsured will be the result."

"There is really no need for Congress to do this," Hogberg further argues. "The private plans that administer Medicare Part D have done a very good job at keeping costs down. Part D costs are coming in under budget. The changes liberals are proposing pit seniors against those who have insurance in the private sector and in the end only would make health insurance more expensive."

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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3 January, 2007

UK Muslims Refuse to Wash Hands in Hospital

And a gutless British government averts its eyes

British Muslims are refusing to wash their hands with required anti-bacterial disinfectant gels. The Muslims are protesting the practice on religious grounds, as the gels contain alcohol.

Anti-bacterial gels are used in hospitals to guard against superbugs, including Methicillin-resistant Staphylococcus Aureus (MRSA) and Periventricular Leukomalacia (PVL). British healthcare workers said they were shocked to discover the practice of Muslims refusing to disinfect their hands before entering patient rooms.

NHS care assistant Theresa Poupa at London Chest Hospital said: I could not believe it. The signs are large enough and clear enough but they [Muslims] just took no notice and walked straight onto the ward! I was there almost every day for three weeks and I saw it repeated dozens and dozens of times. When I raised the matter with the nursing staff they just shrugged and said that Muslims were refusing to use the gel because it contained alcohol.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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2 January, 2007

NHS turbulence is set to continue



So, was it the best year ever? The Royal College of Nursing certainly didn't agree with Patricia Hewitt's declaration in April. They booed and jeered at the health secretary when she addressed the nurses four days later. The stormy encounter in Bournemouth came at a time of furious debate about NHS deficits and job cuts. Those arguments resurfaced in the autumn, and will rage again in 2007 as NHS bosses face renewed pressure to balance their books. The final figure for the 2006 deficit in England was 547 million pounds.

Ministers point out it represents a tiny share of the overall budget, which has been boosted by record investment over the past eight years. And they are hopping mad about claims that the NHS is losing 20,000 posts - they say this is alarmist because the real number of people who have actually been laid off is close to 900. But critics say that won't be of any comfort to people who've been made redundant, or to newly trained staff seeking work in the NHS. Next year local demonstrations will keep erupting in areas where there are threats to existing services because of reorganisation.

In a recent appearance before a committee of MPs, Patricia Hewitt remained jaunty about her "best year ever" claim - pointing out that patient care in important areas like cancer has been transformed, with reduced waiting lists. She acknowledged the financial pain that will mean some local deficits persisting - but she said she would take personal responsibility on the NHS as a whole breaking even in 2007. There certainly have been improvements to the health service recently - as one would expect, with the extra billions of pounds that have been pumped in.

But sometimes it is the more basic aspects of care that can prove a stumbling block. Look at the recent furore over the long-running problem of mixed-sex wards, which Patricia Hewitt has told health bosses to investigate.

And then there's that perennial NHS problem - how do you meet ever-higher expectations and provide impressive medical technology without breaking the bank? The theory is you set up an independent body called NICE (the National Institute for Health and Clinical Excellence) to gather the evidence and assess drugs for their cost-effectiveness. This doesn't make bitter arguments go away though.

2006 has brought good news for women who are now eligible for the breast cancer drug Herceptin in the early stages of the disease. But the year will be remembered less favourably by campaigners for people with Alzheimer's Disease, as drugs which were previously prescribed for the condition are now restricted. That row will continue next year, as three drug companies mount a legal challenge, claiming that the decision-making was unfair.

Although NICE will also be investigated by the parliamentary health select committee, it is undaunted. NICE has strong political backing and is an increasingly confident organisation, with a role which has expanded to include public health.

By the end of 2008, patients have been promised they won't have to wait any longer than 18 weeks, between seeing their GP and having an operation. It's a tough target - so expect to see the NHS pulling out a lot of stops to try to get there over the next few years.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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1 January, 2007

BRITISH DOCTOR PAID TO KILL

Vast amounts of money that was supposed to be used to help poor people was diverted to be used in a dangerous campaign designed to show that British government lawyers knew more about medical products than did the drug companies or the FDA. All they succeeded in doing was to turn people off one of the safest and most helpful medical procedures -- with resultant deaths

Andrew Wakefield, the former surgeon whose campaign linking the MMR vaccine with autism caused a collapse in immunisation rates, was paid more than 400,000 pounds by lawyers trying to prove that the vaccine was unsafe. The payments, unearthed by The Sunday Times, were part of 3.4 million pounds distributed from the legal aid fund to doctors and scientists who had been recruited to support a now failed lawsuit against vaccine manufacturers.

Critics this weekend voiced amazement at the sums, which they said created a clear conflict of interest and were the financial engine behind a worldwide alarm over the triple measles, mumps and rubella shot. These figures are astonishing, said Dr Evan Harris, Liberal Democrat MP for Oxford West and Abingdon. This lawsuit was an industry, and an industry peddling what turned out to be a myth.

According to the figures, released under the Freedom of Information Act, Wakefield was paid 435,643 in fees, plus 3,910 expenses. Wakefields work for the lawyers began two years before he published his now notorious report in The Lancet medical journal in February 1998, proposing a link between the vaccine and autism. This suggestion, followed by a campaign led by Wakefield, caused immunisation rates to slump from 92% to 78.9%, although they have since partly recovered. In March this year the first British child in 14 years died from measles.

Later The Lancet retracted Wakefields claim and apologised after a Sunday Times investigation showed that his research had been backed with 55,000 from lawyers, and that the children in the study used as evidence against the vaccine were also claimants in the lawsuit. At the time Wakefield denied any conflict of interest and said that the money went to his hospital, not to him personally. No disclosure was made, however, of the vastly greater sums that he was receiving directly from the lawyers.

The bulk of the amount in the new figures, released by the Legal Services Commission (LSC), covers an eight to 10-year period. All payments had to be approved by the courts. Those who received money include numerous Wakefield associates, business partners and employees who had acted as experts in the case. Five of his former colleagues at the Royal Free hospital, north London, under whose aegis The Lancet paper was written, received a total of 183,000 in fees, according to the LSC.

Wakefield now runs a business in Austin, Texas, two of whose employees are listed as receiving a total of 112,000 in fees, while a Florida physician, who appointed the former surgeon as his director of research, was paid 21,600, the figures show. All have appeared in media reports as apparently confirming Wakefields claims.

It is understood that the payments for writing reports, attending meetings and in some cases carrying out research were made at hourly rates varying between 120 and 200, or 1,000 a day. There was a huge conflict of interest, said Dr John March, an animal vaccine specialist who was among those recruited. It bothered me quite a lot because I thought, well, if Im getting paid for doing this, then surely its in my interest to keep it going as long as possible. March, who the LSC allowed almost 90,000 to research an aspect of Wakefields theories, broke ranks this weekend to denounce both the science of the attack and the amount that the case had cost in lawyers and experts fees. The ironic thing is they were always going on about how, you know, how weve hardly got any money compared with the other side, who are funded by large pharmaceutical companies. And Im thinking, judging by the amounts of money youre paying out, the other side must be living like millionaires, he said.

Also among those named as being paid from the legal aid fund was a referee for one of Wakefields papers, who was allowed 40,000. A private GP who runs a single vaccines clinic received 6,000, the LSC says.

Following The Sunday Times investigation, immunisation rates have risen and the General Medical Council launched an inquiry. This is due to culminate in a three-month hearing next summer, where Wakefield faces charges which he denies of dishonesty over his research. The LSC is also unlikely to escape criticism. Three years ago the commission, which administers a 2 billion budget to give poor people access to justice, acknowledged that the attempt to make a case against MMR with taxpayers money was not effective or appropriate. The total cost for the attack on the vaccine was 14,053,856, plus Vat.

Following media campaigning, lawyers eventually registered 1,600 claimants in the lawsuit. None received any money. This weekend Earl Howe, a Conservative party health spokesman, called for a parliamentary inquiry. Its astonishing, he said. This is crying out for select committee scrutiny. Wakefield said in a statement that he had worked on the lawsuit for nine years, charged at a recommended rate, and gave money to charity. This work involved nights, weekends and much of my holidays, such that I saw little of my family during this time, he said. I believed and still believe in the just cause of the matter under investigation.

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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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

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