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31 August, 2005

THE HIGH COSTS OF HEAVILY REGULATED AND HENCE BUREAUCRATIZED MEDICINE HURT WAGE-EARNERS

To say nothing of the litigation free-for-all that siphons off so many health dollars into the pockets of lawyers

Funding a small-company health plan isn't getting any easier for Hans Steege. The 33-year-old co-owner of Derovations, a $1 million (sales) commercial bike-rack manufacturer in Minneapolis, watched the company's health insurance premiums shoot up 19% in the last year. Now Steege wants to add a technician to his seven-employee roster, but fears his local health maintenance organization will juice rates even higher. "The health insurance thing is a motivator not to hire him," he admits.

To ease the burden, Steege is thinking about switching to a health savings account with a higher deductible and lower premiums. In that case, Derovations would set cash aside in a separate account to cover the deductibles; if the employees don't use the money by year's end, they take it home as part of their compensation. But Steege also is contemplating a far more draconian move. "The expense is growing so much that we are thinking about not offering health insurance as a benefit [at all]," he says. "And that puts our employees at risk."

Steege has plenty of company. Nearly nine out of ten small businesses are shelling out more for basic employee health insurance than they paid last year, according to a new study released this morning by Salary.com, a compensation consultancy in Needham, Mass. Half of the 304 small companies surveyed--from high-tech outfits to asphalt pavers and pizzerias--choked down between 10% and 30% increases, while nearly one in ten reported a rise of 30% or more.

Theories abound to explain escalating health care costs. Suffice it to say the health care market--unlike, say, the market for Gillette razor blades--is not a paragon of efficient supply and demand. Say you have a company with 17 employees, all over age 50. Depending on the local regulations, "you may still have to buy pregnancy insurance," says Scott Simmonds, a health care consultant in Saco, Maine, who works with small businesses.

The backlash: Small businesses are taking steps that have a direct effect on how employees are paid. The tactics run the gamut. One ploy: offering higher salaries, or lump-sum cash payouts, to employees as an incentive not to sign up for health insurance. "Many companies could offer employees a 10% salary increase [in lieu of health insurance] and still lower total payroll expenses in a given year," says Richard Cellini, head of research at Salary.com.

Other companies are lobbying workers to join their spouses' health plans, especially if they work for larger companies. Some employers are tweaking health care eligibility standards based on age, years of employment and hours worked per week. Still others are forming buyers' cooperatives with other companies to wangle bulk pricing. It's not that Steege and his small-business brethren don't want to do right by their employees. "When the company is very small, the employees are like family," says Cellini.

Of the 66 companies with 20 employees or less that Salary.com studied, 33% offered fully funded medical plans (in which the employer covers 100% of the premiums), more than any other size category. That percentage drops to 2.6% for companies with 200 employees and higher. The ugly flip side: 32% of the small fries offered totally unfunded coverage, the least generous of all the size groups....

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 Page is here or here.

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30 August, 2005

A LONG-ESTABLISHED PUBLIC HEALTH SYSTEM EVOLVES TO NEAR-TOTAL MELTDOWN

With 75% of Departmental employees being paper-shufflers rather than doctors and nurses, this is what you expect

Front-line administration staff at hospitals and and medical clinics are facing unprecedented abuse from the public. Clerical staf: are being spat on, threatened with violent attacks and subjected to tirades as patients vent their frustration with the failing Queensiand health system.

In one shocking example, a female staff member at a Gold Coast medical clinic was asked: "Do you want a smack in the mouth"? when she told a male patient his X-ray could not be bulk-billed.

Last year, emergency department staff at the Princess Alexandra Hospital in Brisbane threatened strike action after patients, upset at long waiting times threatened them with knives and pot-plants.

The situation has become so bad the Australian Services Union - which represents about 2000 of the 7000 administrative staff working in Queensland hospitals - held a private briefing with State Health Minister Stephen Robertson a week ago to demand a solution.

Union members have vowed to use the issue to demand increased pay rates during enterprise bargaining negotiations. In its submission to the Morris inquiry, the ASU said health professionals working "at the front line inside hospitals, community health clinics and in primary health care locations" were feeling the most pressure on services. "There's no doubt our members are in the front line," said ASU state secretary Julie Bignell. "We've had members regularly abused, spat upon and threatened."

The submission said understaffing was regarded as "business as usual" in Queensland Health "across all occupation groups, including administrative staff".

More-understanding patients say they feel ashamed at the abuse dished out to clerical staff. Burleigh resident Jackie Moore said it had become a health problem in itself: "Symptomatic of the failing health system in Queensland is the verbal abuse and aggression that staff at some of these branches have to confront on a daily basis, as appointment times are stretched to the limit and waiting time is increased."

The above article by PAUL WESTON appeared in the Brisbane "Sunday Mail" on August 28, 2005

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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 Page is here or here.

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29 August, 2005

Do Canadian Seniors Have More Health Freedom than American Seniors?

According to a recent article by Heritage Foundation researcher Derek Hunter, “Canada’s Medicare [program] now allows Canadians more freedom (at least in Quebec) than American’s Medicare does American seniors.” The article, titled “Doing Your Own Health Care Thing: American Seniors vs. Canadian Citizens,” notes that because of Dr. Jacques Chaoulli’s recent Canadian Supreme Court victory overturning the Quebec ban on private health insurance, Canadians in the province are now free to contract with the physicians of their choice and to purchase private health insurance for the services they need and desire.

However, the article points out that the legal situation in the United States remains unchanged. Hunter writes, “Under the terms of Section 4507 of the Balanced Budget Act of 1997, a senior can contract privately with a physician for a ‘covered’ Medicare service if, and only if, the doctor signs an affidavit to the effect that he is contracting privately with the senior citizen, submits that affidavit to the Secretary of the Department of Health and Human Services (HHS) within ten days, and agrees to forgo all Medicare reimbursement from all other Medicare patients for a period of two years.”

He continues, “But this one-size-fits-all regulation does not fit the infinitely varying circumstances of seniors and especially the Baby Boom cohorts set to retire soon. In a free society, shouldn’t a person’s own reasons for deciding to spend his or her own money on a legal medical service without statutory or bureaucratic restrictions be enough? Privacy, personal convenience, the need for specialized care, or the skills and talents of a preferred physician could all explain a senior wanting to purchase care outside of Medicare. The current regulations make accommodating any of these reasonable desires difficult and oftentimes impossible.”

The article reports that to fix the current law Rep. Sam Johnson (R-Tex.) in February introduced “The Medicare Beneficiary Freedom to Contract Act of 2005” (H.R. 709). Hunter notes that the legislation “would eliminate prohibitions on seniors’ entering into private contracts with medical professionals for legal medical services, regardless of whether those services are covered by Medicare.” However, on close examination H.R. 709 does not make clear that seniors are free to contract privately for all services under Medicare, including hospital (Part A) and prescription-drug services (Part D). Thus to provide American seniors true freedom, there needs to be a clear law stating that all citizens are free to pay privately for the health-care services of their choice, including services covered under all parts of Medicare.

Some have proposed that allowing physicians to bill Medicare patients an additional amount for Medicare-covered services would increase seniors’ freedom. (This is known as “balanced billing.”) While balanced billing can help patients who want to pay extra for Medicare-approved services, it does not help restore the freedom to maintain private contracts, which is the only way to bring decision-making power back to patients and their physicians. He who pays the piper calls the tune. Without the precious liberty to contract privately, citizens' health-care choices will be dictated by Medicare and insurance decision-makers.

We need to move away from relying on and fostering a system in which patients and physicians have to ask Medicare (and insurers): "Big Brother, may I receive/give this treatment?" And in reforming Medicare, we must stop building up Big Government health care (leaving health-care decision-making power with bureaucrats and third parties) and making wealthy people pay more for it!

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 Page is here or here.

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28 August, 2005

Vioxx: who's responsible?

Making pharmaceutical companies pay millions for the unpredicted consequences of their drugs could put a brake on innovation.

Article by by Dr Elizabeth Whelan

Last week's news that a jury found the pharmaceutical company Merck negligent in its marketing of the painkiller Vioxx, awarding $229million in punitive damages, is bad news for all consumers who hope that pharmaceutical companies will continue to develop new drugs - to address not only their aches and pains but life-threatening conditions like cancer, heart disease, and diabetes.

Specifically, the jury declared that Merck must pay more than $253million to the family of a Texas man who died after taking the company's Vioxx painkiller. This is the first personal-injury case over the drug to come to trial. There will be more such cases, including in Britain, where some families are considering taking legal action - and if similar verdicts are the result, we have a classic case of killing the goose that is laying the golden eggs.

Jurors awarded $24.4million in actual damages and $229million in punitive damages to the family of Robert Ernst, whose lawyers argued that Merck rushed Vioxx to market without proper safety testing, to compete with Pfizer Inc's Celebrex painkiller. The family, who claimed Ernst developed an irregular heartbeat because of Vioxx, said the company played down the drug's potential for causing heart attacks and strokes.

In reality, Vioxx underwent years and years of study and evaluation. It was approved by the US Food and Drug Administration. The FDA reviewed all available data and agreed that Vioxx should be marketed. All drugs have risks as well as benefits. The FDA decided that the benefits of Vioxx outweighed the risks. That approval was based on current, state-of-the-art knowledge about the safety and efficacy of Vioxx.

Such safety and efficacy studies are, by necessity, based on examination of results on a relatively small number of patients. Only post-surveillance data (that is, reports of benefits and risk after the drug is approved and used by large numbers of patients) can pick up unforeseen problems like, in the case of Vioxx, increased risk of heart disease in some highly vulnerable users.

If pharmaceutical companies are held liable for unpredicted consequences of pharmaceuticals that receive FDA blessing, what is the incentive for the companies to produce new drugs? If liability costs (a substantial portion of which are paid directly to plaintiffs' lawyers) wipe out the company's potential to recoup the hundreds of millions of dollars (in some cases, over a billion) spent in researching, developing and testing a drug, why would a company even bother to pursue new pharmaceutical innovations?

The time has come to consider providing legal immunity to pharmaceutical companies who are granted FDA approval. Otherwise, we are holding them accountable and responsible for effects that (a) may not actually be validated or (b) were not known at the time the drug was approved.

Not to consider this option threatens the health of all of us, our children and our grandchildren, who look to research pharmaceutical companies to provide the blockbuster drugs of the future.

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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 Page is here or here.

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27 August, 2005

INNOVATION IN SOUTH CAROLINA

On the left, they are calling it radical. On the right, the buzzword is bold. Either way, South Carolina is proposing major changes in Medicaid, the giant federal-state health insurance program for the poor and disabled.

The state says its proposal to establish personal health accounts for most of the state's 850,000 Medicaid recipients will "redefine health care in the United States." The account would be used to purchase private health insurance, or pay for care directly. And the amount of money allocated to each account would depend on the person's age, sex and physical condition.

That's much different from the way Medicaid operates. Now, those whose incomes are low enough and who meet other eligibility requirements are entitled to receive certain approved health care services regardless of costs. South Carolina would cap how much it will spend on a recipient, and if health care costs more than the account will pay for, then the low-income people would have to make up the difference themselves or go without.

States have to get waivers from the federal government whenever they want to use federal Medicaid funds in ways not authorized in federal law. But the implications of South Carolina's waiver request, contained in a 42-page document submitted to the Centers for Medicare and Medicaid Services in June, extend far beyond South Carolina. If South Carolina's plan is approved, analysts say, other states will seek similar changes. Eventually, the experiment could influence national policy, said Nina Owcharenko, a senior health care analyst with the Heritage Foundation, a conservative think tank. "Remember, welfare reform didn't come from Washington the first time around," she said. "It came from states like Wisconsin, which received waivers, and their work later encouraged new federal policy."

South Carolina's request is based on the thought that Medicaid has created little incentive for frugality. South Carolina's share of Medicaid expenditures has grown more slowly than the national average, but the state spends nearly 19 percent of its budget on Medicaid.

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 Page is here or here.

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26 August, 2005

Healthcare Is Migrating South of the Border

California employers are steering Latinos to Mexico, where care is less costly but uneven.

Thousands of Latinos who live near the border are taking advantage of a benefit increasingly offered by their U.S. employers: cheaper healthcare in Mexico. About 160,000 California workers - farm laborers as well as working-class Latinos employed at hotels, casinos, restaurants and local governments in San Diego and Imperial counties - are getting their annual checkups and having surgeries through health networks south of the border, insurers say. The arrangement is cheaper for both employers and employees. In Mexico, healthcare costs are about 40% to 50% lower than in California, freeing some employers to offer services that they couldn't otherwise afford. "It's a win-win situation for me. I'm able to offer it to everybody, and my premiums went way down," said Mark Holloway, part owner of a department store in Calexico, Calif., who said he couldn't afford health insurance for his 50 employees until he enrolled them in a cross-border plan. He said he can sign up several employees, each at about $100 monthly, for about the same price as one employee in a U.S. plan.

Employees enjoy lower premiums and co-payments, typically $5, and the comfort and convenience of describing their aches and pains in Spanish to doctors who, they say, tend to take more time with them. "The rate is good, the service is good," said David Ouzan, a city councilman in Calexico, where about a third of the city's workers use dental and medical clinics in Mexicali, just across the border. "I myself have used dentists in Mexico."

Still, the trend has generated some misgivings among doctors and consumer advocates north of the border. Some worry about the quality of care in Mexico and limited regulatory control. Others say the cross-border plans represent a sad commentary on the limited access that immigrants and the working poor have to treatment in California. They represent a "positive turn of events for cross-border health coverage . but are another reminder about how sick our health system is in the U.S.," said Dr. Robert K. Ross, president of the California Endowment, a healthcare philanthropy.

Mexico has long been a low-cost alternative for thousands of people - many of them uninsured - who price-hunt among clusters of storefront clinics and small hospitals in Tijuana and Mexicali for treatment they can't afford in the States. And some cross-border health plans have operated since at least the 1950s, when Imperial Valley farmers started offering coverage to migrant workers. But the emergence in the last five years of cross-border HMOs, which must be licensed by the state of California, signals the growing acceptance of Mexican doctor networks by mainstream employers and insurers in the United States.....

Enrollees are typically Mexican citizens legally employed at U.S. companies, either living in Mexico or in the U.S. Many earn only $5 to $7 an hour and could not afford U.S.-based plans. But others are Mexican Americans, some of them in executive-level positions. "Employers are really surprised a bit by the quality, the cleanliness," said Peter Duncan, a vice president at Blue Shield of California, whose cross-border program is called Access Baja. "Often they had visions of squalor. It isn't Cedars-Sinai. But they find that the basic quality of care is really there."

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 Page is here or here.

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25 August, 2005

OFFICIAL SAFEGUARDS THAT DIDN'T SAFEGUARD

A bureaucrat flouted health policy by allowing Bundaberg Base Hospital to accept more complex operations without adequately reviewing staff credentials, the Morris inquiry has heard.

Michael Cleary, the director of medical services at Prince Charles Hospital, Brisbane, told the inquiry today that he had inspected the Bundaberg hospital's credentialling and privileging process after the Dr Jayant Patel scandal had broke.

Indian-trained Dr Patel has been linked with more than 80 deaths at the Bundaberg hospital Dr Cleary said suspended hospital district manager Peter Leck had given clinicians including Dr Patel ramped up "interim clinical privileges". These privileges relate to the type of operations that can be performed by clinicians, based on their skills and hospital resources.

The South-East Queensland hospital's documentation about credentialling and privileging was located by Dr Cleary after an "extensive search" when he acted as Bundaberg's district manager for three weeks after Mr Leck was stood aside. "There was ... very little evidence that credentials were reviewed - therefore there was only partial compliance with Queensland Health," Dr Cleary told the inquiry.

More here



NEW BOOK COMING

In September, the Cato Institute will release the book Healthy Competition: What's Holding Back Health Care and How to Free It, a blueprint for re-invigorating America's troubled health care sector. Michael F. Cannon, Cato's director of health policy studies, and Michael D. Tanner, Cato's director of health and welfare studies, explain how market competition makes products of ever-increasing quality available to an ever-increasing number of consumers.

They demonstrate how market competition can do the same for medical care and health insurance. The authors even show how encouraging competition can lower the cost of public health programs and improve government regulation of health care. Cannon and Tanner recommend spurring greater competition in the private sector by expanding health savings accounts (HSAs). The authors propose creating "large HSAs" that would give workers control over all their health benefits, rather than just a portion as HSAs now do.

The authors offer advice to Congress, the states and the new Medicaid Advisory Commission (a panel created by Congress) on reforming that program. They argue that Congress should reform Medicaid as it reformed the old AFDC cash-assistance program: cap federal funding and give states broad flexibility to reduce dependence. At the same time, states should encourage private competition by returning their Medicaid programs to their original mission of providing medical care to the truly needy.

The book explores Medicare's enormous unfunded liabilities - which are six times those of Social Security - and argues allowing today's workers to save a portion of their Medicare taxes in a personal account. The authors argue this would encourage competition and "minimize the cost of meeting existing Medicare obligations."

In a foreword to the book, former Secretary of State George Shultz writes, "Cannon and Tanner offer proposals that would further tap the power of markets to make health care more valuable and more affordable. That makes Healthy Competition essential reading."

Michael F. Cannon is the director of health policy studies at the Cato Institute. Previously, he served as a domestic policy analyst at the U.S. Senate Republican Policy Committee under Senator Larry E. Craig (R-ID). Michael D. Tanner is the director of health and welfare studies at the Cato Institute, where he directs research on new, market-based approaches to health, welfare and other government "entitlements."

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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 Page is here or here.

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24 August, 2005

CURRENT BRITISH BARRIERS TO PRIVATE MEDICAL PRACTICE

Bureaucracy gone mad

What's 30 pounds, after all, if it stops another Shipman? That's what I told myself. And there won't be another Harold Shipman. That's what the nice man from the Health Care Commission (HCC) told me. They're making sure of that - with our help of course. The ś30 was what my GP charged me for sending the HCC copies of my personal medical records.

You never can be too sure, can you? I am a doctor so I am under suspicion. Quite right. No one should be above suspicion. I left the NHS last year after 25 years and was hoping to see patients in private rooms two afternoons a week, which means I have to register with the HCC. I downloaded the pack and started on the paper work. I'm happy to comply and pay the ś600 fee. After all, we have to protect the public, don't we?

At least my bank didn't charge me for providing details of my personal finances, which the HCC also needed. The criminal records bureau (CRB) wanted 38 pounds for an enhanced level search. I already had clearance but not at an enhanced level, and not with the HCC name on the form.

What I hadn't realised, until the nice man from the HCC made a visit, was that all the staff also had to have CRB clearance: my secretary, the physiotherapist, the occupational therapist, the nurse, the receptionist, even the cleaner. I was surprised that the women also had to have clearance - after all, how many female paedophiles are there? The helpful man answered my question by mentioning Rosemary West. Good point. No matter how small the risk....

I explained that we see no children under the age of 18, but apparently that doesn't matter. I guess the staff may be up to something at the weekend! It's more complicated getting their clearance because we have to get 'an umbrella agency' to act for us, so the cost goes up a bit to 42 pounds each. It's very straightforward: you just fill in the form, present copies of your birth certificate, passport, utility bills, etc, to the agency, pay the fee, and wait two months. Out of interest, I asked how many people they had found thus far with criminal records? None yet, was the reply. But how can you tell whether the kindly nurse is really a murderous paedophile?

CRB clearance is nothing these days. We all have to do it. Well, that's what I thought, but I was shocked to find that none of my colleagues in NHS hospitals have to do it. New staff yes, but not existing staff. How many people is that? Several hundred thousand, I guess. Now that is scary - think of all the criminals in among that lot pretending to be honest healthcare workers.

What I hadn't appreciated, until the man came to make his inspection, was all the personal data that we needed to keep for our staff (in a locked cabinet, of course). Two references, a recent photo, a copy of their passport, copies of their qualification certificates, a curriculum vitae with explanations for any gaps, a copy of their contract and job description.

Including the cleaner? Yes, including the cleaner. 'It's not me who makes the regulations', said the man from the HCC. 'The onus is on you to comply with the statutory requirements as set out in the standards of care regulations. We are not here to enforce, simply to register. And you must legally register.' We constructed some references for the cleaner and of course enrolled her in the appraisal process, which she didn't seem to mind.

Why the cleaner, I asked? Ah, that's easy - 'Holly Wells and Jessica Chapman might still be alive if these regulations had been in place'. But we don't see or treat children or vulnerable adults - if we did, a further tranch of regulations come into play. Nevertheless, we must do everything we can to prevent frightful murders like that. The cleaner was somewhat grumpy the following week when she couldn't start her work because the electrical testing man was checking her Hoover for safety, another of the HCC requirements, and a bargain at 130 pounds.

Our long-suffering nurse had taken on the role of health and safety officer, and had made a thorough risk assessment of the building. We had a bit of a joke about the kettle, which is a clear risk, but we addressed the problem by putting up a large notice saying it 'may contain hot water'. We also looked at the shiny floor, the fire alarms, fire testing, the safety of the tap water, the evacuation procedures. We thought we had it sorted.

'What about defenestration?' the man asked. Blank looks all around. 'What exactly is defenestration?' 'Big windows like these could blow out in a blast. Is it safety glass?' We agreed to get back to the architect we had used to provide the floor plan that the HCC had required. (Sorry, did I not mention that they need the floor plan in their file, alongside a copy of the lease and planning consent?)

Were we sure the building had the right planning approval? 'But I thought that was the responsibility of the local planning department?' How naive! Did I not appreciate that the HCC is there to protect the interests of patients who might be in a building with potentially the wrong planning use. B1 office use is not the same as D1 public service use. Point taken.

I have to admit that I was really impressed by the man from the HCC. He seemed a very unassuming chap, and yet had a huge breadth of knowledge as well as an understanding of defenestration.

I asked him what qualifications you needed to be able to make a valid judgement about my bank statements, my personal medical records, the floor plan of the building, the lease and our business plan. (We also had to provide him with a business plan, a copy of the last two years' audited accounts and a signed disclosure allowing him to access the company bank account.) He had been a nurse and then a manager in the NHS before. Well, that explains it. Of course, I am sure he had needed extra training on how to evaluate our Patients Guide, which we had to produce as part of the statutory requirements, and similarly our Statement of Purpose, which explains what we do.

We had worked hard on the written policies on complaints, emergencies, fire, health and safety, but we were told they were incomplete. I was told that the full list was in appendix C of the Standards of Care Act. I counted them - 35. It was just as well we looked, since we might have been at risk from an unguarded compliment or gift. We are now mercifully protected by our compliments and gifts policy, which we feel covers all eventualities, as does the risk assessment for COSHH. COSHH? You know, substances hazardous to health. We didn't think we had any of these but we hadn't read the small print. Apparently Tippex can be very hazardous if accidentally swallowed, but now it's covered with a two-page risk assessment.

We got most of the documentation sorted and the HCC came back to have another look. We had installed the emergency call button in the disabled toilet, 'which had to be accessible to the collapsed person lying on the floor', and bulked up the Statement of Purpose, which now includes loads of information about to whom to complain if we aren't matching up.

'What do you do that is so risky?', I hear you ask. I see patients as a medical practitioner as described under section 2(4) of the Standards of Care Act (2000). What that boils down to is being a doctor. I talk to my patients and I suggest things to help them. I don't do surgery or operations. I don't even take blood or carry out intimate examinations, but that's no matter because what I do needs regulation. Because we don't want another Shipman, do we? No, absolutely not.

I am sure we won't have another Shipman, especially now that diamorphine has been banned from every hospital in the whole country on his account, and we have these terrific regulations.

I asked the HCC inspector how they were getting on with the inspection of NHS GPs, but they aren't bothering with them yet. Nor with any of the more than 40,000 physiotherapists practising in the country. Presumably it's based on a risk analysis, just the same as our kettle. The clever people in the HCC have done a risk analysis and they think that the 30,000 NHS GPs are low risk, so they focus on the few dozen private sector people like me. And all for ś78million, which is what the HCC will cost this year. If it prevents one death then that has to be worth it, doesn't it?

Tony Blair doesn't understand this at all. He thinks that Britain is in danger of developing a 'wholly disproportionate' concern about risks. 'Health and safety laws have saved lives by cutting accidents and improving the environment', he said in a speech to the Institute for Public Policy Research in London earlier this year. But he believes that too often public bodies seek to do everything to avoid blame. 'In the end, risk is inescapable', he said. 'The government cannot eliminate all risk. But too often our reflex as a society is to regulate and to introduce new rules.' What is he talking about?

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 Page is here or here.

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23 August, 2005

METASTASIZING BUREAUCRACY

This is how all public medicine systems end up. It's similar in Britain too

The number of bureaucrats working in Queensland Health has almost doubled in nine years while the state faces a "brain-drain" of doctors. The number of pen-pushers has climbed at seven times the rate of nurses. Health inquiry boss Tony Morris this week said four in every five of Queensland Health's 64,000 employees were in non-clinical roles. One in five of the 43,782 full-time equivalent staff employed by the crisis-ridden department is in management and administration – now the second-biggest category after nurses.

Australian Medical Association Queensland president Steve Hambleton said: "The growth of spaces in the bureaucrats' car parks has been the biggest change in the health system in recent years. "The bureaucracy has spawned more bureaucracy. The health planners got it wrong 10 years ago."

While the number of managers and clerical workers soared 84 per cent between 1996 and 2005, the nursing ranks grew by only 12 per cent. The proportion of nurses in the Queensland Health workforce fell from 43 per cent to 38 per cent over the period. The growth in management and administration staff is one of the issues being investigated by the Forster inquiry appointed by the State Government.

Dr Hambleton said a "brain-drain" of doctors was crippling the health system. "Queensland has the lowest number of registered doctors per head of population of any state and territory," he said. Queensland's rate of 241 doctors per 100,000 population falls well short of the national average of 283. Premier Peter Beattie says the shortage of doctors is at the heart of the health system problems. He blames Canberra for not training enough doctors. "Under Federal Government policies controlling the number of university places, 224 doctors graduated in 1976 – and still in 2004, almost 30 years later, 224 doctors graduated," he said.

Last month, Mr Beattie announced his Government would fund 235 doctor training places at Griffith University in addition to the 80 paid for by the Federal Government. Mr Beattie said Queensland was caught up in an international tug-of-war to attract and retain surgeons, anaesthetists and other doctors amid a worldwide shortage.

Dr Hambleton agreed that "we have to recognise we are in a national and global market and do everything we can to retain our doctors". But he said the State Government had driven doctors out of Queensland to seek work in other states and countries. "Our doctors are the worst-paid in Australia and our nurses, I believe, are the second-worst-paid," he said. Dr Hambleton said many Queensland professionals would be tempted overseas unless there were improvements here....

Mr Morris has been a strong critic of Queensland Health and the amount of money it spends on bureaucracy instead of doctors and nurses. "It seems extraordinary to have four people behind the scenes in support of one person in patient care," Mr Morris 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 Page is here or here.

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22 August, 2005

IN QUEENSLAND WE ARE FINDING OUT WHAT HAPPENS WITH A WELL-ENTRENCHED PUBLIC HEALTH BUREAUCRACY

Hospitals' hidden harm:

One in 10 people who enter a public hospital suffer some sort of harm, a confidential review tabled at the health inquiry has shown. Queensland Health bureaucrat John Wakefield yesterday told the inquiry that while this was an unacceptably high rate of harm, it was not harm caused by the Dr Patels of the world but by well-intentioned staff making mistakes.

Dr Jayant Patel, who worked as director of surgery at Bundaberg hospital for two years, has been linked to the deaths of 80 patients. Dr Patel fled in April and police yesterday confirmed accused pedophile and fake psychiatrist Vincent Berg has also left the country. Mr Berg, under investigation for allegedly molesting a Townsville boy, left on Wednesday last week. A savage backlash over the health crisis is expected against the State Government at today's by-elections for the southeast seats of Chatsworth and Redcliffe.

Dr Wakefield is Queensland Health's Patient Safety Centre executive director. The centre compiles information to help standardise state hospital systems. His comments on patient harm were made as the inquiry also received the confidential Queensland Sentinel Event Review. The review disclosed that 84 very serious incidents warranting in-depth investigation occurred in the previous 10 months. Two related to surgery on the wrong patient or the wrong body part but it did not say in which hospital. Four related to a surgical instrument or material being left in a body cavity or in a wound. Two deaths occurred during inter-hospital transfers while nine were categorised as "sudden and unexpected death of an infant associated with labour or delivery". There were 21 unexpected patient deaths two of which occurred during surgery, while another two patients died due to an adverse reaction from an incompatible blood transfusion. Another two were described as "direct maternal death". Forty-two deaths were related to the suicide or unexpected deaths of mental health patients.

Dr Wakefield told inquiry commissioner Tony Morris that a previous national study into harm in hospitals found that one in six patients who had been admitted suffered as a result of the health care they received and that half of these were preventable. He said that most adverse events were due to human error and the cost to the nation was about $4 billion a year. "It is estimated that 50,000 patients suffer a permanent disability and 18,000 preventable deaths occur per annum in Australia as a result of adverse events," he said. "There is no evidence to suggest that the Queensland public health system is any better or worse than any other health care system in the first world in relation to preventable patient harm."

Dr Wakefield said there had been an "absolute focus on productivity at all costs" and the elective surgery program had been part of that in the past few years. "Let's be open and honest about the fact that we actually do harm patients as a result of hospital care, we don't mean to but we do." He conceded that there was no system in place to assess clinicians' performance when concerns were raised. The inquiry indicated yesterday that it may not meet its September 30 deadline.

Source



Bureaucracy still rules, OK

I got quite a shock this week reading the positions vacant columns in recent Queensland Health Service Bulletins. There is page after page of jobs for managers, administration officers, public affairs officers, project officers, information technology workers, social workers and nurses - but few for doctors. There is a sick joke going around that Queensland employs more spin doctors than real doctors.

Despite the Morris inquiry into health, which has damned the bureaucracy, Queensland Health remains bloated with non-medical staff. The bureaucracy still rules. Emergency surgery by new Health Minister Stephen Robertson is needed.

But what has Premier Peter Beattie learnt from the inquiry? Not much, apparently. It is almost as if he is in denial. He was very cute this week dragging his wife, Heather, along to his press conferences. Against all the evidence of grotesque medical blunders and a bullying and secretive bureaucracy moulded by his Government, Beattie and his missus emerged to tell us we were all really to blame for the hospital crisis for growing old and needing medical treatment.

It was bizarre, yet reporters seemed too polite to challenge the Premier. After all, nobody wanted to appear to be insulting his wife, a nursing educator. I wonder how the 108,571 people on medical waiting lists felt when they heard suggestions it was their own fault for getting sick?

Also this week the Premier attempted to shift the blame for his Government's failings in health by blaming the Feds. This was an old Joh trick. What makes the waiting lists look even more pathetic is the Labor boast that it carries a Budget surplus. The money was there, but not spent.

Now Newspoll confirms that Beattie's store of goodwill has begun to drain away. The Labor Government and the Opposition parties are neck and neck. Beattie has squandered an awesome lead. (He enjoys 63 seats in a House of 89.) The hospitals crisis obviously has dealt the Labor Government a savage blow.

So have the Liddy Clark affair and the the dirty water surrounding Energex and the unseemly exit of former speaker Ray Hollis. Accountability starts at the top. Taxpayers money is still going on secret bonuses for government executives and cronyism is rife. As Beattie dashes from one photo opportunity to the next, I have a horrible feeling the unelected bureaucrats are running the show.

The above column by Des Houghton appeared in the Brisbane "Courier Mail" on August 20, 2005 but does not appear to be online anywhere except 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 Page is here or here.

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21 August, 2005

THERE ARE CONSTANT COMPLAINTS THAT BRITISH PUBLIC HOSPITALS ARE SHORT-STAFFED: MEANWHILE:

Dr Michael Daley, 24, had every expectation of making steady progress through the training grades on his way to a consultant post in an English hospital. He did not expect to be signing on the dole. Last week he applied for the job seekers' allowance and on Wednesday he returned to the job centre to sign on. He is now officially unemployed. Dr Daley, a medical graduate from Manchester University, had completed his first "pre-registration" year as a house officer and confidently began looking to the next step on the career ladder, a training post as a senior house officer (SHO).

He made about 30 applications to no avail. More recently he has put himself on the books at four locum agencies but there is no work for him there either. He has a student debt of ś25,000 and a share of a ś200,000 mortgage on his home in Manchester. He says that he is only looking for work in the North West of England, but does not think it is unreasonable to try to find work in one area of the country. He wants to become a physician but has been flexible, seeking SHO posts in a number of specialities, including paediatrics, intensive care and accident and emergency medicine.

Dr Daley entered medical school with five grade A A-levels and his CV is good enough for at least one of the locum agencies to be surprised that he had not secured a permanent post. "When I started in medicine I never imagined I would have this kind of difficulty," he said. "Signing on is not what I wanted and not what I had planned. The position is now that I have three months to look for a job in my field. After that I have to look in other fields. I have also signed on as a bit of a protest." Dr Daley told the British Medical Association News Review that he had been prepared to seek a "trust doctor" post, which was not part of the consultant training system.

He is now looking to work abroad and has approached recruitment agencies in Australia. "It's the sheer number of applications per place here - 600 to 700. It is very hard to get through," he said. Dr Daley is one of a number of young doctors who have been caught out by a mismatch between the increased number of doctors coming up through the system and the number of SHO training posts available, as well as a change in the training structure. Last month the BMA identified more than 100 young doctors who could not find jobs and an average of 200 applications per post, although some had attracted as many as 1,000.

Dr Andrew Rowland, the chairman of English regional junior doctors committees of the BMA, said yesterday: "It is quite worrying as these doctors have cost hundreds of thousands of pounds to train." In Australia, where they are short of about 3,000 doctors, medical recruiters said they would be taking advantage of the situation in Britain. It costs nearly ś250,000 to train a doctor. A spokesman for the Department of Health said: "There is simply no question of hundreds of doctors being 'on the dole'. "It's not unusual for new graduates to either work abroad or travel after their pre-registration house officer year.''

Source



"Expert patients" make healthier people: "Over in Britain they've started a new program on the BBC network (Channel 4), designed to empower and assist those suffering from chronic pain and other prolonged disease. It's called 'The Expert Patient' and it is getting mixed reviews from the medical profession. As the first episode of the show itself acknowledges, when a physician some 30 years ago made the pronouncement to a group of interns that 'This patient knows more about her disease than I do,' he was not being complimentary to the patient. But nowadays even the British government, and the officials in its state-sponsored health system, are moving toward a more self-aware patient model, whereby those actually suffering from chronic pain and other lasting ailments can play a more active role in their own care and treatment. The TV program is designed to promote knowledge in those patients, and the people who care for them, so that the physician's job becomes simpler, and focuses on the larger questions of healthcare."

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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 Page is here or here.

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20 August, 2005

PEOPLE ARE DYING FROM SUPERBUGS IN AUSTRALIAN PUBLIC HOSPITALS BUT OFFICIALDOM IS UNCONCERNED

It's one way to get people off those embarrassing waiting lists, I guess

Hospital patients are dying from superbugs because Australian health authorities are mishandling the crisis, Australia's peak body for surgeons said today. Superbugs were endemic to every hospital in Australia and would spread further unless authorities changed their approach to infection control, the Royal Australasian College of Surgeons said. The common superbug MRSA (methicillin-resistant Staphylococcus aureus), a strain of golden staph, is resistant to most prescribed antibiotics.

Australians should be very concerned about the death rate from hospital superbugs, as the nation was lagging behind international best practice in combating infection, the college's infection control committee head Professor Richard West said. His comments come after the Victorian Department of Human Services released figures earlier this week showing an outbreak of the killer superbug was linked to 123 patient deaths in the past 12 months. The figures, from June 2004 to May 2005, showed that MRSA had been found in more than 30 hospitals, and had infected more than 1,600 people.

But the Victorian Government played down concerns this week, saying only a small number of those who died did so as a result of catching the bug, while the rest were infected with the bug but died of other causes. Victorian Health Minister Bronwyn Pike was confident hygiene measures in Victorian hospitals were sufficient to combat the bug, which she said was "part of the natural world".

Professor West said today he was "astounded" by how lightly the latest problem had been taken by Victorian health authorities. "To say that these bugs are part of the natural world is rubbish," he said. "Other countries are doing much better in controlling the superbug than we are. "Experience in northern Europe has shown that with a more stringent policy, it is possible to get much lower rates of MRSA infection." The policy in other countries of isolating the organism and destroying it in the environment, along with measures to decontaminate staff, were "much more effective" than Australian procedures.

Professor West said Australia should direct more resources towards infection control. The measures should include the adoption of a national database to record and monitor MRSA, he said. Better education of health workers, the implementation of better handwashing routines, the adoption of a policy of searching and destroying the organism, and better-designed healthcare facilities that allowed infected patients to be nursed in an appropriate environment, were also needed.

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 Page is here or here.

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19 August, 2005

A Dark Day for Ambulance Chasers

The earth shook under one of the largest and most powerful liberal special interest groups, the trial lawyers, but the media have barely noticed. A federal judge in Texas abruptly halted the latest class-action scam, and by doing so, has probably done more to halt these frivolous and scandalous lawsuits than any federal tort reform legislation could ever do. The Wall Street journal has editorialized about the case, but most of the major media have remained silent.

Judge Janis Graham Jack is a U.S. District Court Judge in Corpus Christi, Texas. She is also the wife of a medical doctor, and was herself a nurse. Judge Jack was in charge of approximately 10,000 cases involving claims of silicosis, which according to the Houston Chronicle, is the "oldest known occupational lung disease." Following 20 months of pre-trial proceedings, Judge Jack, a Clinton appointee, wrote a scathing 249-page opinion, saying there was no basis for continuing federal jurisdiction, and she recommended that the evidence used by the plaintiffs should be thrown out. She didn't hesitate to use the word "fraud."

The extent of the apparent fraud is indeed shocking, and should lead to congressional hearings with the same passion and outrage that characterized such hearings as those that looked at the Enron scandal. The problem is that too many in Congress are part of the same special interest group that has perpetrated this fraud, and receive large donations from them. For example, silicosis has been on the wane for many years, since its damaging effects have been well-known for so long. But the asbestos lawsuits, which have resulted in huge fortunes for many trial lawyers, saw silicosis as another opportunity. So they set up what the judge indicates was a giant scam.

Many of the suits were originally filed in Mississippi, considered a friendly state for this type of plaintiff lawsuits. According to testimony in the case, more than 10,000 cases of silicosis appeared in 2002 in Mississippi alone. The previous year there had been just 76 such cases. For a disease that averages fewer than 200 deaths a year in this country, all of a sudden beginning in 2001 there were more than 20,000 claims in Mississippi alone, which apparently caught the attention of ambulance chasers everywhere.

So what evidence of fraud did Judge Jack discover? For one thing, 99% of the plaintiffs who supplied greater detail of their ailments were diagnosed by the same nine doctors. They had all been retained by law firms or screening companies that, according to the Wall Street Journal, do mass X-rays on behalf of the firms searching for plaintiffs. In many cases, the doctors never saw the patients, the people who did the X-rays were not radiologists, and one doctor performed more than 1,200 diagnostic evaluations in 72 hours. Another doctor diagnosed more than 3,600 patients with the disease, and admitted in court that he didn't even know the criteria for diagnosing the disease.

Most shocking of all, perhaps, as the Wall Street Journal pointed out, is that "more than 65% of the silica plaintiffs had previously been plaintiffs in an asbestos suit, even though it is clinically impossible to have both asbestosis and silicosis." The Journal noted that it was these massive asbestos suits that were "largely blessed by the courts, that first allowed trial lawyers to co-opt doctors to create millions of phony claims and extort billions out of corporate defendants."

Judge Jack blasted the lawyers, particularly the Houston firm of O'Quinn, Laminack & Pirtle. She required them to pay more than $800,000 of the defendants' legal bills, and charged that their "clear motivation" was "to inflate the number of plaintiffs and overwhelm the defendants and the judicial system."

There has been very little coverage of this story. The coverage includes a lead editorial in the Wall Street Journal two weeks after the fact, a very good article in the Houston Chronicle, an op-ed in the Atlanta Journal-Constitution, and stories in several small Texas papers.

But this is a national story. Don't forget that a prominent trial lawyer, former Senator John Edwards, almost became Vice-President of the United States. What does he think of the verdict in Texas? If the media are interested, Edwards can be reached in his home state of North Carolina, where he has emerged as the director of the Center on Poverty, Work, and Opportunity. Before taking up the cause of eliminating poverty, he made tens of millions of dollars as a trial lawyer. Some of that money was made from legal cases against doctors and hospitals, blaming them for cases of cerebral palsy among children, even though critics said that he relied on "junk science" in some of those suits.

Edwards is convinced that his record as a trial lawyer will not hurt his chances for future political office. He is widely regarded as a possible Democratic Party presidential candidate in 2008. If that happens, the media will do their best to put his record-and the record of other trial lawyers-behind him.

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 Page is here or here.

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18 August, 2005

ZERO RISK MANIA VERSUS THE PATIENT'S RIGHT TO CHOOSE

These are turbulent times for the Food and Drug Administration. The almost daily barrage of headlines questioning the safety of marketed drugs is probably depleting regulators' stocks of aspirin and antacids. But as they try to soothe their own pain, regulators must not forget their mission: to ease the plight of patients who need new medicines.

Past criticism of FDA mostly concentrated on what arguably remains the agency's most important shortcoming: the delays and escalating expense of getting drugs through the development pipeline and into the market. Lately, however, events have shifted the focus to safety. First there were claims certain antidepressants' labels failed to warn doctors that the drugs caused some adolescents to commit suicide. Then the agency was blind-sided by contamination that rendered unusable half the nation's flu vaccine last winter. Finally, there were revelations about previously unknown side effects of several widely prescribed anti-inflammatory analgesic drugs. Regulators' increasing sensitivity to safety may have become contagious: Drug manufacturers, too, seem to have begun to "err on the side of safety" to a degree that triggers voluntary removal from the market of safe and effective drugs.

Consider Tysabri, only the sixth medication approved -- and the first in several years -- for treating Multiple Sclerosis (MS), a debilitating autoimmune disease affecting the central nervous system. The stunning results of clinical trials -- the frequency of clinical relapses was cut more than half -- induced FDA to grant accelerated approval last fall. MS patients eagerly put their names on waiting lists for the medicine. But this ray of hope for MS sufferers was short-lived. By the time several thousand patients were being treated with Tysabri, three confirmed cases of a rare neurological disorder caused by a virus were reported. (Because the drug suppresses certain aspects of the immune response, regulators, clinicians and the drug's developers from the beginning were sensitive to infections as a possible side effect.)

Immediately -- some say prematurely -- the medicine's manufacturers voluntarily halted production and distribution and withdrew Tysabri from the market. MS victims and many neurologists were bitterly disappointed. Now they can only hope a comprehensive review of all the clinical data -- including results of new diagnostic tests on Tysabri recipients -- will permit the drug's return to the market.

The "safety" of a drug is relative. Safety and efficacy, the two criteria for marketing approval, are inextricably linked. Regulators' judgments require a global and often difficult calculation of risk and benefit, including consideration of available alternative therapies. We tolerate more uncertainty and severe side effects for a potential cure for pancreatic cancer or AIDS than for treating heartburn. When FDA grants marketing approval, the drug is deemed safe and effective for conditions on the label.

In the current climate of litigiousness and antipathy to big companies, one can understand the haste to withdraw Tysabri voluntarily from the market. What is also understandable (and lamentable) is the chattering classes' hyping of the drug's health concerns and of the stock market effects of its withdrawal, while ignoring that real people able to lead more normal lives with Tysabri now can't get it.

Another casualty is patients' ability, after consulting with health-care professionals, to make informed decisions about possible treatment options. That fundamental right should not be usurped by risk-averse, publicity-shy bureaucrats, anti-FDA health-care activists or members of Congress.

As more breakthrough drugs come before FDA for approval, the agency must curb its paternalistic instincts and find a way to more sensibly balance safety with patients' right to assume responsibility for their own medical decisions. This would be a sea change for FDA, which in many areas -- "off-label" prescribing, and disseminating new information about drug therapy, among others -- has sought repeatedly to limit physicians' and patients' discretion on treatment decisions.

To this point, FDA has been even-handed on Tysabri. The clinical data justified the accelerated approval; ongoing analysis of safety data is a responsible action; and if the data support it, FDA should work with Tysabri's producers to rapidly reintroduce the drug. Labeling restrictions, such as a prominent "black box" warning or strict limits on who can receive a drug, are "risk-management" options within FDA's purview. In any case, FDA actions must be driven by the data.

The notion FDA should "err on the side of safety" must be qualified for patients with incurable or poorly treatable diseases: For them, there is no safety in the status quo, and they are only damaged further by paternalistic public policies that prevent them from exercising their own judgment about risks and benefits. If FDA must err, it should be on the side of patients' freedom to choose

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 Page is here or here.

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17 August, 2005

GO TO A PUBLIC HOSPITAL AND RISK YOUR LIFE

With the coverup champions at work in the health bureaucracy, who knows how much more of this is going on?

The number of deaths officially linked to Dr Jayant Patel's botched surgery at Bundaberg Hospital has jumped from eight to 13. Associate Professor Peter Woodruff, who finished an audit of clinical records of 221 former Patel patients in June, originally found Dr Patel's unacceptable level of care had contributed to the deaths of eight people, and may have contributed to a further eight. But in verbal evidence to the health inquiry yesterday, Dr Woodruff revealed that after reviewing the cases further he now believed Dr Patel's questionable patient care had contributed to another five deaths. He said that in those 13 cases Dr Patel's level of care fell short of that expected from a competent surgeon.

The deaths of Desmond Bramich, Gerry Kemps and James Phillips, whose cases have been discussed at length at the inquiry, are included in the list. Their names had been previously released from suppression. Dr Woodruff said that in the case of Bramich, while Dr Patel was linked to the death, other medicos might have also contributed. A total of four patient deaths could be linked to other doctors who were "significant contributors to the outcome". Dr Woodruff, the director of vascular surgery at Brisbane's Princess Alexandra Hospital, said some of Dr Patel's surgical cases were "beyond explanation" in terms of why they had been attempted.

In one case, which can not be identified, he questioned Dr Patel's motives altogether because he said the case showed "more than a lack of judgment". "They (some cases) are beyond explanation . . . it's even being generous to him to suggest it's his personality and his wish to re-assert himself," Dr Woodruff said. He found Dr Patel contributed to or may have contributed to an adverse outcome in 48 patients, alive and dead. Dr Woodruff said the surgeon's inadequate care of his patients included carrying out operations without expertise, misjudging the correct operations to perform, deciding to perform operations which were either unnecessary or on occasions destined to fail and operating on the outskirts of or outside his expertise.

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 Page is here or here.

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16 August, 2005

The War Against Pain-treating Drugs: Another Failed Prohibition

America suffers from a psychological disorder that hasn't yet made it into the psychiatric dictionary. Call it the "humanitarian empowering delusion" — the belief that everything that's good should be a right, and everything that's bad should be a crime. Once people get it into their heads that, in order to protect and/or perfect the human race, something should be either a right or a crime, there's no end to the damage their certainties can do.

Especially when they get the government to go along. Your Medicine Men have written frequently on what happens when the Federales decide to go after physicians whose prescription-writing patterns they don't like. We've talked about investigatory abuse and prosecutorial overzealousness, of doctors hounded and ruined for honest mistakes or because something they prescribed ended up on the street through no fault of their own (rather like suing McDonald's because a woman spilled McDonalds' coffee into her own lap). We've noted that the federal offensive against pain management is driving some doctors out of practice, keeping others from treating patients in pain, and forcing many to undertreat patients. But our purpose this week is to provide a bit of historical background, demonstrating how this particular nightmare, like so many others, comes about through the kind of humanitarian empowering ignorance that remains impervious to the real-world damage it does.

In 1914, five years before America embarked on that greatest of all failed prohibitions, Prohibition, Congress passed the Harrison Act. This law, one of the final products of the Progressive regulatory bulimia, outlawed the non-medical use of opium, morphine and cocaine. According to a policy analysis published this June by the Cato Institute, by Ronald T. Libby, a professor of political science and public administration at the University of North Florida, this act "made it a criminal felony for physicians to prescribe narcotics to addicts." As with Prohibition, the Harrison Act created a new criminal class, this time about 250,000 patients and their doctors. Before 1914, opiate narcotics were unregulated and as widely available as aspirin is today. They were also widely used in nostrums for curing or treating many illnesses and conditions.

The humanitarian struggle against addiction has evolved into a war against effective treatment of chronic pain. In 1970, the Harrison Narcotics Act was replaced by the Drug Abuse Prevention and Control Act, which initiated the War on Drugs. In 1975, the Supreme Court ruled that Drug Enforcement Administration (DEA) licensed doctors "can be prosecuted when their activities fall outside the usual course of professional practice" — as though every patient and medical situation was "usual" and no different from any other.

Until the 1990s, the DEA mostly focused on illegal black market drugs, such as cocaine, crack and marijuana. But in 2001, fomented by erroneous media and legislative scares, the DEA created a new mission for itself, combating the illegal diversion of a legal prescription drug, OxyContin. Ironically, these scares were shouted from the housetops during the same time that the medical profession learned that properly managed opiate pain-control drugs could be used very safely and very effectively to break the pain cycle caused by failure of the body's internal pain control systems when overloaded with chronic pain.

We also learned that, properly managed, almost every patient taking these medicines for chronic pain relief easily stops taking these drugs when the pain-causing condition resolves. These patients become "physically dependent" on the drugs for pain relief but do not suffer addiction, that is, do not suffer cravings for a substance, compulsively use the substance, or continue use of the substance, in spite of harm.

Addiction is sometimes ignorantly touted as a very likely consequence of the medical use of opiate medicine for chronic pain. It just ain't so. When appropriately used, powerful pain medicines allow patients suffering pain to improve their lives. In contrast, these same drugs, when abused by addicts, cause drug abusers' lives to deteriorate.

Adding injury to insult, Congress abdicated its duty to control its own government agencies and gave the DEA the power to finance its own operations, that is, to charge what it liked for services and to steal from the innocent (i.e., from not-proven-guilty suspects) and keep the loot. As a result, prosecutors often seize assets and cash from doctors before the prosecutors file any charges. This "civil asset forfeiture" power was designed as a tool against organized crime, not to persecute the innocent. Lacking any cash or resources, doctors are unable to defend themselves in court. This gives the agents and prosecutors incentives to follow the money — first — rather than seek justice, as some openly admit.

At a 2003 training conference for drug diversion agents, Detective Dennis M. Luken, of the Warren-Clinton Drug and Strategic Operations Task Force in Lebanon, Ohio, and treasurer of the National Association of Diversion Drug Investigators, advised agents to "remember that asset forfeiture investigation should begin at the start of your criminal case." In other words, look to the loot first; crime or criminal intent comes second.

Until recently, the DEA published a guidance-for-physicians pamphlet stating: "For a physician to be convicted of illegal sale, the authorities must show that that the physician knowingly and intentionally prescribed or dispensed controlled substances outside the scope of legitimate practice." But just before the lawyers for Dr. William Hurwitz attempted to introduce the pamphlet in evidence in his defense, the DEA withdrew the pamphlet, denied the validity of previous DEA guidelines and failed to define coherent new policies.

The judge agreed that the pamphlet couldn't be shown to the jury, because it did not have the "force of law." This at the same time judges allow government lawyers to use inflammatory language to impugn doctor defendants, such as comparing doctors to the Taliban. Such out-of-bounds rhetoric doesn't have the force of law either, but judges let it pass. Sounds rather ex post facto to us, moving the goalposts, the sidelines and changing the rulebook after the game is over

It's even a bit much for other prosecutors. Thirty state attorneys general have expressed concern about the DEA's quicksand-solid position this January. They signed a letter to the DEA complaining that the DEA wasn't letting them know what agency's policies were. The letter also said, "we have learned that adequate pain management is often difficult to obtain because many physicians fear investigations and enforcement actions if they prescribe adequate levels of opioids or have many patients with prescriptions for pain medications."

People suffering chronic pain are suffering because, for fun and personal profit, DEA agents are telling doctors how to do their jobs. The War on Drugs is taking the lives of way too many innocent patients and doctors. Whether called "collateral damage" or any other name, the damage is excessive and this is one war long since lost. It's time to prohibit this Prohibition against treating pain.

In the end, the real problem is all of us who believe that regulation and prosecution can solve all our problems for us.

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 Page is here or here.

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15 August, 2005

SOME TALK AT LAST ABOUT ENDING BRITAIN'S NHS

A tax-funded National Health Service, free at the point of use for all, is unsustainable and should be scrapped, Britain's most senior doctor says today. In an interview with The Daily Telegraph, Bernie Ribeiro, the new President of the Royal College of Surgeons, says health care in this country should be paid for instead through a social insurance system, similar to that used in France and Germany. Patients would pay a proportion of the cost of their treatment, and take out insurance to cover that cost. "If we are to provide health care free at the point of need all the time for patients, then I don't think that's achievable in the present structure," says Mr Ribeiro. "We will have to look hard at an alternative system." His comments will reignite the political debate about the funding of health care in Britain.

Although some senior figures in the Labour Party called for the introduction of a new funding mechanism in the last Parliament, Gordon Brown ruled out changing the way in which the NHS was paid for. He raised national insurance, following the publication of the Wanless report into the future of the NHS, to increase the resources available for health care.

The intervention from such a senior doctor will also put pressure on the Tory leadership contenders to take a more radical stand in order to differentiate themselves from Labour. Although shadow frontbenchers visited other European countries to explore alternative funding mechanisms before the last election, the party ruled out moving to a social insurance system because it feared a public backlash to such a reform. Andrew Lansley, the Tory health spokesman, said yesterday: "We just don't know what level or standard of care the NHS is capable of providing under the current system if the resources are used efficiently. There are many steps to go through before we get to that stage."

However, Mr Ribeiro criticises such political caution and calls on the Government to reconsider the introduction of a social insurance system in order to generate extra resources for health care and make people value the treatment they get. "We're not a poor country, the working population is reasonably well paid, we could afford our workers to make an identifiable contribution towards health care - not one hidden in national insurance and taxation. "I think the public would be prepared to pay, it's a question of how you structure it. We seriously need to look at this again." Under such a system, he says, contributions would be means-tested, with the poorest paying nothing at all. The rising cost of technology and medical staff will, he argues, make a tax-funded NHS completely unsustainable in the medium term. Mr Ribeiro says: "We're not talking about health care now, we're looking at health care in the future. Look at the cost of technology. "If we're going to have a health care system suited to the future, we've got to be prepared to invest in it. I don't personally believe that can be done out of pure taxation."

A social insurance system would also, he believes, create a stronger link between the money people spent and the treatment they received. "People value what they pay for. The NHS isn't free but people don't see a link between their money and the service." The Government needs to make some tough choices about what should be available on the NHS, he adds. "I would prefer to say we will give you the best emergency care possible, but you may not get all the elective work you want done on the state." Mr Ribeiro calls on the Government to create up to 1,000 more training posts for hospital consultants so that junior doctors who have finished the first stage of their training can go on to become specialists. Earlier this week, the British Medical Association said too many junior doctors were unable to find jobs.

Mr Ribeiro raises concerns, too, about the European working time directive, which imposes a 48-hour working week. The new regime will, he says, make it almost impossible for surgeons to complete their training satisfactorily. "Surgery is a craft, it takes time to learn it." He also criticises the imposition of waiting list targets, which he says have distorted clinical priorities and may even have contributed to the spread of MRSA. "The Government sets targets but, when I do a clinic I'm talking to an individual, not a disease or a statistic. The pressures on the health service from targets have made things go wrong."

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 Page is here or here.

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14 August, 2005

RAMPANT BUREAUCRATIC MISREPRESENTATION: OFFICIAL HEALTH COVERUP UNMASKED

At least we are finding out about it in Queensland: The official number of people on hospital waiting lists in Queensland is 31,478. Claims that the list is, unofficially, much longer have been frequently denied. The Morris inquiry yesterday was told the true figure: 108,571 people are waiting for specialist medical appointments or a hospital bed in Queensland. Isn't "single-payer" medicine wonderful?

The full extent of queues for Queensland public hospitals has finally been made public, with 140,049 people either waiting for an operation or waiting to have their medical condition assessed to determine whether they need an operation. Until this week, the Beattie Government said the Queensland Health Elective Surgery Waiting List Report gave a true indication of the numbers of people waiting for operations in the state's public hospitals. On Thursday, however health commission chair Tony Morris, QC, produced a confidential memorandum to Townsville Health Service district manager Dr Ken Whelan that revealed there was another list of people waiting for outpatient appointments. Public hospital medical specialists see patients at outpatient appointments to assess what medical care they need and whether they need to go on to the "official" waiting list or whether they need other medical procedures.

After tabling the Townsville memo, Mr Morris called on Queensland Health to provide full details of the Specialist Outpatient Department Profile Survey, which was provided to the inquiry yesterday. As at July 1, 2004, there were 31,478 people on the state's official elective surgery waiting list, with a further 108,571 people waiting for outpatients appointments. The issue dominated State Parliament yesterday, with Queensland's new Health Minister Stephen Robertson saying it was misleading to compare people waiting for an appointment to see a specialist with waiting times for elective surgery. "It's like trying to compare apples with oranges and it's dishonest," Mr Robertson said. "Following an initial specialist outpatient consultation, a patient may be returned to the referring general practitioner with recommendations for ongoing management; admitted to the hospital; placed on a waiting list for elective admission; or followed-up in specialist outpatient clinics."

Liberal Health spokesman Dr Bruce Flegg said a large number of Queenslanders die before they are ever seen by a public hospital specialist and conditions of other people deteriorate so badly they can no longer be fixed. "Thousands of Queenslanders have no idea when they can get medical treatment," Dr Flegg said.

A prominent critic of the state's public hospital waiting lists, former Australian Medical Association (Queensland) president David Molloy, last night said even with both sets of waiting list figures, other people were being prevented from getting access to medical services. Dr Molloy said that, earlier this year, a number of letters were sent to Brisbane GPs, telling them waiting lists were so long that they should seek alternative treatment for their patients. "They did this to reduce the number of outpatients and the number of outpatient appointments," Dr Molloy said. "They also don't have to keep official data on when you need entry procedures – colonoscopies or endoscopies – which are used to detect stomach and bowel cancer. They don't keep data on a whole lot of investigative procedures for potentially life-threatening situations."

When 46-year-old Bray Park quadriplegic Elizabeth Yates visited the Princess Alexandra Hospital with bowel problems back in March, she said she was given an appointment for a colonoscopy in July. However, when she arrived at the hospital two weeks ago, she was told there was no bed for her. "It's bad enough for able-bodied people to go through this, let alone someone with special needs like myself," she said. The hospital has now rescheduled her procedure for October, although she remains sceptical as to whether or not there will be a bed for her when she arrives. "With what I've seen in the media about the situation at the moment with the health system, I'm not optimistic I'll get it done," she said.

Gold Coast resident Don Jordan does not understand how the State Government can afford to spend millions of dollars building a new football stadium in his home suburb of Robina when the state's public health system is in a shambles. The 67-year-old whose body is riddled with four potentially lethal aneurisms – one behind his heart and three in his groin and leg area – says he is on the waiting list to get on the waiting list. "I could go any minute, aneurisms are so unpredictable because they can rupture at any time," Mr Jordan said. "I wish they would just tell you the truth (about how long one has to wait)." Mr Jordan says he is frustrated by the State Government's willingness to spend millions on a new football stadium 2km from his home while there are beds sitting empty in the nearby Robina Campus of the Gold Coast Hospital. "I don't know how they can find all that money for stadiums and brag about having a surplus while people are dying waiting to be seen in hospital," 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 Page is here or here.

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13 August, 2005

Medi-Cal fraud flourishing on black market

In a bustling black market trade, unscrupulous medical providers are buying Medi-Cal and Medicare patient identity numbers and using them to get reimbursed for millions of dollars in tests and other services that are never provided, authorities say. Of $34 billion annually spent by the Medi-Cal program for health care for some 7 million poor Californians, state officials estimate that as much as 40 percent or nearly $14 billion is stolen in fraud.

The identity theft scam involves conspirators using stolen patient information purchased for as little as $100. They submit bills for up to $30,000 to cover tests, prescription medicine, wheelchairs and incontinence supplies which are either never delivered or are received and resold on the black market. "These numbers are passed from medical clinic to medical clinic, lab to lab until the medical beneficiary cards are maxed out," said Los Angeles County Sheriff's Sgt. Steve Opferman, who heads the Health Authority Law Enforcement task force. "They suck it right out. That money's gone. It's huge. It's out of control. The health care system is just hemorrhaging."

Patient names and identification numbers are sometimes acquired illegally by criminal middlemen who then sell them to unscrupulous medical providers. Other times, an unscrupulous firm will buy the identification numbers directly, officials said. "At the heart of what the criminals are doing is preying on the economic desperation of the community," said Collin Wong-Martinusen, the director of the state Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse. "The greed and depravity of the people who are committing these crimes is only exceeded by their ingenuity and creativity."

Crooks are drawn to the program, administered by the state's Health Services Department, because there's lots of money to be had, and it's an easy target, authorities said. "It pays first and asks questions later," said Daniel Hancz, a pharmacist who works with Opferman on the HALT task force. "Once you're a provider, it's pretty much an honor system. It's difficult to prevent. "It's after the fact, unless there's a complaint, or unless some red flags go off."

In one raid, authorities found carbon sheets of patient information and stacks of photocopied medical cards and driver's licenses, some obtained from Los Angeles-area hospitals. During interrogations, investigators learned that workers in medical records offices and billing departments had copied the information for cash. In one case, a woman was paid in diet pills, a prosecutor said.

Unscrupulous pharmacies and clinics bill for "ghost patients" people they've never seen, but whose identification numbers were either stolen, traded or sold by the patient himself or herself. Investigators said searches have turned up medical charts in the process of being altered, some that are postdated or written up in a way that makes no sense.

Criminals also forge signatures for diagnoses and drugs, without providing supporting patient complaint histories. "They're a wily bunch," said Teresa Schilling, a spokeswoman for state Attorney General Bill Lockyer. "Like any criminal industry, it is full of people desperate to cheat. They will find any way they can to get through the system. "When we close one door, they look for another one to open. It's always a challenge to keep up, but we're good at it, too."

A recent case in Burbank highlights the issue. Sofik Nazarian, 47, and Vrej Oganesian, 40, co-owners of The Best Pharmacy and Medical Supply on Glenoaks Boulevard, were arrested July 26 on suspicion of billing Medi-Cal for $375,000 in prescription drugs that were not delivered to patients. The two were free on bond, pending an Aug. 16 court hearing to face grand theft charges. Reached at his store after his arrest, Oganesian declined to comment. Neither Nazarian nor her attorney could be reached.

According to court documents, the pair went into business in 1997 and enrolled in the Medi-Cal reimbursement program. Officials audited the firm because of high billings and concluded the suspects had submitted false or fraudulent claims for medical supplies and pharmaceuticals that were not provided to patients, California Department of Justice Special Agent Naureen Zaidi wrote in court documents. Six patients told investigators they had never heard of Best Pharmacy and never received medical supplies from it, although records showed the firm received reimbursement for them, according to court documents. A physician whose name came up as the referring doctor for 18 patients under Best Pharmacy's provider number told investigators that he had seen several of the patients, but that some of the billings under the patients' names were fraudulent, court documents said. Authorities do not know how the duo got the patient information.

"This stuff is so out of control," said prosecutor Albert MacKenzie, who's heading the Los Angeles County District Attorney's Fraud Interdiction Program. "We have to have a more effective way of investigating and prosecuting these cases because the traditional methods of investigation and prosecuting these cases take years. By that time, the money's gone and the crooks are gone."

The state Department of Health Services says it has been working harder to screen prospective Medi-Cal providers and does regular on-site inspections, but officials acknowledge it's an uphill battle. In Los Angeles County alone, more than 39,400 clinics, pharmacies, medical supply companies, and hospitals are authorized to provide services under Medi-Cal, according to DHS statistics. "It never ceases to amaze me what people do to defraud us," said Diana Ducay, the deputy director of the Audits and Investigations Department of the DHS. "There's always a new scheme around the corner."

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 Page is here or here.

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12 August, 2005

"CARING" BUREAUCRATS AT WORK AGAIN

"Don't bother me" is the only goal of a bureaucrat.

Two different pictures are emerging of the Napa State Hospital in the wake of a recent scathing federal report detailing problems at the facility. The first is the image portrayed in the U.S. Department of Justice report, which describes a perilously understaffed mental hospital crawling with illegal drug use, poor supervision of suicidal and dangerous residents, and a staff too quick to restrain, medicate and isolate patients - sometimes for hundreds of hours at a stretch.

The second is the view of state mental health officials and many who work and live at the hospital, who say a previously trouble-plagued hospital is changing its ways and shifting focus to the individual needs of each patient. Some of the accusations, they say, have been overblown and taken out of context. "Nobody denies that ugly - and unacceptable - things have happened within the historic walls of the 130-year-old hospital at the mouth of the Napa Valley. "We take issue with some things (from the report)," said Stephen Mayberg, director of the state Department of Mental Health. "But there are other things that we knew and that we are trying to address and we are aggressively addressing."

The Department of Justice is blunt in its findings, detailed as "widespread and systemic deficiencies" in a 23-page letter to Gov. Arnold Schwarzenegger on June 27 that recently became public. Of particular concern, the letter states, the hospital has failed to adequately supervise suicidal patients and protect its general population from patients prone to violence. In one instance cited, staff failed to prevent a patient from hanging himself in December despite previous suicide attempts and warnings from his family that he was despondent and in need of attention. The report cites six suicides at the hospital since 1999, the most recent when a patient hanged himself in a locked bathroom in March.

In another case, a patient was strangled to death in May 2002 by his roommate, who had a history of violence and attacking sleeping patients. "Patient advocates and patients themselves tell us that staff often fail to intervene with violent patients because the staff are afraid," the report states. The report also details allegations that patients have access to marijuana and cocaine and that one patient died of a drug overdose in fall 2004. The federal agency also accused state officials of failing to cooperate with the federal investigation and of repeatedly refusing to allow access to the facility. Eric Holland, a spokesman for the Justice Department, said the agency had no comment beyond the report.

State mental health officials say they are preparing a formal response and that they had been working to cooperate. Kirsten Macintyre, a spokeswoman for the Department of Mental Health, said the hospital had been trying to set up time for federal investigators to pore over thousands of documents and interviews they sought. "The timing of this thing caught us off guard because we were negotiating with them," she said. "We've always been open and believed in transparency."

Mayberg said the state was aware of many of the problems outlined in the report, and already had begun massive staff retraining and a widespread shift in the treatment philosophy at all of the state hospitals, including Napa. They have moved toward a model that emphasizes the individual and seeks to encourage patients to interact, learn new skills and reduce the amount of seclusion, he said. "We've raised the standards. We can't say that we can predict everybody's behavior at this stage but we are building in as many checks and balances to make sure that none of that occurs (again)," Mayberg said. He said many of the problems - and the needed remedies - stem from a shift in recent years in the type of patients who reside at the hospitals to criminals who have "much more propensity toward violence."

About 90 percent of the 4,600 patients in the state hospitals now come through the criminal justice system. Most have committed violent crimes, including murder, and have been found mentally incompetent to stand trial or not guilty by reason of insanity. "There's nothing that can be said to say that we even defend or justify (the deaths and violence)," Mayberg said. "We have a very different population. The folks we are dealing with now bring a whole new set of challenges." In the aftermath of the report, officials also are making an effort to open their doors to journalists and elected officials.

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 Page is here or here.

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11 August, 2005

PRIVATE HEALTH CARE IS ACCESSIBLE TO ALL IN AUSTRALIA

Earlier on today I went to visit an old friend in hospital who has just had a major procedure. Brisbane has quite a few large private hospitals but I had not been to the Holy Spirit hospital at Chermside before. As the name implies, it operates under the aegis of the Catholic church and my friend has given up the Communism of her youth to return to the faith of her childhood. Admission to the hospital is, however, open to all.

What I found when I went there was a huge institution that was in every way just like a first class hotel. It was immaculate. Conrad Hilton would not be able to do better. And most pleasing of all my friend's procedure had gone well and she was recovering rapidly. And while I was there, there were three visits to her by staff members looking to see what they could do for her.

Clearly, then, she is very rich, No? Someone who has has divorced well, perhaps? Not a bit of it! She has had her fair share of problems in life and has got nothing she did not work hard for. She has however always looked ahead and budgeted for the important things -- including private health insurance. So her stay in hospital is costing her virtually nothing. So she must at least have a good job? Not a bit of it! She is an old-age pensioner (Social Security recipient) who owns her own house but not a lot more.

So how can she afford private health insurance when others cannot? Basically because she does not blow her money on things like beer and cigarettes (though I don't think I will be betraying anything to note that she still enjoys a couple of glasses of wine after dinner).

I guess that you can predict that she has a very low opinion of people who DON'T put aside money for health insurance and who then complain about how badly the "free" government system treats them. I think "No excuse for it", was her phrase.



California trying to make health insurance unaffordable

"Sometimes I really hate being right. Look at my website. On September 17, 2004 ("Oops, Government Does It Again") and June 6, 2003 ("We're From the Government and We're Here to Help You") both predicted massive increases in health care premiums and huge increases in the uninsured from continued regulation of health care financing, principally regulation of health insurance.

This week, the Insurance Commissioner, an advocate for socialized medicine, wrote a report, which he called "Priced Out," showing that insurance premiums have increased 61 per cent, and the number of uninsured has increased to 6.6 million Californians. He blames insurance companies for this.

He is particularly upset at one insurance company who offers an insurance product to young people (18 to 30 year olds) with reduced benefits, high deductibles and low premiums. The product is wildly popular, giving young, healthy people protection against major medical problems at a price they can afford. These younger workers, who just last year were among the ranks of the uninsured, are now insured, and the Insurance Commissioner is mad.

Why?

I thought being insured was good. Well, the report says that those bad insurance companies are giving these workers a choice, buy cheap insurance without pregnancy coverage if you want. That is wrong, complains the Commissioner because those insurance companies should require young, 25 year old single men to pay for insurance coverage for pregnancy because young women get pregnant. Those insurance companies are cherry picking their customers, he claims, by getting these young, single (and usually healthy) men to buy this cheap policy.

Who is he kidding? One of the choices that every worker has is the choice to not be insured. If government raises the price of health insurance, these young men will simply choose to spend the money on their cars, and run the risk of getting really sick and not being able to pay. Then, if the bills get too high, they will just file bankruptcy, and you and I will eat the bill in our insurance coverage.

Those are the choices. Forcing coverage on people doesn't result in more coverage; it will actually result in no coverage at all. More government regulation will continue to drive more people to the ranks of the uninsured because it will price them out of the market.

The recommendations of the Insurance Commissioner to mandate gold-plated health insurance policies for everyone are tantamount to a government order that everyone own a Rolls Royce. Sure the Rolls-Royce is a good car, but not everyone can afford one. If the government ordered that every car look and work like a Rolls, many people would have to go without a car, because the government-mandated car would be too expensive. Those who can't afford the Commissioner's mandated gold-plated health insurance policy will simply go without insurance.

The Insurance Commissioner is correct when he says that the number of uninsured in California has increased because the price of insurance has increased 61 per cent in the last six years in California. It is not greedy insurance companies that have caused the increase, however. It is the number of health insurance policy mandates (well in excess of twenty) enacted by government that have increased the price, and thus increased the number of uninsured. In California, we are all required to buy a Cadillac health policy, or have no health insurance at all. Many have chosen, for financial reasons, to have none at all.

The prescription for this problem by the Insurance Commissioner is more government. Government created the problem with more mandates, more regulation, and more bureaucrats. When will those in government learn that more government cannot fix a problem that more government created?"

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 Page is here or here.

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10 August, 2005

DANGEROUS OVERCROWDING IN A BRAND-NEW PUBLIC HOSPITAL

The "free" public hospital system in Queensland is one of the world's oldest. So it has had lots of time to show how such systems end up -- as bloated bureaucracies where patients are just an inconvenience. The hospital mentioned below is brand new and much bigger than the one it replaced. Its corridors are filled with staff -- but doctors and nurses are rare

DANGEROUS overcrowding in one of Queensland's largest hospitals is at tipping point with emergency specialists vowing to leave patients in ambulances on the ramp outside. A leaked internal memorandum describes pandemonium in Brisbane's Princess Alexandra Hospital, due to a chronic shortage of beds in intensive care, coronary care, mental health, general wards and the chronic overloading of the emergency department.

Princess Alexandra Hospital's emergency department director Phil Kay and nurse unit manager Julie Finucane sent the memo to Queensland Health executives after a crisis meeting with specialists and nursing staff. The memo highlights how serious problems in Queensland's health system are also acute at major teaching hospitals in Brisbane due to undersupply of hospital beds and staff shortages. "Declarations of danger by qualified emergency specialists trained in the field have been over-ridden by non-clinical administration personnel who on almost all occasions have not attended the emergency department to see for themselves," the memo says.

"The senior nursing and medical staff can no longer tacitly support this system of allowing the facility to become so overloaded and crowded that basic safety standards are unable to be supplied by the organisation. We have been forced to unload ambulances into corridors where there are no or inadequate nursing staff and no ability to visually monitor patients. In the opinion of clinicians this has already contributed to one patient being found moribund who subsequently died.

"Patients will be left on trolleys in (ambulance) care either at triage or on the ramp but outside the emergency department work area until a safe treatment area can be found for them."

The above news item appeared in the Brisbane "Courier Mail" of August 6, 2005



MEDICAL CARE FOR CASH IS A BIG SUCCESS FOR ALL

Tremendous savings by eliminating bureaucracy and paperwork. I go to a general practice like that here in Australia. I pay $45 per visit to a very knowledgeable and pleasant GP and later claim the cost on health insurance -- who give me back about $30 of it

Dr. Brian Forrest thought he'd probably take a pay cut when he opened a family practice in 2002 with plans to quit accepting health insurance, charge half what most doctors do and increase the length of patient visits. Instead, the practice is thriving on $45 office visits and Forrest, 33, earns more than he did while working in urgent-care centers. He prefers not to disclose his income, beyond acknowledging that he nets significantly better than the median annual net income for primary care doctors nationally. That was $161,816 last year, according to the Medical Group Management Association, a national professional group.

The trick? The practice, Access Healthcare, sees fewer patients and charges less but collects 100 percent of fees, which are posted in the lobby for all to see, from patients at the time of service. Nationally, medical practices collect less than 70 percent of billed charges, according to research by the association. And to collect even that much, practices must invest in costly computer systems and employees dedicated to handling insurance matters, such as preauthorizing care, filing and refiling claims. That increases overhead and cuts into profit.

Insurance-free or "cash" medical practices such as Access are still a rarity, but Forrest and others see that changing when the advantages -- for both patients and physicians -- become more widely known. Physicians can earn a good living while giving patients time and personal attention. Patients with or without health insurance can get quality health care at an lower cost.

The trend to reduce health insurance premiums by shifting to policies with higher deductibles, may make practices like Access even more relevant. A patient with a $1,000 deductible, for example, is going to be responsible for the majority of day-to-day expenses. That person is going to want the kind of value a low-overhead practice can provide, Forrest said. At Access, cholesterol tests are $25, a finger splint is $15 and a school or camp physical is $25. "For primary care, I think in five years, this is going to be the predominant model," said Forrest. Last year, he recruited a nurse practitioner, Sara Hubbell, to help meet rising demand for care. And Forrest is planning to open a second Triangle location within a year, though he hasn't decided where.

Last month, Dr. Douglas Keith, a Raleigh physician who owns urgent care centers in Garner and Durham, opened an insurance-free primary care practice in North Raleigh. It's a much more cost-effective way to run a medical office, he said. A standard patient visit in his urgent-care clinic costs $115. At Keith Medical Center, the insurance-free practice, it's $50. "At the Garner clinic I have to see 30 patients a day to break even," Keith said. "Here, I need to see 5.6 patients to break even." So far, about 90 percent of Keith Medical Center's patients are uninsured. Only about one in four of Forrest's patients is uninsured, though initially, he expected to see far more.

Forrest found patients with insurance are willing to pay out-of-pocket for the personal attention his practice can give them. He and Hubbell have the luxury of spending 45 minutes or more with patients, if they need to. Many insured patients file claims with their insurer on their own and receive partial reimbursement. "People tell us it's worth it to them, even if they have to pay a little more," Forrest 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 Page is here or here.

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9 August, 2005

MEDICAID HAS GIVEN AMERICA SOCIALIZED MEDICINE

The nation has so vastly extended taxpayer-funded Medicaid to the working poor this decade that it has produced the biggest expansion of a government entitlement since the Great Society was launched in the 1960s, a USA TODAY analysis has found. With little notice, the medical care program paid by federal and state taxpayers has grown from covering 34 million people in 1999 to 47 million in 2004, an examination of government data shows. The expansion has cemented government's role as the nation's primary health insurer. About 100 million people - 1 in 3 - now have government coverage through Medicaid, Medicare, the military and federal employee health plans. More than 10 million others are eligible for Medicaid but have not signed up.

The expansion has won bipartisan support in Washington and state capitals, as a consensus has emerged to provide medical care for the poor, especially children. President Bush has proposed spending $1 billion over two years to encourage eligible families to sign up for Medicaid. Medicaid's growth has continued despite debates about spiraling costs and controversial efforts in Tennessee and Missouri to scale it back. The growth is an aftershock of welfare reform, which since 1997 has pushed individuals off welfare and into the workforce. To support low-wage workers, Congress and state legislatures expanded coverage to low-income working families. Medicaid previously had gone primarily to welfare recipients. Today, a family of four can earn as much as $40,000 a year in most states and get government health insurance for children. The nation's median household income was $43,318 in 2003, the Census Bureau says.

The expansion has had far-reaching consequences: More children insured. The portion of children without insurance fell from 14.8% in 1997 to 11.7% in 2004, the Health and Human Services Department reports. The rate of young children being vaccinated has increased from 72% in 2000 to a record 81% in 2004. Higher costs. Medicaid spending grew from $159 billion in 1997 to $295 billion in 2004. That 85% increase is nearly twice the rise in Medicare, which insures seniors. Washington pays 59% of Medicaid's cost; states pay the rest. Reduced private insurance. Many low-income workers are choosing Medicaid over employer insurance because it is less expensive and often covers more. Medicaid is free or nearly free for recipients. Out-of-pocket costs and the range of services covered vary by state. The percentage of children covered by private insurance fell from 65% in 1999 to 59% in 2004, while those on Medicaid rose from 22% to 29%.

Critics of Medicaid's expansion say it is adding to the federal budget deficit - $412 billion in 2004 - and luring people from employer-offered insurance. "Shame on us for creating perverse incentives that cause people to give up private coverage for Medicaid," says Michael Cannon, director of health care studies at the libertarian Cato Institute in Washington.

But supporters say most Medicaid recipients have no other option and need coverage to keep working. John Begala, a member of the Ohio Commission to Reform Medicaid, says Medicaid's expansion "is one of the great policy success stories of the decade."

Source



HO HUM! THE BAD NEWS FROM THE BRITISH NHS NEVER CEASES

The patient British have had such bad service for so long that most know no better. Note: "A&E" is British for what Americans call "ER" and Australians call "Casualty"

Only half of all children and elderly patients with broken limbs receive adequate pain relief within an hour of arriving at accident and emergency departments. Research by the Healthcare Commission, the health inspectorate, revealed that few A&E departments come close to achieving the government target of providing pain relief within 20 minutes. Even after an hour, only 53 per cent of children and 42 per cent of elderly patients in moderate or severe pain had been given pain-relieving drugs. However, the researchers found that 71 per cent of A&E patients rated their overall standard of care as excellent or very good. There were "disconcerting" variations between hospitals, the commission found. Staffing is not the reason, it concluded. Many departments have acquired extra staff without any improvement, suggesting that investment in services has been wasted. "Extra staff are only likely to yield beneficial results when the purpose of the extra staff is very tightly focused - for example where a problem or bottleneck has been identified," the commission concludes.

The report was based on information about three conditions: children in pain from a broken elbow or wrist, elderly patients with a hip fracture and also patients who had taken an overdose of paracetamol. Standards for treatment were laid down by the British Association of Emergency Medicine. So few met the standards that the commission had to modify them to make a meaningful comparison. But even when A&E departments were allowed an hour to provide pain relief, many failed. In some hospitals only a fifth of children and a seventh of elderly patients had been given painkillers within an hour. Some managed to treat 100 per cent of patients within an hour.

Anna Walker, Chief Executive of the Healthcare Commission, said: "A&E departments have overall made great strides in improving services, in particular on waiting times, which are very important to patients. "They now have to go the extra mile if they are to deliver the care their patients need, and that means focusing on quality as well as waiting."

For patients with a broken hip, X-rays should be taken within an hour. Only a third of patients were treated within the target. Only about 65 per cent of patients who arrived at A&E within eight hours of a paracetamol overdose were treated within the stipulated eight-hour target. The results of the December 2003 audit were shown to hospitals which were then audited again in February 2005. Only 50 out of more than 200 were able to respond in the time given, and these hospitals showed some improvements.

The commission also carried out patient surveys, which showed that the great majority were satisfied, saying that their care had been excellent or very good. Waiting time was the main key to patient satisfaction. The report found no clear correlation between staffing levels and performance of A&E departments. Since 2000 the average department has 20 per cent more nurses, 27 per cent more doctors and 37 per cent more consultants.....

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 Page is here or here.

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8 August, 2005

California's health care system in 'death spiral,' commissioner says

Californian legislators are trying to bring in universal government health care in their State yet this guy is bitching about too many people depending on California's existing government health care. California logic, I guess

With 6.6 million Californians uninsured and costs soaring, state Insurance Commissioner John Garamendi called Wednesday for a series of reforms to save the health care system from what he called a "death spiral." Garamendi released a 73-page report entitled "Priced Out: Health Care in California" that, among other things, showed the average health insurance premium in the state increased 61 percent between 2000 and 2004. He said Californians are paying more for health insurance but getting less as employers offer fewer benefits or pass on a greater share of costs to workers. The increasing cost "is simply placing every Californian at risk," Garamendi said at a news conference outside a closed hospital in North Hollywood. "I believe the California health care system is in a death spiral," he said.

In his introduction to the report, Garamendi, who regulates insurers operating in California, decried the health care system for the poor. "We are already well on our way to having an inequitable health care system where the wealthy live and prosper while others are priced out," he said. "Forty-five million Americans and 6.6 million Californians can already attest to this." Garamendi, a Democrat who has announced he will run for lieutenant governor in 2006, proposed reforms that could eventually ensure every state resident has basic health coverage, either through the government or the private sector. However, he acknowledged that the political climate for such coverage was poor. Californians have repeatedly rejected such proposals in ballot initiatives. In addition, the federal government has legislative control over many of the medical issues involved. Garamendi said it was unlikely the United States would have universal coverage "until we get a different administration in Washington."

He was also critical of health savings accounts, including some plans backed by the White House. The White House referred questions on the issue to the Department of Health and Human Services, which in turn deferred comment to the Treasury Department, which oversees the accounts Garamendi has criticized. No one answered a call at the Treasury Department after hours Wednesday.

Garamendi referred to reduced benefit plans as "skeletal policies" that offer less coverage as a way to reduce costs when major illnesses strike. He specifically pointed to a Blue Cross plan known as Tonik that he said is being marketed to young adults for about $70 a month but doesn't include maternity care or catastrophic illness coverage. Garamendi asked what would happen if a young woman with the policy got pregnant or had a major illness that wasn't covered. "They're going to wind up, probably, on the government dole in the Medi-Cal program," he said.

Blue Cross of California spokesman Michael Chee said Garamendi was misinterpreting the Tonik plan, which provides coverage for everything except maternity. "It's absolutely false to say it doesn't cover catastrophic" care, Chee said. "This is full insurance coverage." The company used focus groups and other research to tailor the plan's cost and coverage for people 18 to 30 years old who represent the largest portion of the state's uninsured, Chee said. "This program was designed with this age group in mind," he said. "We looked at the same uninsured data that Mr. Garamendi sees and determined there was a need for this product for this particular segment."

Joining Garamendi at the news conference was Alicia Ayala, 75, of East Los Angeles, who serves as a board member of a not-for-profit chain of clinics called AltaMed Health Services Corp. Ayala said she has a lower back problem that used to be fully covered by her insurance. Increasing premiums caused her to change coverage, and now she must pay $15 for each visit to physical therapy and $200 for more serious care when the ailment flares up, she said. "We are living longer," Ayala said. "You need to take care of us."

Richard Brown, director of the UCLA Center for Health Policy Research, said many people are being forced into "medical bankruptcy" by increasing premiums, deductibles and copayments, even though they have health insurance. In California, an individual can pay as much as a $10,000 a year for health coverage when all those costs are included, while families can pay as much as $16,000 a year, Brown said. Garamendi has planned a hearing next month in San Francisco on the policies detailed in his report. In October, he plans a hearing on the profits of health insurers.

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 Page is here or here.

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7 August, 2005

Whoever put the care in Australia's "Medicare" was kidding

Australia has a system of universal "free" healthcare that was introduced by the socialists (the Labor Party) and which is called "Medicare". Subsequent conservative governments have been afraid to tinker too much with it except that they give you a partial refund if you opt out of the system and take private insurance instead. So about a third of Australians do opt out and use our excellent network of private health facilities. The Queensland private health system is fabulous in my opinion -- and I use it often. What the Australian public health system generally is like is alluded to below by Dr John Graham, an emeritus consultant physician at Sydney Hospital where he is also chairman of the Department of Medicine.

Australia truly is the lucky country, especially when considering the available health care for its citizens. But none of this can be attributed to Medicare and its "medical benefits". In 1966, when I began my clinical years at Sydney Hospital, Australia could rightly boast the world's best in medical and nursing care. Moreover, the doctors and nurses loved their work, and most patients showed a commensurate respect and gratitude in return.

Most doctors still enjoy good relationships with their patients, but very few love their work any more. Doctoring has been progressively driven off the rails by political and economic expediency. Workplace morale, especially in public hospitals, has plummeted. The artificial barriers to both excellence and expedition in hospital care are endless. Optimal outcomes are frustrated beyond all reason. Patients must sometimes wonder whether or not they are pawns, rather than people. How often must they leave a hospital ward or a doctor's rooms and ask themselves: "Does anyone really care?" When the truth is known, Medicare certainly doesn't, and for any medical practice reliant on Medicare it's almost impossible to.

What is hard to fathom is that Labor, which historically stood up for the least well-off in our society, was the party that brought about the situation where the least well-off are finding it more difficult than ever to get the top level of hospital care for any problems other than emergencies. It was Labor that forsook the honorary (unpaid) specialist system in public hospitals to tighten government control on the doctors. It was Labor in NSW that got rid of the means test that had protected the needy by giving them access to plenty of beds in public hospitals. No wonder waiting lists for the less well-off have blown out. It was Labor, under Gough Whitlam, that introduced Medibank and then entrenched it as the rebadged Medicare under Bob Hawke. It was Labor that embedded the concept of bulk-billing by GPs, which forced them to downscale the quality of their services to fit the remuneration on offer.

The Coalition can't be let off the hook, either. The Federal Government has had more than enough years to rectify the problems and yet has done nothing to change a system that is all about economics and politics and has nothing to do with health care.

Let's look at an example of Medicare in the doctor's office. Why on earth would a bulk-billing GP be enticed to devote 39 minutes to a level-C consultation if he or she could trim it to 20 minutes and get the identical reimbursement from Medicare? With similar farces in Medicare rebates for specialist consultations, it's little wonder Medicare has, through its economics, caused many specialist doctors to stop listening, examining and thinking, and to simply become proceduralists. There is a significant shortage of real doctors doing real doctoring.

In looking at our supply of new doctors, which is patently inadequate, why is the Federal Government limiting the intake of students wanting to study medicine at universities? The answer is Medicare. For every new medical graduate, there is an application to be given a provider number. Without this, a doctor's patients would be ineligible for a Medicare rebate. The Government is worried that more doctors would mean more provider numbers, and hence a bigger government outlay on health. The rationale for limiting entry to medical schools is thus based purely on Medicare doctrine and not on any desire to improve health care.

Whatever the economists' views on Medicare, it has been an experiment without historical foundation, and without any humanitarian intent or scientific validity. And so what should be done?

First, rescind Medicare, and in its place introduce a safety-net rebate scheme for approved welfare-card holders to receive medical and surgical care in GP's surgeries and public hospitals (both as inpatients and outpatients).

Second, return to private arrangements for all other services. Doctors will then have to value those services fairly, while letting patients demand value for their dollar.

Third, let all health insurance funds offer whatever insurance covers they choose, for whatever range of health services their clients may choose.

Fourth, provide 100 per cent tax deductibility for all private health insurance and for all out-of-pocket expenses for medical, dental and pharmaceutical services.

Fifth, amalgamate the state and federal health responsibilities under a federal banner.

Sixth, give back an honorary board of governors to every public hospital so that better trust and meaningful communication can lead to greater efficiency and better staff morale. Greater productivity and generally improved health outcomes will ensue automatically.

And finally, with no Medicare, abolish the ridiculous Medicare levy. Hopefully, the Prime Minister, John Howard, and the Health Minister, Tony Abbott, will show the courage for, and commitment to, genuine reform that will greatly benefit all Australians.

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 Page is here or here.

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6 August, 2005

Public hospital waiting times force British boy to go all the way to India for surgery

Pity he cannot get the treatment his parents have already paid for through their taxes

A British mother is flying her fourteen-year-old son to India for treatment after discovering he would have to wait months for an operation in the NHS. Elliot Knott was told he would have to wait more than four months for an appointment after being left housebound from an ice-skating injury, then face a further wait of at least nine months for an operation. Elliott is suffering from spondylolisthesis, a debilitating condition caused when a vertebrae slips out of line in the spinal column and presses on a nerve. Surgery may be needed if slippage continues or if the back pain does not respond to routine treatment. A spinal fusion is performed and sometimes an internal brace of screws and rods is used to hold together the vertebra as the fusion heals.

The Dorchester schoolboy was referred to Southampton general hospital in May by his local hospital, which does not carry out the procedure. But his mother decided to get her son treated in Delhi after discovering that private treatment in the UK would cost 25,000 pounds, according to a report in the Times. The same operation in India costs just 4,700 pounds. Southampton University Hospitals NHS trust today urged the family to get in touch with the hospital to discuss quicker treatment. A statement issued today by the trust said maximum waiting times being quoted by the family were reducing "all the time".

"Staff with the highly specialised knowledge and skills to treat Elliot and other patients with similarly complex needs are in short supply, and much of their time is taken up with emergency cases. We obviously have to give highest priority to those patients with the greatest clinical need. The consultant can always be contacted by Elliot's GP if he or she believes Elliot needs more urgent treatment for clinical reasons."

The statement continued: "We understand how frustrating this situation is for patients and their families, and are certainly not inflexible or unsympathetic. "We are simply trying to balance scarce skills against high demand for this complex operation."

Elliot's plight coincides with a report published today by health thinktank the King's Fund, which warned that government waiting time targets were under threat from the constraints of financial pressures, unexpected increases in demand, and staff shortages in clinical areas. Its report argues that the government has reasons to feel optimistic that no patient will wait more than 18 weeks from GP appointment to hospital treatment by 2008. [How reassuring!] But the government will need to monitor carefully the impact of potentially destabilising policies, such as payment by results and the extension of patient choice, it warned.

Even if the 18-week target is met, it will not be the "end of waiting times" that ministers have claimed. The government should look carefully at the potential costs and benefits of reducing waits even further by developing policies to remove variations in access to services and unacceptable differences in the quality of clinical practices, the report urged. The report's author, Anthony Harrison, said: "Waiting time targets are based on assumptions that are rarely made explicit: namely that the right people are being identified and referred for the right treatment at the right time."

Source



HOW BUREAUCRATIC MEDICINE WORKS IN THE USA

Great stuff! More is obviously needed!

As far back as 1999, federal and state regulators began to receive complaints that the heart surgery unit at Palm Beach Gardens Medical Center in Florida was a breeding ground for germs. Dust and dirt covered some surgical equipment. Trash cans and soiled linens were stored in hallways. IV pumps were spattered with dried blood. One patient's wife said she saw a medical assistant tear surgical tape with his teeth. State inspectors in 2002 found "massive post operative infections" in the heart unit, requiring patients to undergo more surgery and lengthy hospital stays. In a four-year period, 106 heart patients at Palm Beach Gardens developed infections after surgery, according to lawsuits and government records. More than two dozen were readmitted with fevers, pneumonia and serious blood infections. The lawsuits included 16 patients who died.

How did Medicare, the federal health insurance program for the elderly, respond? It paid Palm Beach Gardens more. Under Medicare's rules, each time a patient comes back for another treatment, a hospital qualifies for an additional payment. In effect, Palm Beach Gardens was paid a bonus for its mistakes.

Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine. "It's the exact opposite of what you would expect," said Mary Brainerd, chief executive officer of HealthPartners, a nonprofit health plan based in Bloomington, Minn. Her Medicare HMO ranked among the top 10 in the nation last year for quality but was paid thousands of dollars less per patient by Medicare than lower-performing plans. "The way Medicare is set up," Brainerd said, "it actually punishes you for being good."

As Medicare approaches its 40th anniversary on Saturday, much of the debate about the nation's largest health insurance program revolves around whether it will remain solvent for aging baby boomers. Yet another critical question is often overlooked: whether taxpayers and patients get their money's worth from the $300 billion Medicare spends each year -- now about 15 percent of federal spending and projected to grow to nearly a quarter of the budget in a decade.

More -- 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 Page is here or here.

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5 August, 2005

MEDICAL MUSICAL CHAIRS

Even spendthrift California cannot afford to pay for its "public" medicine system

Downey Regional Medical Center may have to close its emergency room because of the exorbitant costs of treating uninsured patients, hospital officials said. Nine other emergency rooms in the county have shut down since 2003. Downey's, which served 46,307 patients last year, would be the largest recent closure and would force crowded hospitals in Whittier and Bellflower to absorb its patients, county officials said. "It's going to be horrible," said Carol Meyer, the county's head of emergency services. "Our emergency system is falling apart."

On Tuesday, the private nonprofit hospital asked the county Board of Supervisors to help pay for treating poor patients by approving a plan that would have entailed a tax hike. Supervisors rejected that appeal, arguing that helping Downey could prompt other hospitals to come calling for aid. The county's Department of Health Services is staring at a $1 billion shortfall over the next three years. "I don't know how you could ask us to subsidize a private nonprofit," Supervisor Gloria Molina said. "Every single hospital would line up, because they have the same situation as you do."

The number of uninsured patients using private emergency rooms in Los Angeles County has leaped by a third in the last five years, according to a recent study commissioned by the Hospital Association of Southern California. About 2.25 million county residents are uninsured - one of the highest percentages of any major U.S. metropolitan area.

Emergency room losses cost Downey Regional between $7 million and $11 million last year, said Robert Fuller, the hospital's chief operating officer. He said the hospital has gobbled up a $60 million surplus during the last five years, with half of that spent on treating uninsured people. As an alternative to closing its emergency room, the hospital is considering no longer accepting patients brought in by ambulance from outside Downey's city limits.

Source



Second bogus psychiatrist revealed in Queensland public hospital system

Still trust your local regulators?

The Queensland Government's health crisis deepened yesterday when it was revealed that a second bogus psychiatrist had worked in one of the state's major regional hospitals. Documents sent by Queensland Premier Peter Beattie to hospital inquiry commissioner Tony Morris QC yesterday showed that Vitomir Zepinic - a Yugoslav immigrant with no medical or psychiatric qualifications - worked as a psychiatrist at Toowoomba Hospital for almost two years. The revelation that Mr Zepinic had worked at the hospital west of Brisbane from April 2000 to March 2002 came just a day after it was revealed at the Morris inquiry that Vincent Berg, a bogus psychiatrist with phony qualifications from the former Soviet Union, had worked at Townsville Hospital in 2000. The existence of the two impostors was not revealed to the public until this week.

However, the documents produced by Mr Beattie revealed that the Government had a contingency plan for Wendy Edmonds, then health minister, to announce the two cases in parliament in 2002 in the event that the Opposition learned of the bogus psychiatrists. Under the heading "Topic: Bogus Shrinks", a ministerial staff member prepared an answer for Ms Edwards to a "possible parliamentary question". The documents revealed further evidence of efforts made by former Queensland Health director-general Steve Buckland to conceal Mr Berg's tenure at the hospital from the public, including his former patients.

Psychiatrists and administrators at Townsville Hospital sent a briefing note to Ms Edmonds recommending that Mr Berg's activities be made public so that all of his former patients could be located to determine whether they needed treatment. They said that the patients should be informed that Mr Berg's qualifications were invalid. But in a handwritten notation, Dr Buckland said that his decision not to inform the patients was "appropriate, ethical and clinically sound given that the client base have a mental illness". Dr Buckland was sacked last week in a major overhaul of Queensland Health prompted by the Morris inquiry's investigation of Jayant "Dr Death" Patel.

John Allan, director of Townsville Hospital's Mental Health Unit, told the inquiry in its second day of Townsville sittings that when he tracked down more than 200 of Mr Berg's former patients, he felt frustrated and "compromised" by his inability to tell them that the self-styled psychiatrist was a fake. Mr Allan said one of Mr Berg's worst mistakes was to take a long-term schizophrenic, who was facing a murder charge, off his medication. The man was later acquitted of murder because of his mental illness.

Mr Zepinic was deregistered by the Medical Board of Queensland in May 2002 after it was discovered that although he had completed post-graduate training in psychotherapy, he had no formal medical qualifications.

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 Page is here or here.

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4 August, 2005

Phony psychiatrist's havoc 'was hushed up' by the Queensland public health system

Your regulators will protect you -- NOT

A bogus psychiatrist with phony qualifications from the former Soviet Union worked for 12 months at the Townsville Hospital mental health unit, but his dangerous reign was hidden from the public in a cover-up by Queensland Health. The Morris inquiry was told yesterday that Vincent Berg treated at least 250 people, changed medication prescribed to patients by other psychiatrists and told patients with obvious mental problems that there was nothing wrong with them. The inquiry also heard one of his patients had committed suicide, while another who had been prescribed medication that caused dizziness died of a head injury after falling from a bed.

In his CV, Mr Berg said he was a refugee from the Soviet Union who had arrived in Australia in 1992. He claimed to have been a Russian Orthodox priest who had been persecuted by the KGB for his religious beliefs. Queensland Health's employment of Mr Berg was revealed publicly for the first time yesterday when the inquiry began hearing evidence in Townsville, shifting its focus from Jayant "Dr Death" Patel to problems with the public health system in north Queensland. Commissioner Tony Morris QC accused recently-sacked Queensland Health director-general Steve Buckland of deliberately withholding information about Mr Berg from the inquiry. Mr Morris said investigators had been forced to conduct "something of a raid" at Townsville Hospital to obtain evidence. The seized documents included emails from Dr Buckland warning staff not to give information on Mr Berg to the media, the police or the Queensland Crime and Misconduct Commission.

Townsville Hospital medical services director Andrew Johnson said that after Mr Berg left the hospital in early 2001 and his phony qualifications were exposed, he planned to publicise the story so that former patients who might have been mistreated by him could come forward. Dr Johnson said an audit by the hospital's psychiatric director John Allan in January 2003 identified 60 patients considered at high risk who needed to be contacted and reassessed. But Dr Johnson said he was told by district health manager Ken Whelan that the word had come down from senior management that neither the CMC nor the media should be contacted. He believed the order had come from Dr Buckland, then general manager of health services. Dr Johnson said Mr Berg, who started work at the hospital as a registrar in January 2000, had been registered by the Medical Board of Queensland. He claimed to have been a fully qualified psychiatrist in the Soviet Union and to have a medical degree from Voronezh State University. But investigations by the Royal Australian and New Zealand College of Psychiatrists in 2002 revealed the qualifications were forgeries.

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 Page is here or here.

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3 August, 2005

SOME IDEAS FOR REFORM OF AMERICA'S HEALTH SYSTEM

America's health care system is sick, and needs help. Health insurance premiums continue to grow at double-digit rates each year. Prescriptions are too expensive for too many people. There is little choice of insurance providers. Lawsuit abuse drives up costs and drives doctors out of practice, leaving the sick in some parts of the country with no one to treat them. And millions of Americans are uninsured.

The current system is the result of trying again and again to reform the system with more government control and less individual choice. It is time to try something different. There are short-term changes that can bring quick improvements within the system and long-term systemic changes that can permanently bring better and more affordable health care.

In the short term, giving more power to consumers will drive down costs and increase the number of insured Americans. According to the Institute of Medicine most adults who do not have health insurance cite the high cost as the reason. Studies also show that state mandates increase the costs of coverage by 15 to 30 percent and drive as much as 25 percent of the uninsured out of coverage.

Consumers need the power to combat the special-interest groups driving the increase in mandated state coverage, which drives up prices. Michael Cannon of the libertarian Cato Institute reports that required coverage in some states includes wigs (seven states), acupuncturists (11), marriage therapists (11), massage therapists (four), osteopaths (24), alcoholism (45), infertility treatment (14) and contraceptives (29). Former Vermont Gov. Howard Dean, a physician himself, was one of the first leaders to try to bring an end to this nonsense. As governor, he pleaded with Vermont's legislature to stop enacting such mandates because they were making coverage too expensive.

Dean's plight is currently being taken up at the federal level by Sen. Jim DeMint, R-S.C., Rep. John Shadegg, R-Ariz., and House Speaker Dennis J. Hastert, R-Ill. Their recently introduced "Health Care Choice Act" would empower consumers to use the Internet and other means to find affordable health insurance policies sold nationwide. It would allow someone in Virginia who did not want to pay for the state's 58 mandated categories of coverage to save money by buying insurance in Idaho, where there are only 13 mandated categories.

Such a policy change would bring the country closer to consumer-driven health care, where we could choose the policies with the benefits we really need and not be forced to pay for things we do not need. And, as Hastert argued, it "gets rid of the red tape that's pricing millions of Americans out of the health insurance market."

Consumer-driven health care is also the long-term solution to what ails the American system. Congress took a big step in this direction in 2003 when it made health savings accounts an option for all. These accounts, funded by tax-free contributions from employers and employees, are coupled with low-cost, high-deductible insurance policies that cover catastrophic expenses.

Because we own these accounts, we can take them with us when we change jobs. Money invested in them can be put in checking accounts, money market accounts, mutual funds and certificates of deposit. Money withdrawn for medical expenses is never taxed and can be passed on to a spouse tax-free upon death.

If this sounds somewhat familiar, it is because health savings accounts have a lot in common with what President Bush is proposing for Social Security: the option of accounts that workers would own and be able to pass on. The American Institute for Full Employment (AIFE) has made this connection, and taken it one step further with a comprehensive "7.65 Percent Solution."

AIFE proposes allowing us to put half of our Social Security tax dollars and half of our Medicare tax dollars, which equals 7.65 percent of our income, into an account to be used for all retirement expenses, including health care. Using historical averages as a guide, AIFE says a 23-year-old worker starting one of these accounts today, while earning just $20,000 a year, would have an account of more than $600,000 by age 63 and more than $2 million by age 78. Such large assets would provide security in place of the financially failing government retirement programs of Medicare and Social Security.

A nationwide insurance market and millions of Americans with health savings accounts, 7.65 percent accounts or any other type of individually owned account would have a transforming effect on our health-care system. It would empower us to re-take control of the system and focus it on the treatments and services we really want and need. Health care providers and insurers would have no choice but to listen to us, because we would have the money in our accounts and the choice of shopping elsewhere.

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 Page is here or here.

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2 August, 2005

DIRTY BRITISH HOSPITALS CLAIM ANOTHER VICTIM

Though they are trying to wriggle out of it, of course

One of the Australian survivors of London's bomb blasts has been hospitalised again and risks having her foot amputated after becoming infected with Britain's most notorious hospital superbug. The tragic double misfortune struck NSW woman Alison Sayer, 36, last week as she was recuperating at home in London. Ms Sayer's right knee was shattered on July 7, when she was blown out of her Underground train carriage by the force of suicide bomber Mohammad Sadique Khan's explosives. She spent 10 days in St Mary's Hospital in London, and was discharged a fortnight ago. But a gash on her left ankle, which had been stitched and treated at the hospital, became increasingly inflamed and painful. Ms Sayer's specialist diagnosed the widely feared MRSA bug — better known in Australia as golden staph — which is a major killer in British hospitals.

Now being treated in a private London hospital, Ms Sayer has undergone several operations to have the infection cut out. Doctors have told her family there is a danger her foot may need to be amputated. Ms Sayer's sister, Sydney nurse Amy Gent, has just returned to Australia from London after caring for her sister. "Alison was sort of glad to be home; she's not impressed to be back in hospital," Ms Gent said.

The MRSA bug is the scourge of British hospitals. Ms Gent said she had been worried about the open ward in which her sister was kept during the week after the bombing. "My sister and I thought it might have been from the shower … it didn't seem to be cleaned very often," she said. St Mary's Hospital yesterday told The Sunday Age: "We are very sorry to hear that Ms Sayer has contracted MRSA during what must already be a traumatic time for her. "However, based on the information we have been given today, it is difficult to draw the conclusion that she contracted MRSA during her six days with us. "Our record of her care does not indicate she was displaying any symptoms of being MRSA-positive at the time of her discharge 13 days ago."

MRSA can be picked up anywhere, including in the community. An estimated 30 per cent of healthy adults and children carry a form of the bacteria on their skin or in their nasal passages. The hospital said it had introduced a new infection-control policy dictating that patients should have only two visitors at their bedside at any one time. The policy, it said, was difficult to enforce at the time of the July 7 bombings.

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 Page is here or here.

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1 August, 2005

SPEECH BY DR. JACQUES CHAOULLI: DEFEATER OF CANADA'S MEDICAL SOVIET

Up to the end, most of the commentators thought I would fail. But on June 9, 2005, I won. Across Canada, the elite was astonished. The Dean of Canada's Osgoode Hall law school, Patrick Monahan, was quoted by Canada's National Post three days ago as saying, "I didn't expect a majority of the court to uphold Chaoulli's claim." A constitutional law professor from the same law school, Jamie Cameron, was quoted as being "surprised at the judges' activism.... It's a huge step for Section 7 [of the Canadian Charter of Rights and Freedoms}. I think that the constraints that used to apply to Section 7 have pretty much blown out of the water."

It is significant that I won against a number of lawyers and top expert witnesses representing the government side. For example, during the trial I cross-examined Professor Theodore Marmor from Yale University. Justice Deschamps, concurring with the majority, rejected his testimony, on paragraphs 63, 64 and 67 of the judgment.

For many years, in survey after survey, a majority of Canadians said that they were in favor of private health care alongside the public system. After my victory, ordinary people felt a sense of relief to hear that, for the first time ever, the highest court in the land condemned the Canadian single-payer health care system for causing situations in which patients suffered and died on waiting lists, in violation of the rights to life, liberty, and security protected by Section 7 of the Canadian Charter of Rights and Freedoms.

As a result of this historic judgment, Canadian legal scholars have now classified Canada's legal history about rights and freedoms into two distinct periods: before Chaoulli and after Chaoulli. For many years, I have been studying constitutional law, most of the time alone, and during a short period of time, in year 2000, as a full-time law student in Canada. As a law student, I argued against most of my Canadian professors of law, whose interpretation of the Canadian Charter of Rights and Freedoms was opposed to my own interpretation. Ironically, five years later, in 2005, the Canadian Supreme Court upheld my own interpretation of that Canadian Charter of Rights and Freedoms.

To my knowledge, it is the first time that a court has invalidated a government health care action that had effectively resulted in the suffering or deaths of individuals. The Canadian Supreme Court ruled that a state may not force an individual to endure poor quality health care services or unreasonable waiting times for medically required services, and it cannot prevent average individuals from getting access to private health insurance.

Opportunity for Private Health Care

This Canadian Supreme Court ruling was like the fall of a second Berlin Wall. It opens up a unique opportunity, in the United States and in several OECD countries, to counter what is called in the United States "liberal," and what I call "socialist," lobbies that are pushing their agenda for socialized medicine.

Some commentators believe that this ruling would apply only to Quebec and not to the rest of Canada. I respectfully disagree with their opinion. In my view, a proper reading of the judgment leads to the conclusion that similar legislation in other Canadian provinces may already be considered as violating Section 7 of the Canadian Charter of Rights and Freedoms, which protects the right to life, liberty, and security. For that reason, in my view, there is no need to launch additional legal challenges in other Canadian provinces.

About private hospitals, I was asking the court to declare my right to establish a private hospital in Montreal. The majority of the Canadian Supreme Court gave me the green light to go ahead in establishing a private hospital, when Justice Deschamps, concurring with the majority, ruled at paragraph 51 of the judgment that: "the Minister may not refuse to issue a permit solely because he or she wishes to slow down the development of private institutions that are not under agreement," and when at paragraph 54, she said: "Not only are the restrictions real but Mr. Chaoulli's situation shows clearly that they are."

Practically speaking, that ruling opens the door for a parallel private health care system in Canada running alongside the continuing socialized and compulsory Medicare program run by the "States" or "Provinces," as in other countries of Northern and Southern Europe, Australia, and New Zealand. Obviously, in terms of public health policy, such a result is not good enough. Those who are unable to pay twice, through general taxation and the additional cost of parallel private health care services, will continue to fall through the cracks of a deficient Medicare program.

For a long time, several experts have suggested that legislators should permit individuals to opt out of a state's compulsory Medicare program [In Australia they are allowed to -- to some degree]. But as you well know, legislators from around the world, including here in the United States, have to deal with a potato which is not only hot, but also burning!

Lessons for the U.S.

This victory is particularly important for American people, since they are facing important health policy issues, both at the federal level, regarding the Medicare program, and at the state level. The states of Vermont and California have engaged, or are engaging themselves, in the process of establishing a single-payer health care system which--there is no doubt in my mind--shall lead, like in Canada, to a situation whereby some patients will suffer and die on waiting lists.

I believe that, were it not for particular interest groups pushing for their own agenda, most people around the world would reject such a health care system that inevitably leads to suffering and to death. In 2002, particular interest groups thought they could introduce a single-payer health care system in Oregon, through the initiative and referendum called Measure 23. But three-quarters of the population of Oregon rejected that model. Then, legislators in Vermont passed a bill establishing a single-payer system. A few weeks ago, the Senate of California passed a bill that is even more extremist, in the sense that, like in Quebec, it bans private health insurance covering services already covered under a new California State Universal Medicare program. That bill is likely to pass the Assembly as well. Maybe the governor of California will use his veto power to block that bill, but such a veto would last only as long as that same governor would remain in power. What about the people of California if the bill is passed again and the next governor fails to the veto that bill?

In Canada, in the United States, and elsewhere, liberal groups should be confronted with the failure of socialized medicine, which the four majority justices exposed in the so-called Chaoulli judgment. Moreover, and even perhaps more importantly, they should be confronted with the terrifying opinion of the three dissenting justices. Although the dissenting justices acknowledged that some patients die as a result of the state monopoly, they went on to say that the state monopoly is necessary in order to avoid what they call an unfair situation, whereby those able to pay in a parallel private health care system would save their own life, while those unable to pay would have to wait in the public sector.

For the first time in Canada, a Supreme Court Justice criticized publicly a dissenting colleague sitting on the same bench. Justice Deschamps, about whom I have spoken, wrote at paragraph 16 of the judgment: "The debate about the effectiveness of public health care has become an emotional one.... The tone adopted by my colleagues Binnie and Lebel JJ. is indicative of this type of emotional reaction." Also, she clearly challenged the view of the three dissenting justices, when at paragraph 85, she said: "It must be possible to base the criteria for judicial intervention on legal principles and not on a socio-political discourse that is disconnected from reality."

But make no mistake about it. Although the Berlin Wall fell in 1989, many groups driven by a socialist ideology are still very active in all the OECD countries, including here in the United States, and they share the view of the three dissenting justices I have mentioned.

You might hear from the legislators of Vermont that the Chaoulli judgment is irrelevant to them since the bill they passed doesn't ban private health insurance. They would be right to say that their bill doesn't ban a parallel private health care system. Still, down the road, like in Canada, in the UK, and in several other OECD countries, I believe some patients from Vermont shall inevitably suffer and die on waiting lists if the single-payer health care system is to be implemented in that state. Justice Deschamps had it right when she wrote, at paragraph 96: "Given the tendency to focus the debate on a socio-political philosophy, it seems that governments have lost sight of the urgency of taking concrete action. The courts are therefore the last line of defence for citizens."

I suggest her comment applies as well to the United States and to many countries around the world. I suggest the time has come to take advantage of this historic judgment in order to inform people in Canada, in the United States, and elsewhere about the consequences in terms of human suffering from letting legislators adopt, or maintain, single-payer health care systems.

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?

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