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21 March, 2005
"FREE" HEALTH CARE IN CANADA: IF YOU CAN WAIT LONG ENOUGH
You've actually paid for it in advance. Getting what you paid for is the problem
A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies." The patient wasn't dead, according to the doctor who showed the letter to The Associated Press on condition of anonymity. But there are many Canadians who claim the long wait for the test and the frigid formality of the letter are indicative of a health system badly in need of emergency care.
Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised she would have to wait up to three years for surgery to repair a torn knee ligament. "It's like somebody's telling you that you can buy this car, and you've paid for the car, but you can't have it right now," said Jane Pelton. Rather than leave daughter Emily in pain and a knee brace, the Ottawa family opted to pay $3,300 for arthroscopic surgery at a private clinic in Vancouver, with no help from the government. "Every day we're paying for health care, yet when we go to access it, it's just not there," said Pelton.
The average Canadian family pays about 48 percent of its income in taxes each year, partly to fund the health care system. Rates vary from province to province, but Ontario, the most populous, spends roughly 40 percent of every tax dollar on health care, according to the Canadian Taxpayers Federation. The system is going broke, says the federation, which campaigns for tax reform and private enterprise in health care. It calculates that at present rates, Ontario will be spending 85 percent of its budget on health care by 2035. "We can't afford a state monopoly on health care anymore," says Tasha Kheiriddin, Ontario director of the federation. "We have to examine private alternatives as well."
The federal government and virtually every province acknowledge there's a crisis: a lack of physicians and nurses, state-of-the-art equipment and funding. In Ontario, more than 10,000 nurses and hospital workers are facing layoffs over the next two years unless the provincial government boosts funding, says the Ontario Hospital Association, which represents health care providers in the province.
In 1984 Parliament passed the Canada Health Act, which affirmed the federal government's commitment to provide mostly free health care to all, including the 200,000 immigrants arriving each year. The system is called Medicare (no relation to Medicare in the United States). Despite the financial burden, Canadians value their Medicare as a marker of egalitarianism and independent identity that sets their country apart from the United States, where some 45 million Americans lack health insurance. Raisa Deber, a professor of health policy at the University of Toronto, believes Canada's system is one of the world's fairest. "Canadians are very proud of the fact that if they need care, they will get care," she said. Of the United States, she said: "I don't understand how they got to this worship of markets, to the extent that they're perfectly happy that some people don't get the health care that they need."
Canada does not have fully nationalized health care; its doctors are in private practice and send their bills to the government for reimbursement. "That doctor doesn't have to worry about how you're going to pay the bill," said Deber. "He knows that his bill will be paid, so there's absolutely nothing to stop any doctor from treating anyone." Deber acknowledges problems in the system, but believes most Canadians get the care they need. She said the federal government should attach more strings to its annual lump-sum allocations to the provinces so that tax dollars are better spent on preventive care and improvements in working conditions for health-care professionals.
In Alberta, a conservative province where pressure for private clinics and insurance is strong, a nonprofit organization called Friends of Medicare has sprung to the system's defense. It points up the inequities in U.S. health care and calls the Canada's "the most moral and the most cost-effective health care system there is in the world." "Is your sick grandchild more deserving of help than your neighbor's grandchild?" It asks. Yes, says Dr. Brian Day, if that grandchild needs urgent care and can't get it at a government-funded hospital. Day, an English-born arthroscopic surgeon, founded Cambie Surgery Center in Vancouver, British Columbia - another province where private surgeries are making inroads. He is also former president of the Arthroscopy Association of North America in Orlando, Fla. He says he got so frustrated at the long delays to book surgeries at the public hospitals in Vancouver that he built his own private clinic. A leading advocate for reform, he testified last June before the Supreme Court in a landmark appeal against a Quebec ruling upholding limits on private care and insurance.
George Zeliotis told the court he suffered pain and became addicted to painkillers during a yearlong wait for hip replacement surgery, and should have been allowed to pay for faster service. His physician, Dr. Jacques Chaoulli, said his patient's constitutional rights were violated because Quebec couldn't provide the care he needed, but didn't offer him the option of getting it privately. A ruling on the case is expected any time. If Zeliotis had been from the United States, China or neighboring Ontario -- anywhere, in fact, except Quebec -- he could have bought treatment in a private Quebec clinic. That's one way the system discourages the spread of private medicine - by limiting it to nonresidents.
But it can have curious results, says Day. He tells of a patient who was informed by Ontario officials that since Ontario couldn't help him, they would spend $35,000 to send him to the United States for surgery. Day said his Vancouver clinic could have done it for $12,000 but the Ontario officials "do not philosophically support sending an individual to a nongovernment clinic in Canada."
Canadians can buy insurance for dental and eye care, physical and chiropractic therapy, long-term nursing and prescriptions, among other services. But according to experts on both sides of the debate, Canada and North Korea are the only countries with laws banning the purchase of insurance for hospitalization or surgery. Meanwhile, the average wait for surgical or specialist treatment is nearly 18 weeks, up from 9.3 weeks in 1993, according to the Fraser Institute, a right-wing public policy think tank in Vancouver. A Fraser study last year said the average wait for an orthopedic surgeon was more than nine months.
Prime Minister Paul Martin's Liberal government has pledged $33.3 billion in new funding to improve health in all provinces and territories over the next 10 years. But critics aren't impressed. "It won't make a difference," said Sally C. Pipes, a Canadian who heads the conservative Pacific Research Institute in San Francisco. "They need to break the system down, or open the system up to competition." Pipes is a big supporter of the Bush administration proposal to allow Americans to divert some of their payroll taxes into medical savings accounts. She claims the two-tiered system feared by Canadian liberals already exists because those with connections jump to the head of the medical queue and those who can afford it can get treated in the United States. "These are not wealthy people; these are people who are in pain," said Pipes.
Another watershed lawsuit was filed last year against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients in Quebec who had to wait more than eight weeks for radiation therapy during a period dating to October 1997. One woman went to Turkey for treatment. Another, Johanne Lavoie, was among several sent to the United States. Diagnosed with invasive breast cancer in 1999, she traveled every week with her 5-year-old son to Vermont, a four-hour bus ride. "It was an inhuman thing to live through," Lavoie told Toronto's Globe and Mail.
"This is the first time someone has decided to attack the source of problems - the waiting list," said Montreal attorney Michel Savonitto, who is representing the cancer victims. "We're lucky to have the system we do in Canada," he told the court. "But if we want to supply proper care and commit to doing it, then we can't do it halfway."
An estimated 4 million of Canada's 33 million people don't have family physicians and more than 1 million are on waiting lists for treatment, according to the Canadian Medical Association. Meanwhile, some 200 physicians head to the United States each year, attracted by lower taxes and better working conditions. Canada has 2.1 physicians per 1,000 people, while Belgium has 3.9, according to the Organization for Economic Cooperation and Development. The World Health Organization in 2000 ranked France's health system as the best, followed by Italy, Spain, Oman and Australia. Canada came in 30th and the United States 37th.
Alberta Premier Ralph Klein is pushing what he calls "the third way" - a fusion of Canadian Medicare and the system in France and many other nations, where residents can supplement their government-funded health care with private insurance and services. But some Canadians worry even partial privatization would be damaging. "My concern is that the private clinics would only serve to further drain the scarce physician resources that we already have," said Dr. Saralaine Johnstone, a 31-year-old family physician in Geraldton, a papermill hamlet in northern Ontario. "We first need to guarantee that everybody has access to quality health care," she said, "and we just don't have that."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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 March, 2005
LAWYERS TAKE A HIT
The Ohio State Medical Association (OSMA) Frivolous Lawsuit Committee scored a major victory on behalf of Ohio physicians recently when a Stark County judge formally sanctioned a trial attorney for filing a frivolous lawsuit against a Canton-area physician. The judge also ordered the trial attorney to pay $6,000 to the physician as reimbursement for legal expenses incurred as a result of the frivolous suit. "We are very pleased with the positive ruling in this case," said Almeta E. Cooper, OSMA general counsel and advisor to OSMA's Frivolous Lawsuit Committee, which was instrumental in filing the "motion for sanctions" against trial attorney Catherine Little. "Physicians support the patient's right to seek compensation if they are wrongly injured. But when physicians are needlessly and carelessly named as defendants in a lawsuit, then that is clearly an abuse of the judicial system." The OSMA Frivolous Lawsuit Committee is believed to be the first of its kind in the nation.
The case centers on a medical liability lawsuit filed against Dr. Zev Maycon by Little and her client, Benjamin Barbato. In the suit, Barbato claimed unnecessary severe physical, mental and emotional pain and suffering resulting from a perforated colon caused by a surgical procedure that Dr. Maycon did not even perform. In his written opinion, Judge Roger G. Lile found that Little willfully violated a state court rule, known as Rule 11, that bars baseless court filings. Specifically, Lile found that Little's own physician expert witness did not offer any statement or opinion that Dr. Maycon's treatment of Barbato failed to meet the prevailing standard of medical care. In addition, Lile noted that when Dr. Maycon's attorney asked Little to drop Dr. Maycon from the suit because of the lack of evidence, Little "advised not in terms of evidence, but rather in terms of the lack of an offer of money, which would be the basis of Dr. Maycon's release from litigation." "Such a response," Judge Lile continued, "is clearly frivolous under (Ohio law) as is the retention of Dr. Maycon in this case."
OSMA created the Frivolous Lawsuit Committee in 2004 to identify potential cases in which physicians could seek judicial relief against trial attorneys who file frivolous suits, which all available actuarial evidence shows is one of the primary drivers behind soaring liability insurance premiums for physicians. To date, the OSMA Frivolous Lawsuit Committee has reviewed more than 111 cases submitted by Ohio physicians who believe that they are the victims of a frivolous lawsuit. Lile's ruling is currently being appealed.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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19 March, 2005
BRITISH SOCIALIZED MEDICINE AGAIN
The good cheer of the writer below amazes me after the enormous damage that has been done to her by MRSA -- something not found in British private hospitals
You thought it was difficult to get into an NHS bed? Try getting out when the bureaucrats say no. In my own case you might have thought they would urge me to be gone, for I was a bad patient. Normally I have a high pain threshold, but that Monday as I came round from the general anaesthetic the pain was sensational and I took it personally. Returned to my ward, the curtains drawn around my bay, I heard the sounds of a nearby patient being prepared to be wheeled to the operating theatre. I also heard a woman shouting ‘Do not let Dr Mooney operate on you. Dr Mooney is a bad doctor.’ Dr Mooney was the surgeon who had just operated on me. The woman shouting these denigrations was, I realised, myself. ‘Do not let Dr Mooney touch you,’ I yelled. ‘Dr Mooney is known for the dreadful pain he causes!’
The staff nurse jerked my curtains open and flounced in. Perhaps she didn’t know that patients coming out of general anaesthetic can be distinctly queer in the head. In any case, she and I were soon screaming at one another. From then on, it was war. As I became more conscious I called for morphine. She said it was too soon for me to have more morphine. ‘You will become addicted.’ ‘Everyone except nurses knows,’ I informed the ward at the top of my voice, ‘that you rarely become addicted when morphine is dealing with pain.’
I was desperate to go home. On Friday my consultant sauntered in, surrounded by his adoring team. I am in love with my consultant. Second only to God, he is the most eminent surgeon in his field, eccentric, with a camp sense of humour. ‘You can go home today,’ he said, winked and moved on.
Overjoyed, I began to gather up my things to put in my bag. I can walk only with sticks, so I can’t carry my own bag. Six years ago I had a hip replacement, legacy of a riding accident, in this same hospital (‘flagship of the NHS’). Along with the replacement, the vile MRSA was planted deep in my thigh bone. Three separate replacements were destroyed by the infection before the doctors concluded that I had MRSA — ‘a surgeon’s nightmare’. Well, yes. Also a patient’s catastrophe. With one leg four-and-a-half inches shorter than the other, I found that being crippled put paid to my forte of flying around the world to interview heads of state and suchlike.
The staff nurse appeared. ‘You cannot leave until Monday.’
‘Where is the professor? He told me I can go home today.’
‘He has left the ward.’
At this moment my friend Lady Jane appeared, bearing a basket of smoked salmon and buttered brown bread and red grapes. ‘The hospital won’t let me leave until Monday,’ I told her. ‘Everybody knows that nothing happens in hospital at the weekend. They just don’t want to be bothered with the paperwork on a Friday.’ ‘My driver is parked outside,’ said Jane. ‘Where are your shoes?’ Fifteen minutes later we were in the ward’s reception area.
A woman who looked like a pig and was not in uniform appeared to be the bureaucrat in charge. ‘You cannot leave the hospital until Monday,’ she said. ‘Mrs Crosland’s consultant told her she can go home today,’ Jane replied politely.
‘That will not be possible. She is taking a dangerous drug, and her papers will not be ready until Monday.’
‘I shall be responsible for Mrs Crosland,’ said Jane. ‘I’ll see that a nurse stays with her and administers her drugs.’
A charming Asian in a special nurse’s uniform now appeared. She said she would speak to my consultant. Five minutes later she was back. ‘He says that’s fine.’ The bureaucrat looked deeply aggrieved. ‘That’s not very nice,’ she said.
Soon, however, something strange happened: in defeat, the bureaucrat changed personality and became a human being. She didn’t even look like a pig any more. What is more, she called for a wheelchair. Jane pushed me to the front door. Freedom! My incarceration by the NHS was over".
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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18 March, 2005
A BRITISH HOSPITAL SO BAD THAT A PATIENT SUICIDED
A 94-YEAR-OLD woman drowned herself in a harbour because she could not bear returning to hospital, her family said yesterday. Alice Weeks had been suffering extreme pain with an inflamed gall bladder, but was frightened of attending hospital again. Relatives said the widow's fear stemmed from her last visit, when a female patient, thought to have had psychiatric problems, repeatedly woke her up in the night by standing over her bed and staring at her.
Mrs Weeks, who lived alone, walked out of her home in Poole, Dorset, last Friday evening using her Zimmer frame and walking stick. A couple having dinner in the Quay Thistle Hotel noticed her walking behind a shed by the Fisherman's Dock on Poole Quay at around 8pm.
She is thought to have jumped into the water shortly afterwards, but her body was not found until it was spotted by a fisherman the next morning. Her Zimmer frame and walking stick were found neatly left behind the shed. A post-mortem examination revealed that she had died of drowning. It also showed that she had an inflamed gall bladder, which would have caused extreme pain.
Marian Wood, her daughter, and Grace Collins, her niece, believe that the frightening experience during her earlier stay in Poole hospital in January had put her off returning. She felt particularly vulnerable because she had to take her hearing aid out at night and would be woken up with a start by the patient looming over her bed. Mrs Wood said: "Despite the pain she was in, she had been put off returning to Poole hospital because of this frightening experience that happened to her in January.....
A spokesman for Poole General Hospital said that an investigation was under way. He added: "We were not aware of this incident in January while she was staying at the hospital, otherwise we would have reassured her."
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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17 March, 2005
THE BRITISH DISASTER CONTINUES
Five thousand people a year in England and Wales may be dying unecessarily because of failings in treating strokes. The estimate from the Stroke Association, is based on the latest survey of stroke treatment published yesterday, which shows that some hospitals continue to deliver “lamentable care”. Overall, the audit shows some improvements, with more stroke units and higher scores for most key indicators of care. But treatment for the third most common cause of death, and leading cause of disability, still lags behind other developed countries. “There are huge problems in the delivery of stroke care,” said Dr Tony Rudd, president of the British Association of Stroke Physicians. “Even though 40 per cent of patients are now being treated in stroke units, they are still not being treated as a medical emergency. More than 40 per cent of patients who need an urgent scan aren’t getting it. Even in stroke units, a third of patients don’t have their swallowing reflex checked. Half the people who have a stroke will have lost the ability to swallow. “If this isn’t checked and they are given their tea and cornflakes for breakfast, it’s going to end in pneumonia.”
The National Sentinal Audit for Stroke is funded by the Health Commission and carried out by the Royal College of Physicians. The first was in 1998, and this is the fourth, which is based on returns from all hospitals in England, Wales and Northern Ireland in April last year. The audit found that 82 per cent of hospitals in England now had a stroke unit, compared with 74 per cent in 2001. This is the first audit to cover every NHS trust. They were given a score, out of a maximum of 100, for their adherence to 12 basic standards such as time spent in a specialist stroke unit, access to emergency brain scans and rehabilitation services.
The best performing hospitals were North Wiltshire and Devizes Area Stroke Unit and London’s Royal Free Hampstead NHS Trust, which both scored 93 in the audit. Bottom were the Grantham and District Hospital, with 25, and the Royal Oldham Hospital at 27.
The audit found only marginal improvements in rehabilitation services since 2001. The percentage of patients receiving a physiotherapy assessment within 72 hours of admission to hospital increased from 59 per cent to 63 per cent. Patient assessment by an occupational therapist within seven days increased from 51 per cent to 57 per cent.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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16 March, 2005
BUREAUCRACY TRUMPS PATIENT CARE IN BRITAIN'S EMERGENCY ROOMS
Casualty departments have revealed that they are jeopardising patient care and deliberately distorting official waiting times in a desperate effort to meet government targets. Eight out of ten accident and emergency units admit that they discharge patients too soon, give them sub-standard care or send them to the wrong wards to deal with them within the four-hour target.
Today’s major survey by the British Medical Association also casts serious doubt on the accuracy of government statistics on A&E waiting times. Three-quarters of hospitals say that they use a range of tactics during monitoring periods to manipulate the figures. Half say that extra staff have been brought in during weeks in which monitoring takes place, while a quarter admitted that non-emergency surgery was cancelled. One in six hospitals even resorts to the “direct manipulation of the data” to make it appear that they have met the A&E target.
The news turns the spotlight on government claims about NHS improvements, pushing health to the top of the election agenda. It also comes the day after Tony Blair was publicly criticised by a gynaecologist who told him that target-setting in A&E was “actually jeopardising patient care”. Amara Sohail from Basingstoke said: “As someone working within the system, we don’t see more money coming in. Targets don’t work.” She said that the pressure on emergency medical staff would lead to “serious mistakes”.
Mr Blair told her: “If you went back a few years, I think most people would say that accident and emergency departments are a lot better than they were.” He added that he was prepared to look again at the issue of A&E waiting times to ensure that they were “sufficiently flexible”.
The target — that 98 per cent of patients be seen, treated, admitted or discharged within four hours — is due to come into force at the end of this month. The Government says that by the end of last year 96.8 per cent of patients were being seen within this time. But the survey backs data collected from patients by the Healthcare Commission, which also suggested that targets were far from being achieved.
The claim has met with an angry response from the Government. John Hutton, the Health Minister, said it gave “a deliberately distorted picture of the changes that have taken place in A&E departments”. He went on: “Chief executives of NHS trusts are responsible for signing off their performance data. If any doctors have concerns about patient care or fiddling of figures, they have a clinical duty to take them up with their medical director or chief executive or, failing that, with their strategic health authority or the Department of Health. To date we have received no formal complaints.”
The survey was sent to all 200 A&E departments in England, and 163 of them replied. Of the half that said they had failed to meet the Government’s 97 per cent end-of-year target, most cited a lack of beds, delays in accessing specialist opinion or diagnostic services and staff shortages.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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15 March, 2005
PATIENTS WANT, NEED and SHOULD HAVE MORE CONTROL AND MORE CHOICE
The rapid advance of medical science over the past century means patients now have more therapies available to them than ever before. Historically, patients relied on physicians to provide them with information about medical developments. With the arrival of managed care in the 1970s, physicians have seen their caseloads rise. According to an article in the May 2004 Journal of the American Medical Association, physicians spend less than one minute discussing treatment during a 20-minute office visit, on average. About half the time, doctors fail to ask patients whether they have any questions about what has been discussed during the visit. As doctors become more hurried, they have less time for patient education. Patients are finding it increasingly necessary to take matters into their own hands.
The Internet gives patients a powerful new tool with which to educate themselves and manage their health care needs. Many Web sites provide clinical information and resources directly to patients. These include sites dedicated to providing information on treatment alternatives, clinical trials, and prescription drugs, as well as resources for patients afflicted with specific diseases. A few hours on the Internet can substitute for a face-to-face education that would be costly for a patient. Recent reports, including a January 26, 2004, article in American Medical News, suggest it may actually save the doctor valuable time when patients inform themselves before an office visit.
Another trend that may explain consumers' interest in health information is the rise of consumer-driven health care plans. The heath insurance company Aetna, for example, found enrollees in its health reimbursement arrangement (called HealthFund) were more likely to use the Internet to manage their own care. A February 2004 study found HealthFund enrollees used HealthWise (an Internet health information Web service) twice as often as the control group, and the health information Web site InteliHealth 48 percent more often. HealthFund enrollees also searched formularies for drug price information almost twice as often as the control group.....
Home pregnancy tests are so common they are sold in pharmacies, grocery stores, and even inexpensive dollar stores. Ovulation predictor tests and tests for menopause, cholesterol, and other conditions also are widely available. For about $50, parents can buy an EarCheck Middle Ear Monitor that uses sonar to check for fluid behind the eardrum, which may indicate an ear infection. One of the most common reasons kids see a doctor, ear infections account for 20 million office visits annually in the United States. Likewise, kids often develop sore throats that don't require a physician visit. Families can buy a QuickVue Strep Test for about $90, providing 25 tests. The simple test differentiates strep infections, which require a physician visit, from viral infections, which do not.
Why do patients value having more knowledge about what ails them without having to run to the doctor's office? Probably so they can make better decisions about which symptoms require consultations and which they can treat themselves.....
More here:
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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14 March, 2005
MORE ON THE SALLY PIPES BOOK:
The purpose of Sally Pipes' new book, the author says, is "to provide the reader with an easy-to-understand guide" to the problems of affordability, accessibility, and quality of health care in the United States and Canada. Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer seeks out the best approach to solving the complex problem of health care reform while simultaneously preserving the positive attributes of each country's health care system.....
In Miracle Cure, Pipes convincingly demonstrates that although the American and Canadian systems appear to differ dramatically, "they both suffer from symptoms of the same disease--the disease of central control." In the foreword, economist Milton Friedman, a senior research fellow at the Hoover Institution, states, "What should be mutually satisfactory cooperation between patient and physician turns all too often into a bureaucratic nightmare."
Each chapter presents information the general public rarely receives from media sources. "One of the best-kept secrets," writes Pipes, "at least from the media and policymakers who continually talk of a drug cost 'crisis' for low-income seniors, is that there are already programs, both sponsored by governments and private companies, that significantly subsidize this group's purchases of prescription drugs." According to Pipes, "Nearly 20% of seniors, the poorest one in five, were receiving highly subsidized prescription drugs [through state-sponsored or private-sponsored plans for seniors]. An administrative fee of $12 purchases a month's supply of any Eli Lilly and Co. product for lower income seniors or disabled. ... The same is true for Novartis Products [and] Pfizer."
The chapters on consumer-driven health care clearly describe the potential tangible and intangible benefits of health savings accounts (HSAs) and health reimbursement arrangements (HRAs). "HSA plans combine a high-deductible insurance policy with a tax-free savings account dedicated to paying for expenses below the insurance deductible," explains Pipes. Authorized in late 2003 by the Medicare Modernization Act, these plans will soon be widely available to taxpaying citizens under age 65 and may be extended to everyone in the relatively near future, offering cost constraints motivated by preservation of personal savings and implemented by enhancement of the patient-physician relationship. In addition, they avoid the austerity seemingly implied by the term "high-deductible" health insurance.
Part Two of the book, "The Canadian Solution: Legalize Competition," notes that in Canada, the sole third-party payer is the government. "Canada is the only Western country in which private insurance for publicly insured procedures is actually outlawed," notes Pipes. The federal and provincial governments jointly administer the Canadian health care system, called "Medicare." Over time, power in the system has shifted gradually to the federal government, because it controls the funds......
In the conclusion of the book, she writes, "The greatest risk to both systems is not that they will go bankrupt. It is that they will come to see human beings as nothing but cost centers. ... We will lose more than access, affordability, and quality in health care. We will lose our humanity."
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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13 March, 2005
New Medicare Benefit Will Outspend Projections
The new cost projections for the upcoming Medicare prescription drug entitlement are slightly higher this year than last year. Democrats are making hay, while the Bush administration claims the projections are “virtually unchanged.” What’s being ignored is that the actual cost of this new entitlement will likely exceed all current projections. Medicare and other entitlements have a history of spending more than projected. It’s in their nature.
When Medicare was enacted in 1965, official government projections foresaw hospital spending — the program’s largest component — reaching only $9 billion in 1990. Actual Medicare spending on hospital care in that year was $66 billion, or over seven times as high. One result is that Medicare’s payroll tax is now nearly double what its sponsors said would be necessary (having been raised most recently in 1994), and Congress increasingly relies on other revenue sources to meet Medicare’s obligations.
There are three principal reasons why we can expect this new entitlement to cost more than the government predicts.
Reason 1: Politicians don’t like to reveal how much of your money they are spending.
A politician who hides the true cost of his proposal can give away more of your goodies without you taking notice (or at least not until it’s too late). A 2002 study in the Journal of the American Planning Association examining 258 transportation infrastructure projects found that politicians underestimated costs nine times out of 10, and that cost overruns averaged 28 percent. “Cost underestimation cannot be explained by error,” the authors concluded, “and seems to be best explained by strategic misrepresentation, i.e., lying.”
One way to underestimate costs is with overly optimistic economic assumptions, which have a long pedigree under Medicare. President Lyndon Johnson’s administration was accused of hiding the true cost of Medicare by using rosy economic scenarios. Today, Medicare’s actuaries assume that health care costs will grow only one percentage point faster than GDP, even though the gap has historically been over twice as large.
Another way of low-balling costs is by “inflating the denominator.” In 2003, Congress and the president agreed to create a drug benefit that cost no more than $400 billion over 10 years. Most understood this to mean an average of $40 billion per year. But pushing the entitlement’s start date back to 2006 effectively spread an eight-year cost estimate over ten years, and made the projected cost appear 20 percent smaller.
There’s also what we might call “the Nixonian way.” During five months of legislative debate, the Bush administration concealed its own projections that the legislation would actually cost between $500 billion and $600 billion. At the same time senior administration officials claimed – on television and in newspapers – that the program would cost only $400 billion, one such official threatened to fire Medicare’s chief actuary if the actuary went public with the higher cost estimate.
Reason 2: People alter their behavior to maximize their entitlement.
Medicare spending exceeded initial projections because seniors consumed more care when they bore less of the cost. Once taxpayers subsidize seniors’ consumption of prescription drugs, seniors will consume more drugs than they did before.
Many will drop the drug coverage they already have to take advantage of the new entitlement. The Congressional Budget Office estimates that every fourth participant in the new entitlement would have had private drug coverage anyway. Congress was so worried that employers will drop their retirees into the new program that it will begin bribing employers not to do so — to the tune of about $5 billion per year.
Actual spending on employer subsidies will probably be larger, as employer groups manufacture ways to qualify for the subsidy. These behavioral changes will leave taxpayers paying for costs that someone else was already paying voluntarily.
Reason 3: Congress often expands the entitlement.
Cost projections cannot predict future changes in legislation. Once a program is in place, beneficiaries lobby Congress to expand it. The Medicare drug benefit came about under political pressure from Medicare beneficiaries for greater subsidies. The same has happened with Social Security. Once the drug benefit takes effect, expect to hear pleas from seniors for further subsidies to fill in the infamous “doughnut hole.”
Just how expensive the new Medicare prescription drug entitlement will be is impossible to say. Jagadeesh Gokhale of the Cato Institute and Joe Antos of the American Enterprise Institute posit that the actual cost could be over twice as high as current projections. They may be wrong, but if history is any guide, they’re definitely in the right neighborhood.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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12 March, 2005
DEADLY PUBLIC MEDICINE
BBC News broadcasts today are leading on the story that 'ministers think they have turned the corner in tackling the antibiotic-resistant superbug MRSA' that is rife in Britain's state-run hospitals. 'The number of infected patients, we are told, 'is lower than at any time since records began.'
Let us ignore the point that records only began in 2001, when the superbug was already tearing through the National Health Service. In April to September 2001, some 3,598 NHS patients were infected with MRSA. In the equivalent April-September period 2004, on which all this hype is based, the number was 3,519. Not much of a difference. Especially if you are one of the 3,519.
True, that number is down by 421 cases on the previous six months. But the fact is that each year, around 5,000 NHS patients die from infections they picked up in hospital. About 1,000 of those die from MRSA. And how many patients die from MRSA in the private sector? None.
(Post lifted from the Adam Smith blog)
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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 March, 2005
RISK-AVERSE BUREAUCRACY AND PUFFED-UP DO-GOODERS HURT MS SUFFERERS
Now they have no drug to help them. How many of them were asked if they were willing to take a small risk to get help for their suffering?
Anna Peabody's dreams of motherhood and marriage -- and merely walking upright -- came alive with the arrival of Tysabri.
Multiple sclerosis patients such as she had waited years for the drug, the first promising treatment in nearly a decade. Early last year, Cambridge biotech giant Biogen Idec Inc. said Tysabri warded off MS more powerfully than even the most optimistic predictions. Peabody, 19, thought the drug ''would change everything."
Just one year of data from test patients was enough to wow federal regulators. They approved Tysabri a year ahead of schedule, without public discussion or debate, and before planned clinical tests were completed. But there were concerns: Some scientists thought the drug would leave patients vulnerable to deadly infections. At the time, Biogen Idec's vice president of medical research, Al Sandrock, declared: ''No multiple sclerosis drug currently on the market has been approved with less than two years worth of data."
But in a tragic flash, it all unraveled. Two test patients contracted a rare infection. One died. Last week, Biogen Idec and its partner, Elan Corp., pulled the drug from the market.
Tysabri's precipitous rise and fall has called into question the FDA's decision to quickly and quietly approve a potentially risky drug, criticism that comes on the heels of recent controversies over its handling of painkillers and antidepressant drugs.
''They should take as much time as they need to make sure the drugs are safe and effective," said Arthur Levin, director of the Center for Medical Consumers, an advocacy group. Quick approval, he said, ''increases the risk that we're going to discover really serious threats to the public health later on after a drug has been approved."
What I would really LOVE now is for the complacent Mr Levin to get MS
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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10 March, 2005
Public hospitals never have enough funding. Those bureaucrats are expensive: "Australia's quality of medical training was being eroded because of the downgrading of public hospitals, the Australian Medical Association (AMA) said today. AMA president Dr Bill Glasson told a Sydney medical training conference Australia's great public hospitals - which had been icons of medical training - were being destroyed because of a funding shortage. Private hospitals were now carrying out 50 per cent of surgery across the country, Dr Glasson said. Public hospitals no longer had enough positions for junior doctors and due to the emphasis on service delivery did not spend as much time training students. "As our public hospitals become downgraded, we are able to provide less and less services to most public hospitals and therefore less teaching opportunities," Dr Glasson told reporters. Training would have to be delivered in public and private hospitals, Dr Glasson said.
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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 March, 2005
LYING WITH STATISTICS
Here's how to think about the numbers presented in a recent L.A. Times story - an exercise in "Yes, but what would the numbers be if ...?" The February 9, 2005 edition of the L.A. Times has a story on U.S. health-care costs derived from a new study by researchers at Boston University School of Public Health. Major points include:
* Rising health-care costs are absorbing nearly one-fourth of all economic growth. The statistics cited to support this fact are that spending for health care this year will be $1.7 trillion, which is up $621 billion from 2000. That $621 billion increase represents 24 percent of the total GDP growth between 2000 and 2005. By contrast, increased spending for military defense during that same period accounted for only 10 percent of GDP growth. The growth in medical spending during this period was three times the growth rate in educational spending.
* U.S. health-care spending per person in the U.S. is double that in Canada, France, Germany, Italy and Britain. The study researchers argue that the $1.7 trillion annual cost of health care in the U.S. would be adequate to provide coverage for everyone if proper controls on medical costs were in place.
* Doctors receive or control 87 percent of all health-care spending. This is broken down as 21 percent in doctors' fees and 66 percent in doctors' orders for drugs, diagnostic tests, hospitalization and other prescribed services such as physical therapy. The L.A. Times story offers no explanation for what the remaining 13 percent of medical costs are. Presumably, a large part of it is administrative costs.
* The researchers conclude that the only way to manage health-care costs is to force everyone into a socialized medicine scheme.
"Yes, BUT WHAT WOULD THE NUMBERS BE IF ...?"
The story fails to reach the level of detail required to understand what's really going on. For instance:
* If doctor fees represent 21 percent of total costs ($357 billion annually), what percentage of those fees represent the cost of purchasing medical malpractice insurance, and is that insurance cost rising faster or slower than the aggregate rate of growth in medical costs?
* What percentage of total medical costs result from the practice of defensive medicine, which incurs unnecessary medical costs for the sole purpose of reducing vulnerability to unjustified or frivolous malpractice claims?
* Is it the assumption of the researchers that a socialized medicine solution in the U.S. would somehow magically eliminate all medical malpractice suits?
* What percentage of total medical costs are prescription drugs, and are those costs rising faster or slower than the aggregate rate of growth in medical costs?
* What percentage of total medical costs is incurred for acute hospital care, and are those costs rising faster or slower than the aggregate rate of growth in medical costs?
* What percentage of total medical costs is incurred in nursing home care, and are those costs rising faster or slower than the aggregate rate of growth in medical costs?
* Is the rate of growth in Medicare costs rising faster or slower than the rate of increase in the number of covered persons after factoring out the new prescription drug benefit?
* Medicare is a form of socialized medicine, somewhat comparable to that which exists in Canada, France, Germany, Italy and Britain. However, Medicare, unlike those European plans, does not cover all medical costs. Also, U.S. retirees pay a monthly Medicare Part B premium of $54.00 (about $650/year, deducted out of their Social Security checks. Consequently, the government-paid Medicare cost per retiree should be substantially less than the cost per retiree in those European nations. But if the annual Medicare-paid portion of medical coverage (less the $54/month premium) per retiree is comparable to or higher than the government-paid cost in those European nations, doesn't that eviscerate the argument that a socialized medicine approach for everyone would result in substantially reduced medical costs?
* The Bush plan for controlling medical costs proposes that many consumers should become managers of their own health care by a combination of tax-sheltered health savings accounts and high-deductible catastrophic health insurance. But the Boston University study argues that the sickest individuals are not competent to make their own decisions about medical treatment, and thus the Bush plan won't work.
The L.A. Times story does not offer any kind of objective proof that a socialized medicine solution, where medical decisions are influenced or dictated by a mindless bureaucracy, would produce superior overall outcomes.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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8 March, 2005
ANOTHER EXAMPLE OF SPENDING MORE MONEY TO GET WORSE RESULTS
When will people realize that governments shouldn't be running hospitals? This story is about the public hospital system in my home State of Queensland in Australia. Fortunately we also have an excellent private hospital system with minimal waiting times -- and affordable health insurance
Queenslanders are continuing to languish on hospital waiting lists with official figures showing more people are waiting longer for urgent operations despite State Government claims it is beating the problem. The increase in numbers waiting for urgent and semi-urgent operations is contained in the latest Elective Surgery Waiting List Report. A spokesman for Health Minister Gordon Nuttall said $110 million had been allocated over three and a half years to cut elective surgery waiting times, as well as a further $20 million last month. This is included as part of Queensland Health's annual budget, which over the past four years has increased from $4 billion in 2001-02 to $5.1 billion in 2004-05.
During this period, an analysis of elective surgery waiting list reports shows the extra money bought Queensland only 231 extra admissions to hospitals during the December quarter 2004 compared with December 2001. Brisbane hospitals admitted 101 fewer patients when statistics were compared between the December quarter 2001-02 (13,221 admissions) and the December quarter 2004-05 (13,120). The waiting list data also shows more people are waiting for urgent and semi-urgent operations over the four years, while the non-urgent has dropped considerably.
In the most urgent Category 1 for operations, as at January 1 this year, 77 people had waited more than 30 days for urgent operations, which was up from April 1, 2002, when 72 had waited more than 30 days. An independent audit of Queensland hospital waiting lists was promised by the current government during last year's state election, but this is yet to happen.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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7 March, 2005
AND YOU THOUGHT ENGLAND WAS BAD
The NHS in Scotland gets lots more money but produces much worse results. The perfect demonstration that it is bureaucracy, not money that is the problem
Chronic mismanagement of the Scottish NHS has resulted in treatment rates falling behind England for the first time despite billions of pounds of extra investment, a damning new report by a leading health expert reveals. The report has concluded that the English health system has powered ahead of its Scottish counterpart in many vital hospital services, seeing more patients, despite costing less and having fewer doctors. Dr Matthew Dunnigan, senior research fellow at the University of Glasgow, said last night: "The difference is in NHS management. If you speak to English doctors they tell you that although it is not perfect, there is a drive and initiative and coherence which is lacking in Scotland."
His findings reveal that England is now out-performing Scotland for the first time on new outpatient procedures, hospital visits in which patients are seen by hospital consultants for initial treatment. It also shows that the number of cases seen in all stages of the hospital service - from the GP’s door right through to hospital inpatient treatment - has dropped since 1999, following devolution. Yet over the same period, the number of cases seen in outpatients and inpatients in English hospitals has soared.
Scotland on Sunday can also reveal that there are now 1,000 fewer acute hospital beds in Scotland compared with 1999. Doctors warned last night that the reduction had already led to further waits for those on the list, and an increased risk of MRSA infections due to over-crowding on wards. The new revelations come after damning waiting list figures emerged last week, showing that 113,000 people are on the inpatient waiting list - the highest figure ever. A further 240,371 Scots are currently awaiting outpatient treatment, 45,000 of whom have been waiting for more than six months.
By contrast, the number of patients awaiting treatment for more than 6 months in England - with a population 10 times Scotland - is a mere 2,452. In total there were only 64,466 patients waiting for their first outpatient appointment across the whole of England at the end of 2004.
Dunnigan’s study used the Scottish Executive’s own figures and comparable statistics from the Department of Health in London to provide a like-for-like comparison. In 1990, Scottish outpatient clinics saw 212 Scots per 1,000 head of population for new acute appointments. That compared with only 157 per 1,000 in England - reflecting the fact that Scotland has long had greater health needs. However, by 2003, while the Scottish figure had risen slightly to 241, England had soared ahead to 251. The turnaround means that from seeing 35% more new patients in 1990, outpatient clinics now see 4% fewer today than in England.
England’s improvement has been achieved despite the fact that English taxpayers pay around £200 less per person for the NHS than do Scots. The English also have only 2.1 doctors per 1000 people, compared to Scotland’s 2.5. Dunnigan said the figures showed the English system had advanced rapidly in giving more patients access to consultants - while Scotland had stayed the same, despite its massive extra investment. "Despite having more cash, we are only achieving parity with England. That is a major failure. England has caught up with us and now passed us," he said.....
Nanette Milne, health spokeswoman for the Scottish Conservatives, said: "There is clearly something wrong with the Scottish system, if you are getting 22% more per head of population compared to England yet it is not coming out the other end."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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 March, 2005
VISITING YOUR DOCTOR VIA EMAIL
"In a move to improve efficiency and control costs, health plans and medical groups around the country are now beginning to pay doctors to reply by e-mail, just as they pay for office visits. While some computer-literate doctors have been using e-mail to communicate informally with patients for years, most have never been paid for that service.
Brian Settlemoir, 39, an accountant in Folsom, Calif., recently sent an e-mail message to his doctor at the Creekside Medical Group to ask if it was time to reduce the dosage of a medicine after his cholesterol level dropped. The prompt answer was "not yet." "I'm sitting at work," Mr. Settlemoir said. "I've got e-mail open anyway. It's much easier than calling and getting voice-mail prompts and sitting on hold. It's very valuable to me."
Blue Shield of California pays his doctor $25 for each online exchange, the same as it pays for an office visit. Some insurers pay a bit less for e-mailing, and patients in some health plans are charged a $5 or $10 co-payment that is billed to their credit card and relayed to the doctor.
For doctors, the convenience of online exchanges can be considerable. They say they can offer advice about postsurgical care, diet, changing a medication and other topics that can be handled safely and promptly without an office visit or a frustrating round of telephone tag. And surveys have shown that e-mail, by reducing the number of daily office visits, gives physicians more time to spend with patients who need to be seen face to face.
For patients, e-mail allows them to send their medical questions from home in the evening, without missing work and spending time in a doctor's waiting room. In fact, many say exchanges in the more relaxed, conversational realm of e-mail make them feel closer to their doctors.
The patients can also use the e-mail connections, which they reach through secure Web sites, to get X-ray and test results and request prescription renewals. Doctors are not paid for these services, except in time saved in the office.
This shift toward online doctor-patient communication is important for another reason. Physicians and health care technology specialists say they believe that it could help spur the changeover to electronic health care information systems, which government officials and industry leaders say is needed to reduce medical errors and promote better care. Doctors at the clinics of the University of California, Davis, grew accustomed to using e-mail for clinical purposes before the clinics introduced electronic medical records, said Dr. Eric Liederman, medical director of clinical information systems at Davis. The messaging "gave them some comfort and facility with using the computer," he said.
Early research at clinics at the university found that using e-mail improved the productivity of physicians, decreased overhead costs and improved access to doctors for patients, including those who still telephoned. "There was a huge reduction in the number of calls," said Dr. Liederman, who is a big fan of e-mail exchanges.
Doctors and insurers say online consultations can be especially useful for patients who have chronic conditions like diabetes, asthma and heart problems. They have been frequent users and being in touch can help them to comply with regimens to cope with their diseases. "Patients love this stuff; I love this stuff; the staff loves this stuff," said Dr. Barbara Walters, a senior medical director at Dartmouth-Hitchcock Medical Center in New Hampshire......
Kaiser Permanente, the nation's largest nonprofit managed care company, has tested patient-physician messaging in the Pacific Northwest and is starting the program this year in Hawaii and Colorado as part of Kaiser's $3 billion information technology program. Kaiser's salaried doctors get credits for messaging, adding to their pay......
A bill introduced in the House on Feb. 11 by Charles A. Gonzalez, a Democrat from Texas, and John M. McHugh, a Republican from New York, for the first time included a provision to authorize Medicare to make "bonus payments" to doctors for e-mail consultations."
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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5 March, 2005
AMERICAN MEDICAL SYSTEM FAR BETTER FOR YOU THAN THE SOCIALIZED BRITISH VERSION
The British National Health Service is one of the oldest of its kind so shows how such services end up
"In "Die in Britain, survive in U.S.," the cover article of the February 2005 issue of The Spectator, a British magazine, James Bartholomew details the downside of Britain's universal health care system. Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. "Britain has one of worst survival rates in the advanced world," writes Bartholomew, "and America has the best." If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent. Again, reports Bartholomew, "Britain is at the bottom of the class and America is at the top."
Explains Bartolomew: "That is why those who are rich enough often go to America, leaving behind even private British health care." The reason isn't that we sue more in America and scare doctors into efficiency, or that our medical schools are better. It's more simple than that. "In America, you are more likely to be treated," writes Bartholomew, "and going back a stage further, you are more likely to get the diagnostic tests which lead to better treatment."
More specifically, three-quarters of Americans who've had a heart attack are given beta-blocker drugs, compared to fewer than a third in Britain. Similarly, American patients are more likely than British patients to have a heart condition diagnosed with an angiogram, more likely to have an artery widened with angioplasty, and more likely to get back on their feet by way of a bypass.
On the availability of equipment, explains Bartholomew, Britain has only half as many CT scanners per million people as the United States, and half as many MRI scanners. With lithotripsy units for treating kidney stones, the United States has more than seven times the availability per million of population than Britain. Not only is the British equipment in short supply, but much of what's there should be loaded up and carted off to the nearest scrap dump. An audit by the World Health Organization, for instance, found that over half of Britain's X-ray machines were past their recommended safe time limit, and more than half the machines in anesthesiology required replacing. "Even the majority of operating tables were over 20 years old -- double their life span," reports Bartholomew.
Taken as a whole, Britain's universal health care system has evolved into a ramshackle structure where tests are underperformed, equipment is undersupplied, operations are underdone, and medical personnel are overworked, underpaid and overly tied down in red tape. In other words, your chances of coming out of the American medical system alive are dramatically better than in Britain. "Having a diagnosis test beyond an X-ray in Britain tends to be regarded as a rare, extravagant event, only done in cases of obvious, if not desperate, need," writes Bartholomew. "In Britain, 36 percent of patients have to wait more than four months for non-emergency surgery. In the U.S., 5 percent do. In Britain, 40 percent of cancer patients do not see a cancer specialist."
On how things worked in an individual case, Bartholomew writes of Peggy, an American radiologist, who went to Britain to meet her English boyfriend's family. While she was there, her boyfriend's father found blood in his urine and went to a local National Health Service hospital in which no CT scans or cystoscopy tests were done. The patient had asthma and laid in his hospital bed with breathing difficulties but still didn't see a specialist. He was told it would take six weeks. Short of the six weeks, he was discharged from the hospital. Back home, before his appointment with a consultant came up, he died of an asthma attack.
As a footnote on Canada, the average wait for a simple MRI is three months. In Manitoba, the median wait for neurosurgery is 15.2 months. For chemotherapy in Saskatchewan, patients can expect to be in line for 10 weeks. At last report, 10,000 breast cancer patients who waited an average of two months for post-operation radiation treatments have filed a class action lawsuit against Quebec's hospitals."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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 March, 2005
THE "WHO CARES?" BRITISH SYSTEM
Michael Howard provoked a row yesterday by raising the case of a woman still waiting for surgery after seven cancellations. He highlighted the plight of Margaret Dixon, 69, whose operation to repair a broken shoulder was repeatedly postponed because of a shortage of high-dependency beds. Mr Howard said that her experience represented the "real world" in the National Health Service where extra money being spent was not reaching front-line services. Tony Blair said that such an experience was unacceptable but was exceptional.
The row was the first time that Mr Howard had raised the case of an individual patient at Prime Minister's Questions since he misrepresented the facts concerning a breast cancer patient from his constituency last June. He claimed that she would have to wait 20 months for radiation treatment, rather than 20 weeks. Mr Howard said that Mrs Dixon, who lives in Penketh, near Warrington, Cheshire, and has osteoarthritis, was told that she might not survive surgery and on each occasion said goodbye to her family in case she did not. Hers was not an isolated case, the Tory leader said, and 67,000 people had NHS operations cancelled last year, 10,000 more than five years ago.
The Prime Minister snapped back that the Conservatives had faxed him information on Mrs Dixon's case seven or eight minutes before he entered the chamber and he could not know all the facts of her case, but most NHS patients were well treated. Extra money being spent on the NHS, which the Conservatives opposed, could be seen in more nurses, extra wards, new hospitals and the fact that cancer deaths were down by 30,000 under this Government and cardiac deaths are down 25,000 a year, Mr Blair said.
The row heightened as Mr Howard said that extra money was being spent on bureaucrats in primary care trusts and managers in the NHS, whose numbers were rising at three times the rate of doctors and nurses while average waiting times had risen in the past four years. "Mrs Dixon and the 67,000 patients who have had their operations cancelled represent the real world and the real NHS and you are living in an entirely different universe," the Conservative leader said. Mr Howard said the reality of the NHS under Labour was that 250,000 people without medical insurance paid for private care because they would not get the treatment they wanted under the NHS, a threefold rise.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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 March, 2005
COX-2 DRUGS OVERSOLD BUT STILL IMPORTANT
All drugs have side-effects
Last week, the New England Journal of Medicine took the unusual step of pre-releasing three articles showing that the increased risk of heart and other vascular disease that had caused Merck to withdraw Vioxx from the market is in fact not limited to Vioxx but instead is a ''class effect,'' meaning that all of the so-called COX-2 inhibitors lead to an increased risk of heart disease. Editorialists called this the ''final nail in the coffin'' for all of these drugs, and depending on the report of the FDA advisory panel, they may well be right.
To a bewildered public, this is understandably confusing, but the issues here are fairly simple. They are a combination of good science, poor FDA oversight and greed. All of these drugs have two actions. Even at low doses they are very effective pain relievers, which is why one or two aspirin will relieve your headache. At higher doses, they also have anti-inflammatory properties, decreasing the heat, swelling and tenderness accompanying diseases such as rheumatoid arthritis.
People with rheumatoid arthritis have to decide daily whether the risks outweigh the benefits. They know that the drugs they take have side effects, but without them they might literally be bedridden. For them, the risk of ulcers, or even a heart attack, might well be worth taking.
However, only about 1% of the population has rheumatoid arthritis, while a huge percentage have other causes of chronic pain such as back problems, neck pain, etc. So, rather than a limited approach directed at people who might need and benefit from these drugs, the makers of the new COX-2 inhibitors spent hundreds of millions of dollars advertising them directly to consumers, creating an enormous demand and reaping billions in profits. And now they are paying the piper.
So what should you do about your lumbago, or whatever? If you don't have rheumatoid arthritis or a similar disease, try simple pain relievers such as acetaminophen first. In doses up to 2,000-3,000 mgs. per day, these drugs are remarkably effective, although the higher doses should be avoided in heavy drinkers. If they aren't effective, try ibuprofen. It is inexpensive and relatively short-acting. Most people have few stomach problems, although if you have a history of stomach disorders you might add a stomach protective agent like ranitidine or omeprazole.
When all of this shakes out, there will still probably be a small group of people with diseases such as rheumatoid arthritis who will do best on the COX-2 inhibitors, and I hope they are kept on the market for those people.....
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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2 March, 2005
ANOTHER FARCE FROM BRITAIN
A grandmother who waited three years to see a consultant finally got her appointment, and found that the doctor had died two years earlier. Janet Warnes, 68, was first referred to Iain Fraser, an ear surgeon, in 2002. She received a letter from Leeds General Infirmary last year asking if she still needed the appointment.
An examination was fixed for last month, but when she arrived at the hospital with her appointment card, Mrs Warnes said the receptionist told her that the doctor had been dead for two years. Mrs Warnes, of Leeds, said yesterday: "I was starting to think I might be dead before I finally saw a doctor, but I never expected him to be."
When Mrs Warnes was seen by another doctor, she was told that she could now go on the waiting list for a hearing aid, but that it might now take another two years.
Leeds Teaching Hospitals NHS Trust, which runs Leeds General Infirmary, apologised to Mrs Warnes but said that her experience had been caused by a "one-off computer system error".
Source
How medical boards nationalized health care: "Besides paying some of the highest prices for health care, we have the dubious distinction of having the most heavily regulated healthcare system in the world. In no other country on earth are doctors and hospitals subjected to as many oversight and enforcement agencies, bureaus and commissions. Rules, regulations, and laws are duplicated, redundant, multiplied, magnified, and contradictory. Laws and regulations covering doctors and hospitals plus all the other parts of our healthcare system now account for over half of all the words, sentences, and paragraphs in our entire body of law. If regulations could make a healthcare system work better, ours would surely be perfect. In fact, the opposite has occurred."
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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1 March, 2005
COMPREHENSIVE HEALTH INSURANCE PRODUCES HUGE WASTE
The biggest problem is too much insurance rather than too little
If preventative, first-dollar health plans work, why isn't the cost of health care going down instead of up? We know that hospitals and health providers are merging into ever-larger firms, presumably to achieve economy of scale, but premiums aren't going down. We know that doctors and clinics are working harder and making less money, so where is all that money going? The answer, as I described yesterday, is administration... paper-shuffling. Where health care was once a matter between a doctor and a patient, that relationship is now divided by a mountain of clerical workers, managers (almost 4 of them for each doctor), and paperwork ... in clinics, companies who manage health plans, and insurance companies. Doctors and patients are now as isolated from each other as farmers are from grocery shoppers.
There are about 44 million Americans who aren't covered by a health care plan. In 2002, 17.3% of non-elderly people were uninsured. That's up from 13.7% in 1987. The "problem" is getting worse. There is an abnormal percentage of racial minorities, especially Hispanics. About 20% are children. 83% are under 35 years of age, and 34% are ages 21-24. 80% of uninsured people are part of working families. They're employed heavily in service jobs and blue-collar jobs. Over half of the uninsured adults who are working are working full-time. National surveys consistently show that the high cost of health insurance is the primary reason people are uninsured.
Statistically, uninsured people go longer between recommended tests, such as Pap smears, mammograms, and prostate exams. I would wager that they have much lower rates of unnecessary surgery too.
Uninsured people do become hospitalized and accumulate costs they can't pay, and a substantial part of that will end up being reimbursed by the federal government. About $41 billion won't be paid for, and the feds will pick up about 2/3 of that. I don't know why they will, but I imagine it's for the benefit of the providers.
Those who raise a fuss about the uninsured imply that being insured reduces total health care cost. Even forgetting that costs have ballooned, that argument doesn't hold water: Even counting the $41 billion in uncompensated care, uninsured people STILL spend 45% less than insured people do. To me, that's an indication of just how wasteful and ineffective health care plans really are... or does it mean that uninsured people are just healthier?
Well... mandatory insurance is often touted as the solution. We'll just force everyone to have insurance, and there won't be any more uninsured folks. All employers, presumably including self-employed people, would have to purchase a plan. Another case of "magic money"; where is the money employers have to spend on health care plans going to come from? From reducing the employees' pay? From laying off some people? Mandatory insurance would undoubtedly put some firms out of business immediately, and it would have a chilling effect on new business startups.
Of course, it would also mean that total health care costs will go even higher, health care providers will get bigger still, the health care industry will expand even more, providing even more unneeded services at still higher rates. At least we'll all be in the SAME sinking ship. There is a place for insurance in covering health care costs, but it isn't in the sort of plans that have become common. Insurance should be used to cover catastrophic losses, not routine expenditures, which are no more than a way to put more money into the coffers of providers.
Americans must realize that money an employer puts into a health plan is money that would otherwise go into their paychecks. From your paycheck, it can be used for a variety of things, depending on circumstances. When it's going down the health care toilet, you're forced to "use" it or lose it, so you tend to use it, even if you don't need to. The incentives lead to overuse and waste. The average cost of single coverage is $3,695/year. For family coverage it's $9,950. If an average family needs that much expenditure in health care, then we've become a very sickly society.
The California Chamber of Commerce produced an ANALYSIS OF THE ECONOMIC IMPACTS OF MANDATORY HEALTH COVERAGE IN CALIFORNIA (pdf) and reached these conclusions:
"Research suggests that mandated employer-provided health insurance does not curb the upward spiral of health-care spending and insurance premiums. In fact, it may have the opposite effect because it does little to inhibit administrative overhead or unnecessary tests and utilization of services. Research also suggests that mandated employer-provided health insurance programs are not necessarily an efficient, targeted vehicle for insuring the uninsured. Nor do such programs necessarily help the most disadvantaged and vulnerable workers."
Like all other plans based on the use of force, mandatory health care coverage is not only immoral, but it won't work, and it will have many negative consequences. There ARE some good ideas around that CAN solve the problems in health care, but they don't use force, so they're not political solutions. Mandates are force, and when force is used, other, better solutions are simply eliminated. The recent history of American health care is filled with forceful measures that have changed the best health care system in the world into one that has become nothing but a monstrous money vacuum. Despite ever-increasing technology, ever-increasing expenditures, and widespread "preventative" health care, we don't seem to be healthier. Obesity is up, asthma is up, and none of the other problems have disappeared. Somebody's getting rich from health care, but it damned sure isn't American workers.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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