Archives for the 'Healthcare Reform' Category
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Great Britain’s vaunted National Health Service denied a 61-year-old woman a heart operation because she was too old. Can’t waste the money!
But then the media got involved. Reports the Daily Mail:
However late yesterday, following media interest in Mrs Simpson’s plight, the PCT backed down and agreed to fund her treatment.
Medical director Dr David Geddes apologised to Mrs Simpson for the “distress” caused by the delay.
He said: “We have reviewed the case in the light of the additional clinical information and national guidance and, as Mrs Simpson fits the clinical criteria, we have agreed funding for her treatment.”
“All decisions are taken on individual clinical needs; we do not discriminate on the grounds of age.
“Our procedures exist to ensure fair decision-making, based on clinical evidence, for all our patients.”
Of course. Just an innocent mistake.
Remind me again why we should nationalize health care in America …
A Former British Commie Says Yes to Profit in Health Care
Leave it to a Brit who used to be a communist to support relying on the profit motive to improve health care. Writing in the Guardian, Richard Smith argues:
Profit is a filthy word for many health campaigners. It evokes fears of the rich getting better treatment than the poor and of shareholders fattening themselves on money that should have gone to sick children. Sadly, this is a wholly erroneous and very English way of thinking - driven, I believe, by the Romantic poets (better hills than profits) and snobbery (it’s people in trade who care about profits). The reality is that profit benefits health care just as it does all other enterprises.
I was once secretary of the Greenwich Young Communist League and deplored profits, although I knew nothing about economics. Twenty years later I was learning economics at the Stanford Business School when the Berlin Wall came down. Planned economies, we all came to realise, don’t work. We need a mechanism to drive up quality and value and drive down costs - and competition combined with investment and profit is the most successful mechanism. Adam Smith worked it all out more than two centuries ago.
Most of us thus accept that the majority of our products and services are delivered by profit-making enterprises. My food, water, pens, books, music, phones, flowers and computers are all delivered to me by profit making companies. As I look around my study I can’t immediately identify anything that comes from an enterprise unconcerned with profit. I see a picture of my dead father painted by an old girlfriend of my brother’s, but she was paid more for the picture than it cost her to paint it - profit. For that’s what profit is - a payment for something that exceeds my costs. I sell my labour for profit. Indeed, no enterprise - charity, hospital, doctor, or health service - can continue if expenditure exceeds income. “No margin, no mercy,” say the nuns who run a large US hospital.
When will America’s lefties have the same insight?
GINA Law Passes, Will Afflict Insurers and Employers
On April 24, the Senate voted 95-to-0 to pass the Genetic Information Non-Discrimination Act (GINA), which bans insurers and employers from taking genetic information into account. The Economist blog suggests it could doom private individual insurance in the future, as people who test negative for genetic risk factors for diseases refuse to buy health insurance policies that are priced the same for them as for riskier people who test positive for those genetic risk factors, effectively forcing those with lower risks to subsidize those with higher risks. Such adverse selection would cause the market for such insurance policies to dry up.
Last year, I criticized the GINA bill in the National Law Journal for lacking a “direct threat” exception that would allow employers not to use people with hazardous conditions (like a genetic tendency to seizures) for jobs where they could unintentionally cause harm to the public (like a person prone to seizures driving a bus). Existing laws such as the Americans with Disabilities Act contain such an exception. Greg Conko, who studies biotech law and policy, pointed out that there was no need for the GINA bill. He noted there is no pattern of insurers or employers misusing genetic information.
Killing Consumer-Directed Health Care?
One of the most important recent innovations in health care has been the expansion of consumer-directed care, especially through Health Savings Accounts. HSAs offer patients greater control over their money and create an incentive for cost-consciousness. Suddenly people have a reason to shop around and find the best deal for routine care.
But Congress is preparing to wreck the system. At the behest of a congressional staffer-turned lobbyist, the House has voted to impose on HSAs much of the regulatory bureaucracy evident in health insurance. Reports the Wall Street Journal:
Democrats have made affordable health care a mainstay of their election agenda, but apparently only if you’re willing to get insurance through the government. Witness their stealthy assault on Americans who prefer the private-sector option of Health Savings Accounts.
This week, the House passed legislation that included a provision to require every HSA transaction be reviewed and verified as a legitimate medical expense. Democrats say this is to ensure that consumers are using their tax-free withdrawals for a knee replacement, rather than a new iPod. In reality it adds a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs.
A key player here is Ways and Means Health Subcommittee Chairman Pete Stark, whose main purpose in politics is to give the U.S. a government-run health-care system. He is a known opponent of HSAs – once comparing them to “weapons of mass destruction” – because they introduce more individual choice into the health-care marketplace.
Pushing for the provision was a company called Evolution Benefits, which has patented a system for the substantiation of health-care expenses. Evolution’s lobbyist, John McManus, was the former staff director of the Health Subcommittee under Republican Bill Thomas. The company first lobbied for the HSA provision, then withdrew its support when Republicans began to focus on its role. But Ways and Means Chairman Charlie Rangel helped make sure the provision was in the bill, which passed largely on partisan lines.
Leave it to Congress to try to mess up a good thing. It makes you wonder if the politicians want to manufacture a real health care crisis, since it would increase their power.
“Too Much Money for AIDS” Treatment
So much foreign-aid money is being spent on costly AIDS treatment in Africa, compared to other diseases, that “H.I.V.-infected children are offered exemplary treatment, while children suffering from much simpler-to-treat diseases are left untreated, sometimes to die.” Political correctness is at the root of this problem: AIDS afflicts people in wealthy countries like the U.S. and Europe (especially those people who have unprotected anal sex or share needles), but the other diseases that kill millions of people in Africa don’t (indeed, many diseases that kill or cripple people in the Third World, like polio, no longer even exist in the United States). But people who point out the obvious bias in favor of AIDS get criticized by people like Michael Gerson as “mean-spirited,” even though the flood of AIDS money, much of it wasted, has had resulted in a brain drain from primary care that harms some African health-care systems.
In today’s Washington Post, the Chair of Uganda’s National AIDS Prevention Committee makes another important point: cheap and effective AIDS prevention is being shafted in favor of costly treatments for people who already have AIDS. Rev. Sam Ruteikara notes that “to prolong one AIDS patient’s life with antiretroviral treatment for one year costs more than $1,000. In 2007, 1.6 million people in sub-Saharan Africa died from AIDS — and 1.7 million became infected with HIV. In Uganda, we have a proverb: ‘You cannot continue mopping the floor while the broken tap is still running.’ Every $1 spent on treatment is $1 unspent on effective prevention.’”
Socialized Medicine: Wait and Wait, Pay and Pay
You’ve got to love socialized medicine. You have to wait for appointments. You have to wait when you call to schedule appointments. And you’ve got to pay for all that waiting time too!
A patient was left with a phone bill of £127 after being left hanging on the line for 49 minutes to make a hospital appointment.
Wayne Marshall, 30, was left fuming after spending nearly an hour on the phone to the outpatients’ department of Broomfield Hospital.
But he was gobsmacked when he discovered the two calls had landed him with a bill of £127 for just trying to rearrange his appointment.
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Furious: Wayne Marshall was shocked to discover he had been charged with a £127 telephone bill after being put on hold while phoning a Broomfield hospital
Mr Marshall, who is unable to work because of the severity of his epileptic fits, was left waiting on the phone for 21 minutes after first calling the hospital in Chelmsford, Essex, on March 14.
He eventually got through on his second attempt the same day after a 29-minute call.
Mr Marshall, from Witham, Essex, said: “I eventually got through on the second call, explained that I needed to change my appointment time and that was it.
“But when I looked at my bill online I was absolutely flabbergasted. I would have thought it would have been no more than a few quid even with all the time I spent on hold.”
Now Mr Marshall is worried other people may be stung by the cost without realising.
He said: “I have spoken to BT and they have told me that there is no mistake. This is especially bad for elderly people if they do not have an itemised bill as they may be in the dark about how much it is costing them to make thses calls.”
The outraged patient was charged £2.59 per minute for his calls to the 0844 number. His first call cost him £55 and the second £72.
Just want Americans want for their health care system!
More than Rotten Teeth in the UK
picture via freedomandshit.org
I’ve been following the discussion on bad British teeth between Eli and Fran and while it may be that fluoridation in public water offers some protection for teeth, I think it is Britain’s culture-wide belief that “the public good” outweighs individual rights which has caused the rotting of their teeth (among other things).
In fact, recent studies comparing countries with fluoridated water versus countries without, found that the positive effects of fluoride were much less significant than we previously thought.
“In lifetime residents of fluoridated areas 47% had evidence of erosion; in 21% erosion had progressed to the dentine or pulp. The corresponding figures in non-fluoridated areas were 43% and 21% respectively… Levels in fluoridated and non-fluoridated areas were similar. “
Additionally, any positive result from drinking fluoridated water is nullified (especially in the USA) by the increasing reliance on bottled water.
I have to agree with Eli, if only on the point that Brits’ rotten teeth spring from a deeper cause than drinking water. However, I disagree that the fundamental problem is their unwillingness to spend money on public services. While it may be true that Brits spend less than other countries on dental hygiene, the real problem is the enslavement of the profession–namely a disregard for individual rights.
In an article last January, Bloomberg reported that, while many in the UK were doing without regular dental care, many were using private care or, alternately, having work done over seas where they waits are shorter and costs minimal.
And though a startlingly 36 percent of respondents to the poll say they’ve gone more than 2 years without seeing a dentist, the problem isn’t lack of money–it’s lack of dentists. 1 in 10 dentists “dropped out” of the NHS system since April ‘06 when the government changed the contract with doctors. But there is a bright spot on the horizon; something that makes me hope the stereotype of bad british teeth will not apply for much longer. This wonderful development is the invasion of capitalism into the UK dental market. According to the same Bloomberg article:
The U.K.’s private dental market grew 63 percent to 3 billion pounds ($5.9 billion) from 2002 to 2006, overtaking the 2.4 billion pounds budgeted by the government.
Doctors, fed up with being treated like slaves to the state, are refusing to treat NHS patients. You can make the argument that increases in government spending would convince dentists to treat NHS patients, but the root of the problem I continue treating NHS patients While you may argue that increases in government spending on dental care would entice dentists to continue treating NHS patients, I think the root of the problem is the prevention of letting dentists work for profit. The government in the UK treats doctors as if, by virtue of their profession, they are duty bound to sacrifice their lives for the good of the people and implicitly believes that they ought to should treat patients regardless of personal gain or personal pain. The result is shoddy work, long waits, and eventual existing of the system in favor of something more profitable.
Hopefully, with private care on the rise, the British will have something to smile about in the future.
About those Generic Drugs
Everyone likes generic drugs. So do I. Who wants to pay those shocking prices–you know, a couple bucks or even a few bucks a pill for potentially life-saving products: I mean, the gall of those pharmaceutical companies!–when a generic is out there for pennies on the dollar?
Seriously, it’s great to save money. But it appears that not all generics are equivalent to the name brands. Reports the Los Angeles Times:
The Generic Pharmaceutical Assn. touts them with a slightly catchier slogan: “Same Medicine. Same Results.” But sometimes, patients and their doctors beg to differ.
A switch from a long-used brand-name drug to its generic equivalent can, on occasion, bring a shifting profile of side effects. In a number of cases documented in medical journals and recounted in interviews with physicians, a generic version of what is often called a “pioneer” drug simply doesn’t appear to work as well for many patients.
“Everybody thinks generics are swell: To suggest otherwise is like saying you don’t love your mother,” said Dr. Peter R. Kowey, chief of cardiovascular diseases at the Philadelphia area’s Main Line Health System, who reviewed the issue of generic substitution of certain heart drugs for the American Heart Assn. But between some pioneer drugs and their generic imitators, Kowey said, “we are concerned that the margin of difference is large enough” to risk patients’ health.
Last December, the American Epilepsy Society called on the FDA to approve a large clinical trial to determine “once and for all” whether the substitution of brand-name drugs with generics increases the risk of “breakthrough” seizures or toxicity among patients with epilepsy. This type of research would probably take years. But until such a study is completed, the society declared, it would oppose measures by state, federal or private insurance programs that would limit physicians’ choices in prescribing anti-seizure medicines.
Last fall, an independent laboratory, prompted by a flurry of consumer complaints, presented evidence that a generic version of the once-a-day antidepressant Wellbutrin XL may be less effective than the original at reducing some patients’ depressive symptoms. An agency spokeswoman said the FDA is investigating the matter and will make its findings public when the inquiry is complete.
In a report released today, the New York-based ConsumerLab.com, which conducted the Wellbutrin XL analysis, also urges the FDA to review the performance of a new generic for Toprol XL, a once-a-day version of a high blood pressure drug that is the fifth most-prescribed medicine in the United States. That challenge comes after dozens of patients complained to the People’s Pharmacy — a multimedia source of information about drugs and supplements — of erratic spikes in blood pressure and side effects after they had switched from Toprol XL to a new generic version of the drug.
The fact that generics sometimes differ doesn’t mean that we should drop generics. But it does suggest that we–and particularly government medical programs and private health insurance plans–should be more judicious in promoting generics. Saving money ain’t everything when it comes to health care.
Having a Baby? Don’t Do it in Great Britain!
The British may love babies, but they sure don’t show it. Maternity wards often are full and have to be closed to new mothers. Reports the BBC:
Many hospitals across England had to turn away women in labour last year because they were full, figures show.
More than 40% of 103 trusts that responded to a survey by the Tories said they had shut their doors or diverted women to other sites.
Larger maternity units seemed to be more at risk of having to close, the inquiries by the Tories suggested.
The government said maternity units sometimes were forced to take action because it was hard to predict demand.
Labour’s manifesto statement says that by 2009 all women will have choice over where and how they have their baby.
“It is a major cause of anxiety to telephone, or even arrive at a maternity unit, when in labour to find the doors are shut”
Spokesperson, National Childbirth TrustIt also promised that every woman would be supported by the same midwife throughout her pregnancy.
Out of 103 trusts - 70% of the total - providing maternity services that responded to the freedom of information request, 42% had to close their units or divert women to another site at least once in 2007 because of capacity problems.
One in 10 said they had shut their doors more than 10 times.
University Hospitals of Leicester NHS Trust, one of the biggest maternity providers in England, reported closing 28 times.
Remember this the next time some politician says that nationalized health care would be good for America!
Britain Cares for Animals Better than Humans
Britain’s National Health System is notoriously underfunded. The government makes ends meet by denying service. The elderly don’t get transplants. People pull their own teeth. Indeed, Prime Minister Gordon Brown wants more people to treat themselves.
But pets need not worry. Brits might be unwilling to care for themselves and their neighbors. But they will spend on their pets. Reports Reuters:
Forget worming pills and a flea collar — a trip to the vet in Britain these days could be about heart surgery, joint replacement, chemotherapy or a host of other cutting-edge procedures.
Britain is one of the few countries in Europe to offer many of these complex treatments: devoted British pet-owners have fuelled a fast-growing insurance market that helps fund care which would otherwise take a big bite out of a bank account.
Research firm Datamonitor has forecast the country’s pet insurance market will grow to almost 600 million pounds ($1.18 billion) in 2011 from nearly 380 million pounds in 2006.
“It wasn’t that big a market a few years ago but now it is growing,” said Kelly Ostler-Coyle, a spokeswoman for the Association of British Insurers. “It is a combination of how much people value their pets and (the fact) that there are more providers in the market.”
At Davies Veterinary Specialists, the largest private clinic of its kind in Europe, a lobby full of barking dogs is evidence of the lengths pet-owners are prepared to go for treatments for their pets, which can easily cost thousands of pounds.
The sprawling complex not far from London boasts five operating theatres and nearly 30 veterinarians — with specialties ranging from orthopedics to oncology. Its facilities include a gleaming new MRI machine and CT scanners.
“People are very dedicated to their pets here and willing to spend time, effort and money to get them well,” said Lea Liehmann, a soft-tissue surgeon at the clinic.
Canada is much the same way. If you want a CatSCAN or MRI for yourself, get in line — but if you’re willing to pay you can get one for your pet right away. A medical system that treats animals more quickly than humans is strange indeed.
Health Care, Aisle 5!
Although Great Britain is not normally where one would think to look for ideas on health care reform, the government is going to experiment by installing doctors in J. Sainsbury, a leading supermarket. Reports The New York Times:
Some Britons can add a visit to the doctor to their shopping lists. On Monday, J Sainsbury, one of Britain’s largest supermarket chains, is to become the first in the country to offer a visit to a family doctor in one of its stores.
Unlike Wal-Mart’s entry into health care with clinics and discount pharmaceuticals in the United States — a foray by a private enterprise into public health — at Sainsbury, a team of government-financed doctors will see patients. To start, they will work in the evenings and on Saturdays in a fully equipped consultation room in one store in Manchester. If the pilot project succeeds, it is expected to be introduced in other Sainsbury stores this year.
The supermarket doctors will help not only patients but also the government. British authorities have struggled to improve their taxpayer-financed national health service and to make doctors more readily available to patients. The doctors may also help Sainsbury. Like other retailers, the company is searching for ways to increase profits as growth in its traditional food business has slowed.
The National Health Service remains a highly flawed program, sacrificing patient choice to government control. But the willingness of the Brown government to consider creative reforms like supermarket docs should encourage American politicians to look for answers in private entrepreneurship rather than public mandates.
So Much for the Wonders of Canadian Health Care
Let’s see. The U.S. is supposed to follow Canada in nationalizing health care because it’s such a wonderful success. NOT!
A former Liberal Party health minister in Quebec has proposed several reforms, including expanding the role of private providers. It seems that the existing system risks collapse. Reports the Toronto Star:
The architect of Quebec’s now-overburdened public health-care system is proposing a strong and controversial remedy that includes further privatization and user fees of up to $100 for people to see their family doctor.In a 338-page report, former provincial Liberal health minister Claude Castonguay concluded that Quebec can no longer sustain the annual growth in health-care costs. The province currently spends about $24 billion annually on health care, or about 40 per cent of its budget.
“If nothing is done, at one point we will reach a crisis point … this is why we say it is urgent to act,” Castonguay said. “There’s no miracle solution, there is no simple solution.”
Castonguay told a news conference in Quebec City that his report is consistent with the guiding principles of publicly funded, universal health care.
However, it makes a raft of bold recommendations, including:
A new tax, including a “health-care deductible” based on income and the number of visits made to a doctor’s office or hospital in a calendar year. Low-income families and children would be exempt.
Encouraging private-sector involvement in the management of hospitals and medical clinics.
Lifting a ban that prevents doctors from practising both in the public system and privately.
Raising the provincial sales tax by up to one percentage point.
The Canadians Can’t Get Enough of American Health Care
Canadians like to dismiss America’s health care system, claiming that their system ensures coverage for everyone. Apparently everyone except those sent to the U.S. to be treated. Reports Toronto’s Globe and Mail (subscription required):
More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here. Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins.
George McGovern: Be Wary of Lending and Insurance Regulations
Congress is now so bent on overregulation that is that it’s getting a plea for restraint from George McGovern, the 1972 Democratic presidential nominee. In the Wall Street Journal, he warns against rewriting the terms of subprime mortgages to benefit current borrowers, noting that most such loans are “neither delinquent nor in default.” (Congressional proposals now seek to freeze or cut interest rates for many subprime borrowers with adjustable rate mortgages, even if they profited from the extremely low introductory rates they received, can afford the new, higher rates they now will be charged after the expiration of those introductory rates, and would ultimately end up paying less overall than borrowers who obtained fixed-rate mortgages).
He notes that paternalistic regulation to protect current borrowers will backfire against future borrowers, as it often does against consumers. (John Berlau discusses how a mortgage bailout will harm borrowers and the economy here, here, and here). McGovern points to how heavy state regulation of the health-insurance market makes health insurance coverage unaffordable for many uninsured people, because “many people can’t afford the gold-plated health plans that are the only options available in their states,” and because state insurance commissions forbid people to buy less expensive plans across state lines. (Eli Lehrer links to a solution to this problem that would benefit consumers with lower prices and more choices — Optional Federal Charter — here).
McGovern also notes that banning payday lending can backfire by forcing “people in need of immediate money” to pay for current expenses with money they don’t have through more costly means like “skipped credit card payments” and “bounced checks.” (John Berlau explains how payday lending bans can backfire against consumers here).
“Privacy” Laws Handcuff Police Searching for Murderers
Helen Smith writes about how California privacy laws kept police from searching for potential suspects in the killing of a psychologist. Overlawyered discusses the possible role of the federal medical privacy law HIPAA in delaying the apprehension of a mental patient who killed a New York therapist.
California’s privacy laws restrict not just the government, but the freedom of private parties. Even the California state constitution’s privacy guarantees have been held by state courts to restrict private entities like employers, requiring them to turn a blind eye to undesirable employee characteristics that are relevant to hiring decisions. So private employers risk lawsuits by the ACLU and its allies for attempting to exercise their freedom of contract.
That’s a very different philosophy than the federal Constitution, whose privacy guarantees only restrict government entities. (Federal statutes like HIPAA and FERPA are another story: They do bind private institutions, resulting in billions of dollars’ worth of red tape and harm to patients’ family members and next-of-kin).
Massachusetts’s insane privacy laws protect the “privacy” of kidnappers calling in a ransom demand and police abusing motorists, criminalizing citizens’ taping of such crimes. That infringes on civil liberties and First Amendment rights.
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