Thursday, September 27, 2007

Politics | What Sicko doesn't tell you ...

Politics What Sicko doesn't tell you ...

Local people from Portsmouth to Scarborough have been protesting against ISTCs draining scarce NHS funds, which has led to service closures and staff redundancies to balance the books. There is not an area of the country where services are not being cut and closed. Protests against the closures of accident and emergency departments and hospital services are happening in Surrey, East and West Sussex, Kent, Worcester, Manchester, Leeds, Durham and Huddersfield; and against the 150 community hospitals in places such as Norfolk, Cambridge, Leicester, Devon, Marlborough and Bromley. The NHS, the government says, has had unprecedented levels of funding - so where has all the money gone if it isn't into services? Is it really all down to bad managers and greedy doctors and nurses?

All markets need systems for pricing, billing and invoicing. Labour has introduced those: the electronic patient record, part of the £1bn IT disaster. The NHS too is being transformed from within. Foundation trusts such as University College London Hospitals Trust have been given new powers to enter joint ventures with commercial companies such as the Hospital Corporation of America and to spend millions of pounds on advertising campaigns, PR agents, mega-departments of finance and accounting, press officers, management consultants and profits. As in the US, billions of pounds, probably approaching 20% of annual NHS funds - estimated to be £20bn in England in a year - are being squandered on what are called the transaction costs of the market.

Earlier this year the US chief executive officer of UnitedHealth, Bill McGuire, was sacked along with other board members for repricing share options. His annual $126m package was not enough for him. Meanwhile more than 50 million Americans, including 10 million children, go without care - in the richest country in the world. Is this what we want?

· Allyson Pollock is author of NHS plc: The Privatisation of Our Healthcare and professor and head of the centre for international public health policy at the University of Edinburgh.

Interesting piece about how greed and capitalism are not turning out to be the cure for the NHS. And, on the other hand, how the NHS needs some serious work, making the case for Medicare for all all the stronger.

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With health deal, UAW's clout, influence grow

With health deal, UAW's clout, influence grow:

"'The size and visibility of this trust fund puts the UAW at the epicenter of the health care debate,' said Harley Shaiken, a labor expert at the University of California, Berkeley and a longtime adviser to the union. 'It expands the UAW's visibility, influence and clout in a major way.'

The UAW has long been an outspoken advocate for nationalized health care. Union leaders already are making it clear that they intend to use their new clout to push for a national solution to rising health care costs. '(This) strengthens our commitment to national health care reform,' said Alan Reuther, the UAW's chief lobbyist in Washington. 'This is an issue that has to be addressed by Congress.'

The timing could not be better. 'National health care could be on the agenda as early as 2009,' said Mike Whitty, a labor expert at the University of Detroit-Mercy. 'It will allow the union to take the lead in pushing for a single-payer national health policy.'"

Another push towards the tipping point?

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Wednesday, September 26, 2007


"Ensuring the welfare of America's children should be top priority among congressional members. That's why I supported SCHIP when it was created by the Republican Congress in 1997. I would continue to offer my support this year; however, Democrats have politicized this program and used it as a platform to take one giant step toward a national socialized health care system."

It's always disappointing when a member of Congress argues against the straw man of "socialized medicine" when nobody is advocating for a socialized system in which the government owns all parts of the health system. It can work: look at the VA, and imagine the VA if it weren't underfunded and forced to outsource parts of its responsibilities to those wonderful "privateers" (remember the Walter Reed debacle - outsourcing).

But virtually nobody wants socialized medicine. Virtually everyone whom I've ever heard advocate for universal coverage advocates for a single payer system where we, the taxpayers, pay for our health insurance via taxes, and it is administered through a system like Medicare is right now. Medicare contracts with private companies that operate under Medicare rules (our rules, by the way, Congress sets the rules) and pay hospitals, doctors, etc. No socialized medicine, thank you; Medicare for all, please.

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Tuesday, September 25, 2007

Kolodner says U.S. docs weak on IT adoption, stresses interstate collaboration

Kolodner says U.S. docs weak on IT adoption, stresses interstate collaboration:

"Most patients in the United States receive care in physician practices with one or two providers, yet only four percent of these practices have electronic health records, said Robert Kolodner, MD, here Monday. "

"We’re not getting value for our healthcare dollar in this country,” Kolodner said. “We’re paying more, but we’re ranked much lower than most other developed nations in health outcomes. Health IT is the right thing for our families and communities, but it’s also the right business case.”

In other nations, healthcare IT adoption is subsidized or incentivized more appropriately. Also, there is more uniformity with a single payer or universal system that reduces much uncertainty about purchases and implementation. A practice or hospital does not have to deal with a fragmented sytem on the outside with a myriad of insurers, hospital systems, etc, each with its own unique IT structure (or lack thereof).

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Thursday, September 20, 2007

Our Health-Care System Needs Intensive Care -

Our Health-Care System Needs Intensive Care -

Some responses to John Stossel's typically inane piece in the WSJ...

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Girl power has seized the day at university and college campuses

Girl power has seized the day at university and college campuses:

Vive la Différence!

Interesting piece on how women are changing the scientific world. This includes, healthcare, of course.

"'Women are not crazy, and they insist on a more balanced life. But there are social implications.' Indeed, flip through a scientific journal, policy paper or professional magazine, and it doesn't take long to find an article on the changing of the gender guard and the repercussions on salaries, staffing levels and job benefits when women seize the reins in medicine, law and the sciences. For now, on campuses at least, there's little evidence of strain or backlash. "

I think a more European approach to life might have some of the healthcare benefits that allow them to out live us...

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NEJM -- Health Care for All?

NEJM -- Health Care for All?
by M. Gregg Bloche, M.D., J.D.

Just some commments. Dr. Bloche describes the origins of state benefits such as heath care and notes that post war treatment of those who scraficed was an impetus:

In exchange for widespread sacrifice, citizens began looking to the state
to secure their welfare.

I always am taken aback when people view democratic governments as 'the other'. As Pogo said, "We have met the enemy, and he is us." I understand with the ridiculously low level of civil participation these days in the us, it seems like us v. them. And especially with the current administration, I definitely feel like I'm a "them" these days. But, "the state" is still us. Our government, our social contract.

The new compact is likely to start with an enhanced sense of individual obligation — to eat sensibly, exercise regularly, avoid smoking, and otherwise care for ourselves. It may include an obligation to buy insurance. Government, in exchange, can offer some protection against the threat of economic and social change that will disrupt people's coverage by destabilizing employment and family relationships. Not only can the state provide subsidies to enable poorer citizens to buy insurance; it can, at low cost, combine people's purchasing power and clear away obstacles to competition, empowering markets to extend coverage to tens of millions who now go without it. Government can also fashion incentives to foster evidence-based practice, health promotion, the elimination of racial disparities in care, and the reduction of medical errors.

I absolutely hate this "personal responsibility" and "individual obligtion" crap. The people who are largely harmed by issues typically cited (obese, smokers) usually either a) don't start draining the system until they are in Medicare or b) save us money by dying young (we get all of their Medicare and Social Security money). The other personal responsibility issues, such as seeing your physician and buying your meds are at least as much economic issues as responsibility issues.

And again with the subsidiesand incentives! Many are so poor that this doesn't help. And most don't know how to put their risk into perspective. Why is this so incomprehensible?

What is possible is a new reciprocity of personal and public commitment, tailored to American self-reliance and the uncertainties of a global economy. This arrangement stands a decent chance of delivering near-universal coverage. Success could cement a new understanding of government's role — not as a guarantor of easy living irrespective of striving but as an insurer of basic decency when self-reliance fails.

Ugh. Reaarange those deck chairs. Again.

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Wednesday, September 12, 2007

First world results on a third world budget | Special reports | Guardian Unlimited

First world results on a third world budget Special reports Guardian Unlimited:

A nice, evenhanded piece on the Cuban system, with some comparison with the UK's NHS at the end. Clearly not the be-all-and-end-all of healthcare, but, really, can't we do better than Cuba?

"But how good, exactly? And how does Cuba do it given such limited
means? Neither question is easy to answer. The communist government is not
transparent, some statistics are questionable and citizens have reason to muffle
complaints lest they be jailed as political dissidents. According to the World
Health Organisation a Cuban man can expect to live to 75 and a woman to 79. The
probability of a child dying aged under five is five per 1,000 live births. That
is better than the US and on a par with the UK.

Yet these world-class results are delivered by a shoestring annual per capita health expenditure of $260 (£130) - less than a 10th of Britain's $3,065 and a fraction of America's $6,543. There is no mystery about Cuba's core strategy: prevention. From promoting exercise, hygiene and regular check-ups, the system is geared towards averting illnesses and treating them before they become advanced and

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Tuesday, September 11, 2007

More on US Health Care and Health Insurance cost

Two new bits in the Inbox today regarding US spending on health care and consumers spending on insurance:

From Health Affairs:
Health Spending In OECD Countries In 2004: An UpdateGerard F. Anderson, Bianca K. Frogner and Uwe E. Reinhardt
In 2004, U.S. health care spending per capita was 2.5 times greater than health spending in the median Organization for Economic Cooperation and Development (OECD) country and much higher than health spending in any other OECD country. The United States had fewer physicians, nurses, hospital beds, doctor visits, and hospital days per capita than the median OECD country. Health care prices and higher per capita incomes continued to be the major reasons for the higher U.S. health spending. One possible explanation is higher prevalence of obesity-related chronic disease in the United States relative to other OECD countries.

From The Kaiser Family Foundation:
Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent), according to the 2007 Employer Health Benefits Survey released today by the Kaiser Family Foundation and Health Research and Educational Trust. Key findings from the survey were also published today in the journal Health Affairs.The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation has gone up 17 percent.

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Monday, September 10, 2007

David Brooks: European system won't fix U.S. health care woes

"Some liberals, believing that government should step in as employers withdraw,
support a European-style, single-payer health care system. That would be fine if
we were Europeans. But Americans, who are more individualistic and pluralistic,
will not likely embrace a system that forces them to defer to the central
government when it comes to making fundamental health care choices."

Yeah, the elderly are practically rioting in the streets to get rid of Medicare, aren't they? What a self-serving load of hogwash. It's easy enough to just say you are ideologically against any kind of reform involving a single payer type solution. It's another thing to blame it on the "American Character", as if this is some unchanging monolith, or ever was.

"We shouldn't disrupt the lives of those who are happy with the insurance they

Mr. Brooks apparently doesn't realize what a vanishingly small number of people this is these days.In the end, Brooks advocates yet another half-baked idea that tinkers aroun the edges and fails to provide real healthcare security for all Americans.

read more digg story

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Thursday, September 6, 2007

Public Citizen | Publications - Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822)

Public Citizen Publications - Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822):

The states that had the lowest ratios and therefore had the highest
disparities in Medicaid and Medicare payments in 2003 now have the following
Medicaid-to-Medicare ratios:
Medicaid-to-Medicare Fee Ratios for Selected Primary Care Procedures,
Low-Parity States, 2007

New York .29
New Jersey .31
Rhode Island .40
Pennsylvania .42
District of Columbia .48

Read the full report to get the idea, but what we in healthcare have known all along is that Medicaid is de facto rationing. It is a severe economic disincentive to serve this population. And it is worth noting that, depending upon where you practice, Medicare is likely your lowest payer to begin with, so these numbers become even more tragic.

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NEJM -- Efficacy and Safety of Epoetin Alfa in Critically Ill Patients

NEJM -- Efficacy and Safety of Epoetin Alfa in Critically Ill Patients

Results: As compared with the use of placebo, epoetin alfa therapy did not result in a decrease in either the number of patients who received a red-cell transfusion or the mean number of red-cell units transfused.

Conclusions: The use of epoetin alfa does not reduce the incidence of red-cell transfusion among critically ill patients, but it may reduce mortality in patients with trauma. Treatment with epoetin alfa is associated with an increase in the incidence of thrombotic events

Then, in the discussion:

In contrast, [to trauma patients] no significant reduction in mortality was seen among surgical and medical patients receiving epoetin alfa.


The use of epoetin alfa is not supported for patients admitted to the ICU with a nontraumatic surgical or medical diagnosis, unless they have an approved indication for epoetin alfa.

The only reason I post this is because of the extraordinary amount of money I saw spent on promoting the use of this very expensive drug in the critically ill patient population over the past five or ten years. And, mea culpa, I fell for it, too. It will now, hopefully, dry up as yet another revenue source for these companies as word (slowly) filters out to the critical care community. I'm betting there won't be a full court press to get the word out about this particular article.

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Robert E. Litan -

How to fix healthcare...Mr. Litan describes how private health insurance is stifling American business and the lays out his remedy: adjusting the tax treatment of private health insurance.

I am sure this would help literally thousands of already well-insured people, so, "Hear, hear!". Snark.

It reminded me of an old Monty Python sketch called "How To Do It!", in which the presenters breathlessly make their pitch:

Alan: Well, last week we showed you how to become a gynaecologist. And this week on 'How to do it' we're going to show you how to play the flute, how to split an atom, how to construct a box girder bridge, how to irrigate the Sahara Desert and make vast new areas of land cultivatable, but first, here's Jackie to tell you all how to rid the world of all known diseases.
Jackie: Hello, Alan.
Alan: Hello, Jackie.
Jackie: Well, first of all become a doctor and discover a marvellous cure
for something, and then, when the medical profession really starts to take
notice of you, you can jolly well tell them what to do and make sure they get
everything right so there'll never be any diseases ever again.
Alan: Thanks,
Jackie. Great idea. How to play the flute. (picking up a flute) Well here we
are. You blow there and you move your fingers up and down here.

It is so tiresome to keep hearing these inane ideas about tinkering at the edges of such a profoundly dysfunctional system.


read more digg story

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Tuesday, September 4, 2007

Firedoglake - Firedoglake weblog » Welcome To My World

Firedoglake - Firedoglake weblog » Welcome To My World

Jane Hamsher posts one of her surgeon's bills. As Sicko pointed out, even getting sick with insurance is tough financially on top of the usual travails.

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