http://forums.nurse.com/blog.php?162055-insenescence1 This is a Nursing discussion forum. en Thu, 20 Jun 2013 05:06:13 GMT vBulletin 60 http://forums.nurse.com/images/misc/rss.jpg http://forums.nurse.com/blog.php?162055-insenescence1 http://forums.nurse.com/entry.php?141-Rationing-Health-Care-Daschle Tue, 30 Dec 2008 05:07:59 GMT [url]http://online.wsj.com/article/SB123060332638041525.html[/url]

People are policy. And now that President-elect Barack Obama has fielded his team of Tom Daschle as secretary of Health and Human Services and Melody Barnes as director of the White House Domestic Policy Council, we can predict both the strategy and substance of the new administration's health-care reform.

The prognosis is not good for patients, physicians or taxpayers. If Mr. Daschle meant what he wrote in his book "Critical: What We Can Do About the Health-Care Crisis," Americans can expect a quick, hard push to build more federal bureaucracy, impose price controls, restrict medicines and technology, boost taxes, mandate the purchase of health insurance, and expand government health care.

In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs. Under Mr. Obama, it is likely that that system will be expanded and that new government insurance for the nonelderly, nonpoor will be created.

Given the opportunity, Mr. Daschle would likely charge the board with determining which treatments and drugs are cost effective and therefore permissible to use for patients covered by the government. And because the government is such a big player in the health-care market (46% of health-care spending comes from the government), the board would effectively set parameters for private insurers.

It is nearly certain that the process of determining which drugs and which treatments would be approved for use would be quickly politicized. The details of health-care policy may not be kitchen table conversation, but the fact that a Washington committee can deny grandma a hip replacement due to her age, or your sister a new and expensive drug, is. Health care is personal and voters will pressure lawmakers on access to care.

Liberal experts, Mr. Daschle included, believe that America needs to ration new technology and drugs. In his book, Mr. Daschle complains about overuse of new technology and praises the United Kingdom's National Institute for Health and Clinical Excellence (NICE), a rationing system that controls government costs. NICE's denial of care is legendary -- from the arthritis drug Abatacept to the lung cancer drug Tarceva. These drugs are effective. It's just that the bureaucrats don't consider them cost effective.

Americans will not put up with such limits, nor will our elected representatives. Mr. Daschle himself proves this. He punts the hard decisions about rationing to an unelected board. Yet his main proposals are not only about expanding subsidized programs to cover more people but about adding the massively expensive benefit categories of mental health, which has a strong lobby behind it, and long-term care, which is important to the broad middle class.

One of the great myths in health care is that the uninsured are responsible for driving up private premiums by shifting costs. Uncompensated care certainly shifts some costs to private payers. Yet these costs are actually quite manageable in the aggregate, akin to what retailers lose due to shoplifting. The major cost shift is from government programs -- Medicare and Medicaid -- to private plans. The government pays doctors to treat Medicare and Medicaid patients. But the rates it pays, on average, are less than the cost for providing care to these patients. This is why Medicaid patients, and increasingly Medicare patients, struggle to find doctors. Putting more people on these programs will destabilize the remaining private system and create a coalition for price and wage controls.

Americans will never tolerate this. Remember our managed-care experiment in the 1990s. It succeeded in its main goal of controlling costs without an aggregate reduction in health quality. But in asking Americans to limit their choices, it prompted a bipartisan act of Congress to provide patients with a Bill of Rights. Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.

Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.

The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.

Mr. Daschle and the Democrats have spent years developing both the policy and political strategy to make the final push for taxpayer-financed universal health insurance. They have the players on the field, a crisis providing a sense of urgency, and a playbook filled with lessons learned from years of health policy reform disasters -- most recently that of HillaryCare in 1994.

The big questions for believers in private medicine are at this point political and strategic. With employers and most insurers reportedly on board with the new administration's desire for radical overhaul, who will step in to ask the tough questions? Will these issues get raised in time to provoke a meaningful, fact-based debate? Americans could easily find that Mr. Obama's 100-day honeymoon ends with a whole new health-care regime they hadn't quite bargained for.

Ms. Pipes, president and CEO of the Pacific Research Institute, is the author of "The Top Ten Myths of American Health Care: A Citizen's Guide" (Pacific Research Institute, 2008). ]]> insenescence1 http://forums.nurse.com/entry.php?141-Rationing-Health-Care-Daschle http://forums.nurse.com/entry.php?123-Going-broke-in-a-socialized-system Mon, 24 Nov 2008 05:53:25 GMT This fellow is going broke because of his wife's devestating medical condition...and she hasn't even been treated yet.

Strange; I thought it was only Americans who were one illness away from medical bankruptcy because of our semi-privatized system.

[url]http://www.google.com/hostednews/canadianpress/article/ALeqM5hbWRf-ivmQ4cBXEayjF0MO-XRYFg[/url]

"Unless he gets some financial help, Ken MacKay says his savings will soon dry up, forcing his wife Marilyn - awaiting a double-lung transplant in Toronto - to return home to Cape Breton to die." ]]> insenescence1 http://forums.nurse.com/entry.php?123-Going-broke-in-a-socialized-system http://forums.nurse.com/entry.php?119-It-ain-t-just-about-the-syringes Fri, 21 Nov 2008 07:11:47 GMT Turns out that someone was also reusing finger-stick lancets...the same one for over a YEAR! ... Turns out that someone was also reusing finger-stick lancets...the same one for over a YEAR!

[url]http://www.google.com/hostednews/canadianpress/article/ALeqM5hBQU-oAGiLTlxNBUXqdTrWr0Q7Jw[/url]

"WINNIPEG — Manitoba's largest health authority launched an internal investigation Thursday after 17 patients may have been exposed to blood-borne infections while having their blood-sugar levels tested.

Health officials say they are looking into how a nurse at a Winnipeg clinic improperly reused a blood sampling needle for over a year after getting the single-use device from an industry representative." ]]> insenescence1 http://forums.nurse.com/entry.php?119-It-ain-t-just-about-the-syringes http://forums.nurse.com/entry.php?113-Canadian-Citizen-say-s-Air-Ambulance-system-flawed Fri, 14 Nov 2008 16:03:53 GMT [url]http://www.cbc.ca/health/story/2008/11/12/air-ambulance.html[/url]

36 year old Newfoundland resident was transported to Halifax by air ambulance for lifesaving surgery. After several weeks in the ICU, her physician cleared her to return home...but the government refused to dispatch an ambulance.

I found the "comments" to this article to be just as interesting as the story; apparently this woman was supposed to be transferred back to another health care facility, and ended up paying her own way via commercial flight. ]]> insenescence1 http://forums.nurse.com/entry.php?113-Canadian-Citizen-say-s-Air-Ambulance-system-flawed http://forums.nurse.com/entry.php?112-Syringe-Re-use-Drama-Expands Fri, 14 Nov 2008 06:41:52 GMT Another entry in the ongoing saga of the cost-saving maneuver of reusing syringes in Canadian Health Care facilities. See previous blog entries... Another entry in the ongoing saga of the cost-saving maneuver of reusing syringes in Canadian Health Care facilities.

See previous blog entries here; [url]http://forums.nurse.com/blog.php?b=98[/url], here [url]http://forums.nurse.com/blog.php?b=95[/url], and here [url]http://forums.nurse.com/blog.php?b=85[/url]

Now the latest from Candian news.

[url]http://www.cbc.ca/health/story/2008/11/13/syringes-re-used.html[/url]

Originally it was supposed to just be one facility, and officials were confident that this practice was isolated.

Then we found out that this was going on at a second facililty, and then a third. Each time, the officials reaffirmed that they didn't think this was a widespread problem.

Now, just a couple weeks later, the number of facilities found to be reusing syringes (and the leftover drugs in these syringes), on multiple patients.

Don't be surprised if folks now don't believe the Sask health minister when she says that it's "not necessary" for people to be tested. I'm guessing it's because it would be expensive for this single-payor system to test the thousands of people who were victims of this malpractice...and besides, we can't be confident that they aren't reusing the lab-draw needles used to collect the samples. ]]> insenescence1 http://forums.nurse.com/entry.php?112-Syringe-Re-use-Drama-Expands http://forums.nurse.com/entry.php?111-Can-someone-help-me-with-this-math Fri, 14 Nov 2008 06:25:37 GMT I just ran across this article today on the cost of healthcare for Canadians in 2008. ... I just ran across this article today on the cost of healthcare for Canadians in 2008.

[url]http://www.cbc.ca/health/story/2008/11/13/health-spending.html[/url]

It says,

"Health care spending in Canada is expected to outpace inflation to reach $171.9 billion in 2008, up more $10.3 billion from last year's estimate, according to a report released Thursday."

(Here is another link to another Canadian news source; the previous link seems fickle).

[url]http://www.theglobeandmail.com/servlet/story/RTGAM.20081114.whealth14/BNStory/specialScienceandHealth/home[/url]

The current population of Canada is about 33 million and some change.

So, I'm understanding that it's costing the gov't almost $172 billion to insure 33 million in 2008...and that doesn't count what Canadians spent on themselves for things that are not covered by the gov't, or medical care that they came to the US to obtain because of the notorious Canadian wait-lists.

But I also read today that Obama's new health care plan, supposedly designed to cover approximately 2/3 of the currently uninsured 47'ish million Americans (or about 31 million, almost the population of Canada), will cost only $ 75 billion...far less than half of what Canada spends to cover about the same number of people.

Even with incremental increases from now until 2018, they claim the annual cost for the US program will be about $130 billion per year.

Wait a minute.

The population of Canada is 33 million.

The population of the US is about 300 million.

It cost Canada $172 billion last year to insure 33 million, but it will only cost the US $130 billion 10 years from now to insure 300 million (or the comparative number of uninsured)?

I'm no math major, but this looks like a bill of goods. ]]> insenescence1 http://forums.nurse.com/entry.php?111-Can-someone-help-me-with-this-math http://forums.nurse.com/entry.php?110-Democrat-Blesses-the-Crowd Wed, 12 Nov 2008 08:05:19 GMT [url]http://www.politickernj.com/matt-friedman/25358/urinating-jersey-city-councilman-politically-alive-now[/url]

New Jersey Democrat smiles at crowd below while whizzing off the balcony onto a crowd of concertgoers below.

I wonder if this has moved him up the list to be Obama's Press Secretary? ]]> insenescence1 http://forums.nurse.com/entry.php?110-Democrat-Blesses-the-Crowd http://forums.nurse.com/entry.php?107-More-gov-t-money-means-higher-rates-of-infection Tue, 11 Nov 2008 03:35:21 GMT [url]http://www.amherstdaily.com/index.cfm?sid=188321&sc=510[/url]

Despite expanding political attention and an increase in gov't funding, rates of MRSA have doubled, and VRE infection rates have increased 77% in Canadian Hospitals with 80 or more beds.

Are we ready to invite this kind of 'oversight' into our hospitals? ]]> insenescence1 http://forums.nurse.com/entry.php?107-More-gov-t-money-means-higher-rates-of-infection http://forums.nurse.com/entry.php?105-This-is-just-a-personal-observation-so-you-can-ignore-it Mon, 10 Nov 2008 06:45:13 GMT I just had an interesting discussion with one of our NM's this evening...about universal health care.

In Hospital A is a baby #1 who is slowly recovering from an extensive surgery and several related complications. This child's 'home' is about 100 miles away, and was sent to Hospital A to receive specialized services.

This child has a sibling (baby #2) who needed less-complicated surgery at the same time, and was able to receive that surgery at Hospital M near home, putting this child's poor mother in an unfortunate circumstance to where she couldn't be with both of her babies at the time of their surgery and recovery.

She attempted to go to Hospital A to be with baby #1 for a short time after surgery, but was unable to leave Hospital M near her home because she had to stay in-house to learn how to care for baby #2 who will have a longer and more complicated rehabilitation, even though the surgery was less complicated. That means she has spent almost no time with baby #1 in Hospital A.

Hospital A, recognizing the inconvenience and unfortunate condition that this placed the mother in, originally agreed to transfer baby #1 back to the hospital near home after baby #1 had stabilized after surgery. All related services were involved; both hospitals, social services, surgeons, and intensivists.

I almost forgot; this baby is on a gov't payor program, adminsitered by the state.

Things were moving along and about to be executed, when the gov't payor system presented the absurd reality that is part of gov't-run payor systems; they not only refused to pay to have baby #1 returned home, they said that if Hospital A transferred baby #1 back home to Hospital M, the entire reimbursement would be forwarded to the home hospital...even though they didn't perform the complicated surgery and recovery (not to mention they aren't qualified to do the surgery)...leaving the facility that actually did provide the surgery and care not only completely uncompensated for the hundreds of thousands of dollars worth of specialized care, but simultaneously STILL leaving them liable for any litigation for any malpractice that might have occurred.

This not an oddity; it is the reality of gov't payor systems.

Canada, which arrogantly proclaims it's system to be superior to the US system, routinely accesses the very system that they criticize. This occurs because their 'superior' system is actually unable to accomodate their most vulnerable...their babies. Hundreds of high-risk obstetrical patients are transferred hundreds of miles to US hospitals because Canada routinely lacks the capacity to properly care for the potentially critically ill neonate, leaving the infants and their distraught mothers not only far from home...but in another country to deal with the stress of delivering a high-risk newborn.

Not to mention the irony that the Canadians claim to have better rates of infant mortality, but they aren't sending their healthy moms to the US to give birth...only the sickest.

You too, can have this high-quality 'system' should you so desire. ]]> insenescence1 http://forums.nurse.com/entry.php?105-This-is-just-a-personal-observation-so-you-can-ignore-it http://forums.nurse.com/entry.php?103-No-bandages-for-breast-cancer-survivors Sat, 08 Nov 2008 07:28:57 GMT I guess universal coverage isn't so universal.

People constantly complain about what insurance companies won't cover, apparently failing to realize that gov't payors don't cover everything as well...which is why the gov't is being petitioned to pay for lymphedema compression bandages for cancer survivors.

[url]http://www.metronews.ca/halifax/local/article/137403[/url] ]]> insenescence1 http://forums.nurse.com/entry.php?103-No-bandages-for-breast-cancer-survivors http://forums.nurse.com/entry.php?100-Putting-babies-on-the-waiting-list Thu, 06 Nov 2008 06:18:59 GMT [url]http://www.canada.com/vancouversun/news/story.html?id=6219c084-1ede-4da9-843a-208585259a4c[/url]

"Babies and toddlers are waiting twice as long for hernia surgery than is considered safe, increasing the risk they will need urgent bowel surgery and may suffer damage to a testicle or ovary, a new study has concluded."

"They found the median waiting time was 35 days from the time of diagnosis to surgery."

"Children who waited more than 14 days had a doubled risk of "incarcerated" or strangulated hernia, in which a loop of bowel gets stuck in an opening in the abdominal wall.

If that happens, the bowel, over a period of hours, gets starved of its blood supply and the blood supply to the gonads - testicles or ovaries - can be squeezed off, causing damage or death to the tissue."

In one hospital alone in British Columbia, there are 75 babies waiting for just this kind of surgery. This is not even a 'quality of life' surgery like a hip replacement ]]> insenescence1 http://forums.nurse.com/entry.php?100-Putting-babies-on-the-waiting-list http://forums.nurse.com/entry.php?98-Dead-babies-and-keeping-drug-prices-down Wed, 05 Nov 2008 09:17:11 GMT [url]http://canadianpress.google.com/article/ALeqM5j-BLfRdE0k8_xMNPrJlj09o4Q8mQ[/url]

[url]http://www.canada.com/reginaleaderpost/news/story.html?id=253af01f-bf02-4335-ad63-f4660b7b3d86[/url]

Just reuse other medical supplies and save whatever drug is left over in the syringe to use on the next patient.

It seems that every few days we find another Canadian facility that has been reusing syringes on multiple patients. This, however, is the first I've read that they also have been saving whatever drug is left over in the syringe for the next patient. I suppose that's one way to keep drug prices lower than in the US.

I hope the US consumer is ready for this new philosophy in health care.

BTW, when is the last time a baby died of syphilis in the US?

[url]http://www.canada.com/edmontonjournal/news/story.html?id=0629ccf8-6e2e-4db4-b51d-f8c0048133f1[/url] ]]> insenescence1 http://forums.nurse.com/entry.php?98-Dead-babies-and-keeping-drug-prices-down http://forums.nurse.com/entry.php?97-We-re-not-really-closing-any-quot-hospitals-quot Sun, 02 Nov 2008 13:52:05 GMT It's because if they don't have 24 hour emergency departments, then they aren't really hospitals.

The case of mistaken identity is blamed on the consumers; "During his remarks Tuesday, Dr. Kitts said there was a misconception with Niagara public that there are six hospitals in the region. He said there is in fact one hospital, spread over six sites."

[url]http://www.niagarathisweek.com/news/article/216721[/url] ]]> insenescence1 http://forums.nurse.com/entry.php?97-We-re-not-really-closing-any-quot-hospitals-quot http://forums.nurse.com/entry.php?95-Dirty-syringes-not-an-isolated-event Fri, 31 Oct 2008 15:38:02 GMT An anonymous physician is opening up about the practice of reusing syringes on multiple patients in Canadian healthcare facilities. ... An anonymous physician is opening up about the practice of reusing syringes on multiple patients in Canadian healthcare facilities.

[url]http://www.canada.com/calgaryherald/news/story.html?id=02de54d1-fb8b-4cd0-bb17-e0742dc29eda[/url]

See my previous blog entry here; [url]http://forums.nurse.com/blog.php?b=85[/url]

Not only are they risking the transfer of infectious diseases, they are also risking the administration of residual medication that may have remained in the previously-used syringes.

Originally this was announced as being an isolated situation, and Dr. Predy, acting Medical Officer of Health, said that this was not occurring in other Alberta, Canada facilities. And even now, as it is revealed that this is occurring in Alberta, Dr. Predy is now saying he doesn't think the practice is widespread. ]]> insenescence1 http://forums.nurse.com/entry.php?95-Dirty-syringes-not-an-isolated-event http://forums.nurse.com/entry.php?93-No-blood-No-surgeries Thu, 30 Oct 2008 03:54:22 GMT So much for their waiting list for surgeries.

[url]http://www.barrieadvance.com/barrieadvance/article/120822[/url]

Today, Canada's national blood supply is just under two day's worth.

But I don't know why this is a problem; when Canada get's low on neonatal ICU beds, they just use American neonatal ICU beds. When they get put on a Canadian waiting list for surgery or an MRI or CT scan, they just come to the US and get it here. Makes me wonder why the superior Canadian system can't just access the blood supply from the inferior American health care system. ]]> insenescence1 http://forums.nurse.com/entry.php?93-No-blood-No-surgeries