Happy Halloween

You have been officially mooned for Halloween.

Stay safe and have fun.

Why Malpractice Not Part of the Bill

The Obamacare bill HR 3200 that has been passed out of committee contains 1018 pages of increased taxes, increased government mandates, increased oversight, restrictions on physicians, hospitals, patients, insurance companies, and employers and not a single mention anywhere of tort reform.

Any meaningful healthcare reform has to address this in some fashion as our legal system does contribute to the problem.

If we want to emulate European systems, than why is tort reform not part of the change.

Here is an excerpt from Medical Economics about malpractice in other countries. There should be some changes in our system if the democrats really want reform.

Malpractice: Do other countries hold the key? - - Medical Economics Practice Management


Are doctors better served by judges than juries?

The United States is one of the few countries where a jury routinely decides whether a doctor committed malpractice. The norm elsewhere is for a judge to try malpractice claims and other civil litigation, says David Bernstein, a professor at the George Mason University School of Law in Arlington, VA. That's true in Germany, the UK, and most Commonwealth nations. In Canada, every province except Quebec gives warring parties the jury option. However juries heard only 4 percent of cases going to trial in 2002, according to the Canadian Medical Protective Association, which provides malpractice coverage for 95 percent of the nation's physicians.

Bernstein and others argue that judges usually render better decisions than juries because their education and experience enable them to understand complex cases, arrive at sound conclusions, and resist purely emotional arguments. "Plaintiffs' lawyers want ignorant juries that they can manipulate," Bernstein says.

Unlike juries, judges must put their decisions in writing—another plus. "It forces them to be more methodical and logical," says anesthesiologist John Hickey, CEO of the Medical Protection Society, which provides malpractice coverage to physicians in the UK and dozens of other countries. Written decisions also give plaintiffs and defendants a clearer basis for appeal, and clearer precedents for other courts as well as for the medical profession.

However, not everybody believes that juries can't be trusted. Social psychologist Neil Vidmar, who teaches at the Duke University School of Law in Durham, NC, points to studies showing that outside medical experts tend to agree with jury decisions, and that judges tend to agree with juries in all manner of civil litigation. "Most malpractice cases aren't rocket science," notes Vidmar, author of Medical Malpractice and the American Jury: Confronting the Myths about Incompetence, Deep Pockets, and Outrageous Damage Awards (University of Michigan Press, 1995). "They usually boil down to a communication breakdown or some organizational matter."
And some proponents of trial-by-judge temper their support. "I've heard the 'dumb jury' argument, but our experience hasn't proven that to be the case," says FP John Gray, CEO of the CMPA in Canada. Likewise, John Hickey in the UK says court decisions didn't tilt noticeably in favor of physicians after Ireland switched to nonjury civil trials several decades ago.

Proponents of trial-by-judge in the United States face a huge obstacle. The Seventh Amendment in the Bill of Rights—and most state constitutions—guarantees the right to a jury trial in civil suits involving more than $20. "I don't think a constitutional amendment to eliminate civil jury trials would have a chance," says Kenneth Suggs, secretary of the Association of Trial Lawyers of America, which represents the plaintiffs' bar. "Thomas Jefferson thought this was one of the most important rights that citizens had."

It would be possible for US judges to wield more power—even without a constitutional amendment, says Bernstein. They could grant more pretrial summary judgments in cases where one side can't prove the facts are contestable. And state legislatures, he says, could authorize judges to award damages if the plaintiff wins, bumping the jury aside.

Court-appointed experts: nothing but the truth

Expert witnesses are often called "hired guns" because they're seen as weapons for plaintiff and defendant alike in the adversarial setting of the courtroom. Juries may view their testimony as partisan, and therefore not entirely credible.

But what if a truly neutral expert witness added his two cents' worth? Wouldn't that contribute to a fair verdict? Germany thinks so. Its judges routinely pick their own expert witnesses in malpractice cases, although plaintiffs and defendants can hire experts as well. "This prerogative gives a judge a more unbiased view," says gynecologist Bernhard Gibis, director of quality for the National Association of Statutory Health Insurance Physicians, which represents 142,000 German physicians who treat patients in the government health insurance system.

Having judges appoint experts isn't an alien concept in the United States. "It's permitted under the Federal Rules of Evidence, and many states have copied the federal rules," says Ken Suggs. "However, court-appointed experts are the exception rather than the rule in this country.


Courts generally can't afford them."

Even if taxpayers did pony up more money for court-appointed experts, their value shouldn't be overestimated. "Even a supposedly neutral witness will have biases," says Vidmar.

Clamping down on attorneys' fees

An attorney who charges a contingency fee is taking a gamble. He'll collect nothing if his client loses. But if his client receives court-awarded damages or a settlement, the attorney receives a pre-determined share—usually 30 to 40 percent.

Germany prohibits attorneys from taking civil cases on contingency. True, German lawyers can charge more for cases involving larger sums of money, but only according to a government fee schedule. And the fee schedule isn't generous by American standards. A lawyer handling a case valued at $600,000 and actually tried before a judge would normally collect only about $7,500.
The UK bans percentage-based contingency fees, but in the 1990s, it introduced what's called a conditional fee. As in the United States, the plaintiff pays his lawyer only if he wins. However, the lawyer can collect no more than double what he would normally charge—not a formula for a million-dollar payday.

Critics of US contingency fees say they divert too much money away from injured patients. They also steer lawyers away from solid cases involving low damages and toward speculative suits worth millions. "An attorney has an incentive to take on a lot of cases with a high dollar value, but a low probability of success," says law professor David Bernstein. "If he files enough of them, he's bound to win one and strike it rich."

To Neil Vidmar, though, contingency fees are a necessary evil, because most patients can't afford to pursue a malpractice claim on their own. And since contingency-fee attorneys must invest tens if not hundreds of thousands of dollars in a lawsuit, he says, lawyers choose only those cases with the best chances of winning. "Contingency fees improve the quality of cases filed," adds Ken Suggs. "You don't have a motive to file a frivolous case."

Tort reform pending in Congress would put contingency fees on a sliding scale to minimize the attorney's cut, but if Canada's experience is any indication, this measure may not amount to much. Canada's provinces have gradually embraced contingency fees over the years, with the last holdout, Ontario, coming on board in 2002. "In our view, it's made no difference," says the CMPA's John Gray. "We don't see a lot of nonmeritorious claims being pursued regardless of how the attorneys are paid."

The loser-pay rule: a judicial speed bump?

One gripe about American justice is that even if you triumph over a plaintiff, you (or your insurer) still have to shell out big bucks to defense attorneys. In Germany, the UK, and other Commonwealth countries, the loser pays the winner's legal bill.

"This rule would dampen our fervor for speculative suits," says law professor David Bernstein. "And it would discourage plaintiffs from trying to wear out the other side with excessive discovery."

Opponents of the loser-pay rule, of course, challenge the assumption that doctors are beset by a tidal wave of flimsy lawsuits. Ken Suggs says the loser-pay rule would discourage plaintiffs with legitimate claims. However, there's a way to make the rule less risky for plaintiffs. In the UK and Germany, they can buy special insurance that will cover what they'll owe a defendant if their suit fails.

Alaska is the only state that observes the loser-pay rule in some form. Florida tried it out with malpractice litigation during the early 1980s, but dropped the rule after doctors there were disappointed with the results. They found that while their costs went up when they lost a case, they often couldn't collect from insolvent plaintiffs when they won. So much for deterrence.
Florida's experience mirrors that of Canada, where the loser-pay rule is on the books. "We seldom attempt to collect costs from plaintiffs when we win," says John Gray. "Frequently, the families who sue aren't well off to begin with, and they're attempting to care for someone who is severely injured."

The no-fault approach: End the blame game

Several countries, Sweden and New Zealand among them, have a no-fault system of evaluating and paying medical malpractice claims, similar to the way car accidents and workplace injuries are handled. If someone is injured by medical treatment and meets certain criteria, the government cuts a check.

The word "no-fault" is a bit misleading, though. In Sweden, an injury must be deemed "avoidable" to merit compensation. In New Zealand, about 10 to 15 percent of compensated injuries are each year classified as medical errors. The rest are "mishaps," or very bad outcomes. The physician didn't make a mistake, but the bad outcome is severe enough and rare enough to warrant compensation (there are criteria for severity and rarity). But whether an injury is considered avoidable, the result of error, or just bum luck, the no-fault approach spares physicians the ordeal of litigation.

Meanwhile, injured patients reap significant benefits. The streamlined nature of no-fault translates into speedy decisions and payments within months. In contrast, plaintiffs in a malpractice suit might have to wait years for their money. In addition, the ease of no-fault systems encourages small claims that might otherwise be shunned by plaintiffs' attorneys. That's an important consideration to legal experts who say that contrary to conventional wisdom, the US tort system doesn't do enough for victims of malpractice. Only one in eight actually files a claim and only one in 15 receives any money, according to a landmark study of hospital patients in New York published by Harvard University researchers in 1990.

A mandatory no-fault system for medical malpractice in the United States probably would meet tremendous resistance from trial lawyers who'd see it as an infringement on the public's right to file suit and their ability to earn a living. Some scholars question whether it would adequately deter medical negligence, given that nobody's taking the rap for mistakes. And it's not clear whether the United States could afford no-fault.

However, a 1997 study published in Law & Contemporary Problems suggests that a no-fault system in the US is within our economic reach. The study concluded that no-fault could compensate two to three times more victims than the court system, while costing the same or less than what doctors and hospitals pay in malpractice premiums. The researchers came to this conclusion by hypothetically applying the Swedish avoidability test to Colorado and Utah patients injured by medical care in 1992.

Affordability, though, is a real-life issue for New Zealand's no-fault system. Outlays for patients injured by medical errors and mishaps rose 82 percent from 1997-'98 to 2001-'02. The cost per claim has been rising dramatically, and the system piles on new claims even while it continues to pay on old ones. Some New Zealanders are so concerned about the level of spending that they've proposed having physicians reimburse the government for what it pays injured patients.
New Zealand's situation doesn't surprise health care economist Patricia Danzon, a professor at The Wharton School of the University of Pennsylvania. "I don't think there's an advantage in moving away from a fault-based system," she says. "It's hard to define a compensable injury if you eliminate the idea of error. You don't want to pay for all bad outcomes, but where do you draw the line? The cost can go through the roof."

Overseas physicians pay high premiums, too

Even if the US wanted to imitate other countries in their approaches to medical malpractice, there are a number of caveats to be considered first. For one thing, cultural differences can make it hard to transplant features of foreign legal systems into ours. It's said that Germans respect authority more than Americans do. So while Germans may be content with judges issuing verdicts, Americans may not.

Plus, any success that other countries have in avoiding an American-style malpractice crisis can't be solely attributed to their legal systems. Germany, the UK, and Canada have various forms of universal medical coverage that tend to reduce damages doled out by courts, says social psychologist Neil Vidmar. "A big proportion of awards are for past and future medical care, and in these countries, these costs are paid by the state."

As it is, the malpractice blues are a worldwide phenomenon, infecting countries that US doctors would consider models for tort reform. Australia has a legal system like that in the UK, for example, but it's been experiencing a malpractice meltdown similar to ours—skyrocketing premiums, bankruptcy for the nation's main carrier (now on government life support), and cries for tort reform from doctors. United Medical Protection, the distressed carrier, has attributed its woes to a downturn in investment income and higher reinsurance costs following Sept. 11 as well as increased litigation and higher court awards.

Lawsuits also are on the rise in Germany, says gynecologist Gerhard Gibis. "People are less likely to view the doctor as a superman who always does the right thing," he says. Gerhard Bester, a plaintiff's attorney in Munich, says a newfound willingness of doctors to testify about each other's mistakes has also contributed to the surge in litigation.

What concerns malpractice carriers in the UK and Canada isn't so much an increase in malpractice claims as an increase in their monetary value. The average award or settlement for Canada's primary malpractice carrier rose 38 percent from 1997 to 2001, despite an inflation-indexed cap on noneconomic damages now set at close to $290,000 (in Canadian dollars). The average payment per claim for the UK's Medical Protection Society rose by 48 percent in roughly that same period.

Bigger payouts are cited as one reason high-risk specialists in both countries have been jolted by sharp hikes in malpractice coverage. The MPS upped its rates 18 percent for ob/gyns and 17 percent for neurosurgeons in 2003, although many nonsurgical specialists such as pediatricians saw theirs drop 10 percent. CMPA rates in Ontario, Canada's most populous province, rose 10 percent for orthopedic surgeons, neurosurgeons, and heart surgeons in 2003. Ontario internists and FPs who don't perform hospital procedures also got hit hard with rate increases of 24 percent and 19 percent, respectively.


Canadian doctors are largely insulated from malpractice sticker shock because provincial governments foot much or most of the bill, says John Gray. "The rate for an ob/gyn in Ontario is $75,000, but the government pays about $70,000 of that." You'd think Canadian doctors would be more content than their US peers, but Gray reports that some ob/gyns in Ontario are leaving practice, while neurosurgeons no longer perform

Obama Rhetoric

In a recent article at the Hudson institute and from the American Spectator, we once again see how Obama and the Liberals continually exaggerate and use inflammatory rhetoric to promote their radical healthcare agenda.

In his weekly radio address June 6, the President claimed "skyrocketing costs" were making it impossible for families to afford health care. Secretary of Health and Human Services Kathleen Sebelius was right on message, warning a women’s group about the same "skyrocketing costs." Senators Edward Kennedy and Max Baucus, chairmen of two committees drafting proposals, warned that soaring health spending threatens the stability of American families and the economy.

These doomsday scenarios are untrue. Health care spending is increasing at more moderate rates than in previous decades. Spending increased 10.5 percent in 1970, 13 percent in 1980, and consistently less than 7 percent in each of the last five years, reaching a low of 6.1 percent a year ago (see chart 1).

The rest of the article Hudson Institute > Downgrading American Medical Care describes how this radical agenda will downgrade the wonderful healthcare we currently enjoy.

There are problems with the delivery of healthcare and it can be improved, but Obamacare is not the answer or the reasonable approach we should be taking!

Personal Responsiblity

Thomas Sowell points to the real problem of our society and the progressive liberal mindset that prevents the solution. I’ve stated it many times on this and other blogs that personal responsibility is the key to solving most problems.

The bigger question is; What is Governments role? I’d like to hear some of the thoughts on what people really think the Government should be doing in our everyday lives.

The Great Escape by Thomas Sowell on National Review Online


Much harm results when we run from personal responsibility.

Many of the issues of our times are hard to understand without understanding the vision of the world that they are part of. Whether the particular issue is education, economics, or medical care, the preferred explanation tends to be an external explanation — that is, something outside the control of the individuals directly involved.

Education is usually discussed in terms of the money spent on it, the teaching methods used, class sizes, or the way the whole system is organized. Students are discussed largely as passive recipients of good or bad education.

But education is not something that can be given to anybody. It is something that students either acquire or fail to acquire. Personal responsibility may be ignored or downplayed in this “non-judgmental” age, but it remains a major factor nevertheless.

After many students go through a dozen years in the public schools, at a total cost of $100,000 or more per student — and emerge semi-literate and with little understanding of the society in which they live, much less the larger world and its history — most discussions of what is wrong leave out the fact that many such students may have chosen to use school as a place to fool around, act up, organize gangs, or even peddle drugs.

The great escape of our times is escape from personal responsibility for the consequences of one’s own behavior. Differences in infant-mortality rates provoke pious editorials on a need for more prenatal care to be provided by the government for those unable to afford it. In other words, the explanation is automatically assumed to be external to the mothers involved and the solution is assumed to be something that “we” can do for “them.”

While it is true that black mothers get less prenatal care than white mothers and have higher infant-mortality rates, it is also true that women of Mexican ancestry get less prenatal care than white women and yet have lower infant-mortality rates. But, once people with the prevailing social vision see the first set of facts, they seldom look for any other facts that might go against the explanation that fits their vision of the world.

No small part of the current confusion between “health care” and medical care comes from failing to recognize that Americans can have the best medical care in the world without having the best health or longevity because so many people choose to live in ways that shorten their lives.

There can be grave practical consequences of a dogmatic insistence on external explanations that allow individuals to escape personal responsibility. Americans can end up ruining the best medical care in the world in the vain hope that a government takeover will give us better health.

Economic issues are approached in the same way. People with low incomes are seen as a problem for other people to solve. Studies that follow the same individuals over time show that the vast majority of working people who are in the bottom 20 percent of income earners at a given time end up rising out of that bracket.

Many are simply beginners who get beginners’ wages but whose pay rises as they acquire more skills and experience. Yet there is a small minority of workers who do not rise and a large number of people who seldom work and who — surprise! — have low incomes as a result.

Seldom is there any thought that people who choose to waste years of their own time (and the taxpayers’ money) in school need to change their own behavior — or to visibly suffer the consequences, so that their fate can be a warning to others coming after them not to make that same mistake.

It is not just the “non-judgmental” ideology of the intelligentsia but also the self-interest of politicians that leads to so much downplaying of personal responsibility in favor of external explanations and external programs to “solve” the “problem.”

On these and other issues, government programs are far less likely to solve the country’s problems than to solve the politicians’ problem of getting the votes of those whose think the answer to every problem is for the government to “do something.”

Questions for the Congress

Our friends at the Heritage Foundation welcome the opportunity for open discussion on the Healthcare issue. With the debate in full swing, there are ongoing questions that all the congressmen should be asked.

The facts related to the Liberal agenda and links are also included thanks to Heritage.org

Can you promise me that I will not lose my current plan and doctor?

President Obama says it is “not legitimate” to claim the “public option is somehow a Trojan horse for a single-payer system.” But Reps. Barney Frank (D-MA), Jan Schakowsky (D-IL), and Nobel Prize winning economist Paul Krugman have all admitted that the public option will inevitably lead to government-run health care. The independent and non-partisan Lewin Group estimates that about 83.4 million people would lose their private insurance if Obamacare became law.

Can you promise that you and your family will enroll in the public plan?

Members of Congress and their families currently receive health care through the popular, and completely public-option-free, Federal Employees Health Benefits Program (FEHBP) which allows members of Congress to choose between 283 private health insurance plans. Sen. Tom Coburn (R-OK) proposed an amendment that would require all members of Congress and their staffs to enroll in the newly-created public health insurance plan. His amendment passed by just one vote in the Senate Health Committee. In the House, Rep. Dean Heller (R-NV) offered a similar amendment and all 21 Democrats on the House Ways and Means Committee voted it down. If the public plan is so great, then Members of Congress should by willing to forfeit their private coverage and join the millions of Americans who would be moved into the public plan.

Can you promise that Obamacare will not lead to higher deficits in the long-term?

President Obama said that he would not support health care legislation that would add to the national deficit. But Congressional Budget Office director Douglas Elmendorf has stated that the House health care legislation would “generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.” To help Obama keep his promise, Rep. Patrick Tiberi (R-OH) offered an amendment that would require the Secretary of Health and Human Services to submit an annual report to the President and Congress, comparing the expected revenue and spending under the bill’s provisions for the upcoming 10-year period. In the event that projected spending under the bill outpaced revenue, the Secretary would have to reduce spending so that it would not exceed revenue. Democrats defeated Tiberi’s amendment.

Can you promise that government bureaucrats will not ration health care for patients on the public plan?

President Obama promised on July 22 that health care reform would keep the government out of health care decisions, but both the House and Senate bills call for an increased role of comparative effectiveness research (CER). More information on health care effectiveness is good as long as doctor’s and patients are the ones empowered to use that information. Conservatives in both the House and Senate offered amendments prohibiting the use of CER by government to mandate, deny, or ration care. These anti-rationing amendments were defeated in both the House and Senate.

Can you promise me that my tax dollars will not fund abortions?

The House bill, as currently drafted, allows the Secretary of Health and Human Services to outline the minimum benefits that must be included in any health plan. There is no specific provision in the bill that would require insurance coverage of abortion. However, since the decisions over benefits are left to the Secretary of HHS, with recommendations from a newly created Health Care Benefits Advisory Committee, there is nothing to prevent the current or future Secretary from including abortion coverage in Americans’ health insurance. Conservatives in both the House and Senate offered amendments that would prohibit the use of taxpayer dollars to fund abortions. The tax payer funded abortion bans were defeated in both the House and Senate.

Since none of them will be able to offer reasonable answers to any of these questions, we are hopeful that more and more Americans will see through this charade being played by Obama and his fanatical friends.

10 reasons why America lost the Olympics

10. Dead people can't vote at IOC meetings

9. Obama distracted by 25 min meeting with Gen. McChrystal

8. Who cares if Obama couldn't talk the IOC into Chicago? He'll be able to talk Iran out of nukes.

7. The impediment is Israel still building settlements.

6. Obviously no president would have been able to acomplish it.

5. We've been quite clear and said all along that we didn't want the Olympics.

4. This isn't about the number of Olympics "lost", it's about the number of Olympics "saved" or "created".

3. Clearly not enough wise Latina judges on the committee

2. Because the IOC is racist.

1. It's George Bush's fault.

The Non-Healthcare crisis

In this op-ed from David Limbaugh, he explains why Obama cannot afford to tell the truth and give all the information about the numbers.

David Limbaugh : Obama Can't Afford To Tell Truth on Health Care - Townhall.com


President Barack Obama is spreading disinformation about health care almost as quickly as he's driving up the national debt, such as that 47 million Americans can't get health care and that a government takeover would be a panacea.

Democrats have constantly demagogued the 47 million uninsured figure to gin up public fear about the scarcity of health care access, especially for the poor. They follow up with the promise that under their plan, we would achieve universal access. But both are untrue.

In "The Top Ten Myths of American Health Care," Sally Pipes points out that while there are some Americans who simply can't afford health insurance, many millions who can afford insurance choose not to buy it and "very likely would not want to be 'rescued' by mandatory socialized medicine."

In the first place, the 47 million number is grossly inflated. The Congressional Budget Office survey generating it included those who were uninsured for any part of a year, despite the fact that almost half of these remain uninsured for an average of only four months.

Some 38 percent of this 47 million -- almost 18 million -- make more than $50,000 a year, and 10 million of them make more than $75,000. Of all the uninsured groups, this is the only one that is growing, because in a still-free country, they've made their own decision not to buy expensive insurance while (most of them) are young and healthy. The Census Bureau also reports that more than 10 million of the uninsured are not American citizens.

But how about the very poor? Well, it turns out that the Democrats are shedding crocodile tears here, as well. Pipes explains that "as many as 14 million of the 45.7 million uninsured -- poor and low-income Americans -- are fully eligible for generous government assistance programs like Medicare, Medicaid, and SCHIP." But "they're just not enrolling in the programs."

So while Obama tells us that almost 8 million children lack health insurance, he doesn't disclose that 5 million of them only lack insurance because they haven't been enrolled in the available programs. Not only would this fact undermine the urgency of his appeal; it illustrates that even under his "universal access" plan, not everyone would acquire coverage anyway. Indeed, the CBO has estimated that some 17 million would remain uninsured if the Democrats' plan were implemented.

Yes, there are people who fall through the cracks (Pipes' words) -- mostly those who earn less than $50,000 per year but too much to qualify for government help. When it's all said and done, there are probably about 8 million of these "chronically uninsured," who really can't afford insurance and don't qualify for help -- though they are able to receive emergency room care. And many of these 8 million would be better able to afford coverage if government regulations and mandates hadn't driven up the costs so much.

But how urgent do you suppose Obama's call for universal coverage would sound if he were to come clean with these figures? The truth is he couldn't get to first base if he used the 8 million figure instead of 47 million.

But there's another important factor to keep separate, as well. There's a major difference between a lack of insurance and a lack of care. Under Obama's socialized medicine scheme, not only would universal insurance coverage be impossible to achieve but also access to medical care and the scope of care would be dramatically reduced, as it has been in every socialized system in the world and in our own government health programs.

It is axiomatic that price controls result in rationing and waiting lines, and many of the very people Obama is using to shame us into supporting socialized medicine would suffer drastic reductions in the quantity, scope and quality of care. Hit hardest would be the elderly. Big Brother would make the decision as to scope and even quality of care. Chilling evidence for this is already in the draft bills and in Obama's unwitting admissions to that effect.

It is true that our health care costs are very high and rising at alarming rates, but not for the reasons Obama wants you to believe. Rather, it's because we Americans demand greater quality care and medications (and we get them), which are expensive, and because of already excessive government interference with free market forces.

It's no wonder costs are skyrocketing when government-mandated coverage requirements choke competition and prevent more affordable plans and when 60 percent of Americans have employer-provided health insurance and don't directly pay for their care, which necessarily increases demand (and prices).

The solution lies in unleashing market forces (more on this later), not the tyrannical hand of government.

So when you really figure out that it's not about healthcare, access, or insurance for the majority of Americans, you have to ask yourself what the underlying motive truly is.

The answer is power and control that the radical left wing wants to obtain.

NHS is a Worse Value

Here is an article in the BBC reaffirming the claim that the American Healthcare system is better and more efficient than their own NHS (National Health Service)

BBC News HEALTH NHS 'worse value than US provider'

This begs the question as to why the liberal democrats really want to model a better system after one that itself claims to be inferior.

The answer is quite simple. It’s not about healthcare as much as it is about government control.

This should once again bring up the question as to what is the role of government.

2009-2010 Flu Shots

The FDA approved influenza vaccine for the 2009-2010 season is widely available and recommended, but it is important to note that the vaccine will not protect against the H1N1 flu virus.

The H1N1 vaccine is now available and will be administered at most of the local schools starting this week.

The public needs to understand that the vaccine is not 100 percent effective but most studies support the fact that vaccination is the best protection against the flu and that high-risk Americans should be vaccinated.

High risk individuals for the seasonal flu are young children, elderly people, and those with chronic medical conditions including heart disease, lung disease and diabetes. The H1 N1 seems to be targeting more pregnant women and young children and sparing the elderly.

As for the seasonal flu vaccine; what to include in it is always somewhat of a guessing game and some years provide better protection than others. But the H1N1 vaccine was designed and targeted directly at the H1 N1 virus and will be much more effective.

So quit procrastinating and get your Flu shots

Newest Pertussis Study

In a recent study in Pediatrics, children who do not receive the regular schedule of vaccines due to parent choice are more likely to get whooping cough than their fully immunized peers. Certainly this shouldn’t come as any surprise.

The study showed that 11% of cases of pertussis (whooping cough) in a Kaiser Permanente pediatric sampling in Colorado were linked to declined vaccines on the part of parents, and the number of parents refusing immunizations for their children is growing.

These results dispel one of the commonly held beliefs among vaccine-refusing parents, that children are not at risk for vaccine-preventable diseases.

The number of whooping cough cases has grown since the 1980s and there are still deaths every year from the disease.

The study reviewed medical records of children age 2 months to 18 years old in the Kaiser Permanente Colorado health plan from 1996 to 2007. During the study, there were 156 confirmed cases of whooping cough. Children in these cases were compared to 595 control children who didn't get whooping cough.

Results of the government-funded study indicated that those children where parents declined vaccines were 23 times more likely than vaccinated children to get the infection.

It is studies like these that lend support to getting the recommended vaccines including the H1N1 vaccine that many parents are electing to forego because of irrational fears.

Historical Revisionism with Different Morals

Here are Two Different Versions and Two Different Morals!

OLD VERSION:

The ant works hard in the withering heat all summer long, building his house and laying up supplies for the winter.

The grasshopper thinks the ant is a fool and laughs and dances and plays the summer away.

Come winter, the ant is warm and well fed.

The grasshopper has no food or shelter, so he dies out in the cold.

MORAL OF THE STORY: Be responsible for yourself!

MODERN VERSION:

The ant works hard in the withering heat al l summer long, building his house and laying up supplies for the winter.

The grasshopper thinks the ant is a fool and laughs and dances and plays the summer away.

Come winter, the shivering grasshopper calls a press conference and demands to know why the an t should be allowed to be warm and well fed while others are cold and starving.

CBS, NBC , PBS, CNN, and ABC show up to provide pictures of the shivering grasshopper next to a video of the ant in his comfortable home with a table filled with food. America is stunned by the sharp contrast.

How can this be, that in a country of such wealth, this poor grasshopper is allowed to suffer so?

Kermit the Frog appears on Oprah with the grasshopper, and everybody cries when they sing, 'It's Not Easy Being Green.'

Jesse Jackson stages a demonstration in front of the ant's house where the news stations film the group singing, 'We shall overcome.' Jesse then has the group kneel down to pray to God for the grasshopper's sake..

Nancy Pelosi & John Kerry exclaim in an interview with Larry King that the ant has gotten rich off the back of the grasshopper, and both call for an immediate tax hike on the ant to make him pay his fa ir share.

Finally, the EEOC drafts the Economic Equity & Anti-Grasshopper Act retroactive to the beginning of the summer.

The ant is fined for failing to hire a proportionate number of green bugs and, having nothing left to pay his retroactive taxes, his home is confiscated by the government.

The story ends as we see the grasshopper finishing up the last bits of the ant's food while the government house he is in, which just happens to be the ant's old house, crumbles around him because he doesn't maintain it.

The ant has disappeared in the snow.

The grasshopper is found dead in a drug related incident and the house, now abandoned, is taken over by a gang of spiders who terrorize the once peaceful neighborhood.


MORAL OF THE STORY: Be careful how you vote in 2010.

Judicail Activism

A couple of months ago, we saw that Judicial activism is still alive and well in the 9th Circuit Court. This time, the most overturned appellate court had issued another ruling that is sure to proceed to the Supreme Court and will likely be overturned. We heard very little about this in the liberal media.

The 9th Circuit overturned an injunction in a district court case, allowing the state of Washington to force a pharmacy to stock and dispense morning-after pills.

Religious reasons are the rationale behind their decision, but the ruling goes even further by impinging on private businesses what they can and cannot stock.

Business owners make decisions all the time about their inventory and what they do and do not stock. Even apart from religious grounds, which are protected by the Constitution, business owners that don’t want to sell Tylenol, or widgets, or chlorine for swimming pools, should be able to decide that on their own. If customers object to their policies, they will find other businesses to patronize. The government has a public interest in telling retailers what they cannot sell for safety reasons (like dynamite, as an example), but should not force business owners to sell something they personally object to.

This is an intrusion on businesses and Judicial Activism by the radical 9th Circuit.

AMA sends letter Over new ARRA rule

It has been several months since the AMA sent this letter http://www.ama-assn.org/ama1/pub/upload/mm/399/letter-hhs-guidance-securing-phi.pdf to the Dept. of Health and Human Services related to the new mandates on healthcare providers implemented in the American Recovery and Reinvestment Act of 2009.

As typical of Washington, they implement new burdensome rules but never actually define or give specifics on how to follow or be compliant.

This letter was trying to get some answers on the question of how to make protected health information (PHI) unusable, unreadable, or indecipherable to unauthorized individuals and prevent triggering the breach notification requirement in this new legislation.

As of this date, there are still little specifics on how we can comply with the new regulations.

IU study on overuse of specialty care

In a recently-released report by the Indiana University Center for Health Policy it was suggested that Hoosiers use specialists too often and it increases medical costs. The report also supported the medical home concept as a means to contain health care spending.

The health care home model is virtually the same as the primary care physician but it emphasized more control of the PCP. The PCP would coordinate and oversee all aspects of that patient’s care as well as coordinate visits with specialists. This is the way it should work anyway but there is not enough time or reimbursement to primary care doctors to make this feasable.

The study showed that in Indiana, patients tend to see a specialist without first consulting a primary care physician. The study noted that the state has more specialists than the national norm, and a shortage of family doctors and pediatricians which leads to the increased utilization of specialists.

It also showed that medical students in Indiana are increasingly choosing to specialize rather than enter primary care further impacting Indiana’s shortage of primary care physicians. The report showed that increasing reimbursement for primary care physicians and other primary care providers would help attract additional students to enter primary care.

But when you see Indiana legislators failing to address the problem, there is little hope of much change. The Medicaid rates in Indiana have not increased for more than 15 years even though every other aspect and cost of medicine has dramatically increased.

The problem is well-known, but the actions from legislators has been dismal. If insurance were used as it was intended and not for every aspect of care, things would change. When patients have more financial liability in the process, they make better value decisions.

New EMR surveys

In two recent surveys (the Deloitte study here and the Kaiser study here) more and more patients would like physicians to offer more online access.

The Deloitte survey showed that 60 percent of respondents wanted online access to their doctors, medical records, test results and same-day appointments and one in four said they would pay physicians more for the online convenience.

The Kaiser Family Foundation study found that 72 percent of patients believed quality and coordination of medical care would improve if physicians used electronic health records (EHR), but it was also noted that EHRs would not necessarily result in cost savings.

During a recent medical informatics summit in Indianapolis it was also noted that patients want online services, and liability carriers are offering discounts for doctors who offer secure online health records.

At the end of last year about 13 percent of physicians were prescribing electronically, but with the incentives available through Medicare’s e-prescribing incentive program, it will likely increase to some degree. But it is very unlikely that the majority will use EHR’s until the cost benefit ratio improves dramatically and certainly won't change much until we see how bad Obama is going to effect us with his radical agenda.

The Riches of Aging

I have silver in my hair

Gold in my teeth

Stones in the kidneys

Sugar in the blood

Lead in the feet

and an inhaustible supply of natural gas

I never thought I'd accumulate such wealth!

H1N1 Information

Many people are asking about the H1N1 vaccine and if they should get it for themselves or their kids.

We are recommending the vaccine and trying to follow the CDC recommendations and the summary is as follows. The biggest issue is that everyone is wanting Tamiflu and it really is not recommended for everyone because the majority of people have mild self-limiting disease. But it takes more time talking patients out of getting the prescription because for the majority of them, thier insurance pays for it. For patients who have to pay the $60 or more for the prescription, they usually choose to ride out the symptoms.

This is another perfect example of how when patients have more of the burden of the cost, they choose more wisely and are more cost-conscious

Recommended Use of Influenza A (H1N1) 2009 Monovalent Vaccine

ACIP recommends that vaccination efforts should focus initially on persons in five target groups (Box) whose members are at higher risk for influenza or influenza-related complications, are likely to come in contact with influenza viruses as part of their occupation and could transmit influenza viruses to others in medical care settings, or are close contacts of infants aged <6 href="http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0821a1.htm#box#box">Box).
Initial Target Groups

When vaccine is first available, ACIP recommends that programs and providers administer vaccine to persons in the following five target groups (order of target groups does not indicate priority):

1. pregnant women,
2. persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
3. health-care and emergency medical services personnel,§
4. persons aged 6 months--24 years, and
5. persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.¶

These five target groups comprise an estimated 159 million persons in the United States. This estimate does not accurately account for persons who might be included in more than one category (e.g., a health-care worker with a high-risk condition). Vaccination programs and providers should begin vaccination of persons in all these groups as soon as vaccine is available.

Subset of Target Groups During Limited Vaccine Availability

Current projections of initial vaccine supply indicate that establishment of a subset of the five initial target groups will not be necessary in most areas. However, demand for vaccination and initial supply might vary considerably across geographic areas. If the supply of the vaccine initially available is not adequate to meet demand for vaccination among the five target groups listed above, ACIP recommends that the following subset of the initial target groups receive priority for vaccination until vaccine availability increases (order of target groups does not indicate priority):

1. pregnant women,
2. persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
3. health-care and emergency medical services personnel who have direct contact with patients or infectious material,
4. children aged 6 months--4 years, and
5. children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications.

This subset of the five target groups comprises approximately 42 million persons in the United States. Vaccination programs and providers should give priority to this subset of the five target groups only if vaccine availability is too limited to initiate vaccination for all persons in the five initial target groups.

Antiviral Chemoprophylaxis

The infectious period for persons infected with the 2009 H1N1 virus appears to be similar to that observed in studies of seasonal influenza. Infected persons may shed influenza virus, and potentially be infectious to others, beginning one day before they develop symptoms to up to 7 days after they become ill. Children, especially younger children, and persons who are immune compromised can shed influenza virus for longer periods. However, the amount of virus shed generally correlates with magnitude of fever and for these recommendations, the infectious period for influenza is defined as one day before until 24 hours after fever ends.

Post exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

**Persons who are at higher risk for complications of influenza and are a close contact of a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period.

**Health care personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period. Information on appropriate personal protective equipment is available at: Infection Control for Patients in a Healthcare Setting and might be updated frequently as additional information on transmission becomes available.

· Antiviral agents should not be used for post exposure chemoprophylaxis in healthy children or adults based on potential exposures in the community, school, camp or other settings.
· Chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the last contact with an infectious person.
· Chemoprophylaxis is not indicated when contact occurred before or after, but not during, the ill person’s infectious period as defined above.

Patients given post-exposure chemoprophylaxis should be informed that the chemoprophylaxis lowers but does not eliminate the risk of influenza and that protection stops when the medication course is stopped. Patients receiving chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.

For antiviral chemoprophylaxis of 2009 H1N1 influenza virus infection, either oseltamivir or zanamivir is recommended (Table 1). Duration of post-exposure chemoprophylaxis is 10 days after the last known exposure to 2009 H1N1 influenza.

Oseltamivir was authorized for use for chemoprophylaxis under the EUA for children younger than 1 year of age, subject to the terms and conditions of the EUA. (See Treatment and Chemoprophylaxis for Children Younger than 1 Year of Age, below.) Age-based dosing recommendations are provided in the fact sheetsincluded with the EUA letter of authorization, however weight-based dosing is an alternative preferred by some experts who are currently conducting studies of oseltamivir use in this age group.

An emphasis on early treatment is an alternative to chemoprophylaxis after a suspected exposure. Persons with risk factors for influenza complications who are household or close contacts of confirmed or suspected cases, and health care personnel who have occupational exposures, can be counseled about the early signs and symptoms of influenza, and advised to immediately contact their health care provider for evaluation and possible early treatment if clinical signs or symptoms develop. Health care providers should use clinical judgment regarding situations where early recognition of illness and treatment might be an appropriate alternative to chemoprophylaxis.

Persons at ongoing occupational risk for exposure (e.g., health care personnel, public health workers, or first responders who are working in communities with influenza outbreaks) should carefully follow guidelines for appropriate personal protective equipment. Efforts to reduce the risk of exposure or infection for healthcare personnel should include appropriate administrative controls (e.g. having health care personnel stay home from work when ill, and triaging for identification of potentially infectious patients), cough and hand hygiene, personal protective equipment, and vaccination when available.

**information taken from CDC website

Potential New Development for Memory Diseases

Although years away from clinical use, in the May 7 issue of Nature, they report on a new gene that when activated functions as a negative regulator of learning and memory. By using other genes and/or drugs, this can be targeted and repressed leading to enhanced learning and memory.

With the population aging and more and more dementia (Alzheimer’s) being seen, hopefully, this research will allow us to someday develop and test one of these HDAC2-selective inhibitors for human diseases associated with memory impairment.

That is unless the Obamacare plan passes and then research and development on issues like this will likely be minimized. After all, the Obama supporters have little use for older folks with dementia.

Trampoline injuries

As we leave the summer behind, we will see less of certain types of injuries. One of these will be with trampolines. During the increased use in summer came an increase in the number of associated injuries. A recent study analyzed 50 cases presenting to the accident and emergency department at a hospital over six weeks and compared the injuries with the safety guidelines provided by the Royal Society for the Prevention of Accidents

The most important factor associated with trampoline injury is having too many users on a trampoline at one time. The results showed that the lightest person is five times more likely to be injured and the severity of the injury also increases with the mismatch between child and adult weights. 80% of user suffered injury and 74% were when multiple users were on the trampoline. 64% occurred on trampolines without a safety net. The most common injuries were 54% legs, 32% arms, and 14% head, neck, face and chest.

A child of around 45 lbs can experience a force equivalent to a 10 feet fall when bouncing with an adult of 170 lb individual.

It was found that adult supervision is crucial in preventing trampoline injuries and the most influential role of a supervising adult is to ensure safety guidelines are followed, exuberance is controlled, and help is provided with setting up and dismounting from the trampoline.

As a side note, it was also found that children have been hurt while being supervised or bouncing with adults who have been drinking and therefore alcohol and trampolines are a poor combination

Socialism we should demand

From our friends at Hot Air » Blog Archive » A Modest Proposal, 2009 Edition, we should definitely consider this proposal as we move closer towards Socialism. I am sure none of my legal friends would have any problem with this.

Ladies and gentlemen of the Hot Air community, I have discovered an unfair disparity in access to a vital resource based on the economic condition of the consumer. This disparity is not just egregious, but it threatens the very core of our American way of life. People routinely get denied adequate and competent service on the basis of their ability to pay, even though they have a right to it, while the rich eat up all the resources with their ability to access the best and brightest in the field. And in the instance of fairness, the federal government needs to find a solution and impose it on the industry as a whole.



I refer, of course, to legal representation.



Oh, sure, in an emergency, the government will foot the bill for a public defender to represent the poor and indigent, but that’s hardly a comfort to those who needed a lawyer before getting into the emergency condition in the first place. Besides, while we have many dedicated public defenders, it’s hardly a news flash that the wealthy can afford much better representation and have a much better chance of prevailing in court in criminal cases. When the poor, working class, and middle class end up in that emergency situation, they can lose their homes and property to pay for decent legal care — and that shouldn’t happen in America, should it?



After all, unlike health care, Americans actually do have a Constitutional right to legal representation in court. Some will scoff and say the lack of a lawyer, or a bad lawyer, can’t cause your death. Those critics may want to talk with the inmates who got freed from Death Row and lifetime prison sentences after having mediocre attorneys lose cases when the defendant was really innocent. Bad or nonexistent legal representation can take years off of your life, and can definitely get you killed.



Even beyond that, though, the wealthy and connected have access to a much wider range of legal services than even the middle class can afford. Estate planning, trust funds, tax shelters — all of these can be expertly provided to those with the resources to afford them, while other Americans get second-class status in our legal system. For those who aspire to egalitarianism of result, this arrangement should be such an affront that it demands real action — now.



I propose that the government impose a single-payer system on the legal profession. Instead of charging private fees, all attorneys would have to send their bills to LegalCare, a new agency in the federal government. Because the government can bargain collectively, they can impose rational fees for legal services instead of the exorbitant billing fees attorneys now charge. Three hundred dollars an hour? Thing of the past. Everyone knows that the government can control costs through price-setting; now we can see this process applied to the legal system, where the government has a large interest in seeing cost savings.



How will we pay for LegalCare? I take a page from the House surtax method here, which will disproportionately hit doctors in a wide variety of disciplines. In this case, I propose a 5.4% surtax on lawyers, judges, lobbyists, and political officeholders at the state and federal level. They’re the ones who have enriched themselves through this inequity in the legal system. After all, why should we all have to pay for the single-payer legal system when we can penalize lawyers instead?



Now, this will have some impact on the legal-services market. On the downside, we’ll have fewer attorneys. Law schools will get a lot less competitive as students avoid the law and the limited amount of money available through LegalCare, and existing attorneys may leave the profession as well as they fail to make enough money from the price-controlled compensation they get from the government. All this will mean longer wait times and rationing of services as people flood attorneys’ offices to demand services disconnected from the actual cost to provide them. It may take a couple of years to get a will done, so start when you’re young.



On the plus side … we’ll have fewer attorneys. And politicians! Best of all, everyone will get the same level of legal care regardless of their ability to pay, thanks to LegalCare and the government-imposed rationing of a resource to which we have a right to access at any time we want, for any reason we want.



Addendum: In case anyone misses the point, this is a satire. However, I wouldn’t put it past certain statists to consider this a pretty good idea…

Those Frustrating Days

Did you ever have one of those days when you just want to say "Aw Crap"

The following photos are impressive for the magnitude of the destruction both in cost, effort to fix and ego.

But none even come close to the last picture that will cost us more than we can imagine and certainly brings more choice words than "Aw Crap"

The Modest Healthcare Proposal

Philadelphia’s “The Bulletin” recently had an interesting article published on the Healthcare dilemma. The link is here: A Modest Health-Care Proposal - The Philadelphia Bulletin Archives

Sure, the viewpoint is radical, but isn’t this really what some of the fanatical left really want?

A Modest Health-Care Proposal
By Sheldon Richman, For The Bulletin
Sunday, September 20, 2009

Enough dithering! President Barack Obama says it’s time to act on health care. I agree.

But act how? Are we really going to be happy with the pussy-footing proposals floating around Congress? All the so-called reformers want to do is tinker with insurance regulations. But how effective would that be, considering that the insurance companies themselves support the changes?

We have taken our eyes off the ball, people. Let’s get back to first principles. Mr. Obama’s premise is that we have a right to health care. A right.

America was founded on the idea of rights — inalienable rights. No one can take them away. I assume that when people say that health care is a right, they mean that health care is an inalienable right. Mr. Obama apparently agrees. In his speech before Congress he called for free services, such as physical exams, colonoscopies, and mammograms. Free! You have a right to those things.

Well, OK. But why stop at free preventive services? Why not free treatments, free surgery, free drugs, and so on? We need those things as much as a physical exam. If we have a right to health care and if we are unable to obtain those services, our rights have been denied or violated. That is something the advocates of health-care “reform” say we must not tolerate.

Okay, let’s not tolerate it. Let’s make sure no one’s right to health care is violated. Let’s get serious for a change.

But how? I can think of only one efficient way to accomplish this. Let’s enslave the providers of medical services — doctors, nurses, paramedics, dentists, chiropractors, acupuncturists, psychiatrists, and the rest. My proposal may shock people, but I am confident that this feeling will wear off as we think about how logically it flows from the principle that we have a right to health care.

First, let me point out that there is no other good alternative. Any other system designed to deliver health care as a matter of right will have gaps through which the least fortunate inevitably will slip. Isn’t that the problem we’re trying to fix? Obama’s approach isn’t much better. He wants to force the insurance companies, with taxpayer subsidies if necessary, to insure everyone — healthy or sick, young or old — at the same price. He might even like a government insurance option, though he can’t make up his mind whether or not that is an essential feature of his plan.

Regardless, it’s a bad plan. Requiring insurance companies to pay for our medical care misses the point. Where do you think insurance companies get their money? From us! What kind of right to health care is it if we end up paying for it anyway? Obama means well, but his plan is a shell game.

On the other hand, enslaving the doctors and other providers would have none of the defects of the current system or the leading reform plans. It goes right to the source. We have a right to health care? Fine. Force the doctors to provide it.

Of course, this wouldn’t be free. I’m no pie-in-the-sky utopian. The doctors and the others would have to be fed, clothed, and housed. They’d need certain comforts. That’s understood. But it would be far easier to keep a lid on costs by enslaving the providers than by the patchwork system we have now, or would have under Mr. Obama’s plan.

The biggest problem I can see is that if doctors are going to be our slaves, no one will want to be a doctor. Most people don’t relish the idea of being slaves even in the national interest. They’re selfish that way.

We certainly can’t be a world-class country without doctors and nurses, so I have a solution to this problem: conscription. President Obama should direct the nation’s schools to look out for students with an aptitude for biology and direct them into medical studies. Then, at the appropriate time, the government should draft those young people into the newly created U.S. Medical Service Corps.

I know what you’re thinking: As word of this got around, the best students will play dumb. If that happens, we’ll have no other choice than to pick our doctors by lottery.