Here are comments from a doctor who has read the bill:

Discussions for Patients, Family, and Friends HD For Patients
1

THE ONE WORD TO DESCRIBE OBAMACARE

Written by Dr. Dave Janda

Thursday, 23 July 2009

As a physician who has authored books on preventative health care, I was given the opportunity to be the keynote speaker at a Congressional Dinner at The Capitol Building in Washington last Friday (7/17).

The presentation was entitled Health Care Reform, The Power & Profit of Prevention, and I was gratified that it was well received.

In preparation for the presentation, I read the latest version of “reform” as authored by The Obama Administration and supported by Speaker Pelosi and Senator Reid. Here is the link to the 1,018 page document:
http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

Let me summarize just a few salient points of the above plan. First, however, it should be clear that the same warning notice must be placed on The ObamaCare Plan as on a pack of cigarettes: Consuming this product will be hazardous to your health.

The underlying method of cutting costs throughout the plan is based on rationing and denying care. There is no focus on preventing health care need whatever. The plan’s method is the most inhumane and unethical approach to cutting costs I can imagine as a physician.

The rationing of care is implemented through The National Health Care Board, according to the plan. This illustrious Board “will approve or reject treatment for patients based on the cost per treatment divided by the number of years the patient will benefit from the treatment.”

Translation…if you are over 65 or have been recently diagnosed as having an advanced form of cardiac disease or aggressive cancer…dream on if you think you will get treated…pick out your coffin.

Oh, you say this could never happen? Sorry… this is the same model they use in Britain .

The plan mandates that there will be little or no advanced treatments to be available in the future. It creates The Federal Coordinating Council For Comparative Effectiveness Research, the purpose of which is “to slow the development of new medications and technologies in order to reduce costs.” Yes, this is to be the law.

The plan also outlines that doctors and hospitals will be overseen and reviewed by The National Coordinator For Health Information and Technology.

This " coordinator" will “monitor treatments being delivered to make sure doctors and hospitals are strictly following government guidelines that are deemed appropriate.” It goes on to say…“Doctors and hospitals not adhering to guidelines will face penalties.”

According to those in Congress, penalties could include large six figure financial fines and possible imprisonment.

So according to The ObamaCare Plan…if your doctor saves your life you might have to go to the prison to see your doctor for follow -up appointments. I believe this is the same model Stalin used in the former Soviet Union .

Section 102 has the Orwellian title, “Protecting the Choice to Keep Current Coverage.” What this section really mandates is that it is illegal to keep your private insurance if your status changes - e.g., if you lose or change your job, retire from your job and become a senior, graduate from college and get your first job. Yes, illegal.

When Mr. Obama hosted a conference call with bloggers urging them to pressure Congress to pass his health plan as soon as possible, a blogger from Maine referenced an Investors Business Daily article that claimed Section 102 of the House health legislation would outlaw private insurance.

He asked: “Is this true? Will people be able to keep their insurance and will insurers be able to write new policies even though H.R. 3200 is passed?” Mr. Obama replied: “You know, I have to say that I am not familiar with the provision you are talking about.”

Then there is Section 1233 of The ObamaCare Plan, devoted to “Advanced Care Planning.” After each American turns 65 years of age they have to go to a mandated counseling program that is designed to end life sooner.

This session is to occur every 5 years unless the person has developed a chronic illness then it must be done every year. The topics in this session will include, “how to decline hydration, nutrition and how to initiate hospice care.” It is no wonder The Obama Administration does not like my emphasis on Prevention. For Mr. Obama, prevention is the “enemy” as people would live longer.

I rest my case. The ObamaCare Plan is hazardous to the health of every American.

After I finished my Capitol Hill presentation, I was asked by a Congressman in the question-answer session: “I’ll be doing a number of network interviews on the Obama Health Care Plan. If I am asked what is the one word to describe the plan what should I answer.”

The answer is simple, honest, direct, analytical, sad but truthful. I told him that one word is FASCIST.

Then I added, “I hope you’ll have the courage to use that word, Congressman. No other word is more appropriate.”

Dr. Dave Janda, MD, is an orthopedic surgeon, and a world-recognized expert on the prevention of sports injuries, particularly in children.

2

My enthusiasm for the bill has waned since last I heard the public option was being de-fanged. I was very much in favor of a strong public option.

I did hear the other day some reps are considering non-profit co-ops, guess I’m neutral on the idea until somebody like the Congressional Budget Office studies it.

However what has the Congressional Budget Office liked since 1991?
http://www.pnhp.org/facts/single_payer_system_cost.php?page=1

Physicians for a National Health Program, excellent articles and FAQs
http://www.pnhp.org/

3

Apparently there are multiple versions of Dr. Janda’s article floating around so you might want to check Snopes.com and search for Dr. Janda’s name to find the actual text of what he wrote. Dr. Janda deserves to have his opinion. However, even doctors have been known to believe things that have been written that aren’t backed up by facts. I’d suggest looking at the nonpartisan website to read the facts about health reform before you believe all you read and hear – no matter who is saying it.
www.factcheck.org

If health reform dies this year, I hope that people realize that many of the things they’re fighting against in health reform will happen if the insurance industry stays in charge. People say that with health reform you’ll be forced to change plans and doctors. Pardon me…but do people really believe that you are guaranteed 100% by anyone to keep exactly the same health insurance coverage you have this minute and to see the exact same doctors you have now in a private marketplace? With Original Medicare, people can go to any doctor who accepts Medicare without having to jump through referral hoops. And Medicare has offered better coverage over the years and has started adding more preventive benefits to its health insurance plan. In the private marketplace employers change plans as often as annually and when those plans change, to save money in company paid premiums, benefits may change and there may be a whole new network of doctors and your doctor may not be in that network. I’ve known dialysis patients whose plans changed and they had to change dialysis clinics and home dialysis equipment or they may not have been able to keep doing home dialysis because the clinic they had to go to didn’t offer it. The only other option for them was to wait until the next year and choose a different plan (if available) or pay higher out of network costs.

Like Plugger, I’m in favor of offering Americans a public option, especially those that the health insurance industry do not want. And I’d ensure that companies over a certain size that offer health insurance now cannot dump their employees and push them into the public option to save money.

If insurance companies are so great, I don’t know why they’re scrambling so hard to keep from having to compete with a public option. They should be able to compete quite well with the public option…they will just have to return some of the profits they have been making into providing better benefits than the public option at a competitive price.

4

[QUOTE=Beth Witten MSW ACSW;18342]Apparently there are multiple versions of Dr. Janda’s article floating around so you might want to check Snopes.com and search for Dr. Janda’s name to find the actual text of what he wrote. Dr. Janda deserves to have his opinion. However, even doctors have been known to believe things that have been written that aren’t backed up by facts. I’d suggest looking at the nonpartisan website to read the facts about health reform before you believe all you read and hear – no matter who is saying it.
www.factcheck.org

If health reform dies this year, I hope that people realize that many of the things they’re fighting against in health reform will happen if the insurance industry stays in charge. People say that with health reform you’ll be forced to change plans and doctors. Pardon me…but do people really believe that you are guaranteed 100% by anyone to keep exactly the same health insurance coverage you have this minute and to see the exact same doctors you have now in a private marketplace? With Original Medicare, people can go to any doctor who accepts Medicare without having to jump through referral hoops. And Medicare has offered better coverage over the years and has started adding more preventive benefits to its health insurance plan. In the private marketplace employers change plans as often as annually and when those plans change, to save money in company paid premiums, benefits may change and there may be a whole new network of doctors and your doctor may not be in that network. I’ve known dialysis patients whose plans changed and they had to change dialysis clinics and home dialysis equipment or they may not have been able to keep doing home dialysis because the clinic they had to go to didn’t offer it. The only other option for them was to wait until the next year and choose a different plan (if available) or pay higher out of network costs.

Like Plugger, I’m in favor of offering Americans a public option, especially those that the health insurance industry do not want. And I’d ensure that companies over a certain size that offer health insurance now cannot dump their employees and push them into the public option to save money.

If insurance companies are so great, I don’t know why they’re scrambling so hard to keep from having to compete with a public option. They should be able to compete quite well with the public option…they will just have to return some of the profits they have been making into providing better benefits than the public option at a competitive price.[/QUOTE]

I guess it is very difficult for me to see how we would avoid rationing by increasing patients by the millions and not increasing the supply of physicians. Again, the reason for excessive health insurance costs is government mandates and regulations. If we would eliminate these burdens, dialysis patients would not have to be concerned with an employer changing health plans, each and every year. This is because costs would become affordable. If Obamacare is so urgent and necessary, why does the plan not take effect until 2013? Insurance companies are scrambling from having to compete with the public option, because you cannot compete with massive entity that does not have to show a profit at the end of the fiscal year. As stated by President Obama, “UPS and Fed Ex are doing quite well in competition with the Post Office, it is the Post Office that is having all of the problems.” Now, what does that tell you? By the way, Fed Ex is contracted by the Post Office to perform their overnight deliveries. Do you want people to be insured by UPS, Fed Ex, or the Post Office?

5

[QUOTE=plugger_;18341]My enthusiasm for the bill has waned since last I heard the public option was being de-fanged. I was very much in favor of a strong public option.

I did hear the other day some reps are considering non-profit co-ops, guess I’m neutral on the idea until somebody like the Congressional Budget Office studies it.

However what has the Congressional Budget Office liked since 1991?
http://www.pnhp.org/facts/single_payer_system_cost.php?page=1

Physicians for a National Health Program, excellent articles and FAQs
http://www.pnhp.org/[/QUOTE]

If the co-ops are funded by the government, it is just national health care in a different name.

6

[QUOTE=plugger_;18341]My enthusiasm for the bill has waned since last I heard the public option was being de-fanged. I was very much in favor of a strong public option.

I did hear the other day some reps are considering non-profit co-ops, guess I’m neutral on the idea until somebody like the Congressional Budget Office studies it.

However what has the Congressional Budget Office liked since 1991?
http://www.pnhp.org/facts/single_payer_system_cost.php?page=1

Physicians for a National Health Program, excellent articles and FAQs
http://www.pnhp.org/[/QUOTE]

I find the 45.7 million figure hard to believe. This is because I have read many misrepresentated figures over the years from these groups of people. For example, the overbearing complaining about the homeless in the 1980’s, which the numbers were blown way, way out of reality. The same people that complained about the homeless, were the same people that caused the issue of the homeless. This is because of the deinstitutionalization policies of the 1960’s. My mom was a Psych RN and one night we were watching a movie about a mental healh institution in the early 1900’s. The movie protrayed the residents of this institution running around and displaying extremely abnormal behavior. Yet, my mom said in the modern facilities, the residents are so drugged, they lay or sleep on the bed, all day long. Yes, my mom said for years and years, the vast majority of these institutions were snake pits because society did not know what else to do with them. When my mom started as a Psych RN, she worked at Our Lady of Peace in Louisville in the early 60’s. Our Lady of Peace was a swanky mental hospital, where the families of the residents had big bucks. My mom worked with a guy who thought he was Jesus Christ.

When I was working as a police officer, the vast majority, around 75 percent, on the streets were mentally ill. I was more than happy to buy a meal for them, however, was not going to give them money for booze and drugs, which is what the vast majority wanted to do with the money. Yes, there are people on the street that are truly hungry. Yet, trying to protray the United States as some vast soup kitchen is devoid of any reality. We should do our best to help our fellow man and woman with caring hearts. However, as we are helping them, we also need to use our common sense.

7

It would be nice if you backed up this statement. I’ll make a statement and back it up: it is these corporate bureaucrats running private insurance helping to cause a big increase in our health care costs, the government actually runs health care more efficiently.

“After analyzing the costs of insurers, employers, doctors, hospitals, nursing homes and home-care agencies in both the U.S. and Canada, they found that administration consumes 31.0 percent of U.S. health spending, double the proportion of Canada (16.7 percent). Average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare. Streamlined to Canadian levels, enough administrative waste could be saved to provide compressive health insurance to all Americans.”

BEST MEDICAL CARE IN THE US
“And for the past six years the VA has outranked private-sector hospitals on patient satisfaction in an annual consumer survey conducted by the National Quality Research Center at the University of Michigan. This keeps happening despite the fact that the VA spends an average of $5,000 per patient, vs. the national average of $6,300.”

8

The Government has been shifting the cost of health care on the private sector for years. In fact, Medicare pays somewhere in the neighborhood of $.80 cents on the dollar of a average hospital stay. The hospital has to make up the lost revenue, somewhere, and they do it with the private insurance patient, who pays $1.32 for the average hospital bill on the dollar. Believe it or not, Medicaid pays even less than Medicare, I know this having worked in the public assistance building. Having worked for the government, when I hear someone express that the government is cheaper than private insurance, I know this is because of massive government cost shifting.

If Obama wants to address the cost of medical care, he needs to make a serious plan for tort reform. He decries the income of physicians, but, does not single out the income of trial lawyers, taking money out of the medical system, think of John Edwards. In more than a few cases, I have been told by hard science individuals, Ph.D’s, that the breast implant case was a fraud with faulty scientific evidence. These actions deprive individuals of money that can be used by the hospital to care for indigent patients. You will never guess who donated the most to the campaign of Obama, Trial Lawyers. In addition, who received the most money from Wall Street, Barack Obama, not John McCain, not by a long shot. http://www.opensecrets.org/pres08/contrib.php?cycle=2008&cid=N00009638

Physicians are paying hundreds of thousands per year in malpractice premiums, guess who pays the bill for that tab, patients. Do you want to pay to enrich lawyers? Not me. Have never met a bureaucrat that I liked corporate or government, self-serving crooks. What about the Union bosses that are living like corporate fat cats, while the Union members struggle to make ends meet? I am with the man or woman that carries his or her lunch pail to the job,

I want a system that is going to work for the average Joe or Jane. We have have ever increasing regulation of our health care system and costs that continue to go thru the roof. Guess what, Joe and and Jane know how to spend their own money, not a bunch of worthless bureaucrats. I would cut income taxes to a one percent flat tax rate and eliminate excessive government mandates and regulations. Premiums would be affordable for the individual and the family.

I did not support any Government bailout of the corporations, would not have given any of them a dime, why should we pay for their screwups? Highway robbery of the taxpayer.

9

Christopher J. Conover is an assistant research professor with the Center for Health Policy, Law and Management in the Terry Sanford Institute of Public Policy at Duke University.

Students of regulation have known for decades that the burden of regulation on the U.S. economy is sizable, with the latest figures suggesting this cost may approach $1 trillion in 2004. Surprisingly, given that the health industry is often viewed as among the most heavily regulated sectors of the U.S. economy, previous estimates generally have ignored the cost of regulating health care services.

Using a “top-down” approach, one can arrive at a “back-of-the-envelope” estimate that health services regulation imposes an annual cost of $256 billion per year (with a range of $28 billion to $657 billion), suggesting that health services regulations could increase estimates of overall regulatory costs by more than 25 percent.

A far more accurate “bottom-up” approach suggests that the total cost of health services regulation exceeds $339.2 billion. This figure takes into account regulation of health facilities, health professionals, health insurance, drugs and medical devices, and the medical tort system, including the costs of defensive medicine. Moreover, this approach allows for a calculation of some important tangible benefits of regulation. Yet even after subtracting $170.1 billion in benefits, the net burden of health services regulation is considerable, amounting to $169.1 billion annually. In other words, the costs of health services regulation outweigh benefits by two-to-one and cost the average household over $1,500 per year.

The high cost of health services regulation is responsible for more than seven million Americans lacking health insurance, or one in six of the average daily uninsured. Moreover, 4,000 more Americans die every year from costs associated with health services regulation (22,000) than from lack of health insurance (18,000). The annual net cost of health services regulation dwarfs other costs imposed by government intervention in the health care sector. This cost exceeds annual consumer expenditures on gasoline and oil in the United States and is twice the size of the annual output of the motion picture and sound recording industries.

Finding ways to reduce or eliminate this excess cost should be an urgent priority for policymakers. It would appear from this preliminary assessment that medical tort reform offers the most promising target for regulatory cost savings, followed by FDA reform, selected access-oriented health insurance regulations (e.g., mandated health benefits), and quality-oriented health facilities regulations (e.g., accreditation and licensure).

Full PDF:

“The high cost of health services regulation is
responsible for more than seven million
Americans lacking health insurance, or one in six
of the average daily uninsured. Moreover, 4,000
more Americans die every year from costs associated
with health services regulation (22,000) than
from lack of health insurance (18,000). The annual
net cost of health services regulation dwarfs
other costs imposed by government intervention
in the health care sector. This cost exceeds annual
consumer expenditures on gasoline and oil in
the United States and is twice the size of the
annual output of the motion picture and sound
recording industries.”

10

[I]Do you even read all the stuff you post radio fan?

If people feel confused after all the smoke and furry on the conservative right then this article should help you understand the outlines of what is actually being legislated.[/I]
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/14/AR2009081401669.html

Your Handy Health Care Cheat Sheet

Health-care reform is not that hard to understand, and those who tell you otherwise most likely have an ulterior motive. 

 [B]Reform proponents exaggerate the complexity of the issue to elevate their own status as people who understand it; opponents exaggerate it to make the whole endeavor out to be a bureaucratic monstrosity. [/B]

This gets a bit tiresome for reporters such as me who are writing article after article about the debate, only to have another pundit, politician or colleague dismiss the whole subject as an incomprehensible mess. Well, health care is a mess. Our current system is a mishmash that consumes 16 percent of the economy. Fixing it could be very simple: a single-payer system. To the dismay of many liberals, President Obama and congressional Democrats think it’s more realistic to build on what’s already there, which is why legislation overhauling it comes in the form of 1,000-page tomes.

Yet the basic outlines are emerging. What follows is an attempt to boil the health-care debate down to 1,000 words – a summary you can take to the beach or on the plane or, if you already know it all, send to your Aunt Millie. Love the proposals or hate them, people can try to make sense of them. There is no excuse!

Let’s start with the problem that Obama and the Democrats are trying to solve. It’s actually two related problems. First, there are 47 million people in this country without health insurance. Second, health-care costs have been surging to the point where premiums are eating up more of our paychecks and where Medicare and Medicaid are badly straining the national budget.

The proposed solution to the first problem is straightforward: The legislation on the table would make Medicaid available to more people and would cover others by helping them buy their own insurance, with subsidies based on income. The venue for people to buy insurance would be an “exchange,” a marketplace that would replace the uncompetitive and lightly regulated landscape that now confronts individuals and small businesses trying to buy coverage. Insurers on the exchange would have to meet basic standards and would no longer be allowed to deny coverage or price it exorbitantly because of preexisting conditions; they’d still be able to set rates based on age, but not to the degree they do now.

The thinking is that insurers would comply because they would want the customers coming to the exchange, notably the younger and healthier uninsured. This is one reason all the proposals would mandate that people buy insurance, or risk paying a fine. This would draw younger people, who spend relatively little on health care, into the exchange, lowering the price of coverage for everyone. At least at the outset, larger businesses and people who receive coverage from their employers probably wouldn’t be able to buy on the exchange, to keep the employer-based insurance system that covers most Americans from unraveling.

Extending coverage to the uninsured would cost a lot – around $1 trillion over 10 years. But the country spends more than twice that much on health care in a single year, and the Medicare drug benefit passed in 2003 was expected to cost more than half as much. Obama proposes paying for most of the effort by squeezing money out of Medicare and Medicaid, including the subsidies that go to private Medicare Advantage plans and Medicaid funds that hospitals get to treat the uninsured. He would pay for the rest by shrinking the itemized deductions of wealthy taxpayers, which Congress has resisted. Other money-raising ideas include higher taxes on millionaires, proposed by House Democrats, and a plan being considered by the Senate Finance Committee, which is still drafting its legislation, to impose a tax on the most expensive health plans. All the proposals would level some kind of fee on employers who don’t provide coverage, with exemptions for the smallest businesses.

The debate over helping the uninsured has gotten tangled up with the other major challenge, slowing the growth of overall health-care spending. Republicans deride Obama and the Democrats by saying they claim to be saving money even as they expand coverage, an impossibility. Reformers say this is unfair – they acknowledge the upfront expense in trying to cover the 47 million but say their parallel attempts to “bend the curve” on spending would reduce costs over the long run for everyone. They say it makes sense to do both at the same time – to mix the honey of broader coverage with the bitter medicine of cost control.

What is unclear is if the proposals would achieve long-term savings. Reformers tout a new federal effort to determine, with the help of computerized records, the “comparative effectiveness” of treatments. But they say this effort would not take cost into account or issue firm guidelines over what to cover – assurances made, in part, to avoid upsetting providers and patients groups. End-of-life care eats up a huge slice of spending, but the proposals do little to address this directly. And the clause in the House bill about providing Medicare reimbursements to doctors for counsel on end-of-life questions originated in an earlier proposal backed by Republican senators.

Similarly, the bills call for empowering a federal panel to set Medicare rates free of pressure from providers, and for programs to test payment models that emphasize the quality of care instead of the quantity of treatments delivered. But these steps may not be enough to bring about the change that many experts urge – away from a system in which we pay for every MRI or drug infusion on a case-by-case basis, and toward one in which salaried medical professionals are paid to do what it takes to keep us healthy.

Dominating the whole debate is the question of whether to include a government-run insurance plan on the exchange. Proponents say such a measure – included in the House bill and the Senate health committee bill – would provide the uninsured with a guaranteed high-quality plan, in case insurers still try to game the rules to deny coverage or payments. They say it would also restrain the overall growth in costs. A low-priced competitor, the logic goes, would drive insurers to pressure doctors to deliver the most cost-effective care. Providers would agree to do so to keep insurers in business and avoid being left with only a government plan. The bills call for setting the plan’s rates slightly above Medicare rates, to avoid putting too much cost pressure on providers. But opponents of the public option predict that the government would set the plan’s rates so low that it would drive private insurers out of business.

The public option may not make it into the final bill. Obama supports it but has not drawn a line in the sand for it. To get Republican votes, the Senate Finance Committee’s bill is likely to include member-owned cooperatives instead of a public option, though critics say those would lack competitive clout. Even some liberal reformers are not sure the public plan is worth staking everything on, considering that it may serve relatively few at the outset. It may be enough, they say, to fight for strong regulations on the exchange and subsidies big enough for families to afford to buy coverage.

These are the main features of what Congress will take up come September. The two Senate bills must be merged into one, followed by votes in each chamber and a conference committee to reconcile the House and Senate bills, and then a vote on the final product. It’s your health care. Don’t let anyone tell you that it’s somehow beyond your grasp.

macgillisa@washpost.com

Alec MacGillis is a reporter on the national staff of The Washington Post.

11

You are trying to make fun of me with your elitist, arrogant tone, not going to work. You have how much experience in working for and dealing with the effects of government policy? What do you believe will be the practical effect of adding millions to the insurance rolls when the physician’s offices are unable to accept additional patients, have any ideas? So, you think the co-op option which would be funded by the government would not have the same issues as single payer? In my real world experience, anytime the government pays for anything, they want total and complete control, Real World 101. I do not care if it is medical care, tuition vouchers, food stamps, or any government program. Do you honestly believe that the government has your medical best interest at heart? If you do, I have a bridge to sell you. When I worked in goverment, the administrators were always asking how can we cut this or that, without thinking, “Is this a good idea or not?” Do you think it is a good idea for individuals with no law enforcement experience, anywhere, making funding decisions about law enforcement? What qualifies the government to run health care? What is the national debt again? Where in the Constitution does it give the Federal government the authority to make private health care decisions? How many promises has the Federal government made that have been broken over the years, how do you trust these people? I would rather be on the conservative right that with you and your friends on the looney left. What entitles you to take the earnings of your fellow citizens for your selfish benefit?

"Dependence begets subservience and venality, suffocates the germ of virtue, and prepares fit tools for the designs of ambition." --Thomas Jefferson, Notes on Virginia, Query 19, 1781

I have never understood the entitlement mentality. Public assistance is only supposed to be temporary, not a way of life. So, tell me, what leads you to believe that your citizens are supposed to be working to support you, on a permanent basis? St. Paul said, “Those who do not work shall not eat.”

How do you and your friends on the left propose to restrain costs by increasing regulations, which creates more and more cost and providing huge subsidies, even more cost? We have done it your way, with more government payment of claims and regulation, enjoy paying more and more for premiums instead of receiving a raise? Medical costs can be well controlled with competition with the consumer as the driving force. Consumers have much more cost control power than government. LASIK cost procedures have decreased by 30 percent and physicians give their patients their phone number, why? competition. A monopoly in any sector of the economy is a very negative deal for the consumer, In a monopoly, consumers have very little control over prices charged by that monopoly. In a Government health care monopoly, that monopoly does not care about the health care services provided to the customer, work for the government, you will see what I mean. In the public assistance building, workers have the idea that the client should be grateful that they have time to serve them, if not, they will just have to come back the next day, increasing time, cost, and gas to the environment. Workers in the public assistance building do not have incentive to satisfy the consumer. Money and income equals power and many in the government do not want us to have that power, except for themselves. If the hospital screws up, I am not going to pay the bill. If the Government hospital fouls up, what recourse will you have? Medical personnel need to be held accountable to the patient, do no harm. To say because I disagree with you and your friends on the left slamming this public option down my throat, I have an ulterior motive, is more of the left and their crock of bull statements, “Two paychecks away from being homeless.” Which party was it said that wanted to throw people off of Medicare and force seniors to eat dog food? As stated by your good friend, Rep Major Owens, “They are coming for the sick, they are coming for the poor.” Major, that is your party, not mine.

12

Hospitals creaking under the strain as NHS vacancies are left unfilled

From The London Times August 7, 2009:

Medical leaders have warned that shortages of doctors, nurses and other clinical staff are putting the NHS under unsustainable pressure as a generation of health workers enters retirement amid cutbacks in junior doctors’ working hours.

The number of vacancies for hospital doctors, dentists, nurses and midwives has risen for the first time in five years as trusts struggle to recruit and retain staff. New data from the NHS Information Centre revealed that more than one in twenty medical and dental posts were vacant at the end of March, in some cases for months at a time, while thousands of nursing and midwifery posts were also unfilled.

Of the total number of vacant posts, one in five — 5,500 jobs — had been left unfilled for three months or more, suggesting long-term problems with recruitment. Senior staff leaving the service and the reluctance of younger people to replace them were blamed for the shortfalls as total vacancy rates increased across most staff groups. Doctors’ leaders have also warned that the European Working Time Directive, which from this month limits junior doctors to a maximum 48-hour week, could create shortages, leaving trusts to rely on temporary or locum staff.

The Times reported last week that trusts were spending tens of thousands of pounds to fill vacant posts, with recruitment agencies charging from £90 to £116 an hour to provide nurses and doctors on demand. The latest statistics only cover vacancies where trusts are actively recruiting for a post, however, so may underestimate the true scale of shortages, which are particularly acute in London.

The health service spent more than £584 million on employing agency staff in 2007-08, the latest year for which full data is available. A study published last year by the London School of Economics suggested that trusts that relied heavily on agency nurses to cover vacancies had higher mortality rates among patients who had a heart attack than those with more permanent staff.

Peter Carter, the chief executive of the Royal College of Nursing (RCN), said that the scale of the problem was worrying. “While we are concerned about long-term vacancies, even unfilled short-term ones leave nurses under unsustainable pressure and, with higher workloads, too busy to provide the standard of care they would like,” he said. “Rising vacancy rates are due to a combination of factors — more nurses are retiring and fewer are coming out of training; add to this an increase in demand for nurses, coupled with recent changes in migration policies, restricting recruitment from outside of the EU.”

The number of empty jobs was measured on March 31 this year. Among hospital doctors and dentists, excluding trainees, the vacancy rate was 5.2 per cent, compared with 3.6 per cent in the same month last year. The long-term vacancy rates for this group jumped two thirds from 0.9 per cent to 1.5 per cent. Vacancy rates for GPs increased only slightly from 1.6 per cent to 1.9 per cent.

Medical leaders have said that qualified nurses and midwives are retiring at a greater rate than newly trained staff can enter the professions. For nurses, vacancies rose from 2.5 per cent to 3.1 per cent in a year. London had the highest long-term vacancy rate among qualified nursing staff, increasing from 1.2 per cent in 2008 to 1.6 per cent this year. A poll of more than 8,600 children aged between 7 and 17, conducted for the RCN this year, found that only 1 in 20 considered nursing to be an attractive career.

The Royal College of Midwives (RCM) has also called for 5,000 extra staff to be recruited to fulfil official pledges to improve care and choice of services for mothers and babies. The Government has promised funding for the equivalent of 3,400 posts. Among midwives, vacancies increased from 2.1 per cent in 2008 to 3.4 per cent, with long-term vacancies accounting for about one in four of all empty posts.

Cathy Warwick, general secretary of the RCM, said: “The overall increase in vacancy rates may suggest there are more midwifery jobs available but employers are struggling to fill them. Perhaps increasing numbers of student midwives are not yet resulting in enough newly qualified midwives coming through the system. It could also mean that more midwives are leaving a service suffering from very heavy workloads.”

Anthony Halperin, trustee of the Patients Association, said: “Nursing staff see that there are higher rewards in the private sector while doctors and dentists no longer see medicine as a career for life, or are having their hours cut back by European legislation. All of this has negative outcomes for patients.”

Stephen O’Brien, the Shadow Health Minister, said: “With swine flu continuing to spread and the European Working Time Directive limiting doctors’ working hours, this is the worst time for staff vacancies across the NHS to rise.”

The Government said that more medical staff were working in the NHS or in training than ever before. Ann Keen, the Health Minister, said: “Across most staff groups vacancy rates continue to be low at around 2 per cent. The number of longer-term vacancies show a slight rise on last year but remain lower than 2006.”

13

Warning: 200,000 NHS nurses are about to walk out the door

The “Sixties Bulge”, as it is known in the NHS, refers not to obesity in those approaching old age but a looming workforce problem that has been visible from some considerable distance.

Mass recruitment schemes in the Sixties were a great success. Nursing numbers rose as social shifts allowed greater numbers of women to take up full-time careers, while doctors’ ranks swelled with immigrants from the Commonwealth.

This workforce bulge can, in part, be identified as a cause of recruitment ripples ever since. Sharp rises in the uptake of staff occurred as the NHS expanded to meet further demand but these have prompted a natural slowdown in recruitment. The key, which the Government has yet to grasp properly, is to soften the troughs as effectively as possible.

Take nursing, where the effect of demographics is felt most acutely. In the mid-Nineties health professionals raised concerns about future vacancies. Labour took action when it came to power and hired a total of 80,000 more nurses, many from the Philippines and India. Now the NHS has limits on international recruitment and fewer nursing places in tertiary education.

However, an estimated 200,000 nurses are expected to retire over the next decade, a disproportionate chunk of the workforce and the most valuable in terms of experience. Health professionals argue that governments rarely factor in vital long-term workforce planning because they focus on short-term parliamentary cycles.

For this latest ripple to occur at a time of severe economic stretch is even more concerning. Past worries about retaining sections of the doctors’ workforce have been solved with attractive pay packages.

The likelihood of enough money being found to replace the retiring nurses is slim and will perversely mean the NHS ends up paying more for the quick-fix sticking plasters of agency workers who can earn ten times the hourly rate of a middle-ranking staff nurse. There will be tight restrictions to come on pay and pensions, encouraging the more experienced to look for work abroad or in the private sector.

Solving the ebb and flow of recruitment should be key to the Government’s attempts to improve care and to treat more people outside hospital. These policies need experienced doctors and nurses, and a farsighted approach to recruitment.

Attractive pay packages, I thought those things do not happen in a country with single payer, Greedy physicians.

14

Take a guess, where, oh where, was this procedure developed? THE UNITED STATES

New treatment could save the sight of children with eye cancerMark Henderson, Science Editor

Recommend?
Children with eye cancer are being offered a new treatment that could spare them the distressing side-effects of chemotherapy while improving the chances of saving their sight, The Times has learnt.

The procedure, which allows doctors to target tumours with toxic chemotherapy drugs while avoiding healthy tissues, has been given to 12 children with retinoblastoma at Great Ormond Street Hospital in London.

It involves passing a catheter through the patient’s blood vessels from an incision in the groin to the ophthalmic artery, which supplies the eye with blood. Chemotherapy drugs are then administered via the catheter.

As the drugs are infused directly into the eye, tiny doses can be used — as little as 5 per cent of the amount that would be given in standard chemotherapy — while still getting more to the site of the tumour than with conventional, body-wide treatment. Healthy tissues are not exposed to toxic drugs, avoiding serious side-effects such as sickness and nausea, hair loss and suppression of the immune system.

The entire procedure takes about an hour, with the child under a general anaesthetic.

Research in the United States has indicated that the technique, called intra-arterial chemotherapy, is at least as effective as standard treatments for retinoblastoma and may even lead to better outcomes.

As higher quantities of drugs reach the tumour than in ordinary chemotherapy fewer cycles of treatment are generally needed, which can raise the chances of saving a patient’s sight.

“This treatment gets the drugs directly to the place where they need to be soaked up,” said John Hungerford, a consultant ocular oncologist at St Bartholomew’s Hospital in London, who has pioneered its introduction to Britain. “It is proving to be a very good approach.”

Stefan Brew, a consultant neuroradiologist at Great Ormond Street, who inserts the catheters used in the procedure under X-ray guidance, said: “The advantage to doing it this way is that the drug is quite toxic and if you can deliver the entire dose to where the tumour is, you can get a high dose to the tumour and low dose to other tissues.

“The logic is to deliver the chemotherapy directly to the tumour in a targeted way, rather than the traditional blunderbuss approach.”

Retinoblastoma, a type of eye cancer that affects about 40 to 50 children — usually under the age of 3 — each year, is generally caused by a genetic mutation and can affect one or both eyes.

It usually responds well to treatment but is often diagnosed late. The main symptom is a white pupil that becomes visible only when the tumour fills one third of the eye.

Retinoblastoma is usually treated with systemic chemotherapy, in which the patient’s whole body is exposed to drugs so that some reach the eye. This causes severe side-effects and if it fails, the affected eye must sometimes be removed in a procedure called enucleation.

The intra-arterial approach was developed by teams led by Akihiro Kaneko, of the National Cancer Centre in Japan, and David Abramson, of Memorial Sloan-Kettering Cancer Centre in New York, to deliver a powerful chemotherapy drug called Melphalan directly to the tumour.

At present, it is used only when patients have already failed to respond to chemotherapy or when the cancer has returned and patients have already lost an eye to the disease. If chemosurgery continues to achieve good results, however, it could become a frontline treatment.

“All the children we have treated have responded well, though it is early days with some of them,” Dr Brew said. “At the moment it’s for children who have failed conventional treatment but what I’m hoping is that, as long as we can demonstrate that it is safe and effective, the next step would be to widen the criteria for use.”

Judith Kingston, a consultant paediatric oncologist at Great Ormond Street, said: “The biggest advantage is that the child doesn’t become systemically ill. He or she can have a normal life between treatments.”

The procedure is available on the NHS on a case-by-case basis, although only one of the children treated so far in Britain was an NHS patient. It costs £10,000-£15,000. Dr Kingston said that while this was more than standard treatment, there were savings on the follow-up care of patients suffering chemotherapy side-effects.

Libby Halford, the chief executive of the Childhood Eye Cancer Trust, said: “We are involved with the children and families affected by retinoblastoma right from diagnosis and all through their treatment and it can be extremely gruelling. The effects of chemotherapy can be very distressing.

“It’s important that new treatments such as this are in the armoury: to have it available in the UK is wonderful. You’ve been able to travel to the US, but the cost is huge and the families get immensely stressed. Losing both eyes is such a dreadful thing for parents to come to terms with when another treatment is available.”

— Further information on retinoblastoma is available from the Childhood Eye Cancer Trust

15

Oh. My. God.

This procedure was created through a socialistic international collaboration of not for profit research.

The horror. The horror.

16

[QUOTE=Bill Peckham;18368]Oh. My. God.

This procedure was created through a socialistic international collaboration of not for profit research.

The horror. The horror.[/QUOTE]

The last time I looked, New York was in the United States. Most medical research is discovered at the University level. I never said or implied that non profit research is a bad thing, not sure how you would have come to that conclusion.

17

Bill, this is one of your liberal friends:

I am finally scared of a White House administration

By Nat Hentoff

I was not intimidated during J. Edgar Hoover’s FBI hunt for reporters like me who criticized him. I railed against the Bush-Cheney war on the Bill of Rights without blinking. But now I am finally scared of a White House administration. President Obama’s desired health care reform intends that a federal board (similar to the British model) — as in the Center for Health Outcomes Research and Evaluation in a current Democratic bill — decides whether your quality of life, regardless of your political party, merits government-controlled funds to keep you alive. Watch for that life-decider in the final bill. It’s already in the stimulus bill signed into law.

The members of that ultimate federal board will themselves not have examined or seen the patient in question. For another example of the growing, tumultuous resistance to “Dr. Obama,” particularly among seniors, there is a July 29 Washington Times editorial citing a line from a report written by a key adviser to Obama on cost-efficient health care, prominent bioethicist Dr. Ezekiel Emanuel (brother of White House Chief of Staff Rahm Emanuel).

Emanuel writes about rationing health care for older Americans that “allocation (of medical care) by age is not invidious discrimination.” (The Lancet, January 2009) He calls this form of rationing — which is fundamental to Obamacare goals — “the complete lives system.” You see, at 65 or older, you’ve had more life years than a 25-year-old. As such, the latter can be more deserving of cost-efficient health care than older folks.

No matter what Congress does when it returns from its recess, rationing is a basic part of Obama’s eventual master health care plan. Here is what Obama said in an April 28 New York Times interview (quoted in Washington Times July 9 editorial) in which he describes a government end-of-life services guide for the citizenry as we get to a certain age, or are in a certain grave condition. Our government will undertake, he says, a “very difficult democratic conversation” about how “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care” costs.

This end-of-life consultation has been stripped from the Senate Finance Committee bill because of democracy-in-action town-hall outcries but remains in three House bills.

A specific end-of-life proposal is in draft Section 1233 of H.R. 3200, a House Democratic health care bill that is echoed in two others that also call for versions of “advance care planning consultation” every five years — or sooner if the patient is diagnosed with a progressive or terminal illness.

As the Washington Post’s Charles Lane penetratingly explains (Undue influence," Aug. 8): the government would pay doctors to discuss with Medicare patients explanations of “living wills and durable powers of attorney … and (provide) a list of national and state-specific resources to assist consumers and their families” on making advance-care planning (read end-of-life) decisions.

Significantly, Lane adds that, “The doctor ‘shall’ (that’s an order) explain that Medicare pays for hospice care (hint, hint).”

But the Obama administration claims these fateful consultations are “purely voluntary.” In response, Lane — who learned a lot about reading between the lines while the Washington Post’s Supreme Court reporter — advises us:

“To me, ‘purely voluntary’ means ‘not unless the patient requests one.’”

But Obamas’ doctors will initiate these chats. “Patients,” notes Lane, “may refuse without penalty, but many will bow to white-coated authority.”

And who will these doctors be? What criteria will such Obama advisers as Dr. Ezekiel Emanuel set for conductors of end-of-life services?

I was alerted to Lanes’ crucial cautionary advice — for those of use who may be influenced to attend the Obamacare twilight consultations — by Wesley J. Smith, a continually invaluable reporter and analyst of, as he calls his most recent book, the “Culture of Death: The Assault on Medical Ethics in America” (Encounter Books).

As more Americans became increasingly troubled by this and other fearful elements of Dr. Obama’s cost-efficient health care regimen, Smith adds this vital advice, no matter what legislation Obama finally signs into law:

"Remember that legislation itself is only half the problem with Obamacare. Whatever bill passes, hundreds of bureaucrats in the federal agencies will have years to promulgate scores of regulations to govern the details of the law.

“This is where the real mischief could be done because most regulatory actions are effectuated beneath the public radar. It is thus essential, as just one example, that any end-of-life counseling provision in the final bill be specified to be purely voluntary … and that the counseling be required by law to be neutral as to outcome. Otherwise, even if the legislation doesn’t push in a specific direction — for instance, THE GOVERNMENT REFUSING TREATMENT — the regulations could.” (Emphasis added.)

Who’ll let us know what’s really being decided about our lives — and what is set into law? To begin with, Charles Lane, Wesley Smith and others whom I’ll cite and add to as this chilling climax of the Obama presidency comes closer.

Condemning the furor at town-hall meetings around the country as “un-American,” Harry Reid and Nancy Pelosi are blind to truly participatory democracy — as many individual Americans believe they are fighting, quite literally, for their lives.

I wonder whether Obama would be so willing to promote such health care initiatives if, say, it were 60 years from now, when his children will — as some of the current bills seem to imply — have lived their fill of life years, and the health care resources will then be going to the younger Americans?

Nat Hentoff is a nationally renowned authority on the First Amendment and the Bill of Rights and author of several books, including his current work, “The War on the Bill of Rights and the Gathering Resistance”. Comment by clicking here.