NICE (England’s National Health Service’s National Institute of Health and Clinical Excellence) is the model upon which President Obama and many in his party wish to base the Comparative Effectiveness Commission which is called for in the proposed health reform legislation coming out of the House. The story below illustrates that essentially this type of board, with its allegiance to those who appointed the various board members, will place expenditures over patients when making decisions. In this case, a form of treatment which is minimally invasive and works for many patients is being removed as an option, a choice, for patients. So many on the left are all for choice – when it comes to abortion – but not so much when talking about the rights of patients to consider which options of care they might wish to receive.
Make no mistake, as budgetary restraints become greater, the politicians in Washington will look ever more feverishly for methodologies designed to limit choices and options in health care. The lowest bidder mentality will prevail and the common denominator will be: all things being equal, we will always go with the “cheaper chicken” as well as remove other options from your consideration. Many are positing that these opinions are based on reactionary fears and not on reality. However, it is increasingly clear that thoughtful citizens, who are actually taking/making the time to read part or all of House 3200 are coming to realize that this proposal is no rose and looks more and more like a pig in a poke . . . obi jo
Patients forced to live in agony after NHS refuses to pay for painkilling injections
Tens of thousands with chronic back pain will be forced to live in agony after a decision to slash the number of painkilling injections issued on the NHS, doctors have warned. The Government’s drug rationing watchdog says “therapeutic” injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known. Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy.
Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment.
The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.
But the British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery. Dr Christopher Wells, a leading specialist in pain relief medicine and the founder of the NHS’ first specialist pain clinic, said it was “entirely unacceptable” that conventional treatments used by thousands of patients would be stopped.”I don’t mind whether some people want to try acupuncture, or osteopathy. What concerns me is that to pay for these treatments, specialist clinics which offer vital services are going to be forced to close, leaving patients in significant pain, with nowhere to go,”
The NICE guidelines admit that evidence was limited for many back pain treatments, including those it recommended. Where scientific proof was lacking, advice was instead taken from its expert group. But specialists are furious that while the group included practitioners of alternative therapies, there was no one with expertise in conventional pain relief medicine to argue against a decision to significantly restrict its use.
Dr Jonathan Richardson, a consultant pain specialist from Bradford Hospitals Trust, is among more than 50 medics who have written to NICE urging the body to reconsider its decision, which was taken in May. He said: “The consequences of the NICE decision will be devastating for thousands of patients. It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate.”
One in three people are estimated to suffer from lower back pain every year, while one in 15 consult their GP about it. Specialists say therapeutic injections using steroids to reduce inflammation and other injections which can deaden nerve endings, can provide months or even years of respite from pain. Experts said that if funding was stopped for the injections, many clinics would also struggle to offer other vital services, such as pain management programmes and psychotherapy which is used to manage chronic pain.
Anger among medics has reached such levels that Dr Paul Watson, a physiotherapist who helped draft the guidelines, was last week forced to resign as President of the British Pain Society. Doctors said he had failed to represent their views when the guidelines were drawn up and refused to support the letter by more than 50 of the group’s members which called for the guidelines to be withdrawn.
In response, NICE chairman Professor Sir Michael Rawlins expressed outrage over the vote that forced Dr Watson from his position, describing the actions of the society as “shameful”. He accused pain specialists of refusing to accept that there was insufficient scientific evidence to support their practices. A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.
Iris Watkins, 80 from Appleton, in Cheshire said her life had been “transformed” by the use of therapeutic injections every two years. The pensioner began to suffer back pain in her 70s. Four years ago, despite physiotherapy treatment and the use of medication, she had reached a stage where she could barely walk. “It was horrendous, I was spending hours lying on the sofa, or in bed, I couldn’t spend a whole evening out. I was referred to a specialist, who decided to give me a set of injections. The difference was tremendous”. Within days, she was able to return to her old life, gardening, caring for her husband Herbert, and enjoying social occasions. “I just felt fabulous – almost immediately, there was not a twinge. I only had an injection every two years, but it really has transformed my life; if I couldn’t have them I would be in despair”.
Patients forced to live in agony after NHS refuses to pay for painkilling injections – http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html
www.condron.us www.bloglines.com www.blogburst.com www.blogcatalog.com www.clusty.com
“Courage is lacking in Washington and posturing is in style.”
That sums up our main problem. Scripted protests in town hall uprisings are the most recent evidence. It takes more courage to educate constituents than cater to their ignorance.
As a child of the Sixties growing up in the South I know what it is like to be in a minority that was right confronting a majority that was wrong. Maybe that makes me naive but I’m not intimidated.
Two links here for courageous investigators.
1) PDF link to H.R.3200 (1017 pages) US Government Printing Office
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf
2) Open Congress has a more user-friendly, searchable version where readers/users can register to read and leave comments.
http://www.opencongress.org/bill/popular?types=all
The pdf document is not for the feint-of-heart, but it’s useful if you want to see the actual pages. Simply key in the page number and have your printer spit it out.
On page two: “TABLE OF DIVISIONS, TITLES, AND SUB
TITLES.—This Act is divided into divisions, titles, and subtitles as follows…” Following that is seven pages of nothing but a table of contents (without page numbers so you have to look manually). DIVISION B and its list of contents is pp 215-222.
These two sources are important for anyone looking into the sensational claims and disinformation now being disseminated by a rash of viral emails.
http://www.newshoggers.com/blog/2009/08/preparing-for-viral-emails.html
Nightmare anecdotes from Canada, UK and other countries pour emotional accelerants into an already hotly burning fire. For every one of these there are scores of jaw-dropping anecdotes about insurance refusals to pay for care, dropping those whose claims hit certain limits, or refusing coverage to those who need it most.
Thanks for keeping the comments thread open.
“There are scores of jaw-dropping anecdotes about insurance refusals to pay for care, dropping those whose claims hit certain limits, or refusing coverage to those who need it most.”
Here is where I think we can find the common ground to move forward. Almost all agree that practices by health insurers are not in the best public interest. That is why we have argued from day one for meaningful health insurance reform. This reform can be legislated or even enacted mostly by Presidential order and does not require the voluminous bill that the House has authored. We are getting pushed off track by one side trying to over reach to gain control of something that Americans consider very personal, while the those on the other side, most particularly, health insurers fight to keep the status quo.
There is no need for an expensive public option if only Congress and the President would take common sense steps and create proper regulations for the private health insurance industry. Those regulations will serve the public interests and need not be so punitive as to dismantle the private health insurance system. But as we have said, political courage and common sense are in short supply and posturing for interest groups, constituencies and the cameras is in. That is also why we firmly believe in term limits for all elected officials.
So at last we get to the nub of the issue, the ominous public option. I wondered why this whole effort kicked off with all the usual suspects in favor instead of against. PhRMA, AARP, AMA, even AHIP.
That Obama guy’s a smooth talker, no?
Now we find nested in the bill a few incidentals that rub various furs the wrong way.
PhRMA just loves the concession that Medicare, maybe their largest revenue stream, will continue NOT to negotiate discounts for what they buy. They graciously agreed to cover the donut hole, a clever diversion that was a political two-fer, making both them and the president look good.
AARP, having captured the Medicare set, has it’s eyes set on the upcoming 50-65 set. Anything that snags that population helps their membership, especially the ones that buy lucrative insurance plans.
AMA seems to have become a lapdog, but their reputation in the overall medial community is about like that of the UAW to auto workers. (Isn’t it impressive how Obama castrated the auto unions and made them happy to be steers instead of bulls?)
And after Harry and Louise (AHIP) changed their mind, lo and behold that little public option, tucked in there behind the exchanges, turns out to be non-negotiable for the boss.
Now that’s a tough nut to crack. As long as everyone in the country was obliged, under penalty of taxation, to buy insurance, the insurance industry was salivating. This was an especially sweet deal with tax money tossed in to subsidize those whose income made the premiums unrealistic. But that single-payer public option turns out to be a different animal from the old Medicare. single-payer model. Forty years younger, more agile, and less prone to manipulation by special interests. Hmmm… we gotta kill this thing in the cradle before it ever gets to the playground.
I’m sure you know what I’m talking about. I don’t need to get any more snarky.
FWIW, I’m NOT a single-payer advocate. Maggie Mahar changed my mind about that pretty quick. Like her, I want to see a healthy hybrid of both single-payer and private insurance. I started out as a single-payer advocate, but all it took to make me change my mind was a reminder that if the government has complete control of health care, without private alternatives, there would be nothing to stop officials from imposing exactly the kinds of restrictions that inflame the emotions of so many opponents of this bill. Without private insurance as an option there would surely be no choices.
I’m not informed about Canada and the UK, but I heard that in Canada everyone is required to use Canadian Medicare and private pay is illegal, but in the UK private pay is okay, although apparently pretty expensive. As I said, I don’t know (nor care….we’re discussing what will or will not come to pass in the US).
Anyway, in the same manner that the last administration threw up government roadblocks against a variety of programs in response to the anti-choice crowd, I have no reason to imagine that future administrations would just as readily do the same for that or some other more sinister political reason. In that event, a robust private insurance industry will always be a safeguard.
I am, then, absolutely committed to preserving and protecting private insurance. Besides, this legislation, as far as I can tell, leaves auto insurance, liability, household, and workers comp unmolested, not to mention high-end arrangements that pay for cosmetic and other medical options usually not available anyway to the great unwashed.
The key is common sense regulation and reform of health insurance practices. No exclusions on policies for any reason. No dropping folks. No raising of premiums at will without just cause, etc, etc. This can all be done, but overall the insurance lobby is one of the strongest and most resistant to change and reform, regardless of which party is in the White House.
Your comments about Canada and the UK are on target. Canada has no private insurance option. That is, we think, very bad – for many of the reasons you cited. England has the NHS, which on the whole, does the best that it can, but you can get private insurance and private care. Those with means almost always do – for the reasons we have and others have pointed out in the past.
In the end, we continue to feel that a public option will essentially drive out private insurance and lead to a single payer system over time. We have no long lost love for private health insurers, just read many of the posts we have filed, but we do feel that centralized federal control of so basic a thing as health care can lead to unforeseen and potentially questionable practices. We continue to believe that Congress can act responsibly, extend coverage to most of the uninsured and solve much of the health insurance dilemma that has plagued us for some time without the need for a massive new federal program and bureaucracy.
“…a public option will essentially drive out private insurance and lead to a single payer system over time”
Shouldn’t that have read “…ANOTHER single payer system…”?
(In addition to Medicare.)
If another public option in addition to Medicare turns out to be a horrible idea that will only mean greater opportunity for private insurance. If it turns out to be a good idea and people love it, it’s time for private insurance to toss in the towel. You can’t have it both ways.
My guess is that there is a middle ground with a place for both. As far as I’m concerned a socialistic model along the lines of the VA and Armed Services health networks is very sensible, building on local health departments which could hire physicians and other professionals to work on salary rather than fee for service. Local or regional procurement of supplies and medicine is as feasible for medical care as for highway maintenance, school supplies and firefighting equipment. Fees could reflect actual costs instead of a contrived “Usual and Customary” extrapolation of some market number, derived like commodity prices. Small communities could be part of a regional network, etc…
But none of that is gonna happen.
Between that eminently practical safety net for the poor, unemployed and irresponsible and what we have now, a public option is about all that is left. There should be plenty left for private insurers and their already affiliated urban concentrations of providers and specialists that now dominate health care. Boutique practices are flourishing.
“My guess is that there is a middle ground with a place for both. As far as I’m concerned a socialistic model along the lines of the VA and Armed Services health networks is very sensible, building on local health departments which could hire physicians and other professionals to work on salary rather than fee for service”
Well, we will not endorse any model that is socialistic. The fact that the government repatriates our tax dollars in a federal program does not make that program socialistic. Medicare is paid for by a combination of payroll taxes and premiums and is available to all who qualify via their work record. It is clearly true however, that since the advent of Medicare there is NO private alternative available as a primary health insurance unless you are employed after age 65 by an employer that provides health coverage. Medicare beneficiaries do have the option to obtain private health insurance supplements to cover the large amount of items that Medicare does not cover. Additionally, Medicare beneficiaries are discriminated against by not allowing them to have HSA accounts like all non-Medicare participants can have. More social engineering by the discredited Congress.
This is a conversation with two parts. The first part is about how we are to spend tax dollars (yours, mine and everyone else’s), which is a social question. The other part is about how we may spend whatever resources are our own, privately (yours OR mine OR anyone else’s), which are individual questions.
Tax-favored MSA’s and FSA’s are not only a way to use individual resources, but also a way to spend our collective resources. The tax component is an incentive for individuals to bet against the market about their individual health care needs. And there is every reason to believe that such a policy is good for everyone, lowering the expense risk for both public and private insurance (public insurance being Medicare/Medicaid).
But as you pointed out earlier, the universally accepted outcome for all medical treatments is death, so it makes perfect, cold-blooded actuarial sense not to make these accounts tax-advantaged for the group guaranteed to die, and also statistically certain to run up the most costs along the way, particularly at the end.
How anyone chooses to save, spend, invest or give to others their life’s accumulation of assets is a private matter, subject only to inheritance taxes which don’t apply unless the estate runs past several million dollars. This “social engineering” strikes me as sensible economics which should be instantly clear to those in the business of calculating costs and risks to be applied to cost/risk benefit analyses.
The same muddy thinking contaminates discussions about Social Security and various private retirement arrangements. Defined benefits pension plans are now an endangered species, being replaced by a more modern, tax-favored array of employee paid retirement arrangements. They are tax-favored to wean workers away from the horrendously expensive defined benefits plans which (like employer subsidized health insurance plans, incidentally) are slowly crippling many companies in a maturing marketplace, both domestic and global.
It is entirely appropriate that employees carry the load for whatever retirement lifestyle they aim to enjoy. And it is equally appropriate that all of us be able to use whatever private resources available for whatever medical needs we want, even if that means diamond-studded expensive insurance plans and savings tagged for that purpose.
But just as there is a difference between Social Security and individual security, so too should there be a difference between privately funded (individual) health care and publicly funded health care providing a safety net for (let’s face it and say it out loud) the poor, the unemployed, the irresponsible, the stupid and all the others for whom private arrangements are for whatever reason out of the question.
Two remedies to this puzzle come to mind. One is to continue the tax-advantaged HSA’s alone, even after any public option is offered, but have that exclusion remain only until the age of 65. (Plenty of private companies have rules about mandatory retirement and/or other changes coupled with aging.) Another remedy which is low-hanging fruit for the private insurance sector is to offer discounts for any policy-holder with savings earmarked for their medical needs alone. The company could be the custodian of such accounts in the same way that they manage life insurance and annuities and there could be all kinds of bells and whistles connected with estate planning and such.
I’d like to go on but I hae to go pick up someone at the airport.
“The same muddy thinking contaminates discussions about Social Security and various private retirement arrangements.”
No, we don’t think advocating fair taxation rules is “muddy thinking”. If HSA’s are good for one, they are good for all. If taxes for health policy are good for one, they are good for all. If a public plan is good for Americans, is is certainly good enough for the President and Congress . . . but we know that will never happen. The safety net in America is just that, and expanding that is ALL that we should be doing, not changing a system that in fact most Americans are actually pleased with.
And yes, you can say it out loud, the poor, poorly educated or uneducated, illegal, irresponsible, addicted and stupid (your words) are not reason enough for me or anyone to give up our options for health care for ourselves or our families. The poor you have with you always (Jesus of Nazareth) and we have seen no evidence that this is not going to be the case regardless of the political or social welfare system that so many try to force on their fellows.
America is all about risk taking. About winning and loosing, about success and failure. That is the competitive system that has made us the envy of the world. As you know as a regular reader we advocate personal responsibility for health insurance, behavior and financial success as well. The economy is bad, but those who are waiting for the federal system to save them, will be waiting a long time. Those that take their own initiative will still succeed regardless of the bad economy. They will also find ways to get health insurance. Our plan would make that much easier for all those who truly have a need.
The argument for “fair taxation” falls apart when looks at through the prism of payroll taxes that begin with every first dollar earned for OASDI and Medicare, neither of which is deductible when other taxes on income (both federal an state) are levied. Moreover, after the earnings cap OASDI vanishes every year for high income earners, which is not only regressive but heavily unbalanced to further penalize lower income earners less able to afford it. And this is fair?
And you totally missed the difference between individual security versus social security. That seems to be an alien idea to those whose responsibility boundary stops before including the entire society in which they live.
Plus ça change. Root, hog, or die.
I give up.
Well, it may surprise you, but we do not understand why there ever was an income cap on Social Security and Medicare taxes at all. Fully agree that the Stephen Speilberg’s and Donald Trump’s of the world should be paying on each dollar. If they were, the overall rate for Social Security on a percentage basis could be lowered. The reason we believe that is based on our earlier comment, if one pays, then all should pay. And that should apply to each dollar. There should be no artificial salary ceiling. Another reason that we find this acceptable, is that both in the case of Medicare and Social Security the payroll tax is a “fair tax” in that it is applied on a equal percentage basis as opposed to an accelerating basis. This amounts to a flat tax rate for both programs. That makes it sustainable and supportable. Escalating the tax rate would take us into the realm of the current idiotic income tax system – that we would not be for.
So don’t give up, there remains more common ground than you might think.