Saturday, November 24, 2012

NHS & Obamacare: Opposite directions!


Opposite directions?
©2012 Am Ang Zhang

Now that Obama is re-elected for his second term, Obamacare looks like having a good chance of moving health care in the US in quite the opposite direction to where our NHS is moving.

There is little doubt that a system based on insurance will need smart legislation to control the insurers. If the NHS is going to make use of wealthier individuals to use Health Insurance, then the same smart laws will need to be enacted for the regulation of Insurers. We should have learnt through the banking failures that in business, there is no such thing as self regulation.

The following was published just before the election:

The Affordable Care Act's benefits are hidden beneath the alarmist rhetoric
Nov 5, 2012


Columnist Wendell Potter Robin Holland

Wouldn’t it be great if our candidates had to take a dose of truth serum every morning before hitting the campaign trail? If they did, those of us who will be voting tomorrow wouldn’t be nearly as confused about what Obamacare is and what it isn’t, what it will do and what it won’t.

Since there is no such truth serum requirement, I believe that many of us will actually be voting against our own best interests. Many Americans will vote for candidates who have scared them into believing that Obamacare is a government takeover of health care that it will bankrupt the country while slashing Medicare benefits.

In the event that you or someone you know might benefit from some truth-telling, here, then, are a few things you ought to know before pulling that lever tomorrow:

·         The Affordable Care Act is not a government takeover that has put us on a slippery slope toward socialism, or even toward a single-payer system like the one in the People’s Republic of Canada.
·         The legislation is not going to add trillions to the deficit, even though it will expand Medicaid and provide subsidies to low-income individuals and families to buy private coverage.
·         The Affordable Care Act will not cut Medicare benefits.

One of the reasons the hospital industry endorsed Obamacare is that by bringing more people into coverage, hospitals will not have to provide nearly as much uncompensated care, which hits their bottom lines very hard. So hospitals were quite willing to go along with a reduction in future payments from the government because they know they will more than make up for it by having far fewer uninsured patients.

Here are some things the law will do:
·         It will prohibit insurance companies from refusing to sell coverage to people simply because they have one or more pre-existing conditions.
·         It will also prohibit them from cancelling our coverage when we get sick just to avoid paying for our care.
·         It will prohibit insurers from charging women more than men for comparable coverage and will not allow them to charge older folks more than three times as much as younger folks.
·         It will require them to spend at least 80 percent of what we pay in premiums actually paying claims and improving care.
·         It will allow young adults—who comprise the largest segment of the uninsured—to stay on their parents’ policies until age 26.
·         It will reduce the number of uninsured Americans by at least 30 million if all the states agree to accept federal dollars to expand their Medicaid programs.

That said, Obamacare is not a panacea for all that ails the U.S. health care system. I view it as the end of the beginning of reform. We will have to do more as a nation to bring everyone into coverage, to control costs and to improve the way we deliver care. But Obamacare does not resemble the law that many politicians have spent millions of dollars trying to persuade us it is.  Don’t be fooled into voting against your own best interests tomorrow.

Saving NHS: Control Health Insurers!


Friday, November 16, 2012

Autism: Cheat & Collude



Child Psychiatry is one discipline where TICK BOX approach favoured by those in power will not work. In dealing with Autism, it is often better to think outside the box! Do not tick it. One Autism sufferer actually became a professor!

The Box!



Arktikum, Rovaniemi ©Am Ang Zhang


The Consult:

Dear Cockroach Catcher:

We are a bit stuck with this Autistic boy with unusual OCD symptoms.

The boy was born in the US of American mother and British father. Diagnosed Autistic Spectrum Disorder age 4 with OCD symptoms. Was sent to an institution at age 5 when parents separated and mother could not cope. Father managed to get him to England after 10 months. His obsessional symptoms got worse and amongst them the most difficult is that he can’t bear to wear any clothes which are not brand new. He checks the tag, feels the clothing and sniffs it to decide if he would wear it.

He is on Prozac 40mg, which has reduced the aggressive outbursts but not made any real inroads into the dressing problem……except that he has occasionally managed to wear used socks.


XXXXXXXX

Nowhere else in medicine is “innovation” more appropriate than in Child Psychiatry!

My first thoughts were: Cheat!

Then perhaps: Collude!

Neither would be in NICE or any textbook.

So I wrote back:

I know you may no longer be allowed to be innovative. Sad really. Here are my thoughts:

Cheat: get father to keep all the clothes tags or write to companies to get a lot of them to tag on to his clothes so that they are like new.

That saves some money. Failing that steal the tags.

(I can't believe I said that)

Patients come first.

Collude: because he could sniff and tell that the re-tagged clothes are not new we may have to get him to agree to the ritual of tagging clothes and folding them nicely as if they were new. One of my autistic patients turned our session into a TV session. So collusion is a better way.

It is a pity that nowadays we cannot spend enough time with these patients to understand them. If I may venture further and suggest that the boy perhaps associated new clothing to the new life with his father and he wanted to keep it that way. Obsessional symptoms are essentially a defence in psychodynamic terms and until the child (autistic or otherwise) can be sure of his place at his new home he is going to keep his defences. 

So spend more time with him and you may well be surprised!

It is probably good he was not in an institution. That was what they nearly did to Temple Grandin. There is so much we can learn from her story. She too was nearly institutionalised. She famously created a cuddling machine for herself!

Innovation again.

Wrong may sometimes be right.

Let me know.

Autism: Challenges & Obstacles!



Temple Grandin Website:

Dr. Grandin didn't talk until she was three and a half years old, communicating her frustration instead by screaming, peeping, and humming. In 1950, she was diagnosed with autism and her parents were told she should be institutionalized. She tells her story of "groping her way from the far side of darkness" in her book Emergence: Labeled Autistic, a book which stunned the world because, until its publication, most professionals and parents assumed that an autism diagnosis was virtually a death sentence to achievement or productivity in life.


Autism posts:

Autism: Somalis in Minnesota and Sunshine
Autism, the Brain and Tiger Woods
Autism and Money



Wednesday, November 14, 2012

Central Park: Hello Autumn!

© Am Ang Zhang 2012


Sunset:Finland & NHS!

Yes, the sun is setting in Finland and soon the NHS too.

88% of Finns are satisfied with their universal health care and suicide rate has dropped to 19th place after Switzerland & Belgium. Infant mortality is better than that of Singapore.

© Am Ang Zhang 2012
A reprint:

According to the NAO:

In 2009 the total value of the market for PH(Private Healthcare) in the UK was estimated at just over £5.8 billion. Private hospitals and clinics account for the largest part of the overall PH market, generating an estimated £3.75 billion in revenue during 2009. Fees to surgeons, anaesthetists and physicians generated an estimated £1.6 billion in 2009.

The total number of UK citizens with Private Insurance is estimated to be around 90,000. It is not difficult to work out what good value the NHS has always been.

The NHS was not perfect, far from it and yet successive attempts at fixing it has produce the opposite effect: it needs more fixing.

If you read that line again from the NAO report, it was clear where the problem was: fees to surgeons, anaesthetists and physicians!!!

Yes, that was the main recipient of Private Health income.

To become a Consultant in the NHS used to be prestigious and even those aiming to doing mainly private work will have to wait till they achieve Consultant status in the NHS.

The NHS for all its sins tried to keep every consultant as close to the MAYO ideal by insisting on the same pay-scale.

Several levels of Distinction Awards were used to keep some professors and top consultants happy. Later the name of the Awards was changed and yet it was still the same soup.
If Consultants were prepared to give up one session of pay, then there is no limit as to the private work they can take on. It was a safe way to start your private work and you keep the rather nice NHS pension.
                                                         
What is generally not talked about is that you keep one foot in your NHS hospital and one in your private one.

So far so good and yet this is where the problem starts.

It does not need a genius to work out that people worry about their health and do not want to wait for a suspicious lump to stay in their body too long. They will pay. We need not even mention the manipulation of waiting lists, etc. Then big companies realise that they can attract staff by offering Health Insurance and the rest is as they say history.

Then the rules changed and every consultant can do a maximum of 10% of their NHS pay in private work without having to give up anything. Some hospitals even allow you to use their facilities for a small fee.

Why not, more private patient means less expenditure for the NHS.

Private Insurers discovered that too and they started offering a small fee if you can wait for your operation at your free NHS hospital.

There has never been any control of Health Insurers and I suspect if was not even because they have a strong lobby: just the feeling that the NHS was for everybody so no one could be excluded.

But Health Insurers are cleverer, they exclude chronic conditions, many psychiatric ones belong to that group and often they will exclude after a while.


So, indeed it was a clever move by the present government to simply hand over a portion of money to the GPs and say: get on with it, the best price or better still, why not treat them yourself. You are all doctors, forgetting one of their own just had neurosurgery done at Queen Square.

Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.

There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.

How else could the government continue to claim that competition will improve standard and bring down cost.

Private or NHS, they are the same Surgeons, Anesthetists and  Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.

It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.


Mark Porter: Chairman of the British Medical Association's consultants committee.

NHS services in some parts of England could be "destabilised" by private firms taking advantage ……….to win contracts for patients with easy-to-treat conditions. This could lead to some hospitals no longer offering a full range of services and ultimately having to close.

The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.

The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.

The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.




If we want to keep serving the best interests of our patients, 

we must reject the language of the market 

and embrace the language of 

caring.



NHS & Market Forces: Fund Holding & Medical Ethics

NHS: Looking Sinister!



My friend wrote asking if I have read a recent blog post about our new Health secretary and a former one.

“It is looking sinister!”

 ©2012 Am Ang Zhang

The one-word secret of Hunt’s success: NEPOTISM His relationship to Virginia Bottomley…..his dealings with the British Council….his inheritance of the SW Surrey constituency….

…..So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector……



The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                       Janinie R. Wedel
               

                                                    From:    Shadow Elite: Public-Private Players & The NHS

        
        
I think there is something fundamentally scary about our democracy…. 
Because I think people have a sense that the system is rigged, 
and it’s hard to argue that it isn’t.
                            
Michael Lewis: The Big Short

Wednesday, November 7, 2012

Obama: Presidency & Health Care Reform.

Congratulations to President Obama's re-election as President of the United States of America.

©2012 Am Ang Zhang  
As England moves towards the wholesale disintegration of its health care system, the US may at last be able to reform its health care through its Health Care reform:


(Reuters) - President Barack Obama's re-election victory eliminates the possibility of a wholesale repeal for his healthcare reform law, but still leaves questions about how much of his signature domestic policy achievement will be implemented as the national political focus shifts to the debt and deficit.
The 2010 Patient Protection and Affordable Care Act, which represents the biggest overhaul of the $2.8 trillion U.S. healthcare system since the 1960s, aims to extend health coverage to more than 30 million uninsured Americans beginning in January 2014.
Republican challenger Mitt Romney had vowed to repeal the law if elected, calling it a costly government expansion despite the fact that the reforms are based on healthcare legislation he signed as governor of Massachusetts.
......DID MEDICARE HELP OBAMA?
Another healthcare issue, Medicare, may have helped Obama on his way to reelection.
The victory included wins in swing states where analysts predicted senior citizens motivated by the campaign's Medicare debate could impact a close contest. The list includes Ohio, Pennsylvania, Iowa, New Hampshire and Nevada.
Obama and his allies vigorously attacked Romney's Medicare reform plan, which would convert the popular healthcare program for the elderly and disabled from providing guaranteed benefits to giving beneficiaries a fixed payment to help them purchase their own health coverage.

The Guardian: the Affordable Care Act
President Obama signed the budget reconciliation bill containing a package of revisions to the big health care legislation after giving a speech at Northern Virginia Community College, a setting aimed at drawing attention to the education component of the bill.

“Today we mark an important milestone on the road to health insurance reform and higher education reform,” Mr. Obama said. “But more broadly, this day affirms our ability to overcome the challenges of our politics and meet the challenges of our time.”

He continued, “When I took office, one of the questions we needed to answer was whether it was still possible to make government responsive to the needs of everyday people, middle-class Americans, the backbone of this country, or whether the special interests and their lobbyists would continue to hold sway like they’ve done so many times before. And that’s a test we met one week ago, when health insurance reform became the law of the land in the United States of America.”

In his speech, Mr. Obama also sought to temper some expectations. “The health insurance reform bill I signed won’t fix every problem in our health-care system in one fell swoop,” he said. “But it does represent some of the toughest insurance reforms in history. It represents a major step forward toward giving Americans with insurance and those without a sense of security when it comes to their health care. It enshrines the principle that when you get sick you’ve got a society there, a community that is going to help you get back on your feet. It represents meaningful progress for the American people.


Obama administration’s own timeline 
Prohibiting Insurance Companies from Rescinding Coverage.  In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23, 2010.   

Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.

Paying Physicians Based on Value Not Volume.  A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015. 

Obama from The White House.