Wintery Knight

…integrating Christian faith and knowledge in the public square

White House review of VA finds “corrosive culture” to blame for poor patient care

The Wall Street Journal reports.

Excerpt:

A White House review of the VA health system points to a culture that has degraded the timely delivery of care and requires a restructuring to improve transparency and accountability.

Acting Secretary of Veterans Affairs Sloan Gibson and Rob Nabors, White House deputy chief of staff, told President Barack Obama on Friday that significant further action was needed to address systemic problems.

Six weeks after the president dispatched Mr. Nabors to assess problems within the VA, the president’s aide outlined a long list of issues affecting access to timely care at VA medical facilities.

Mr. Nabors’s work is the latest in a series of reviews and reports issued in the past two months, including those from the VA’s independent inspector general, the Office of the Special Counsel and the VA itself. The new report found what Mr. Nabors described as a “corrosive culture” that affects employee performance and patient care. He added that the Veterans Health Administration structure has “impeded appropriate management, supervision and oversight.”

The review also found that the VA’s goal for scheduling many medical appointments within 14 days is “arbitrary, ill-defined and misunderstood.” That goal had been set in 2011. The VA recently eliminated that 14-day target.

Mr. Gibson praised the report. “We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care,” he said in a statement.

The White House has scrambled to respond to evidence of widespread mismanagement within the VA and to fill a growing number of vacancies in top posts. An internal assessment also revealed improper appointment-scheduling procedures and efforts to hide long wait times across the VA health system.

Another interim report from the VA inspector general confirms that:

The VA’s independent inspector general office has said it would likely issue in August its full report on its sweeping review of the department. An interim report, issued just days before Mr. Shinseki’s resignation, showed problems throughout the VA. They included employees tinkering with official patient appointment wait times to make them seem much shorter than the actual times veterans were having to wait.

In case you were wondering why this is all happening in the VA health care system and not in the private health care system, it’s because the VA is 100% pure government-run health care, as health care expert Avik Roy explains in Forbes magazine. The VA is not scandal is not some sort of aberration from government-run health care. Long wait times and patient deaths are essential to government run health care, in practice.

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American health care: does it cause poor life-expectancy and high infant mortality?

Probably one of the best health care policy experts writing today is Avik Roy, who writes for Forbes magazine.

Here is his latest column, which I think is useful for helping us all get better at debating health care policy. (H/T Matt from Well Spent Journey)

Excerpt:

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s not true.

[...]If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you’re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

Here is the raw data:

Health care outcomes

Health care outcomes by country and type of treatment

Click here to see the larger graph.

So, what explains this?

The article continues:

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.

It’s great that the Japanese eat more sushi than we do, and that they settle their arguments more peaceably. But these things don’t have anything to do with socialized medicine.

Finally, U.S. life-expectancy statistics are skewed by the fact that the U.S. doesn’t have one health-care system, but three: Medicaid, Medicare, and private insurance. (A fourth, the Obamacare exchanges, is supposed to go into effect in 2014.) As I have noted in the past, health outcomes for those on government-sponsored insurance are worse than for those on private insurance.

To my knowledge, no one has attempted to segregate U.S. life-expectancy figures by insurance status. But based on the data we have, it’s highly likely that those on private insurance have the best life expectancy, with Medicare patients in the middle, and the uninsured and Medicaid at the bottom.

I know that my readers who like to dig deep into economics and policy will love the links at the bottom of the article:

For further reading on the topic of life expectancy, here are some recommendations. Harvard economist Greg Mankiw discusses some of the confounding factors with life expectancy statistics, citing this NBER study by June and Dave O’Neill comparing the U.S. and Canada. (Mankiw calls the misuse of U.S. life expectancy stats “schlocky.”) Chicago economist Gary Becker makes note of the CONCORD study in this blog post. In 2009, Sam Preston and Jessica Ho of the University of Pennsylvania published a lengthy analysis of life expectancy statistics, concluding that “the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.”

The funniest thing I have found when talking to people from countries with socialized health care systems, like Canada and the UK, is that they are woefully uninformed about American health care. They literally do not know about free emergency room care, which is free for anyone regardless of insurance – including illegal aliens. They do not know about our expensive Medicaid program, which helps people who cannot afford health insurance. And our very very expensive Medicare program, which provides health care to the elderly – including prescription drugs. I get the feeling that foreign critics of American health care are getting their views from amateur documentaries produced by uneducated Hollywood propagandists, or maybe from TV shows on the Comedy Channel. They certainly are not getting their information from peer-reviewed studies by credentialed scholars from top universities, like the ones cited above.

I have literally spoken to Canadians who think that people in the USA without insurance do not get treatment and just die in the streets from stab wounds. They don’t know about the emergency room rule, or about charity care, or about Medicaid and Medicare. There is a lot of ignorance up there – wilful ignorance, in some cases. And keep in mind that the average Canadian household is paying over $11,000 a year for this substandard health care! They are paying more for less, and that’s not surprising since a large chunk of the taxes that are collected for health care go to overpaid unionized bureaucrats. Naturally, when their left-wing politicians need treatment, the first place they go is to the United States, where they pay out of pocket for the better health care. But that doesn’t stop them from denouncing American health care when they are talking to voters.

Higher infant mortality rates?

One of the other common arguments you hear from uninformed people outside the USA is the higher infant mortality rates argument.

Here’s an article by Stanford University professor Scott Atlas to explain why the argument fails.

Excerpt:

Virtually every national and international agency involved in statistical assessments of health status, health care, and economic development uses the infant-mortality rate — the number of infants per 1,000 live births who die before reaching the age of one — as a fundamental indicator. America’s high infant-mortality rate has been repeatedly put forth as evidence “proving” the substandard performance of the U.S. health-care system.

[...]n a 2008 study, Joy Lawn estimated that a full three-fourths of the world’s neonatal deaths are counted only through highly unreliable five-yearly retrospective household surveys, instead of being reported at the time by hospitals and health-care professionals, as in the United States. Moreover, the most premature babies — those with the highest likelihood of dying — are the least likely to be recorded in infant and neonatal mortality statistics in other countries. Compounding that difficulty, in other countries the underreporting is greatest for deaths that occur very soon after birth.

[...]The United States strictly adheres to the WHO definition of live birth (any infant “irrespective of the duration of the pregnancy, which . . . breathes or shows any other evidence of life . . . whether or not the umbilical cord has been cut or the placenta is attached”) and uses a strictly implemented linked birth and infant-death data set. On the contrary, many other nations, including highly developed countries in Western Europe, use far less strict definitions, all of which underreport the live births of more fragile infants who soon die. As a consequence, they falsely report more favorable neonatal- and infant-mortality rates.

[...]Neonatal deaths are mainly associated with prematurity and low birth weight. Therefore the fact that the percentage of preterm births in the U.S. is far higher than that in all other OECD countries — 65 percent higher than in Britain, and more than double the rate in Ireland, Finland, and Greece — further undermines the validity of neonatal-mortality comparisons.

You can listen to a podcast with Dr. Atlas here, from the Library of Economics web site.

If you want to read more about how American health care compares with health care in socialized systems, read this article by Stanford University professor of medicine Dr. Scott Atlas. And you can get his book “In Excellent Health: Setting the Record Straight on America’s Health Care” from Amazon.

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New study: NHS patients are 45 percent more likely to die than US health care patients

Wes sent me this article from the UK Telegraph.

Excerpt:

Patients are 45% more likely to die in NHS hospitals than in US ones, according to figures revealing how badly England’s health service compares with those of other countries.

Previously unpublished data collated by Professor Sir Brian Jarman over more than 10 years found NHS mortality rates were among the worst of those in seven developed countries.

A patient in England was five times as likely to die of pneumonia and twice as likely to die of septicaemia compared to similar patients in the US, the leading country in the study, the data suggested.

The elderly were found to be particularly at risk in English hospitals compared with those in the other countries.

The figures showed that the situation had improved since 2004, when the death rate in English hospitals was 58% higher than that in the best performing country.

But NHS institutions still lagged behind in the most recent data, from 2012, despite reforms of the health service and increased funding.

Of the other six countries studied, only the US was named because of the sensitivity of the data.

Prof Sir Brian, who adjusted the data to take account of differences in the countries’ health services, did not initially release his figures because he was so shocked by them he at first assumed there must be a flaw in his methodology.

There was, however, “no means of denying the results,” he said.

“I expected us to do well and was very surprised when we didn’t,” the Imperial College London medic told Channel 4 News.

“If you go to the States, doctors can talk about problems, nurses can raise problems and listen to patient complaints.

“We have a system whereby for written hospital complaints only one in 375 is actually formally investigated. That is absolutely appalling.”

Previously, I had posted a summary of a book by Scott Atlas, a medical doctor at the Hoover Institute at Stanford University. In that article, he laid out the reasons why the U.S. healthcare system was the best in the world.

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Harry Reid: Obamacare is “absolutely” a step towards single payer health care system

Here’s a Forbes magazine article by health care policy expert Avik Roy.

Excerpt: (links removed)

When I speak to conservatives about health care policy, I’m often asked the question: “Do you think that Obamacare is secretly a step toward single-payer health care?” I always explain that, while progressives may want single-payer, I don’t think that Obamacare is deliberately designed to bring about that outcome. Well, yesterday on PBS’ Nevada Week In Review, Senate Majority Leader Harry Reid (D., Nev.) was asked whether his goal was to move Obamacare to a single-payer system. His answer? “Yes, yes. Absolutely, yes.”

In one sense, this isn’t shocking. Reid and many other Democrats, including President Obama, have often stated that their ideal health-care system is one in which the government abolishes the private insurance market. Video of the PBS discussion isn’t yet online, but here’s how Karoun Demirjian of the Las Vegas Sun described it:

Reid said he thinks the country has to “work our way past” insurance-based health care during a Friday night appearance on Vegas PBS’ program “Nevada Week in Review.”

“What we’ve done with Obamacare is have a step in the right direction, but we’re far from having something that’s going to work forever,” Reid said.

When then asked by panelist Steve Sebelius whether he meant ultimately the country would have to have a health care system that abandoned insurance as the means of accessing it, Reid said: “Yes, yes. Absolutely, yes.”

Reid noted that he and other progressives fought hard for a “public option” in the exchanges as a Trojan horse for single-payer, but Democrats didn’t have 60 votes in the Senate to achieve it:

The idea of introducing a single-payer national health care system to the United States, or even just a public option, sent lawmakers into a tizzy back in 2009, when Reid was negotiating the health care bill.

“We had a real good run at the public option … don’t think we didn’t have a tremendous number of people who wanted a single-payer system,” Reid said on the PBS program, recalling how then-Sen. Joe Lieberman’s opposition to the idea of a public option made them abandon the notion and start from scratch.

Eventually, Reid decided the public option was unworkable.

“We had to get a majority of votes,” Reid said. “In fact, we had to get a little extra in the Senate, we have to get 60.”

Do you like the service you get at the Department of Motor Vehicles or the Post Office? How would you like to get your health care the same way? That’s what the Democrats are trying to do. We could have gone in another direction and legislated consumer-focused health care, providing an experience similar to Amazon.com – but we didn’t. We can’t keep electing communists and then acting surprised when they push us towards communism.

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New report exposes NHS socialized medicine as an unmitigated disaster

The UK Telegraph reports on the sorry state of socialist Britain. (H/T Dina)

Excerpt:

Eleven NHS trusts were put into “special measures” after an investigation found thousands of patients died needlessly because of poor care.

The report blamed poor staffing levels and lack of oversight, and said that staff did not address the needs of patients. It concluded the hospitals investigated were “trapped in mediocrity”.

[...]The review, ordered by the Prime Minister, began in February following the public inquiry into the scandal at Mid Staffordshire Hospital Foundation Trust, where up to 1,200 people died amid “appalling” failings in care.

Inspectors visited 21 hospitals, run by 14 NHS trusts, which had the highest recent mortality rates in England. They found that some of the risks to patients were so severe that they were forced to step in immediately.

[...]At Buckinghamshire Healthcare NHS Trust, junior doctors described a “frightening” workload which left them responsible for up to 250 patients at weekends. Elderly patients were left on the lavatory with the door open, while others were left on trolleys for hours on end. At one of the trust’s community hospitals, nurses were forced to call 999 because there were not enough doctors.

At Blackpool Teaching Hospitals Foundation Trust, patients’ families had to feed other patients because nurses were busy while other vulnerable elderly people were left in soiled conditions. At Northern Lincolnshire and Goole NHS Foundation Trust, relatives said they were not only washing and dressing patients but turning them to prevent bed sores. Receptionists were left to take decisions about how quickly patients were seen in A&E, as happened in Mid Staffs.

Sir Bruce said: “For me this is in many ways a difficult day for the NHS — because we are laying bare some truths. On the other hand, the transparency with which this review has been conducted, I hope will be a turning point for the NHS.”

Dirt and dust was found to be “ingrained” on the wards at North Cumbria University Hospitals NHS Trust and two operating theatres were shut immediately due to poor hygiene.

Figures showed up to 13,000 excess deaths since 2005 at the 14 trusts investigated, advisers to the review said.

“No statistics are perfect but mortality rates suggest that since 2005 thousands more people may have died that would normally be expected at the 14 trusts reviewed,” Mr Hunt told the Commons.

At Basildon and Thurrock University Hospitals NHS Foundation Trust, up to 1,600 people more than expected may have died during the period. Inspectors found patients stayed up to two weeks in temporary areas without shower facilities. Others were left in ambulances “stacked” outside A&E departments, or waiting hours on trolleys.

At East Lancashire Hospitals NHS Trust, high numbers of stillbirths at the maternity unit — eight in March — were never investigated, nor reported to the trust’s board. An elderly woman was discharged at 3am and told she had “no choice”, inspectors found.

Patients at George Eliot Hospital waited up to 10 days to see a senior doctor. Nurses were not trained to treat bedsores, leaving patients in crippling pain. At Sherwood Forest Hospital NHS Foundation Trust, inspectors found significant backlogs of scans and X-rays which had never been examined, and complaints which dated back three years.

At Tameside Hospital NHS Foundation Trust, whose chief executive and medical director resigned this month, wards had no doctors in charge at nights, while patients were shifted from ward to ward.

At United Lincolnshire Hospitals NHS Trust there were 12 “never events” — incidents so serious, such as operations on the wrong part of the body, or surgical instruments left inside a patient, that they should never occur — in three years. Patients felt too frightened to complain in case it led to worse care, the report found.

What happened? How is it that UK citizens and businesses pay over half their incomes to the government, and yet the government cannot even provide basic health care for customers?

The missing factor

Let Dr. Walter Williams, professor of economics at George Mason University, explain why the NHS has failed to please their customers:

The NHS is what happens when people repeatedly elect governments that are ignorant of basic economics.

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