1. The Building of Shrines for Hospital Administrators – buildings constructed out of desire to make a mark rather than out of necessity.
2. Unnecessary Duplication of Services – Often added under the aegis of point one.
3. Absence of Medical Malpractice Tort Reform – as they correctly point out, the real cost is not in insurance expenditure but in excessively defensive medicine. They put the cost of unnecessary investigations, procedures and hospitalisations at up to $200 billion. MacDoctor thinks this is a bit on the low side and probably does not include unneeded follow up visits and unnecessary time expended in obsessive note-taking and quality control initiatives.
4. Need for Hospitals to Be in the Black - Failing hospitals do have a tendency to try to boost their admission rates rather than make their processes more efficient. Most hospitals in the US would improve their bottom lines tremendously if they specialised, rather than tried to offer all services.
5. Decreased Physician Reimbursement Leading to Unnecessary Procedures – I once knew many doctors in South Africa (where the medical insurance rates were kept artificially low) that saw 100-120 patients a day. The vast majority were return visits for colds and flus and similar self-limited diseases. One doctor I knew routinely saw colds every day until their symptoms resolved – rarely less than five visits. Meanwhile back in New Zealand, most A&Ms charge ACC like a wounded bull…
6. Pay-for-Performance Systems – artificial incentives to perform the easiest, most lucrative procedures, leaving the complex work to an ever-decreasing pool of doctors.

Read the whole thing (you may have to register, but it is free). Two observations:

• Mr. Obama’s healthcare package addresses none of these things. In fact, it is obvious that Obamacare will make most of these things (certainly the last four) significantly worse.
• New Zealand has a similar set of problems. We just call them by other names eg.

1. 1. Empire building
   2. Turf protection
   3. Criminalisation of medical malpractice
   4. Need for DHBs to stay within budget
   5. ACC procedures and investigations
   6. Medical Productivity

Do any of these sound familiar?

Related posts:

1. Over My Dead Body
2. Sounds Familiar
3. Obama talks to the Wall

There will be no full-time journalists but the newspaper will accept any free-lance work from former journalists provided it contains at least one approved word in it’s opening sentence. Approved words are “Sex”, “Gay”, “Hot”, “Global Warming”, “John Key”, and “Pussy”. Names of famous people, politicians and double entendres will be considered.

The Herald will retain it’s entire sub-editing staff of three monkeys and a giraffe who will be employed cutting and pasting parliamentary press releases, Associated Press articles and blog posts. This is not anticipated to require much retraining.

The editor will be replaced next year by a gerbil named Cyril, prior to reducing the number of newspaper pages to three. Quality of editorials is unlikely to diminish.

APN expect to achieve their goal of zero pages by mid 2012, in anticipation of the switch to computer bots assembling the Herald website from small fragments of blog posts, mainly from a housewife in Minnesota.

Related posts:

1. Paying Through the News
2. Strange but False
3. Academic Sensationalism

“It’s a bit frustrating for somebody in my job who spends half their time trying to get the media to take seriously the fact that we might be in electricity crisis next year, which nobody is interested in. And suddenly [the media] getting all worked up about what somebody says on a blog which I don’t think is entirely true.”

What a wonderful idea. Criticise the media and the blogger all in the same sentence. Mr. Chauvel has a political acumen only surpassed by Mr Goff.

Free tip: Next time apologise unreservedly and then pleasantly and good-naturedly deflect all approaches by the media to re-ignite the issue.

The silly, trivial affair was not an entire wash-out. We did, in fact, learn three things:

1. That we should never again to take any notice of main stream media when they complain that bloggers are just “parasites”. This year bloggers have supplied the MSM with this item, “Climategate”, Name suppression and a number of other stories/trivia.
2. That Phil Goff has little control over his caucus. Can you imagine Clark allowing one of her MPs to make so many elementary mistakes?
3. That a 30 minute news bulletin will be a blessing. 60 minutes of this sort of crap is exactly 60 minutes too long.

Related posts:

1. Trivial Pursuit
2. Not OK
3. The Shrill of Phil

Obama clearly understands the last-minute nature of the bill as he attempts to place a human face of suffering onto the healthcare scene in the form of cancer sufferer, Natoma Canfield. Canfield wrote to the President worried that her lack of health insurance (which she cancelled due to excessive premiums) would mean that she would lose her house. Fox News has been quick to point out that there is little danger of that happening as Canfield is likely to be entitled to state aid and is eligible for charitable aid from the cancer hospital she attends. Such is the danger of using specific people (as Phil Goff can confirm)

Unfortunately, the underlying problem with Obama’s health care bill is that it will almost certainly drive most doctors to refuse medicaid patients. Already the large drop in medicaid rates has forced many doctors to refuse medicaid. This will only get worse as large numbers of patients eligible for Obama’s plan are patients who would be likely to access more than the average amount of services (people like Natoma Canfield, for instance). This will force medicaid to steadily revise its payments downwards, rather than upwards, leading to a tsunami of doctors refusing these patients. Particularly as these are the sort of patients most likely to sue you.

Picture it. More and more taxpayers dollars being siphoned down the giant healthcare black hole that Obama is creating. Fewer and fewer people actually able to use medicaid to obtain healthcare. Larger and larger co-payments. Fewer and fewer people remaining on private insurances as Obamacare forces up premiums. And Obama will be saving the best for last…

Waiting lists.

Enjoy.

Related posts:

1. Obamacare Wins (Maybe)
2. Over My Dead Body
3. Insurance Claim

1. Cash payments to parents for completing immunisations at 6 months and four years.
2. Cash bonuses to doctors for improving their immunisation uptake
3. Monitoring immunisation targets and having immunisation days
4. Attempted eradication of measles
5. Schools refusing to take un-immunised children

While this worked well in Australia, one has to consider the composition of parents un-vacccinated children. They come in two types.

1. Parents who are genuinely concerned that vaccination is dangerous
2. Parents who couldn’t be arsed to vaccinate their kids.

I postulate that Australia had a great deal of parents in the second category. Unfortunately, I suspect New Zealand has a far smaller portion of parents in category 2 and a much higher spread of parents in category 1. Parents in category 1 are not going to be moved by any financial incentive (seen as “we’ll give you this small amount of money, if you let us poison your children”). They will not be persuaded by GPs with a vested financial interest, nor by nurses with a gung-ho “vaccinate anything that moves” attitude. Schools refusing to take children will just see these parents move their children to private schools or to a home-schooling environment (where, frankly, they will be unlikely to catch the childhood diseases they are not immunised against!). In short, New Zealand is unlikely to see the massive improvement Australia saw and the increase expenditure will be largely wasted.

Note: I have no hard data to support my conclusion, just my general experience. But it would be very advisable for the MoH to run a survey to determine the mix of parents who decline to immunise their children before copying Australia’s effort.

I also have deep concerns about the ethical nature of banning children from creche, primary and secondary schooling on the basis of their immunisation status. That goes for threatening to cut benefits as well. To me, it seems incredibly stupid to seriously harm children’s education and deepen their poverty levels in order to force people to have their children immunised. The consequence will be that those who opt out for conscientious reasons will suffer these harms, since they sincerely believe their children’s health will be seriously harmed by vaccination. These methods are therefore, in my opinion, completely inappropriate, regardless of the numbers of parents in the first category above.

You wouldn’t approve of a doctor who gave a person (of sound mind) an injection against their will. Why should we approve a government that tries the same thing?

Related posts:

1. Attack of the Vaccine Nazis
2. Ethical Jab?
3. Gardasil Update