Health care for all in California?

Governor Schwarzenegger's plan could prove too ambitious

The issue of universal health care looks set to become a key topic in the run up to next year's US presidential election. With Congress stalled on enacting a nationwide plan, individual states are starting to take matters into their own hands. In California, Governor Arnold Schwarzenegger has just won approval from legislators for a major health-care reform which will expand coverage to most of the state's uninsured.

It took nearly a year of sometimes fractious haggling, but legislators in America's most populous state have done what many predicted they could not. They have approved a bill to extend health insurance to virtually everyone in the nation's most populous state - all 36 million of them. True, the measure has still to be approved by the state Senate and ratified in a popular vote, but it is nonetheless a considerable achievement.

A jubilant Arnold Schwarzenegger emerged to hail the vote a "giant step forward". He believes the un-glamorously titled Health Care Security and Cost Reduction Act could eventually provide a template for the entire nation.

But ironically, the greatest opposition to his plan comes from members of his own party. Republican lawmakers point to California's $14bn deficit as evidence that the so-called Golden State cannot afford such an ambitious measure. Other opponents argue that it will lead to tax increases - from a governor who previously vowed not to raise taxes.

The governor's plan would require all Californians to obtain health insurance by 1 July 2010 - providing subsidies for those who would otherwise have struggled to pay the premiums. It would promote preventive care and also compel insurance companies to spend 85% of those premiums on patients...

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Australia: Government hospital incompetence kills baby

MAREEBA'S model midwife maternity unit's reputation is being seriously questioned after the death of a baby that hospital staff have said "was likely to have been preventable". The death of the baby at the Mareeba Maternity Unit while a 19-year-old woman was in labour has been blamed on a culture of fear, lack of training and a breakdown in procedure by staff. The incident is being investigated by the Health Quality and Complaints Commission, after an internal investigation.

The Cairns Post has obtained copies of Queensland Health's internal reports and memorandums into the May 2007 death. It found the handling of the birth by staff may have "contributed to the baby not being born alive" and described the death as "likely to have been preventable".

The report is a damning assessment of the teenager's care. In it, the nurse unit manager reported that clinical decisions made throughout the episodes of care were a contributing factor and stated "something should have been done sooner". The report also cited an ill-defined model of care, a reluctance of non primary midwives to take responsibility and a lack of managerial leadership, collaboration and communication as a possible contributing factor to the death.

A source told The Cairns Post babies were dying and mothers were being damaged and placed at significant risk of dying with "full acknowledgement and support of Queensland Health management". The whistleblower said Queensland Health was ignoring the situation. "This unit is allowed to continue to function, despite significant safety concerns raised by the staff working at the Mareeba Maternity," they said. "There is a strong culture of bullying and harassment . midwives and other nursing staff who have raised concerns have not been supported or even listened to by management and have been bullied, encourage to leave, from the workplace. "There have been numerous cases of disasters or near disasters that have been brought to Queensland Health management attention with no interim safety measures put in place to protect this community and its mothers."

Cairns and Hinterland Health Service district manager Angela Beckett said a small number of complaints from staff about unsafe working practices formed part of the complaint made to the HQCC being investigated. "Regarding complaints of bullying and harassment, specialist staff from the Workforce Directorate and the Northern Area Health Service have been working with the staff of the Mareeba Maternity Unit to improve communication and relationships and to ensure that the culture within the unit is open and honest," she said. Mrs Beckett said an internal audit of clinical work practices at the maternity unit and the district found there were no concerns about patient safety. "If the district had any concerns about patient safety, the district would not have hesitated to close the unit down," she said.

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