Massachusetts Health Reform: Rewriting History

On January 31, Shikha Dahlia of the Reason Foundation wrote an op-ed in the Wall Street Journal, "Saying No to Coercive Care". It was great to see someone from Reason Foundation have a swing at the pinata: after all, it was back in November 2004 that Ronald Bailey wrote a feature in Reason Magazine demanding "Mandatory Health Insurance Now!" Anyway, Ms. Dahlia points out that, with costs now anticipated at $400 million, the "reform" is costing 85% more than originally budgeted.

That did not sit well with Jon Kingsdale, the reform's czar (officially, Executive Director of the Commonwealth Health Insurance Connector Authority), who responded in today's WSJ that "the original estimate by the conference committee that wrote the legislation in 2006 pegged it at $725 million" (letter to the editor: "Bay State Insurance is Doing Fine, Thanks"). To be blunt: What is he talking about?

Everyone who has followed the travails of the Massachusetts reform knows that the originally budgeted cost was $125 million from the general fund. Indeed, it's on p. 17 of the health care reform conference committee's report to the House joint caucus, of April 3, 2006, which is at the state's website here - or at least it will be until someone in the Connector bureaucracy reads this blog and makes the report disappear!

The wheels are coming off the Massachusetts health reform - and rewriting its history will not change that.

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Australia: Health watchdogs only interested in paperwork

OFFICIALS did not hear the cries of a dying man during a federal investigation into a fatal disease outbreak at a Melbourne nursing home last year because they never left the facility's office, preferring to check paperwork rather than patients.

Minister for Ageing Justine Elliot yesterday accused the former government of sitting on a report by the Aged Care Commissioner into the Broughton Hall nursing home outbreak for nine months. A summary of the report by Aged Care Commissioner Rhonda Parker, filed in May last year and tabled in parliament yesterday, revealed that departmental staff sent to investigate a gastroenteritis outbreak, which eventually killed five people, checked only the nursing home's paperwork and not its residents.

One nursing home resident, Merson Dunstan, who later died, had cried out for help during a departmental visit to Broughton Hall in April last year. But Ms Parker found his calls were not heard because the staff never left the nursing home's office. The departmental staff cited the need to respect infection control protocols for the failure to check on the physical state of residents.

Ms Elliot promised a strengthening of departmental guidelines in order to prevent a repeat of the mistake. "While it does not bring the matter to a close, I hope it is a step forward for the Dunstan family," she said. "It must have been a frustrating and indeed sad nine months for the Dunstan family, and our thoughts are with them as they face the coroner's investigation."

An Aged Care Standards and Accreditation Agency audit on Broughton Hall following the deaths said staff had not known what to do in the event of an outbreak, which delayed reporting and identification of the disease. It found other problems with staff training and in clinical-care management and evacuation procedures at the home.

Then ageing minister Christopher Pyne released the audit results last year, a month before he received the Aged Care Commissioner's report. He said at the time that the audit showed direct links between the breaches and the five deaths at Broughton Hall. Yesterday, Mr Pyne told parliament he had been grievously misrepresented by the new minister's claim that he had done nothing with Ms Parker's report, saying it had fed into later investigations. "Those parts of the report that were germane to the Department of Health and Ageing, which I was a part of, I asked to be implemented," he said.

Ms Elliot hand-delivered a copy of the Aged Care Commissioner's summary report to the Dunstan family earlier this month, but she said the full report could not be released publicly because of Privacy Act considerations. The Dunstan family said through Ms Elliot's office that they were declining comment on the matter. Ms Elliot said guidelines for nurses investigating clinical care in nursing homes were being revised with the help of state, territory and local health authorities. They would provide more specific pointers on how to identify potential problems, she said.

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