A report by the U.S. Preventive Services Task Force established new guidelines on Monday for breast cancer examinations. The new guidelines are, which are for the general population and not patients deemed high risk for breast cancer, are (http://www.msnbc.msn.com/id/33973665/ns/health-womens_health/):
- Most women in their 40s should not routinely get mammograms.
- Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)
- The value of breast exams by doctors is unknown. And breast self-exams are of no value.
The confusion behind the new guidelines has already created a stir. Even though many in the cancer society are easing back the promotion of self-exams, they are still advocating that mammograms be performed for women earlier than the new guidelines. Dr. Otis Brawley, the society chief medical officer, said in a statement, "This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over." The World Health Organization recommends mammograms are performed every two years after a woman reaches 50 years of age while Britain looks to perform mammograms every three years.
Ask yourself this, why is the U.S. Preventive Services Task Force looking to change the age to start breast cancer detection? One only need to take a look at the current health care reform debate going on in Washington D.C. Part of the reform bill passed by the House; H.R. 3962 http://docs.house.gov/rules/health/111_ahcaa.pdf. An aspect of the bill that was labeled as "Death Panels" by the Right and said not to exist by the Left is indeed what is going on. See Sec. 223. Health Benefits Advisory Committee on page 111 of the H.R. 3962 bill. The U.S. Preventive Services Task Force is just the precursor to the Health Benefits Advisory Committee. The reason why the U.S. Preventive Service Task Force stated for moving the mammograms from age 40 to age 50 is because the research performed showed that screening 1.300 women in their 50's proved to save one life while it took 1,900 women in their 40's to save the same life.
While the change in guidelines only has immediate impact for those women on Medicare and Medicaid it does lay lend insight into what Americans can expect from the Health Benefits Advisory Committee if health care reform is passed in its current form. President Obama claims, repeatedly, that if one likes their insurance they will be able to keep it and that no government bureaucrat will get between the patient and their doctor; really? Isn't the change in guidelines by the U.S. Preventive Services Task Force doing just that? Granted it will, to start with, affect those on Medicare and Medicaid. Americans need to wake up and see what health care reform is really all about; more government control over your lives.
As I have stated several times, health care reform can be achieved without a 2,000 page bill or raising taxes or increasing spending. So, why do our leaders in Congress feel that adding a public option will increase choice and competition to the point that it will achieve the goal of lowering cost and premiums? I still have not seen an answer to this question – on any stage! One argument the Right has been making is that the current health care reform being proposed by the Progressives will lead to rationed care. I ask you, isn't that what the U.S. Preventive Service Task Force is doing with changing the guidelines of mammograms?
Women of America see the change guidelines for mammograms for what it is; a government bureaucrat coming between you and your doctor. Write your member in Congress and the president to voice your opinion on the change in guidelines. For the rest of Americans realize this is just the start if health care reform passes as the government will start decided when and how often other preventive services will be performed; essentially rationing care.
While I don't comment much on your blog, I will chime in.
ReplyDeleteHere's how I see it--and I'm seeing it from the angle of a person who fundraises for an organization every year (Susan G Komen) whose money goes towards education, research and awareness. You know why I choose to fundraise for them--because of Amy. It's because of the research that they've done that Amy's chemo was cut from 8 treatments to 4.
Is there evidence that when a report comes out that insurance companies will change their policy? If so, when and who? Yes, I get it--it's at the time when the Obama Health Reform is on the center stage--but we cannot assume that because this research came about that automatically women have to wait until 50 for a mammogram and their insurance won't pay for it. Yes, I get it--gov't was involved so that means FOR SURE that it will change insurance. But really? Are we SURE? Or just jumping on the "Don't agree to a public option" bandwagon because this major research finding came about?
Do I agree with the age 50 suggestion? Hell no. Do I agree that self exams are worthless? Of course not--that is how MANY cases are found.
While they say that the research points to faulty false positives, why not work on improving the tests, rather than push out the recommended age.
Kelley
ReplyDeleteYou are correct that, and I think I pointed that out in my entry, the change in guidelines will not have an immediate affect on private health care insurers. The point of the entry is to bring to light a concern that many against the public option or exchange have been touting; rationed care.
The change in guidelines will only have an immediate affect on those that rely on Medicare or Medicaid for their health insurance but if the public option is passed through "health care reform" it will have more affect on private insurance. As companies way the cost of coverage versus the penalty for not offering coverage.
The one proclamation made by President Obama was that no government agent will come between you and your doctor, well the change by the U.S. Preventive Service Task Force just did that. Imagine what will take place down the road when the Health Benefits Advisory Board is established!!
This is a warning flag that most media outlets will not raise; rather they will focus on the change in guidelines and sweep under the carpet what is really going on.
I know you are personally connected to this issue with the great work done through the fundraising you do. I agree with finding ways to improve the tests to reduce the false positives; sounds like a great Six Sigma project. The pushing back the age is essentially government agent getting between a decision that should be made by you and your doctor; welcome to the start of rationed care.
This isn't about rationing care, it's about taking out what has been deemed unnecessary screening that could possibly cause more harm than good. It's eliminating wasteful spending. If there is no need to have it done every year starting at 40, why should it be done?
ReplyDeleteThe mortality rate in the United States is 19.1 per 100,000 compared to Britain's 24.3 and Canada's 21.1. Both of the later countries wait until 50 years of age.
ReplyDeleteAs the debate moves forward, I am sure more data will come out. As that data gets vetted, the decision by the U.S. Preventive Services Task Force is rationing care under the guise of saving money. I am all for avoided useless testing for any cancer's or other medical procedures which is why I agree with Kelley that the focus needs to be on the test being given to mitigate the chances of false-positives.
At the end of the day, it is government intrusion into your choice to have the mammogram while opening the door to other "preventative services". If starting tests on women at age 40 is truly unnecessary than why is the U.S. mortality rate lower than Canada and Britain?
Because maybe the treatment for those over 50 is that much better? So from now on, will any recommendations to decrease testing be seen as rationing? It's not an intrusion into the choice, no one is stopping a woman from getting it, but it's about who should pay for what has been deemed unnecessary. Rationing would involve limiting needed care to save costs. Don't forget that this is a recommendation, no rationing has begun by the Task Force.
ReplyDeleteFrom my reading of Kelley's comment, she is not advocating giving the test but improving on the tests we use. The current practice would not allow that.
If the government decided that one only needs one dentist exam a year to have healthy teeth, versus the two that is recommended now, is that rationing or eliminiting soemthing that is not necessary?
Anon - What are you talking about? The U.S. has a better moratility rate than two countries that wait until 50 that we continue to compare health care form to. How is that better?
ReplyDeleteLet's define rationing before moving forward. According to the Webster Dictionary ratioing is "
1 : to supply with or put on rations
2 a : to distribute as rations —often used with out b : to distribute equitably c : to use sparingly
Can we agree that rationing is the balancing of resources, i.e. taxpayer money, to distribute care, i.e. preventative medicine, to those on public run government health care?
I understand that the guidelines are what they are; guidelines. The fact still remains that these guidelines will be implemented into the Medicare and Medicaid programs as well as other insurance programs that recieve government funds.
As for Kelly's response did you miss this part: Do I agree with the age 50 suggestion? Hell no - How does that translate to Kelly not advocating the tests given when a women reaches 40 rather than waiting until 50?
As to your dentist analogy - the answer would be yes to rationing of dentistry if it results in a cut back in benefits to those on a public option or any government run care.
Different Anonymous here:
ReplyDeleteNo offense, the connection you are making is pure delusion. All the panel decided is that by raising the age to 50 for those who are non-risk, lowered the amount of false positive results. Nobody anywhere said that women can't get a mammogram before 50. It really had nothing to do with government run healthcare and like you are suggesting and to say otherwise-I'm sorry is not correct.
I've read three different sources on the issue and not one stated that-am I missing something?
Nutrition, seat-belts, teenagers and alcohol-
Doesn't the government have all sorts of studies and guidelines, basically used to keep them unbiased?
If the study was done by a non-governmental insurance backed panel, would your opinion on the matter change?
As I have commented before, Viper. I know your opinion on single payer healthcare will not change. But your arguments against it are purely symbolic.
Insurers ration care all the time. I would hate to see what my premiums would be if they didn't.
Healthcare debate is driven by scare tactics. Pure and simple. A commisioned government study is a poor example of how government is creeping up into our daily lives.
Thank you for letting me post
New Anon - Thank you for your readership and your willingness to comment. I am listening to Morning Joe right now and Dr. Nancy just stated that the guideline change is rationing of health care.
ReplyDeleteI am not making a symbolic leap nor am I delusional about seeing the bigger picture. You are correct that I do not believe that a single payer healthcare system is good for America. A single payer healthcare system that relies on taxpayer money puts government agency into the mix thus hard choices will need to be made whether to allow you to have your prostrate test or your diabetes insulin.
You are correct that private insurer's are bound by the new guidelines but those that are on Medicare and Medicaid will be affected by the new guidelines. Based on some additional reading I did yesterday in the international realm, I found out that the right age for starting mammograms is still a question for debate while many in the international community believe the manner in which the test is performed does more harm to women.
Perhaps it is time to look more at the test, not just to mitigate the false-positives as Kelley is looking for, to determine if the current process produces additional harm to women. In a study I found in a Helsinki paper said that MIR's are a safer method. I have yet to find out how much the current test costs vs. a MIR.
I know from personal experience that when I last had my knee MIR'd that it cost me, out-of-pocket, $600.
Just to apply a slight correction-you must have been referring to an MRI. Magnetic Resonance Imaging scan.
ReplyDeleteI never mentioned my actual opinion on the mammogram guidelines. I simply do not have the expertise on it, however, I can see women using their doctors and not some government task force to make their breast-health decisions. At least I hope so.
However, I know many doctors in the field right now and they all say that here in the US, with both private and public insurance plans, in industry rations its care. How?
First of all most employer run plans require a pre-approval for surgery. Actually a good idea, really, because I don't want my premiums to go up just because somebody reads to much WebMD.
Second, nobody is approved for any prescription without ensuring that the treatment can't be remedied without an over-the-counter equivalent.
I do not know your situation, but quite simply we all have to live with rationing of healthcare. Basically so that insurers can survive the ridiculous costs that hospitals and clinics pour on them and then pass on to us.
I really don't care what Dr. Nancy says on CNN. I rarely watch cable news. But she's right, and we can add that kind of rationing we do to all of the other kinds.
I would never call you an anti-healthcare reformer. The 8 points you've brought to my attention made a lot of sense. But it is just not enough. We need to scrap Medicare and Medicaid, have just one entitlement that covers basic healthcare for everyone and allow insurers to compete for supplimental insurance. Everyone deserves at least basic healthcare.
Thank you for letting me post
Anon..
ReplyDeleteAhh yes. I meant MRI nice catch. I do recognize that rationing does take place. Currently, Americans have the ability to choose additional or other private insurance programs to get the coverage they need. If we move to a single payer system, which will happen if a public option is put into play, Americans will no longer have that option.
Now I agree that the 8 points I have made in the past are not a cure all for reform but they move us down the path of reform further than either the Senate or House plans. Also, the plan I put forth does not cost American taxpayers a dime nor add to the deficit.
I do agree that Medicare and Medicaid need to be phased out. Entitlement programs should never exist in the United States. We as United States citizens, because of luck of where we are born, are not entitled to anything. Our Constitution does offer us the security that we will be able to pursue our dreams to obtain what ever status, job, or position in society we want regardless of our start in life.
Now I see that Sen. Reid has made public his plan. I will have to take a look at it. I have been sending in my plan for reform to my represntatives and the president on a weekly basis hoping that they will hear the call.
"We as United States citizens, because of luck of where we are born, are not entitled to anything. Our Constitution does offer us the security that we will be able to pursue our dreams to obtain what ever status, job, or position in society we want regardless of our start in life."
ReplyDeleteSo lets just get rid of government then, really.
Everything the government passes is an entitlement to something. Whether you like it or not. Police, fire, education, defense. We pay our hard earned taxpayer dollars to support these entitlements. Usually with good reason.
Now my main arguement doesn't mean I believe that we are all entitled to a new Lexus. Or, a 2-story house. No, that I understand.
If the private sector could provide EVERYONE with basic healthcare, I would be all for it and a champion of free-market principles. However, that just doesn't ever seem to be the case.
Extreme poverty exists in this country wholesale, and it seems to be a little more than a bother to those in conservative circles. Why do those pesky entitlement programs exist?
Probably because the free-market principles fail to connect with those in need. How much is a private plan for a single mother of three working as a temp? I know people personally who usually have $50 left after bills are paid working two jobs. Now, I read articles(I'll try and get them to you later) that say that insurers are squeezing every last penny out of large plans and paying for less care. Hospitals and clinics are charging astronomical amounts for services ($18 baby aspirin, anyone) so that they can recover costs from the ER (the only place that is lawfully required to give care).
I realize that I am not going to convince you differently, but the quote that I copied and pasted from your comment above is my interpretation of symbolism.
The only reason against an entitlement for everyone to get healthcare is just because we live in America, and we just don't do that kind of thing. Here you are on your own, but if you work hard and play your cards right you can get healthcare just like me. That, to me, is pathetic. We act as if nobody in poverty actually works hard and that the "I got mine, forget about everyone else" mentality is really what America is all about.
European leaders learned long ago that providing people with the basics: education, sanitation, police, fire, and healthcare, the free-market will pick up everything else. Check out this article about scientific R&D: http://www.newsweek.com/id/222836/page/1
I realize that you don't agree, and I am sure that you will revisit the healthcare debate on this blog again, so if you don't want to respond to this thread I can understand
Thank you for letting me post
Anon..
ReplyDeleteI was not able to get your article to work. I will try dropping a few things at the end of the string and see if it works. In the meantime, I agree that Government's role is to provide basic security to ensure we are able to pursue our dreams in America.
You example of baby aspirin is prime to the debate on health care. The reason why hospitals have to charge as much as they do it because of government entitlement programs that undercut their abilities to meet their costs of services and medication.
Not to long ago the Mayo Clinic reported that they lost ~$800M due to servicing Medicare patients. Now, where do you think they are going to recoup those costs? They raise the prices on services to the rest of us with private health insurance. The Mayo Clinic is a beckon, both nationally and internationally, of cutting edge medicine. Imagine what would happen to their abilities to provide the type of elite service if all their patients were on Medicare, Medicaid, or public option. The quality of care would diminish, the expertise of doctors would evaporate, and the Mayo would become a county hospital.
The free-market would provide a viable option for those less fortunate if we did a few of the steps I outlined. The first is the eilimination of the anti-trust exemption health insurance providers enjoy. Second is to allow health insurance to be sold between states without restriction. The increase in options (supply) while keeping the demand relatively even (only 10% Americans are without health insurance for one reason or another) thus driving down the price of premiums. This is what boggles my mind why our educated political class cannot see the easy fixes to health care reform.
After that is in place then we can move onto eliminating pre-existing conditions exemption, tort reform, and other aspects of reform. Americans do get basic health care right now. Charities exist to assist people. Communities ensure clean running water and sanitation systems. Hospitals take people in regardless of insurance coverage in time of serious need.
I find it interesting that you bring up the Mayo clinic. The truth is that they actually are limiting Medicare payments for primary care visits only, and only on a trial basis. Like any business, due to the economy the way it is, it needs to make cuts. As for the $800M you quoted, a small portion of that is probably medicare reimbursement. It is actually the loss that the hospital took over the past X number of years, falling right in line with most hospitals in the country.
ReplyDeleteBy contrast, a recent report by the commission that advises Congress on Medicare found that hospitals relying most on Medicare and Medicaid, without a big private-payer base, report per-procedure costs in line with Medicare rates -- suggesting that those hospitals can make do with Medicare payment levels.
Your trumpeting of the Mayo Clinic is right on. However, the Mayo Clinic is non-profit. It relies heavily on donations, fees, investors, etc., to provide the kind of services it gives. Waiting lists to get care are high at Mayo and most of the treatments given are done just as good at your local hospital and even your "gasp" county hospital.
In a single payer system, the supply would be the actual healthcare. I could use any clinic or hospital, and they would all be competing for my business. I want my set-aside money to pay for the healthcare directly, instead of me paying an insurance company that purposely drives up costs to get the heathcare I need and then passes the increased cost back to me.
If we could create a tax-base that funds primary healthcare, we could scrap Medicare and Medicaid, stop the ridiculous practice of negotiations in payments, and provide EVERYONE with basic healthcare. Insurers can now compete for customers in the supplimental healthcare market where they can apply as many rules as they need to for their profits. It's like car insurance, you don't get in accidents, and your rate is decreased. You live a healthy lifestyle, you get cheaper rates.
No Viper, some Americans do not get basic health care. Very few charities exist to cover it, not enough to come close and emergency rooms are way to crowded now to cover those who don't need emergency care.
Anon..nope the loss of $800M is just medicare and not in general or over X # of years. The Trib ran the articlea few months back. I'd have to look up the blog entry that I first noted it on to get the exact date.
ReplyDeleteAnon..If a single payer system exist, your cash has no bearing on the issue. You will not have places competing for your business because their reimbursement rates don't change regardless if you go to the Mayo or to County.
ReplyDeleteThe reason we see less charities assisting is because people have turned to the beast in Washington D.C. for the answer. Congress is stripped away the tax write off many enjoyed for giving to charities too.
Some Americans choose not to purchase health care insurance and should not be forced to either. Health insurance is not a right nor is a requirement like the car insurance argument I hear. The mandate on car insurance is not the same as mandating health care insurance; rather it is an infringement on my right as a free citizen of the United States.
Viper...
ReplyDeleteI don't care what the article says. Judging from the fact that you got it from a newspaper gives me cause to believe that it wasn't factually correct. $800M? Those numbers just don't add up. The Mayo is probably the only hopspital system that can do this while every other hospital in the country would go down the tubes without their Medicare reimbursements.
And congress has not stripped any tax write offs from charities...yet.
Look, you and I can argue forever and we will never agree. But, what I think that you need to see is that your arguments against a single-payer system are symbolic. Your 8 points, as I've said before, make sense but if people who can't afford insurance now probably won't be able to afford it then either. You hate the government so much, so why do you blame them for the problems that were largely caused by insurance companies to begin with?
A single-payer system CAN work here in the US. Your, and other libertarian efforts, to argue against it don't factually add up. Not once on these threads have I seen any real head-scratching "your right" moments. All I read is how the government is terrible, all democratic politicians are stupid and crooked, and that just being born here in the US is such a privilege. The debate really boils down that.
Our government IS bloated. Its inefficient at times, secretive on how it spends our tax money, elections are bought, and can be highly unfair. But if you believe that just a few regulatory efforts will change the healthcare insurance industry-one that spends the most on lobbying efforts by millions-you are delusional.
I do not hate government. I do not like the size to which government has grown and to the extent to which it intrudes into our personal lives. In regards to the Mayo, I did contact them to verify the figure and they agreed the dollar amount reported was accurate.
ReplyDeleteA single-payer system will increase our taxes, ration care, and stiffle medical research and advancement. What medical device company or cancer society is going to want to develop new methods if the government is going to set the market price? Who will want to become a doctor or a nurse as the clinics and hospitals will be forced to offer less pay due to the reimbursement rates under a single-payer plan?
My arguments against a single-payer system are not symbolic but that is a point in the conversation that we will have to agree to disagree on. You say that I blame the goverment for the problems in the health care system. This is partly true. The biggest hurdle any new insurance company or small insurance company has is the anti-trust exemption the industry enjoys. Remove that alone and competition opens up and plans are offered at all strata of income.
OK...and those with no income. Sorry folks, but this society thinks you should be on your own. Just don't get sick.
ReplyDeleteBefore I want to go any further, however, just ask yourself who funds the research for cancer drugs, medical devices, treatments, medical discovery, surgical procedures, scientific discovery and the like?
The government. More specifically the NIH-National Institute of Health.
Billions of your tax money goes to university teaching hospitals, research hospitals, and the private sector to perform all of the medical research and advancement that you talk about. Private industry does medical research too, but remember, they have advertising, payroll, and investors to worry about.
And who must be informed of the new discoveries being made.
The government-more specifically the FDA who spends millions of your tax dollars testing drugs, devices and such so they can be cleared for public use.
Your argument brings up portions of our healthcare society that are actively being paid for by the government. I am talking specifically about basic healthcare, not advanced healthcare, not research.
Hospitals and clinics are the ones who set their prices, not the government. There will be no negotiated discounts like what insurers do.
Like I have stated before-you are not buying into this and I can understand your apprehension. However, if your plan was so good why wasn't it done years ago? We have been living with a crappy healthcare delivery system that is bloated, controlling, and just plain inefficient for some 40 years now. Things just need to change. Stop thinking of this as government intrusion and look at the facts in front of you. A hybrid public/private system is going to happen someday.
This will be my last post on this thread, however, just to point out: Most countries who have the hybrid public/private systems, the private portion is regulated to those 8 points you've made. That is why I think that what you've said makes sense(including the tort reform). Most government public plans can actually cost money to the user if they are employed and choose not to have an employers private plan. For those who are unemployed or very poor, medical coverage is subsidized by the government. So really, the market can dictate who gets the coverage that they need and competition is opened up between private and public plans. Remember, the public plans do not cover as much as the private ones do, so if you are looking for Cadillac healthcare in the public plan, you wont find it. Additionally, there are no negotiated discounts in either of them so reimbursement rates are competitive and profitable for the healthcare facility.
Thank you for letting me post. Thank you for letting me debate and I will respond accordingly on future topics.