Obama’s ‘Hope Without Change’ on Health Care Policy
Research shows that spending on health care differs considerably across regions within the United States, with no difference in outcomes. Much of this research has been undertaken within the Medicare program, so that the problem cannot be blamed on lack of government involvement. Moreover, the research shows that differences in spending across regions are accounted for mostly by differences in the amount of services provided, not by price differences.
From a cost-effectiveness standpoint, to paraphrase the old Pogo cartoon, “We have met the enemy and he is us.” Given unlimited access to medical services without having to pay for them, as consumers we will choose procedures with high costs and low benefits.
Consider the following examples of what I call “gray area medicine,” meaning medical procedures that are neither absolutely necessary nor absolutely unnecessary.
On the ABC news program, President Obama mentioned that hip surgery on his terminally ill grandmother was not particularly helpful in retrospect. Yet he would not go so far as to say that such surgery is absolutely unnecessary.
In the United States, beginning at age 50 it is recommended that individuals get a colonoscopy in order to screen for colon cancer, and to repeat this procedure about every five or ten years. This protocol is not absolutely necessary. The cost per life saved may be quite high, perhaps one million dollars or more. In Canada, the budget does not allocate enough equipment and specialists to carry out this protocol. On the other hand, the colonoscopy protocol is not absolutely unnecessary. The scientific evidence strongly supports the efficacy of the protocol for preventing a very common form of cancer.
Consider the case of a young woman with cancer. After one attempt at chemotherapy, the cancer returns. Suppose that the best available treatment at this point costs $100,000 and offers a chance of working of only one in 200. A rational bureaucrat might say that you would have to treat 200 such people to save one life, for a cost of $20 million. But would you be prepared to say that this treatment is absolutely unnecessary? Would you say that if it were your own daughter?
Americans do not want to change the way that they make medical decisions today, and President Obama recognizes that. However, our health care spending decisions create a financial mess, because we are spending each other’s money. President Obama recognizes, too, that this system is unsustainable.
What President Obama does not acknowledge is the fundamental contraction between rhetoric that promises the status quo to individuals while also promising to solve fiscal problems that can only be achieved through reductions in our use of medical services. Politically, this “hope without change” promise is difficult to assail. The internal contradictions will only become evident in later years, when the tough choices have to be faced.
The only part President Obama leaves out when he says you can keep your current healthcare is that you are going to have to pay for the new scheme, whatever it is, whether you keep your old one or not. If you can afford redundant insurance, feel free…
Wha..Whad…Whaddya mean the President can’t have it both ways? Why can’t you just let him play both sides of the fence? He needs to assuage the fearful who may lose their plans and simultaneously whip up fear into those who want coverage (and those Senators/Congressman who need to provide it for them). Moreover, he wants to play the reasonable man insofar as he can rationally deny pain relieving procedures such as the hip replacement in the terminally ill based solely upon cost.
Kling’s point that Obama’s change but keeping the same,if Obama were telling the truth,is a contradicion and doesn’t make sense,is a good one.
But the largest contradiction is in the first quote from Obama: “Medicare and Medicaid are the biggest drivers of the federal deficit by a huge margin.” The government runs both of them and is failing with them big time and has broken its financial promises on both. So,why make both of them several times as big with national health care? This bankrupts Uncle Sam,but what does it solve? Nothing, and brings on a castrophe with national bankruptcy. Obama’s programs–porkulus,cap and trade,nationalizing healthcare are the national bankruptcy bills.
Barack Obama subconsciously wishes to destroy our medical institutions. Moreover, he wants to destroy the country—and then rebuild it to be a socialist paradise. Hard core leftists strive to destroy the existing society. Death supposedly comes before rebirth, the flowering of a an utopian new age. Obama, in his heart of hearts, does not really care about improving our medical situation. It’s merely the means to the end. The ultimate goal is to impose a benevolent dictatorship.
The historical comparison to make with ‘the one’ is Henry VIII and his destruction of the Catholic Church in England for the benefit of his political allies. He was after power, Obama is after power. It is that simple. He will screw anyone, lie about anything and two breaths later deny lying and screwing both, while blaming outside agitators, or the Kulaks, or counter-revolutionary forces, or Bush, or greedy ‘fill-in-the-blanks’. If only the press would turn on him…
It is a trillion dollar bet with 300 million people’s lives, health, and fortunes, rushed through legislation, mostly unread, based on a dubious premise and a something-for-nothing ideology. The further downside is that it puts big government in competition with the free market. Actual “health” is a remotely side issue.
This is actually a pretty good analysis of the problem of the current system thought the examples of what happens suck. The problem is not that some of the procedures only cure one in 200, it is that in some cases there is no evidence there is any difference between doing the procedure and doing nothing. That is why the study of the effectiveness of procedures is one of the keys to controlling healthcare costs. This is one of the initiatives Obama is putting intoplace and one the Republicans are against
By the way – you do not have any control over which plan your company chooses now. Mine seem to change every two years
“If the current system is “unsustainable” how can Obama assure Americans that they can keep the insurance they have?”
He can’t. He’s lying.
But it’s worked just fine for him so far because no one is stopping him. No one is exposing his lies. So….no problem,…I guess.
I won’t believe there’s a single functioning brain on the eastern shores of the Potomac until I see the Articles of Impeachment.
“If the current system is “unsustainable” how can Obama assure Americans that they can keep the insurance they have?”
Obama is correct the current system is unsustainable.
And he is also correct that you can keep the insurance you have.
By putting forth a public plan to compete against private insurers will force costs down. Medicare and the VA are both much more efficient systems and both work pretty well.
And most importantly, ever other industrialized country in the world has some sort of a public plan. And they all deliver the same level of care for half of what we spend.
You guys aren’t afraid of a little competition, are you? And the only thing unsustainable are the costs. How do you propose lowering health care costs?
The Shadow:
“By the way – you do not have any control over which plan your company chooses now.”
Absolutely 100% correct. Your employer controls your health insurance. Including which doctor or hospital you can use.
And your insurer profits immensely by limiting your choices and denying claims.
jharp:
The “You guys aren’t afraid of a little competition” argument is utterly ridiculous. The Federal Government doesn’t compete, it governs. Saying that the Federal Government is going to offer an alternative in a free market system is a complete lie and you know it. As I posted in comments elsewhere, is it difficult to imagine Barney Frank bringing the CEO’s of the biggest private, for profit health insurers in the nation in for “hearings” and then berating them for “abusing the American people and profiteering on the backs of the hard working men & women that make our coutnry great?” Is it that hard to imagine Obama in a “press conference” saying directly into the cameras “Now, as for the insurance companies that don’t want to work with us, that don’t want to lower the cost of insurance to the American people, the companies that profit from the fear mongering of the previous administration and the failed policies of the past 8 years, that take insurance premiums from the hard working people of America, from people just like me & you, I do NOT stand with them.” Then after both of those things have happened, Congress rushes a bill through both houses and the President signs it. The bill is 937pages long and contains legislation that covers 638 different topics. It is rushed through in 3 days with the President and the Democratic led Congress saying “we have to get it passed NOW so that we can enact our 90% tax on the profits of insurance companies. They must not be allowed to profit on the backs of America’s working men & women any longer!”
That’s not competition.
As for “you dont’ have a choice in who your employer chooses.” Feel free to choose which argument below you prefer, they both work:
a – Actually, you do have a choice: Your employer’s option or go buy insurance yourself. My employer doesn’t “control” my health insurance or my doctor or my hospital. They select the insurance options that they are willing to pay a portion of for me. I can choose to pay the rest or to skip their insurance and go buy my own.
OR
b – Neither do Union members. The Union decides on a carrier & everyone in the Union has to go with that carrier, but you never hear unions disparaged the way you hear employers disparaged.
Mr. Kling’s point is valid. Mr. Obama is trying to be all things to all people in this argument.
“Medicare and the VA are both much more efficient systems and both work pretty well.”
Are you kidding? You obviously have no experience with either. The level of care our vets receive is atrocious.
“a – Actually, you do have a choice: Your employer’s option or go buy insurance yourself. My employer doesn’t “control” my health insurance or my doctor or my hospital. They select the insurance options that they are willing to pay a portion of for me. I can choose to pay the rest or to skip their insurance and go buy my own.”
Poppycock. You obviously have never tried to buy insurance or you would be painfully aware that individuals do not have equal access to health insurance.
“b – Neither do Union members. The Union decides on a carrier & everyone in the Union has to go with that carrier, but you never hear unions disparaged the way you hear employers disparaged.”
Th unions do have a choice then.
And the first part of your post is incoherent. The fact is that health insurers have been dragged up in front of Congress and have openly admitted purging their roles of patients after they have become ill and after they have paid premiums for years.
And you are wrong that the federal government doesn’t compete. That is exactly what it does with Medicare and the VA and it is winning. And the public plan is going to compete with the private insurers. Get used to it.
momof3,
No I’m not kidding and you are ill informed if you don’t know of the success of the VA. Take a look at the link. The same level of care we receive for a fraction of the cost. Sorry it’s a pdf so I can’t post excerpts.
http://www.himss.org/foundation/docs/RachelMayo.pdf
And just once. One time I’d like to see a positive suggestion on how to fix our broken health care system.
We rank 37th in quality of care.
And first in cost. By double.
Go for it guys. Obama is willing to listen and adopt ideas than would work.
Instead, every single right wing post is nothing but bashing Obama.
Our broken health care system has gone on long enough. And Obama is going to do something about it. You can either sit on the sidelines and whine, or get off your duffs and offer something constructive.
I wish people would quit using MEDICARE and the VA healthcare system as good examples of well run enterprises. MEDICARE is atrociously run and billions of dollars in the hole now. Wait until the Baby Boomers hit MEDICARE age and find out that MEDICARE comes with free drugs! And the VA healthcare system is hardly an exemplar of efficiency, and is exactly what Obamcare will look like on a large scale. I am happy to pay my private health insurance premium because I know it works. Just as I know from first-hand experience about MEDICARE and the VA system. VERY poor examples.
16. jharp,
How about criminally charging people who make frivolous law-suits against doctors? Cracking down on lame-assed law-suits would cut down health-care costs BIG TIME.
You know what welfare medical coupons did for me when I was growing up? I ended up with every damned molar in my mouth filled by a nazi dentist who wanted to make a ‘buck’ off of the gov’ dime.
THAT is the nightmare of ‘government’ medical.
I’ve lived the nightmare. I know wtf I’m talking about, homey.
This, is who you are defending in refusing to support a plan that competes with health insurers.
The report, released by Health Care for America Now (HCAN), uses data compiled by the American Medical Association to show that 94 percent of the country’s insurance markets are defined as “highly concentrated,” according to Justice Department guidelines. Predictably, that’s led to skyrocketing costs for patients, and monster profits for the big health insurers. Premiums have gone up over the past six years by more than 87 percent, on average, while profits at ten of the largest publicly traded health insurance companies rose 428 percent from 2000 to 2007.
Far from healthy market competition, HCAN describes the situation as “a market failure where a small number of large companies use their concentrated power to control premium levels, benefit packages, and provider payments in the markets they dominate.”
Delia:
16. jharp,
How about criminally charging people who make frivolous law-suits against doctors? Cracking down on lame-assed law-suits would cut down health-care costs BIG TIME
Malpractice lawsuits are about 1% of the costs of our health care.
Still waiting for suggestions.
And for Hotpatch 6, “I am happy to pay my private health insurance premium because I know it works.”
That’s great. And you can keep the coverage you now have under Obama’s plan.
Andy – What a stupid argument. If you pick up a plan yourself you wouls pay an astronomical amount. By selecting the plan, you employer does put parameters around your choice. To argue otherwise is simply wrong.
Mom of 3 – Medicare and the VA system – Are you a vet or over 65?
Delia – Do you know how much law suits add to the cost of healthcare – Please tell me. I bet if you were maimed by a surgeon you would the first one to sue
I had the worst medical and dental EVER by the ‘welfare system’. Do you idiots actually believe 0bamacare is going to be any IMPROVEMENT over that crap sandwich?
We pay for our OWN medical without insurance. We’ve had some catastrophic happenstances and we PAID for them on our OWN.
Just because so many of you LEFTIES are teat suckers doesn’t qualify forcing EVERYONE on some lame assed medical ASSISTANCE.
-And, forcing a new medical ‘regime’ on society is not an ‘improvement’.
Yes, can always use ‘improvement’. Big shocker.
Everything in LIFE could use ‘improvement’. La-la-la.
Using medical crap as a political wedge to socialize medicine is NOT an ‘improvement’.
NADA. Zilch.
-And, expecting someone to dream up a ‘plan’ that is better than what we have is living in a utopian dipshit world of dumbshittery.
How about kick out all of the teat sucking ILLEGALS for one?
THERE’s your IMPROVEMENT!
I missed this.
“Instead, the problem is that Americans make extravagant use of medical procedures with high costs and low benefits.”
Somewhat true. And who is to blame?
And what should be done about it?
24. jharp:
I missed this.
“Instead, the problem is that Americans make extravagant use of medical procedures with high costs and low benefits.”
Somewhat true. And who is to blame?
And what should be done about it?
~
Huh? Oh, you mean ‘Chiropractors’?
Yeah. QUACKS.
“Instead, the problem is that Americans make extravagant use of medical procedures with high costs and low benefits.”
Somewhat true. And who is to blame?
And what should be done about it?
~
Huh? Oh, you mean ‘Chiropractors’?
No. I was quoting Arnold Kling. Why don’t you ask him what he means.
And I’ll answer my own questions. Who is to blame for the problem that Americans make extravagant use of medical procedures with high costs and low benefits.”
Clearly, as clear as can be the blame rests on those who profit immensely from our current system. Hospitals, Big Pharma, Medical device makers, doctors, and health insurers.
And the answer is a single payer system that measures the cost/benefit of health procedures.
Just like every other country in the world does it. And delivers the same level of care for half of what we spend.
Somewhat true. And who is to blame?
The problem with thinking anything is ‘free’ or all-inclusive ‘paid’ is that people suck off the system for every cough and hiccup.
Should healthy people have to pay for unhealthy people?
Look at the pathetic pyramid scheme that is ‘social security’ that is going to collapse on itself? Socialism at it’s stupidest.
Delia:
“The problem with thinking anything is ‘free’ or all-inclusive ‘paid’ is that people suck off the system for every cough and hiccup.”
Nothing is free and co pays offer are the solution that even the dimmest bulbs should realize.
“Should healthy people have to pay for unhealthy people?”
Yes. What do you believe? That we should let them die?
“Look at the pathetic pyramid scheme that is ’social security’ that is going to collapse on itself?”
Social security is a good system. And has worked out very well.
And no offense Delia but I was worried about you the other day when you said you wouldn’t be posting any more. It sounded like you had some mental health issues. And it sounds like it today too. Go get yourself some help.
Delia – I take it you will refuse Medicare and continue to pay for your own insurance when you reach 65
Meanwhile, Mister Tax the soda pops, cigs, booze and twinkies and ding-dongs thinks he can save the world whilst he sneaks a ciggie on the sly and drinks his fancy drinks with the umbrellas in them.
Whatta guy! All hail the MORON.
28. jharp:
“What do you believe? That we should let them die?”
If they want to ‘pay’ and can afford whatever crap they want at age 80 years old then go for it.
Otherwise yes, DIE with dignity rather than having your life dragged out in diapers or on life machines.
I saw my beautiful, wonderful, intellegent, retired teacher grandmother die in an ‘old folks’ home. She didn’t even know who I was.
28. jharp,
You might think you are funny or clever with your ‘get help’ crap but, I’ll give you a pass since I figure you must have some serious issues of your own. I unfortunately had to attend a funeral over the weekend and I’m upset, yes, insane, no.
0bama’s gran-gran got hip surgery before she died.
What say you about that, Jharp?
P.S. Jharp:
You obviously don’t know me here. I’m a perpetual smartass and a ‘drama-queen’ extraordinaire. I do the dramatic ‘exit stage left eveeeeeeeen’ when I’m tired of dealing with trolls like you.
Count yourself flattered. You tuckered me out.
Next time I’ll try to flail about like a fish and do jazz hands to please you [Showgirls movie style].
P.S. Your reply to me was ‘actually’ nice but tainted with lame props on that thread you mentioned.
32. Delia:
“0bama’s gran-gran got hip surgery before she died.
What say you about that, Jharp?”
I say I’m happy that she was able to improve her quality of life in her final years.
And yeah, I’d be willing to pay more taxes to make sure no one is denied something that will improve their quality of life.
P.S. Jharp:
“You obviously don’t know me here. I’m a perpetual smartass and a ‘drama-queen’ extraordinaire. I do the dramatic ‘exit stage left eveeeeeeeen’ when I’m tired of dealing with trolls like you.
Count yourself flattered. You tuckered me out.”
Fine, I understand. I just thought I sensed a hint of decency about you. And you sounded pretty down and I thought I’d offer you advice that would improve your quality of life.
33. jharp:
“And yeah, I’d be willing to pay more taxes to make sure no one is denied something that will improve their quality of life.”
‘Gov’ medicare [sp?] has failed and is going in the tank now too. Gov. funded medical care will leave us with only nazi care [sorry, lived it, know it and have a mouth full of 'fillings' to speak for it]. Doctors [the GOOD ones] will give up or go totally ‘high end’ for ‘customers’ er ‘patients’ who can ‘pay’ regular prices and the ‘nazi docs’ will be the ones ‘others who will ‘service’ the ‘minions’.
The ‘hint of decency’ you ‘get’ from me is perhaps because I grew up poor and fatherless and at one time ended up in a foster home because my mother could not support my sister and I because my mother feared she had uterine cancer and my sister and I cried every night thinking our mother was going to die.
Perhaps the ‘hint of decency’ you ‘get’ from Delia, is that she’s been from hell and back and I could tell you a plethora of harrowing stories about my survival.
Oddly, I was cleaning my office and I glanced at my ‘white board’ and there, written in tiny letters I had written, “2009, I’m still alive.”
Sometimes you just gotta make lemonade. Yaknow?
When the Democrats insist that their plan will help “real Americans” get access to much-needed health care, I’ve always thought Rush Limbaugh’s comment was the most pertinent one: watch what Congress and the President do themselves. If they sign on to the plan, it’s probably pretty good; if not, then their attitude is rather like the Obama’s on the public school system: it’s good enough for *your* kids, but of course his deserve special treatment. Trust me, the way this is playing out, everyone will have the “choice” of an extremely expensive health insurance plan, or the government one, which will be cheap, and provide all the compassion of the IRS, the efficiency of the welfare system, promptness of the Post Office, and the frugality of the Pentagon. When you have headaches, you go to your doctor, and wind up in the hospital with an amputated foot, you won’t be able to sue, and there will be heartwarming stories about how wonderful it is that someone else has a new foot, or something. Sounds idyllic, doesn’t it?
33. jharp,
Having a heart is off-limits.
You must hate my guts!
Mental health? Very funny. Nyuck!
“Mental health? Very funny. Nyuck!”
“Next time I’ll try to flail about like a fish and do jazz hands to please you”
“Mom of 3 – Medicare and the VA system – Are you a vet or over 65?”
No. Every man in my family (on both sides) is either active or a vet though. Not one who has any other option uses VA. And my parents thank their lucky stars they have private retirement health insurance, since their friends who use medicare do not get their level of care.
And f*ck the government if they think they can tell me to just die if I get stage 4 cancer. Some few people survive that, and yes I will use every available treatment option to try and be one of those who do. My life and treatment is my decision, no one else’s. Period.
Anyone who thinks social security is a great plan that’s working our well is not worthy of comment as they are obviously a troll.
As for suggestions, we’ve offered plenty on this topic: stop giving free care (and it is free to them, they pay no taxes) to millions of illegals. Free up insurance and make it look like car insurance-you can buy whereever you want, the level of coverage you want past a small state-mandated minimum, and no plan covers gas and oil changes (regular care like vaccines etc). Insurance should cover the unexpecteds like cancer, not the guaranteed foreseeable expenses like physicals and vaccines. And just like crappy drivers with lots of accidents have to pay more, so too should unhealthy people. That’s life.
“As for suggestions, we’ve offered plenty on this topic: stop giving free care (and it is free to them, they pay no taxes) to millions of illegals.”
So let them die. Good one. And they do pay taxes.
“Free up insurance and make it look like car insurance-you can buy whereever you want”
That’s what Obama is proposing. And one of the choices is a public plan.
“and no plan covers gas and oil changes (regular care like vaccines etc).”
So I guess the poor will just have to tough it out. And never mind those nasty diseases that are contagious (tuberculosis) and can easily spread throughout the population.
“And just like crappy drivers with lots of accidents have to pay more, so too should unhealthy people.”
And what if they can’t afford it, just like we have today. Let them die? And their unhealthy children? Just let them tough it out? A strep infection that can be easily cured with $4 worth of antibiotics and a $50 doctor visit. Sorry but no money no cure. Never mind that the strep can easily kill your children.
Six years ago, the Kaiser Foundation asked a national sample of adults to rate the Medicare program. Medicare was hugely popular among those aged 65 or greater. Eighty percent rated Medicare favorably. Similarly, more than half of seniors (62 percent) considered Medicare “well run” compared to only 28 percent willing to say the same of “private health plans such as PPOs and HMOs that people get through their jobs.”
My daughter, sister and I were almost killed by an uninsured drunk driver. Luckily, ‘we’ had insurance that covered us for ‘uninsured’ a**holes and if we hadn’t had our seatbelts on we would have surely died or been severely disabled for life. [yes, that's a PSA to where your frickin' seatbelts].
We were appointed ‘free’ lawyers [my sister and I]. My lawyer encouraged me to ‘milk’ the system for all it was worth and write a ‘diary’ of my pain and ‘suffering’. I refused. Maybe I was stupid but the fact I walked away from a collision that totalled my car and my daughter, sister and I lived to tell the story, well, I dunno, I thought ‘milking the system’ was the last thing on my mind. I worked out daily after I recovered from the pain [whiplash]. I wore one of those idiotic ‘neck brace’ things for a while but my doctor told me if I wore it for too long my neck would get lazy and rely on it. That scared the crap outta me. So, I took it off [oh c'mon, give me a Forrest Gump moment here] and, my neck hurt so bad but, I managed to fight the pain and hold my head up high. I worked out like a mad-woman on a mission. I refused to be anyone’s ‘victim’. My daughter, being so young, suffered the least.
My sister played the ‘victim’ role and won twice the money I did. She also still suffers from knee problems because she didn’t do physical therapy but rather she went to a ‘Chiro-witch-doctor’.
To this day, lifting my head at certain angles is excruciating. But, surviving a drunk driver in a HUGE truck who shoved our HUGE AMERICAN car under ANOTHER huge truck made me believe in ANGELS.
Was I on topic? The point I was trying to make is that there will be people who ‘milk’ the system and suck it dry.
So then, jharp, you are proposing that no one have any responsibility to pay for their own care? Is medical care the only area in the world that one can demand another’s service for free? I’ve yet to see someone so poor that they couldn’t come up with $20 for a vaccine or $4 for meds. Even bums on the street can afford beer. If they prioritize other things over medical care, why should I care?
How happy are Americans with Private vs Medicare
Indeed, the latest ABC News/Washington Post poll found 62 percent of Americans expressing support for “having the government create a new health insurance plan to compete with private health insurance plans.” Other pollsters describing the public option as “government administered” and “similar to Medicare” gauged even more positive reactions: 67 percent in a Kaiser Family Foundation poll in April and 72 percent in the most recent CBS News/New York Times poll.
So if Americans live in fear of government intrusion into health care, why does likening the public option to Medicare make reform more popular?
Consider some results obtained by the same Kaiser tracking poll. When asked how much they trust various health care players “to put your interests above their own,” respondents rank doctors (78 percent trust “a lot” or “some”) and nurses (74 percent) at the top of the list.
Among those insured through Medicare, however, “the Medicare program” (68 percent) scores nearly as high. Among those with private insurance, “your health insurance company” earns much less trust (48 percent).
momof3:
“So then, jharp, you are proposing that no one have any responsibility to pay for their own care?”
No. Absolutely not and it is foolish for you to suggest so.
“Is medical care the only area in the world that one can demand another’s service for free?”
No. Our national defense. Many that are dirt poor and pay no taxes get it for free.
And only the poor get health care for free. Just as they do today. Obama’s plan guarantees equal access for all American’s with a public option that is open to all.
“I’ve yet to see someone so poor that they couldn’t come up with $20 for a vaccine or $4 for meds.”
Then you haven’t been around much. It happens every day. Think, you bozo, sick children with dirt poor parents who simply wait to see if the kid gets better. And when they don’t they often are running to the emergency room, the most costly treatment, for something that has developed into something much more costly and serious. And we pay the bill. Often hundreds of thousands that could have been treated for $50.
“Even bums on the street can afford beer. If they prioritize other things over medical care, why should I care?”
Because we don’t formulate our health care policy over issues like bums on the street being able to afford beer.
And more importantly it is in all American’s best interest for a healthy America.
Just imagine the bum on the street passing tuberculosis to everyone he encountered. Then everyone he encountered passes it on to everyone they encounter. And so forth.
43. momof3,
Exactly. If we the ‘healthy, hard working, enabled’ pay for all of the ‘douche-bag leeches’ of society, is that really fair?
Meanwhile, dipwad will tax twinkies, Pepsi and donuts.
Morons are running our country now.
YAYYYYYYYYYYY!
Interesting article from the NEJMCMS’s Landmark Decision on CT Colonography — Examining the Relevant Data
Sanket S. Dhruva, M.D., Steve E. Phurrough, M.D., M.P.A., Marcel E. Salive, M.D., M.P.H., and Rita F. Redberg, M.D., M.Sc.
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In an unprecedented endorsement of evidence-based medicine, the Centers for Medicare and Medicaid Services (CMS) recently decided to deny coverage of computed tomographic (CT) colonography for cancer screening, concluding that “the evidence is inadequate.”1 The CMS emphasized that the “pivotal, overarching concern” in its decision was the fact that the findings of trials showing a benefit of screening with this method were not necessarily generalizable from the study populations to other groups of patients. In particular, the CMS noted that the mean age of participants in the studies that were cited in support of coverage was significantly lower than that of Medicare beneficiaries. There were no studies evaluating this technology in the elderly, nor were there analyses of subgroups of participants over 65 years of age.
Does the CMS’s strict application of evidence-based analysis herald a shift in its approach to national coverage decisions? We hope so.
Although it may seem obvious that a new therapy should be shown to benefit patients in the Medicare population before taxpayers pay for it, in practice such proof has often not been required. In 2007, we surveyed 141 clinical trials that the CMS had used as the basis for six decisions regarding coverage of interventions for cardiovascular disease in the past decade.2 We found an age disparity similar to that cited in the decision regarding CT colonography: the mean age of study participants in the cardiovascular trials was 60.1 years — well below the average age of Medicare beneficiaries. As the CMS found with CT colonography, the trials we reviewed largely did not report outcomes according to age group. These findings suggest that many previously approved interventions may lack evidence of benefit in the Medicare population — the group for which U.S. taxpayers are footing the bill. We believe that the CMS’s decision in the CT colonography case, therefore, is a long-overdue step toward meaningful validation of clinical-trial evidence in Medicare beneficiaries.
Our optimism, however, is cautious. Powerful pressure will inevitably be applied to the CMS. Indeed, after the agency published its draft decision in February, proponents of CT colonography, in a now-familiar pattern, quickly mobilized. More than 350 comments were submitted to the CMS by interest groups, many with a financial stake in use of the technology. Radiologist groups and manufacturers of CT equipment, among others, launched a write-in campaign, conducted congressional briefings, and persuaded 56 members of the U.S. House of Representatives to sign letters urging the CMS to reconsider. Advocates for the medical-device industry asserted that the agency lacked the authority to consider data on cost-effectiveness in its decisions. Already at least one representative, Kay Granger (R-TX), has issued a press release expressing the hope that the CMS will reconsider its decision.3
The CMS’s handling of CT colonography is a departure from some of its past decisions. Under similar circumstances 2 years ago, the agency issued a draft decision withdrawing broad coverage of cardiac CT on the grounds that there was insufficient evidence of benefit in the Medicare age group. Medicare contractors had reimbursed for the technology under local coverage rulings since the fall of 2006, after the CMS had initially declined to issue a national coverage decision. When the CMS reopened its consideration of cardiac CT and issued a narrower draft decision memo, it received a flood of letters in protest. (Rather absurdly, proponents of cardiac CT argued, among other things, that the CMS had never before insisted on evidence of benefit, and it would be unfair to discriminate against this particular technology by imposing such a requirement.) In the face of these letters and considerable congressional pressure, and thanks to an internal decision that withdrawing coverage required evidence of harm or lack of benefit, the CMS withdrew the more restrictive draft national decision and issued a final decision that maintained generous local coverage.4 Given this history, we worry that the CMS may waver in the face of the struggle between science and politics.
Indeed, it is worth asking why the CMS has acted differently this time. Perhaps the agency is responding to the current economic reality: with the Medicare hospital insurance trust fund projected to become insolvent by 2017,5 the CMS no doubt recognizes the need to ensure that we are spending Medicare dollars, first and foremost, on improving the lives of Medicare beneficiaries. With Medicare expenditures increasing at an unsustainable pace, the CMS appropriately — indeed, necessarily — considered whether the procedure is effective in its beneficiaries.
Regardless of whether we are confronting an economic crisis, a policy of insisting on data relevant to the Medicare population is commendable and has a broader application. We suggest that in future coverage decisions, other subgroup data should also be considered. Our above-mentioned study revealed that 75% of participants in cardiovascular clinical trials are male, whereas men make up only 42% of the Medicare population. Outcome reporting according to sex occurred in only 18% of trials. Given the sex differences in the safety and effectiveness of medical interventions and the fact that most Medicare beneficiaries are women, it is crucial to have data on risks and benefits in women. Furthermore, only 5% of studies reported data on race, and only 1% stratified results according to race.2 In its decision on CT colonography, the CMS noted in particular the lack of data in black patients, who have an increased rate of death from colon cancer.
These disparities indicate that researchers need to carefully consider the epidemiology of the relevant disease and to ensure that studies are adequately powered to provide meaningful data on discrete subgroups. We hope that this decision by the CMS will spur the enrollment of older patients, women, members of racial minorities, and other poorly studied subgroups and the reporting of subgroup data in more published clinical trials.
Another important fact distinguishes the CMS’s latest decision: screening for colorectal cancer is one of very few procedures for which the CMS is specifically authorized to consider costs. (The Social Security Act grants such authority for colorectal-cancer screening tests, prostate-cancer screening tests, and certain other preventive services.) In our view, given the economic realities facing Medicare, health care reform must include explicit authority for the CMS to consider costs in all its coverage decisions in order to assess the true value of a given procedure. The agency’s examination of value would acknowledge the crucial importance of age-specific data on clinical effectiveness as well as cost-effectiveness in the population for which the CMS is responsible. We applaud this landmark decision, and we hope that the agency remains firm in its evidence-based approach and extends its application as health care reform proceeds.
Dr. Redberg reports serving as a member of the California Technology Assessment Forum. No other potential conflict of interest relevant to this article was reported.
Dr. Redberg served as a member of the Medicare Evidence Development and Coverage Advisory Committee from 2003 through 2006, and Dr. Phurrough was director of the Coverage and Analysis Group at the CMS when the proposed decision on CT colonography was released in February 2009. The opinions expressed in this article are those of the authors and do not necessarily represent the positions of the CMS or the U.S. government.
44. The Shadow,
The best ‘health care’ I get is the health care I pay for in CASH.
I’m sure that will spin your head on its tiny axis but, that’s how it is for me. I PAY IN CASH. I PAY MY MED BILLS IN CASH. I hardly get sick and if I *DO* I PAY MAY FREAKIN’ BILLS!
‘Insurance’ is a joke. If you’re healthy, you’re not going to want it. PERIOD. FORCING people to pay for the dead head, leftist, hippy-boomer-douche-bags that are NOW paying with their health declining for their meth/crack/pot/cigs/booze/STD’s/Skankitude etc. don’t give me any ‘empathy’.
I think you old, nasty, lefty farts should stew in your own juices and suffer YOUR consequences rather than making tax-payers PAY for your ‘boozin’, floozin’, felchin’, herpes’ years.
Sorry, take it like a man, losers. I’m not paying for your herpes meds or your next abortion, lamerz.
Delia:
“The best ‘health care’ I get is the health care I pay for in CASH.
I’m sure that will spin your head on its tiny axis but, that’s how it is for me. I PAY IN CASH. I PAY MY MED BILLS IN CASH. I hardly get sick and if I *DO* I PAY MAY FREAKIN’ BILLS!”
Delia, you are a fool.
What say you if you end up like Terry Schiavo? Or just a little better than her? Unable to work and millions in expenses.
Who picks up the bill for that?
Huh? You no better than the bums on the street. Ignoring taking care of providing proper coverage and instead relying on the government to take care of you.
Good analysis of thepros and cons of the public healthcare option from the economist Brad DeLong
“The economic logic behind a public plan springs from these information and selection problems. Private health-insurance companies are currently spending a fortune in a negative-sum game by which they try to make other private companies and not themselves actually pay for treating sick people. A public plan run by bureaucrats would not face those incentives, and would not waste money in that way. A public plan would, however, have its own inefficiencies: it would be run by bureaucrats, and would waste money in other ways.
Which set of inefficiencies would be greatest? We don’t know. The argument for a public plan is that we should be like the mongoose Rikki-Tikki-Tavi, whose motto is: “run and find out.” We should set up a public plan, let it compete with the privates, and see if it can provide care people like more cheaply than the private insurance companies. Friedrich Hayek would approve: the idea is to use the market as an institutional discovery mechanism.
The arguments against a public plan are two:
It would be able to provide people with better health care more cheaply, and would drive the private-insurance companies out of business, and their executives would lose their jobs and be sad, and their shareholders would lose their money and be sad, and their lobbyists would lose their jobs and be sad, and their tame legislators would lose their campaign contributions and be sad.
Mankiw’s argument that a public plan will inevitably receive large and wasteful federal subsidies no matter what the initial law says.
The exammple Mankiw uses to back up his argument seems to me to be very strange. It is: “Fannie Mae and Freddie Mac, the mortgage giants created by federal law, were once private companies. Yet many investors believed–correctly, as it turned out–that the federal government would stand behind Fannie’s and Freddie’s debts…” and thus provide them with a subsidy.
There is a problem with this argument.
The problem is that in the past year and a half the Federal government has stood behind the debts of not just Fannie and Freddie, but AIG, Bear Stearns, Merrill Lynch, Bank of America, Morgan Stanley, and Goldman Sachs–none of which bear any resemblance whatsoever to a “public plan.” The government has stood behind Fannie and Freddie not because they were, before 1968, public enterprises but because they were–like AIG, Bear Stearns, Merrill Lynch, Bank of America, Morgan Stanley, and Goldman Sachs–too big to fail. The Treasury staff would have loved to have let Fannie and Freddie default on their bonds had they not feared the systemic consequences.
The fact that Mankiw can’t find an example of his argument (2) makes me think that it is very weak, and that the real reason people oppose the public plan is (1).”
mom of 3 – I wonder how many American agree with your opinion “Anyone who thinks social security is a great plan that’s working our well is not worthy of comment as they are obviously a troll.”
According to a survery in 2007, 44% of retired American depend heavily on social security as their major source of income.
The Shadow,
Good posts. And notice the lack of even one intelligent response. They’ve got nothing.
I especially liked Delia who “pays cash for her health care” while relying on the government for catastrophic care. What a hypocrite.
Obama, though he could be more forceful, is handling this beautifully. I can’t see how even someone who is in full blown wingnut state, can muster any reasonable objection to a public plan to compete with the private plans.
And mom of 3 is Palinesque in her complete lack of understanding the subject.
Anyone care to offer a coherent argument against a public plan? A public plan similar to the ones used by the other 29 industrialized countries that deliver the same level of care for 1/2 the cost.
52. jharp:
“I especially liked Delia who “pays cash for her health care” while relying on the government for catastrophic care. What a hypocrite.”
Nice try, nimwad. We *HAVE* had catastrophic health-care happenstances and we HAVE paid for them on OUR OWN.
I don’t want YOU or DOHbama to save my ass. Okay? I’ll even f*cking sign something to abolish any ‘freebies’ from the ‘gov’.
I DO NOT WANT YOUR TAXES so that you can save some lame assed twat who sucks off the gov. teat and smokes crack in the alley.
Nope. No can do.
Get RID OF THE illegal HANGERS ON.
DEPORT them, including, DohBama’s butt fugly illegal auntie.
“According to a survery in 2007, 44% of retired American depend heavily on social security as their major source of income”
And this means it works well? It’s a ponzi scheme, and there are fixing to be too many people getting disbersements (boomers) for the rest of us to support.
That 44% of americans failed to plan one iota for their own fully-foreseeable retirement is another issue entirely, and a pathetic one.
“That 44% of americans failed to plan one iota for their own fully-foreseeable retirement is another issue entirely, and a pathetic one.”
What in the heck are you talking about?
How do you have any idea that anyone failed to plan properly?
There are lot’s of mini Bernie Madoffs out there. And health issues and many things that can wipe people’s savings out.
You are a jackass.
And a personal story for mom of 3.
My fathers good friend, a full wingnut republican who worked his entire life for National City Bank, retired some time ago with almost $1,000,000 of National City stock. It paid a dividend of about $40,000 annually.
Today the stock is worth about $40,000 and pays a dividend of $400 annually.
He is now heavily dependent on social security. Is he one of “the 44% of americans who failed to plan one iota for their own fully-foreseeable retirement”
You are an ignorant fool.
“You are an ignorant fool.”
Perhaps, but a fool that knows better than to put all her retirement eggs in one basket. And who certainly knows better than to rely-or even want to rely-on the government to support me.
“Perhaps, but a fool that knows better than to put all her retirement eggs in one basket.”
He didn’t put all of his eggs in one basket. He gambled because he had social security to fall back on.
And let’s face facts, until a year ago bank stocks were very low risk. Yet quite a bit more risky than social security.
The only thing that makes the story somewhat rewarding is he was a wingnut extraordinaire, backing Bush and the GOP’s deregulation all the way. Now, at age 80, he’s busted.
And I might add, you completely missed the point of my post. Lot’s of folks plan for retirement diligently. And sometimes it doesn’t tuen out the way they had planned.
And yes, you are an ignorant fool.
DEPORT ILLEGAL ALIENS.
STAT!
58. momof3,
You’re forgetting that jharp wishes you had aborted your ’3′ kids to save mommy dearest ‘earth’. Take whatever ‘it’ says with a grain of salt.
jharp truly wishes we were all dead and gone. jharp has the scars to prove it. Right, jharp? Those scars are embarrassing but true huh?
Interesting site.
You can accuse a poster of wanting to kill 3 children.
But use the ef word and you get censored.
Go jump in the lake, Delia.
Jharp’s statement seems to highlight the baseline problem here:
“He didn’t put all of his eggs in one basket. He gambled because he had social security to fall back on.”
I don’t know the point you’re trying to make with that, but it’s either “He was dumb” or “He was dumb like a fox.” I agree on both counts:
He’s dumb: I too have little sympathy to those who put their money into “sure bets” expecting to come out on top. I feel a bit sorry for the ignorant who lost their 401ks, but the bank and mattress methods still work well too.
He’s dumb like a fox: I also believe that people act with more risk when they have some assurance they’ll be taken care of. That is probably the fundamental argument against government provided healthcare.
If government health care is so good, why is there an upsurge of private healthcare facilities in Canada? Folks, Obambi’s healthcare is a matter of control. He has already stated that he and his family will not limit themselves to ‘government coverage’.
“If government health care is so good, why is there an upsurge of private healthcare facilities in Canada?”
Because a combination of private insurance and a public plan are the most efficient systems.
“He has already stated that he and his family will not limit themselves to ‘government coverage’.”
And he has also made it clear than no American will be limited to the “government coverage”.
Geez.
#65. In Canada, people are going to private facilities even though they are basically paying twice, since gov healthcare is tooooooo slow. Obviously Obambi knows that the gov healthcare will not be as good as private care.
62. jharp:
“Go jump in the lake, Delia.”
Awwwww. Ran outta gas, harpy?
The lake actually doesn’t sound that ‘refreshing’ though. All of this ‘global warming’ is freezing my lily white arse off.
#65. In Canada, people are going to private facilities even though they are basically paying twice, since gov healthcare is tooooooo slow.
And American’s are traveling abroad for surgeries since our private system is sooooooo expensive. Except the poor of course, all they get to do is pray to get better.
68. jharp:
“And American’s are traveling abroad for surgeries since our private system is sooooooo expensive. Except the poor of course, all they get to do is pray to get better.”
Huh?
7H47 |}1|}n&|25QU0;7 3v3n M4K3 53n53!
I have heard that Obambi’s health care package is intended to cover non-citizens. That’s code for illegal aliens. Can anyone provide a link to the document?
Paul-Indiana,
Are you talking about ‘FAIR’?
Here’s a link:
http://www.fairus.org/site/News2?page=NewsArticle&id=20785&security=1601&news_iv_ctrl=1721
#71. Thanks, Delia. It’s worse than I thought. “demand” !!!!???