When Opportunity Is the Best Birth Control
I was talking with a friend this morning who is a social worker at a large Brooklyn high school. She told me that of the 12 girls she’s seen regularly this year for counseling and group sessions, four of them are currently pregnant. Some of the other ones already have babies or toddlers; others have had abortions in the past. Pretty much everyone at this high school knows someone who has been pregnant or already has a child.
This was especially surprising to me because I read this week that the nation’s teen birthrate actually dropped by 17% between 2007 and 2010 to 34.3 births per 1,000, the lowest rate ever recorded. How could there be such great dissonance between the fact that in New York State, teen birthrates have dropped 13% over that period and my friend’s first-hand experience with her students?
Of course I’ve been around health statistics long enough to know that anecdotal evidence often has little to do with larger-scale trends or findings. Take the case of mammography and its contribution to saving women’s lives: when I wrote about the wealth of evidence pointing out that yearly mammograms for women under 50 actually has little impact on reducing breast cancer mortality but does increase the rate of false positives and over-treatment, I received phone calls and emails from plenty of women whose own experience told them otherwise. “My life was saved by a mammogram that caught my cancer before it could spread,” a close family friend argued. “I don’t believe these studies and I think what you’re writing is dangerous.” Read more…
Prostate cancer is all over the news these days.
First Warren Buffett, 81, announced to his Berkshire Hathaway shareholders that after a routine PSA test, followed by a surgical biopsy, he had been diagnosed with early-stage prostate cancer and planned to undergo a two-month course of radiation therapy.
This announcement immediately set off controversy as prostate cancer experts weighed in on Buffet’s case and bemoaned the precedent it sets. In 2008, the United States Preventive Services Task Force (USPSTF) and other medical organizations began discouraging men over age 75, and their doctors, from using the PSA test. Although it can detect silent prostate cancer, the false positive rate is high and the vast majority of these older men would die of something else in the 10 to 20 years that it would generally take for the cancer to even cause clinical symptoms.
Meanwhile, as Marc B. Garnick, professor of medicine at Harvard Medical School and a prostate cancer expert writes on the Harvard Health Blog, “Buffett’s PSA test set off a disastrous chain of events that will probably do the legendary money manager more harm than good.” Immediate side effects of radiation treatment, writes Garnick, include fatigue and bowel problems; “Over the long term, about 50% to 70% of men lose the ability to get or sustain an erection or experience rectal bleeding.” The better choice is clearly “watchful waiting”—close surveillance and treatment only when and if the cancer progresses.
Now it turns out that Buffet is far from an outlier among men over 75 who, despite recommendations to the contrary, are still getting routine PSA tests. In a research letter published today in the Journal of the American Medical Association, we discover that “Despite the USPSTF recommendation against prostate cancer screening in men aged 75 years or older in 2008, PSA screening rates did not change [in 2010].” In fact, among men 75 and older, some 43% were getting screened in 2008 vs. 44% two years later. This is higher even than the 33% of men aged 50-59 who are getting routinely screened.
In case patients and doctors haven’t kept up with the evidence, here are the undisputed facts about PSA screening and men over 75: The USPSTF gives the test a D-rating and the American Cancer Society holds that “men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening.” Or as Richard Albin , one of the discoverers of PSA wrote in a 2010 op-ed piece for The New York Times, “men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.” Finally, all evidence to date has failed to demonstrate that prostate screening actually decreases mortality.
This is not news. Ablin’s op-ed two years ago noted that 30 million American men were getting the test every year at a cost of $3 billion, much of it paid by Medicare and the Veteran’s Administration. “The test’s popularity,” he wrote, “has led to a hugely expensive public health disaster.” Read more…
ALEC, “Shadowy Group” Behind State Efforts To Sabotage Health Reform Faces Heat From IRS
Last August I wrote an in-depth piece about the American Legislative Exchange Council (ALEC), “a powerful but ‘discreet group’ that counts some 2,000 conservative state legislators as well as representatives from some of the nation’s largest industries as members.” The focus of that post was the prominent role ALEC has taken in organizing state-level resistance to the health reform law. The Council drafted model legislation entitled the “Freedom of Choice in Health Care Act” that has served as the basis for laws passed by eight states (including Virginia, Idaho, and Arizona) and has been “introduced or announced” in 42 others. This law would block any state or federal “public option,” bar the individual mandate and obviate other major provisions of the Affordable Care Act. According to the Council, the mission of ALEC’s health and human services care task force is to promote “free-market, pro-patient health care reforms at the state level.”
Today, Common Cause, a political watchdog group, filed a complaint with the Internal Revenue Service accusing the American Legislative Exchange Council of violating its tax-exempt status by lobbying state legislators. The Council, which is registered as a public charity under section 501(c)(3) of the tax code, recently made headlines because of its support of gun-rights bills similar to the “Stand Your Ground” statute at the center of the Trayvon Martin killing in Florida; advancing laws that weaken labor unions; and support for tougher voter registration rules. Most recently, ALEC has been under scrutiny for its intensive lobbying efforts to convince state legislators to oppose legislation that would make it easier to recover money from businesses that defraud the state.
The New York Times reported yesterday that documents and records obtained by an investigation by the paper and Common Cause “offer a glimpse of how special interests effectively turn ALEC’s lawmaker members into stealth lobbyists, providing them with talking points, signaling how they should vote and collaborating on bills affecting hundreds of issues like school vouchers and tobacco taxes.
“The documents — hundreds of pages of minutes of private meetings, member e-mail alerts and correspondence — were obtained by the watchdog group Common Cause and shared with The New York Times. Common Cause, which said it got some of the documents from a whistle-blower and others from public record requests in state legislatures, is using the files to support an Internal Revenue Service complaint asserting that ALEC has abused its tax-exempt status, something ALEC denies.”
In my piece I explain how as part of their campaign against the Affordable Care Act, ALEC published “The State Legislators Guide to Repealing ObamaCare”, which urges lawmakers to “decline to build the ObamaCare edifice” and offers 14 practical steps states can take to undo or impede the Affordable Care Act. These steps include having states return federal grants for setting up health insurance exchanges, encouraging them to opt completely out of Medicaid, and urging them to file federal waiver petitions to block the medical loss ratio requirement (the new rule requiring insurers to spend 80-85% of premiums on patient care). At that time I wrote, “The last time the states were rallied to rise up against federal legislation was during the civil rights battle over forced integration of schools.” Read more…
Anatomy of Another ACA Lie
By John McDonough
(This post originally appeared on the blog Health Stew)
Lots of folks ask me why I think the Affordable Care Act/ObamaCare is so unpopular. I first assert that it’s not as unpopular as popularly characterized (see Kaiser Family Foundation monthly tracking polls) and then I refer to the deliberate and false claims about the law being widely circulated around the nation, particularly aimed at senior citizens. I wrote about one particular falsehood last month. Now, my newfound pals at the GE Retirees Association yesterday sent me another they have been receiving in their email inboxes:
Subject: Medicare Premiums —FYI
MEDICARE
Look clearly at the 2014 rate compared to the 2013 rate.For those of you who are on Medicare, read the following. It’s short, but important and you probably haven’t heard about it in the Mainstream News:
“The per person Medicare Insurance Premium will increase from the present Monthly Fee of $96.40, rising to:
$104.20 in 2012
$120.20 in 2013
And
$247.00 in 2014.”
These are Provisions incorporated in the Obamacare Legislation, purposely delayed so as not to confuse the 2012 Re-Election Campaigns. Send this to all Seniors that you know, so they will know who’s throwing them under the bus.
Peggy Riehle
Internal Representative
Network Contracting
205-220-6778
Could I verify or contradict the message, my GE Retiree friends wanted to know. Didn’t sound right to me, so I did some investigating. My contacts in the Obama Administration and the U.S. Senate said it’s a viral email lie that has been going around for more than one year now. Independently, FactCheck.org did their own investigation last year of these claims, and here is their conclusion: Read more…
Is the High Cost of Cancer Care Really “Worth It”?
The U.S. spends far more on cancer care than 10 European countries, but according to a new study, it may be “worth it” as “the value of the survival gains greatly outweighed the costs.”
The study, published this week in Health Affairs, found that U.S. spending on cancer care, in 2010 dollars, increased by 49% from 1983 through 1999, from $47,000 per cancer case to $70,000 per case. Meanwhile, in the European countries, spending on cancer care (also in 2010 US dollars) increased 16% from $38,000 per cancer case to $44,000. But the sharp increase in cost seems to come with clear benefits; for patients diagnosed with cancer between 1995 and 1999, average survival from time of diagnosis in the U.S. was 11.1 years, while in Europe it was 9.3 years. These gains were greatest in patients with prostate and breast cancer, as well as chronic and acute myeloid leukemia.
At first glance, this study, which was partially funded by cancer-drug maker Bristol-Myers Squibb, should give ammunition to those stalwarts who continue to insist that America’s health care is the very best that money can buy—at least when it comes to cancer. But despite the findings that the “value of survival” far outweighs the skyrocketing financial costs of cancer care (the National Cancer Institute puts it at $125 billion in 2010)—many questions remain.
First of all, the Health Affairs authors do note some limitations of the study; for example, even though the results suggest that survival gains for U.S. cancer patients have been “worth it” in terms of cost, “this does not imply that all treatments are cost-effective. Additionally, we could not examine the extent to which better outcomes were the result of earlier diagnosis due to screening or newer treatments,” they write. I would add, the data analyzed are more than a decade old—cancer treatments and diagnostic technologies have changed both in cost and efficacy since then. How do we factor in the “value” of a brand new $90,000 cancer drug that keeps a small percentage of very sick patients alive for at most two or three more months?
There are other problems with reading too much into this report. Read more…
On Predictions, the Supreme Court and the Health Law
Last week’s coverage of oral arguments before the Supreme Court debating the constitutionality of the health reform law was like the Super Bowl for health policy types. But instead of being glued to my computer screen, parsing the Justices’ questions and the lawyers’ answers and reading the flood of game-day analysis following each two-hour session, I unthinkingly had made plans to go hiking, mountain biking and rappelling down 180-foot cliffs in the spectacular and isolated environs of Moab, UT.
Instead of witnessing live theater, I read as much as I co
uld before setting off in the morning or before falling asleep that night. And I talked to pretty much anyone I ran into about how they felt about the new health law and how it would impact their lives. Mostly, I learned that for the many young, uninsured people who worked two or three jobs to survive in that town, health reform offered the chance for affordable health coverage. As removed as I was from the doings in Washington, media coverage began to feel like breathless conjecture; the fate of the health law seemed to vacillate widely with every pointed question from one of the justices or a poor performance by the Solicitor General. I am not a constitutional scholar, nor am I an economist. But now, back in New York and a week removed from the reporting frenzy and after digesting commentary by both knowledgeable experts and political hacks (and those in between) the emphasis has shifted to the ramifications of the Supreme Court’s eventual ruling. I will expand on some of these issues in future posts, but first I want to address the science and politics of predictions.
1) On Monday, President Obama said of the health law, “We are confident that this will be upheld because it should be upheld,” adding firmly: “It’s constitutional.” He also warned that an “unelected” group of justices should not overrule the will of Congress. That is tough talk; perhaps the right kind of talk to set the tone for the next few months while the Supreme Court considers the legislation. Nancy Pelosi is also on board: Last week she told reporters, “I have no idea. None of us does,” when asked how the Supreme Court would rule on the health law. But on Tuesday she also expressed this new confidence, telling an audience at The Paley Center for Media, “Me, I’m predicting 6-3 in favor.”
But is the administration’s confidence realistic? I turn to some stalwarts; the legal scholars and policy wonks who have insisted for nearly two years that the constitutional challenge is legally unsupportable. Have they changed their tunes at all? Read more…
How did the challenge to the Affordable Care Act ever make it to the U.S. Supreme Court?
By Maggie Mahar
(This post originally appeared on the blog healthinsurance.org)
In 2009, when someone asked Nancy Pelosi a question implying that health reform legislation might be unconstitutional, she replied: “Are you serious?”
Pelosi wasn’t alone. At the outset, many legal scholars considered the challenge to the Affordable Care Act (ACA) both “implausible” and “frivolous.”
But over the next two years, the notion that state courts might strike down the ACA took on a life of its own. Most people had only a hazy idea of what was actually in the legislation; nevertheless the idea of “health reform” inspired heated rhetoric. Soon, state attorneys general and governors responded to the political opportunities, banding together to make what Slate Senior Editor Dahlia Lithwick calls, “novel arguments in the form of what was always a constitutional Hail Mary pass … It’s no accident that until the lower district courts started striking down the act, none of the challengers really believed that they could succeed.”
Yet somehow, this week, the highest court in the land is hearing oral arguments in a case that even supporters viewed as a long shot. How did this happen?
The media played a major role, fanning political passions by quoting every challenge – including the absurd claim that the bill called for “death panels.” As Rachel Maddow observed Monday night: this case was “built up as the Super Bowl of American partisan politics.” Thus, the Supreme Court was left with little choice: it had to hear “The Case of the Century.” Read more…
Efforts to repeal the Independent Payment Advisory Board (IPAB) have intensified over the last few weeks, culminating in two House committees passing a repeal bill and clearing the way for a floor vote next week. This newly aggressive effort to deep-six IPAB— a 15-person independent commission whose job, starting in 2014, is to advise Congress on how to slow Medicare cost growth—is reigniting charges of rationing, death panels and “pulling the plug on Granny.”
The repeal effort, for an advisory board whose function may be limited if Medicare cost growth continues to abate, seems timed for maximum political effect; highlighting a provision of the Affordable Care Act that conservatives use as the poster child for government over-reach and collateral damage to seniors.
Here’s an excerpt from a video series called “Ask Peter” released by Rep. Peter Roskam (R-IL) that “educates” his local constituents about IPAB:
“In a nutshell, it’s 15 unelected bureaucrats who have one job and that is to push cost out of Medicare. While that sounds nice, it will have a direct impact on reimbursement rates which will ultimately impact how doctors practice medicine.
“There was an expert on IPAB that came in and testified before a Committee that I was present, and he said this: IPAB will absolutely restrict a doctor’s ability to administer healthcare. And he went on to say that IPAB will lead to rationed care.”
It’s clearly necessary to revisit the real facts about IPAB and shed some light on Pete’s and his fellow scaremongers’ rationing charges:
1) IPAB’s cost-cutting recommendation process isn’t triggered unless Medicare spending grows faster than the gross domestic product (GDP) plus 1 percent. As Sarah Kliff explains in Ezra Klein’s WonkBlog, “For a while, keeping Medicare cost growth to GDP plus 1 percent was thought to be absurd. Medicare cost growth vastly outstripped the rest of the economy.” But in the last two years, she writes, “health-care costs have grown more slowly than any other point in the past five decades. They rose 3.8 percent in 2009 and 3.9 percent in 2010.” The GDP, meanwhile, grew at 4.2%.
2) The board, which will include health policy experts and consumer representatives, has no authority to limit Medicare benefits; for example, it can’t force Medicare to stop paying for cancer drugs or cut off life-saving treatments to the elderly.
