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May 11, 2012

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…

May 1, 2012

What Women Have to Gain (or Lose) In the Battle Over Health Reform

By Maggie Mahar

(This post is excerpted from a series that originally appeared on Healthinsurance.org)

When Vice President Joe Biden told President Barack Obama that health reform is a BFD, he wasn’t kidding—especially for women. Currently, state law decides what insurers have to cover. Under the Affordable Care Act, federal law will call for equal benefits in all states.

The male body has long been considered the “standard” for health care coverage. Having a woman’s body is seen as an expensive anomaly, and women pay dearly for being different. When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women.

Take maternity care: In the 41 states where such benefits are not mandated, a 30-year-old woman will find that only 6 percent of plans in the individual market now offer coverage. Guess how expensive those plans are? Under the ACA, maternity care will be considered an “essential benefit” that all insurers selling policies to individuals and small businesses must cover, without charging extra, beginning in 2014.

Some argue that charging women more for insurance is only fair: after all, a woman could become pregnant, and labor and delivery are costly.

But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released last month by the National Women’s Law Center. In 36 states, “92 percent of best-selling plans charge 40-year-old women more than 40-year-old men,” the Center reports, and “only 3 percent of these plans cover maternity services … One plan in South Dakota charges a woman $1252.80 more a year than a 40-year-old man for the same coverage.”

Today, less than half of American women can obtain affordable insurance through a job, which explains why millions buy their own insurance in the individual market. In that market, just 14 states ban gender rating:  California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington. Read more…

April 25, 2012

On Prostate Cancer Screening, Warren Buffett and Ignoring Science

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…

April 23, 2012

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…

April 18, 2012

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

Blue Cross Blue Shield.jpg

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…

April 11, 2012

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…

April 5, 2012

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 could 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…

April 2, 2012

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…

March 20, 2012

Without Individual Mandate, Obama and Insurers Will Call For Overturn of Key Coverage Provisions

It’s great that so many Americans across the political spectrum support two of the most important provisions of the health reform law. According to the latest poll from the Kaiser Family Foundation, 70% feel favorably about guaranteed issue—the part of the Affordable Care Act that prevents insurers from rejecting individuals or businesses because of age, sex, occupation or health status. Americans also support the idea of using community rating when setting insurance premiums; meaning that older people, women or those with chronic illness or pre-existing conditions shouldn’t have to pay more for their coverage.

It’s just too bad that these could be the first consumer protections to go if the Supreme Court overturns the Affordable Care Act’s individual mandate. That’s because, as Uwe Reinhardt, an economics professor at Princeton points out, “The aim is to create a risk pool in which younger and healthier enrollees subsidize through their community-rated premiums the health care of older or sicker individuals.” Otherwise, people wait until they are sick to buy insurance, quickly using up all the resources of a plan they haven’t contributed to when they were healthy. This inevitably drives up premiums for everyone. The ACA without an individual insurance mandate says Reinhardt, “is about as sensible as the idea of manufacturing two-legged stools.”

Americans haven’t grasped that connection; most consumers still believe that all the things they like about health reform—such as keeping their children on their health plans until they are 26, free preventive care, no lifetime limits on coverage and the promise of subsidies to help lower income people afford insurance—will still be available without the mandate. In fact, the Kaiser poll found that two thirds say they continue to have an “unfavorable view of the individual mandate, including 54 percent who take a ‘very unfavorable’ (up from 43 percent last November)” opinion of the provision.

How do we know that insurer coverage mandates won’t work without an accompanying mandate for all Americans to buy insurance? Just take a look at what Ian Millhiser, a policy analyst at the Center for American Progress calls “Seven Horror Stories” from states that already tried to implement community rating without a requirement that everyone purchase insurance:

  • Kentucky: Forty insurers left Kentucky’s market by some estimates, and only two remained before the law was repealed
  • Maine: Thirteen of Maine’s 18 major insurance carriers stopped issuing new individual policies. Many also doubled their premiums
  • New Hampshire: New Hampshire’s insurance law left it with nearly no carriers in its individual insurance market. The state enacted an emergency tax to compensate insurers for the costs of the law, which was repealed in 2002
  • New Jersey: Premiums rose as much as 350 percent in New Jersey after its pre-existing conditions law took effect. Even HMO plans, which tend to resist premium increases, nearly doubled in price
  • New York: The percentage of nonelderly New Yorkers without insurance grew 21 percent, with premiums increasing as much as 40 percent per year.
  • Vermont: Vermont fared better than other states with similar laws, but its premiums spiked an average of 16 percent in two years.
  • Washington: Nonmanaged care options disappeared entirely from Washington’s individual market. Eventually, entire counties had no private individual insurance options at all.

(source: Center for American Progress )

Insurers are already working on contingency plans if the Supreme Court finds the individual mandate unconstitutional. According to the Wall Street Journal;

“Several officials from large health insurers said that if the mandate were struck down, their first priority would be persuading members of Congress to repeal two of the law’s major insurance changes: a requirement to cover everyone regardless of his or her medical history, and limits on how much insurers can vary premiums based on age. The next step, they say, would be to set rewards for people who purchase insurance voluntarily and sanction those who don’t.”

Insurers are also likely to lobby for an end to restrictions on gender rating; i.e. charging women more than men for insurance coverage. According to a new report from the National Women’s Law Center,  in the 37 states that haven’t already banned this practice, 92% of best-selling plans charge women more for coverage. These excess charges vary between states and even between policies in the same state. For example, one plan offered in Arkansas charges 25-year-old women 81% more than men for coverage while another plan in the same state charges women only 10% more for coverage. The Affordable Care Act would prohibit gender rating; a practice that the NWLC report estimates costs women $1 billion a year.

The Obama administration agrees with insurers on the economic ramifications of the Supreme Court striking down the individual mandate. It has filed a brief arguing that if this happens, the requirement that insurers cover everyone who applies and that they use community rating should be overturned.

Despite the contingency plans, many legal and health policy experts believe they will be unnecessary—at least for now. “Most of us who supported the individual responsibility provisions feel the court is going to sustain [the individual mandate],” Ron Pollack, executive director of Families USA tells Kaiser Health News. “There’s no urgent need to define an alternative course at this point.”

March 16, 2012

IPAB Repeal: Does the Health Law Still Need A Cost Savings Board?

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.

Read more…