America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

[LynahFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

If we have all these women with very nasy, involved cancers instead of the little lumpectomy kind the cost of treatment would be significantly higher...

You're painting with a pretty simplified brush here. What's the cost of the test? What's the rate of false positives and negatives? What's the actual incidence rate of breast cancer? What is the actual ratio of cost between a lumpectomy and the more involved kind?

If the test costs, say 1/100th of the later treatment (say, $1,000 vs. $100,000), then you have to catch a case for every 100 tests to make the test "worth it" (from a purely cost point of view). Even if the incidence rate of cancer in the population you're talking about were as high as 1 in 1,000, then 100 tests will, on average, catch only 0.1 cancers (assuming zero false negatives) - so we (as a society) would end up spending 10x as much on testing as we would have on the later treatment. I'm sure these numbers are wrong, but perhaps not unreasonable.

...and the risk of death for those women who would be caught later would be extremely high.

And that's where the value judgement comes in. Is it worth spending the extra money for testing to reduce the death rate of women between 40 and 50? Well, that all depends on how much value we put on a human life.

The deathrate from breast CA dropped correlated to the institution of early mammo (I remember seeing this in nursing school when they showed the graph of deaths from breast CA before and after screening was instituted).

Was that the only factor that changed? Obviously not. Treatments changed, awareness changed, etc, etc. And by how much did the death rate change? And even if it was say, cut in half, did it drop from 1 in 1000 to 1 in 2000 (pretty significant), or from 1 in 500,000 to 1 in a million (pretty insignificant)?

You have to look at the actual numbers involved - not just say "X will get worse or Y will get better." That doesn't mean anything. How much worse? How much better? At what cost?

*And lest you think I'm just being callous, my mother had her first case of breast cancer at age 49, followed by a completely different kind unrelated to the first at age 53. She's since completed 14 marathons and is still going strong at age 65. She found the first lump herself - not via a prescreening mammography.

 

[MattS]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

A point that should be made, as I have heard this commission labelled as Obama's- This commission has been around for years.

As far as I am concerned everything that is Government run/sponsored/funded/etc. is Obama's. He is the head of the Government and it is ultimately his responsibility.


On another note (not directed at leswp)...

I really like it when people argue the rationing of health care for other people down to the simple monetary portion of it.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Lynah, not quoting it all- too long. You are correct. Many things have changed since they started screening early. The point is that the numbers they are presenting are not far off. It isn't as tho it is 1:1400 and 1:5000. There is less than a 1000 person diference. That is small peanuts.

I am too lazy to look up all the stats as I am sure there will be some wonderful journalist somewhere who will do so but with current treatment for breast CA cases that are not caught early the drugs alone for severe cases easily top 100K. Just went to conference this weekend and they were arguing about use of some of the newer drugs that were 60-100K a course. These were drugs used after the first line failed. Don't know the exact math but I betcha that it would take a helluva lot of mammos and lumpectomies to catch up to that.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Every time I've seen teh $1T figure mentioned, it's been for costs over a 10-year period, not annually. Stilll, $10k per person per year is nothing to sneeze at, either.

Actually, its over a 6 year period. In the bill taxes are collected right away, but benefits don't kick in until year 4 which is the only reason why its anywhere near defecit neutral. If they did the analysis for 14 years (10 years of actual benefits) you add another $1T to the cost.

edit: Closer to a $3T 10yr cost in this explanation

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

As far as I am concerned everything that is Government run/sponsored/funded/etc. is Obama's. He is the head of the Government and it is ultimately his responsibility.


On another note (not directed at leswp)...

I really like it when people argue the rationing of health care for other people down to the simple monetary portion of it.

The point is that this panel is a rogue panel that caused problems thru multiple pesidents. I have a hard time having any of them own the decisions of a panel like that. When they made stupid recommendations during the Bush era I didn't ascribe them to Bush and I won't ascribe them to Obama. Now, I might not have a hard time wondering about which insurance companies are involved in influencing their decisions but then I am a cynic in that regard.

The concern for this type of thing is that insurance companies are in it to make money. They are looking for anything that will save them a $ at the current time. The task force is trying to push that the woman can make a choice but if the woman is not financially able then there is no choice if the insurance company has a restricted policy.

I would be much more comfortable with this recommendation if they had a clear cut idea of who is at higher risk other than those with family history. Many women have no known FHX or 'risks' when they are dx'd. There is NO list of agreed upon risk factors yet the task force says that the risks should be weighed before ordering earlier mammos. WHAT risks are they citing?

 

[MattS]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

The point is that this panel is a rogue panel that caused problems thru multiple pesidents. I have a hard time having any of them own the decisions of a panel like that. When they made stupid recommendations during the Bush era I didn't ascribe them to Bush and I won't ascribe them to Obama.

I can't understand this logic at all. You don't like their recommendation, they are a government sponsored panel, and yet you give the Government and the head of Government (whomever it is) a pass? They might be a "rogue" panel (you would know more about that than I) but they certainly shouldn't be one.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I can't understand this logic at all. You don't like their recommendation, they are a government sponsored panel, and yet you give the Government and the head of Government (whomever it is) a pass? They might be a "rogue" panel (you would know more about that than I) but they certainly shouldn't be one.

I am trying to figure out how to explain my view without much success. How is the president, who is not trained in something like this, supposed to micro-manage it. Even if we had an apolitical expert in the White House I am not sure they could get it right because no one knows what right is. It is supposed to be 'evidence based'.

'Evidence based medicine' is something that is fairly recently embraced in terms of the history of medicine (Never heard of it until I was out of school) but the system has potential for flaw. There is a lot of argument regarding the veracity of studies used to garner the 'evidence'. Not surprising as we have many pharm/industry based studies and a dearth of research that is not funded by an interested party. This isn't going to change soon- good research takes time. We just went thru a time that gov't did not place high priority on funding medical research. There were significant cuts/underfunding to a lot of research that would have contributed to making the right decisions about someof these things. I honestly don't know if the funding has been restored. The whole point is to make informed, intelligent decisions regarding recommendations they need enough 'evidence' to do it. No one can agree whther the evidence it OK or not.

 

[Slap Shot]

I am trying to figure out how to explain my view without much success. How is the president, who is not trained in something like this, supposed to micro-manage it.

He's not, but just remember that for many American every failure will be his but none of the successes.

As far as I am concerned everything that is Government run/sponsored/funded/etc. is Obama's. He is the head of the Government and it is ultimately his responsibility.

Just, wow.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

This panel is not run by the gov't. Just heard that clarified.

 

[DrDemento]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Apparently the federal government just announced that they have rescinded any changes in mammography policy that were recommended.

 

[ExileOnDaytonStreet]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Apparently the federal government just announced that they have rescinded any changes in mammography policy that were recommended.

Doesn't seem odd to me.

Why should the feds feel bound to every recommendation they're given, especially when the recommendation is that ridiculous?

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

No- the panel is not a federal panel. Is an independent entity ( this was news to me but I heard a bunch of clarification on NPR today) that the feds do not fund or control. THe HHS lady came out and said the Feds were not changing anything based on this recommendation.

 

[Patman]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Supposedly evidence based medicine but not sure how they figure that.

Depends on how you want to quantify cost and risk*. Now, do we want somebody in washington to decide for it or somebody in the immediate family to decide?

*That's all it comes down to... the cold-hearted scientific analysis of what will yield an optimum solution to somebody's needs and means... probably some consortium of economists (to deal with the math bits) scientists and public policy types. You are left out because we're doing this "for everybody". Typically the insurance company does that to their ends I understand that... but the thing is these things aren't perfect and when the law seeks to restrict the actions of free persons I get worried because they aren't perfect and they won't be fair... and these systems will place mandates of law on people. Remember, to optimize you need control. Eventually the gov't will tell doctors "no you can't do that even if you want to".... right now the doctor can do as he wishes... yes, this would include taking patients on for free... the gov't won't allow that... it doesn't fit their fair system.

These are the people who think with enough effort you can solve or optimize the actions of life and society and that its only proper and moral to do so.

 

[pardonme]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Eventually the gov't will tell doctors "no you can't do that even if you want to".... right now the doctor can do as he wishes...

Do you really think thats true? I think that is an absolutely ridiculous statement. People are still perfectly free to pay for their mammograms themselves, just like you would be perfectly free to buy supplemental insurance policies in the current system, or in any single payer based system that may be established.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Nice post Patman.

 

[ExileOnDaytonStreet]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Depends on how you want to quantify cost and risk*. Now, do we want somebody in washington to decide for it or somebody in the immediate family to decide?

*That's all it comes down to... the cold-hearted scientific analysis of what will yield an optimum solution to somebody's needs and means... probably some consortium of economists (to deal with the math bits) scientists and public policy types. You are left out because we're doing this "for everybody". Typically the insurance company does that to their ends I understand that... but the thing is these things aren't perfect and when the law seeks to restrict the actions of free persons I get worried because they aren't perfect and they won't be fair... and these systems will place mandates of law on people. Remember, to optimize you need control. Eventually the gov't will tell doctors "no you can't do that even if you want to".... right now the doctor can do as he wishes... yes, this would include taking patients on for free... the gov't won't allow that... it doesn't fit their fair system.

These are the people who think with enough effort you can solve or optimize the actions of life and society and that its only proper and moral to do so.

All this talk about personal freedoms being taken away is awfully presumptive. Especially the stuff I underlined. Are those things bad? Of course. Are they inherintly part of every health care referendum? I don't see how you make that assumption, so I don't see how the argument is relevant. Until you see it in the letter of the law, those assumptions don't really hold much water.

It's particularly notable that all of the proposals I've seen revolve primarily around the government getting involved in health insurance as opposed to the actual health care providers themselves. And there's a big difference there. The big spending programs are about providing insurance, not to sponsor government doctors. The supposed "death panels" can only exist on the scale of determining what government coverage would entail, and that is no different from what a private insurance company dictates to its policy holders. It's not as if we haven't heard the horror stories of private insurance companies denying coverage, altering policies and dropping coverage for the sake of cost savings.

As it stands, the status quo of our health care system puts most of the power in the hands of the insurance companies. The doctor's choices are largely limited by what an insurance company will be willing to pay for, and the patient is extremely limited by what procedures and treatments are in their coverage plan. In both cases, the insurers hold the cards, not the doctors- and certainly not the patients.

The things that really stink about the proposed solutions right now are twofold: one is that any effort to mandate insurance for all is completely bogus. THAT is the closest thing we've got to a limit on personal freedoms. The other is that government provided insurance will essentially just be paid for by a pool of taxpayer dollars. When a person on government insurance get's a "free" visit to the doctor, its not that the doctor won't get paid (which you implied, Patman), its that the goverment will pay for it. But that money will have to come from somewhere, and if these plans are "too affordable" (see: negative revenue stream from having lower premiums) then that money will have to come from the deficit. If anything, this provides doctors with an insurance agency (the government) that has no problem paying up, because our government has always had zero problem spending money it doesn't have.

The more I read into this stuff, the more I realize that the solution probably isn't for the government to get directly involved. Strict regulation of the insurance companies is a more appropriate course of action than what we're seeing out of Congress.

 

[joecct]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Is what is before the Congess Constitutional?

Is forcing citizens to either get health insurance or get fined (pay a tax) allowed under the Constitution?

Some will say what about Medicare/Social Security/Medicaid. That is a tax for a service rendered by Uncle Sam. There is no opt in / opt out for wage earners.

But now the Gov'ment is making ME buy a product from a non government entity, and if I don't, I have to pay the Gov'mint? Is it legal?

Wanna make it legal?? - make it a payroll tax for everyone and have the Government run the health insurance business. But that won't fly politically either.

Fight the battle on constitutional grounds. Libertarians (Kepler??) should be aghast at this further encroachment of the government into our lives.

 

[walrus]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

. Libertarians (Kepler??)

TF.

 

[ExileOnDaytonStreet]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Is what is before the Congess Constitutional?

Is forcing citizens to either get health insurance or get fined (pay a tax) allowed under the Constitution?

If health insurance payments comes in the form of taxation... I guess that's legal.

Still shady as hell. I couldn't believe my eyes when I first saw that being reported as part of a bill. Leave it to Pelosi to hijack Health Care reform in the name of lobbyists and special interest...

 

[Foxton]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Is what is before the Congess Constitutional?

That's a good question, perhaps you could give something from the Constitution which it violates? Not that I disagree with the stance that it goes against something, but could you be more specific than just saying it's unconstitutional?

If so do you also propose removing things like requiring auto insurance? Majority of states require that you purchase some kind of insurance and if they catch you without it's big trouble for you.