The background noise is loud this week as commentators wait for the Senate’s next move, and a handful of new voices toss in their two cents.
Libertarian economist Tyler Cowen is offering a 14 piece “recipe” of alternatives to the current Democratic legislation. Cowen says “They’re my ‘attempt to work with some of the same moving pieces which are currently on the table’ set of reforms,” and includes: federalizing Medicaid (currently a state/federal program), boost subsidies to medical R&D, expand “retail” clinics and “Make an all-out attempt, comparable to the moon landing effort if need be, to introduce price transparency for medical services.”
Academic Kenneth Thorpe writes on Huffington Post that stopping obesity should be “at the top of the agenda.” Thorpe, who’s been beating the chronic disease drum for awhile, points to a new study that finds 43% of the U.S. population will be consider obese by 2018.
The Atlantic’s Philip K. Howard has a piece urging greater emphasis on eliminating medical waste and enacting liability reform. He includes a cool graphic breaking down waste:
Joe Flower on the Health Care Blog thinks a new perspective is in order to encourage health insurers to spend more time on the long-term health of their enrollees:
Why aren’t health plans more aggressive in promoting the long-term health of their members, like getting them to eat better, stop smoking, get a little exercise, and all that? Because of “churn” … the industry term for the annual percentage of members who leave a health plan, and it can be surprisingly high. If each year 20 percent of a health plan’s members go to some other health plan for whatever reason (they move, lose their job, change employers, get Medicare, find a better deal), then it is not worth it for the health plan to invest in their members’ long-term health. If the health plan invests time and effort (which means money) to get you to quit smoking, and you then quit and become someone else’s customer, they lose that investment – and the other company gains, by getting a customer who is less likely to need expensive long-term treatments. But what if they did not lose that investment? What if your long-term health profile were a corporate asset of your health plan?
Rachael Larimore of Slate’s Double X says that while no health reform legislation has yet passed, the new recommendations governing mammograms “feels like we’re getting the rationing.” She continues, “The panel’s recommendations aren’t that different from the NHS guidelines in Great Britain, where women over age 50 are “invited” to have a mammogram every three years. That should raise a red flag: Women in the United States are more likely than their British counterparts to be diagnosed with breast cancer, but they are also more likely to survive. If the cancer is caught early, the survival rate in the United States is 97 percent, compared with 78 percent in Britain. That sounds like an argument for maintaining our current standards, not reducing them.”
Dr. Susan Love, breast cancer expert and author, definitely disagrees:
Some breast tumors are so slow growing and are so unlikely to spread that they will never do any harm. Others grow and spread very quickly. The idea that they all can be “caught early” is wishful thinking. In fact screening is best at finding the “good ones” that might even disappear if left alone. Remember the reduced the mortality from mammography is 30% not 100%! If early detection always worked, the number of aggressive cancers we see would have gone down as a result of screening. But as a recent article published in the Journal of the American Medical Association made clear, that’s not what has happened.
The goal of breast cancer screening should be this: to find the cancers that have the potential to kill you, so that an intervention is necessary and can make a difference. We need to stop finding the cancers that will never do anything, and stop over-treating women who have them.
And Chris Fleming of Health Affairs gives an overview of the journal’s new issue, which focuses on HIV/AIDS challenges. Articles describe both global and domestic hurdles to treatment, prevention and vaccine development.
Tags: breast cancer, guidelines, health care costs, health insurance, health reform, HIV/AIDS, mammography, senate
