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Posts Tagged ‘senate’

Democrats Frustrated By Lieberman

LiebermanIndependent Senator Joseph Lieberman made a splash on Sunday after he announced he would not support a Medicare buy-in compromise intended to gain votes from a handful of moderate senators.  Democratic leaders have been courting Lieberman for months — but he  has not agreed to their terms.

And Democrats are angry. Huffington Post’s Sam Stein reports “More than 80 percent of Democrats say they believe Sen. Joseph Lieberman (I-Conn) should be stripped of his powerful chairmanship in the Senate if he ends up supporting a Republican filibuster of health care reform, according to a new poll.”

A frustrated Ezra Klein is definitely one of the 80 percent:

To put this in context, Lieberman was invited to participate in the process that led to the Medicare buy-in. His opposition would have killed it before liberals invested in the idea. Instead, he skipped the meetings and is forcing liberals to give up yet another compromise. Each time he does that, he increases the chances of the bill’s failure that much more. And if there’s a policy rationale here, it’s not apparent to me, or to others who’ve interviewed him. At this point, Lieberman seems primarily motivated by torturing liberals. That is to say, he seems willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.

Andrew Sprung on Andrew Sullivan’s blog says Lieberman’s announcement means “the Gang of 10’s compromise is dead and that a bill can’t get through the Senate with either a public option or Medicare expansion. Unless Lieberman makes one more grandstanding reversal. Or all of Barack Obama’s courting of [Maine Sen. Olympia] Snowe pays off somehow.  Or Susan Collins has an epiphany. Or someone resigns abruptly and Santa is appointed to the Senate.”

The New Republic’s Jonathan Cohn picks out another reason Lieberman may oppose the compromise: “Lieberman isn’t waiting for CBO or anybody else to weigh in. He says he’s worried that the Medicare buy-in would be the first step towards a single-payer system–and that it would bust the budget. (At least, that’s his latest argument. As Steve Benen has noted, it’s changed a few times.) Ergo, it doesn’t have his support.

But Hot Air’s Ed Morrissey thinks Dems have been naive:

Why did this surprise anyone?  Last Wednesday, Lieberman warned that he couldn’t support a Medicare expansion.  A week ago, he appeared with Susan Collins for both of them to publicly oppose a government-run insurance option, reiterating the same position that he had publicly declared two days before Thanksgiving.

How can this be a “total flip-flop”?  It sounds as if Lieberman’s colleagues have wax stuck in their ears.

The American Spectator’s Philip Klein notes things have just gotten tougher for Majority Leader Reid: “Either Reid will have to pull a new compromise out of his hat like magic or get liberals to accept all of Nelson and Lieberman’s demands, or this thing is going to spill over into next year, and the whole effort may collapse altogether. But before you get too excited, just remember that the media was declaring health care legislation ‘inevitable’ last Tuesday, so we shouldn’t assume it’s doomed today. The story keeps changing.”

Monday, December 14th, 2009

Unanswerable Questions

Many blog eyes are focused on where the action is – the Senate.

The Washington Post’s Ezra Klein gives a preview of “worth-taking-seriously” bipartisan amendments to be offered today by Republican Susan Collins and Democrat Ron Wyden. Klein says the proposed changes are substantive, adding, “If the Senate would turn the bulk of its attention to debating what types of plans should be in the exchanges and how they should be chosen, the debate would be somewhat less interesting, but the eventual bill might be a lot better. Collins and Wyden are taking a stab a doing that, and they deserve plaudits for it.” 

Those amendments are sure to add more pages to the bill.  The 2,000+ page length has been a big complaint from right-leaning commentators since the start. But Capital Gains and Games’ Stan Collender says the length isn’t because of the bill itself — it’s the way law is written, which is far from conversational:

If you’re having trouble getting your mind around this concept, think of it as the difference between the formal way you were taught to speak in school when you were learing a foreign language and how you’re more likely to say the same thing now. In other words, instead of saying:

“Good morning.  I hope you slept well.  What are your plans for the rest of the day?”

You probably say something like:

“What’s up?”

In other words, unless you want to speak like you first Spanish or French teacher, you absolutely need to resist the urge to criticize health care reform because of the number of pages in the draft legislation.

James Capretta disagrees and says health bills are so long “because the authors start from the premise that the federal government has the capacity to centrally plan one-sixth of the American economy from Washington, D.C. That’s the main reason the bill contains scores of new agencies, mountains of regulations, and pages and pages of taxes, mandates, and fees.”

Elsewhere, Worker’s Comp Insider hosts Health Wonk Review, your biweekly compendium of  health policy blogging.

Dana Goldman on the New York Times’ Economix says “Everyone from Michael Moore to Sarah Palin agrees that limiting access to any beneficial care, no matter how cost-ineffective, is unequivocally immoral.” He adds, In the absence of such fundamental reforms, there are worthwhile (albeit smaller) steps we can take to encourage greater consciousness of health care costs. And these steps do not require government panels making health care decisions,” and then offers fixes — including fast-tracking some FDA approvals, legal reform and removing the tax exclusion for health insurance.  Goldman offers fixes to get around the idea of “death panels” — fast-tracking some FDA approvals, legal reform and removing the tax exclusion for health insurance.

And Cato’s Tad DeHaven looks at more reports of Medicare fraud in Miami-Dade county and notes that “the defrauding isn’t sophisticated – it’s just good ole fashioned bribery.”  Apparently the defrauders bribed doctors and others with cash to write false prescriptions and referrals.

Thursday, December 10th, 2009

About That Compromise…

Senate Majority Leader Harry Reid announced a cryptic compromise last night — providing just enough detail to send the blogosphere scrambling to eek out the rest.

Today they’ve unfolded this much — there will be some sort of option for those 55-65 to buy into Medicare, coupled with new national nonprofit plans and a “triggered” public option. The problem? No one seems very happy.

TPMDC’s Brian Beutler reports: “The picture, therefore, is decidedly mixed. Which means, after all this effort, 60 votes remains uncertain. That’s probably why Reid sent an array of options to CBO, and why nobody will know the nittiest, grittiest details of the compromise until it’s unveiled.”  Beutler also rounds up Senators’ comments thus far.

There’s still a ton to figure out – The New Republic’s Jonathan Cohn made a list of 10 wonky policy questions, including who exactly will be allowed into Medicare (all workers? only uninsurable?) and what kind of plan would appear, should it be triggered?

Bob Laszewski thinks Democrats have latched onto Republican ideas in terms of the national nonprofit plan — and he says it will fail: “an out-of-state health plan by definition isn’t going to have a local provider network and will have health care costs that are a lot more expensive than a local plan that does have discounts and managed care protocols negotiated with providers. Well, at least neither side–Democrats or Republicans–have the upper hand on this issue.”

And economist Austin Frakt sees flaws in the proposal to open Medicare to more people: “That is, Medicare for the 55-64 age range will probably only be available to those who meet certain tests of neediness, which is closer to the way it operates for disabled individuals than for the elderly. In effect, Medicare will likely be a dumping ground for bad risks, risks that the insurance industry is happy to transfer to the federal government. This version of Medicare for more will not lead to Medicare for all, it may only lead to Medicare for all bad risks. That’s also why it may pass.”

Heritage’s Conn Carroll thinks the deal “reveals how desperate Reid is” and thinks the process continues to violate Obama’s promises: “When President Barack Obama gave one of his first national health care addresses in June, he instructed Congress: ‘As we move forward on health care reform, it is not sufficient for us simply to add more people to Medicare or Medicaid.’ But after months of debate in Congress, that is all Obamacare has turned out to be.”

And Cato’s Michael Tanner says “No wonder Senator Reid wants to keep it a secret,” and gives “afew reasons to believe this is yet another truly bad idea.”

Wednesday, December 9th, 2009

Foggy Future for Senate Bill

The Senate voted Saturday night to begin debate on its health overhaul bill, leaving liberal bloggers jittery about the bill’s future while conservatives enumerate the many challenges to come.

politifact war and peaceBut first — Politifact deconstructs an email by Sen. Orrin Hatch, R-Utah, where he says the Senate health bill is longer than War and Peace.  Politifact’s take? “So while Hatch is right if you simply count pages, when you use a more accurate comparison — the number of words — War and Peace is actually longer. In other words, he is right by one measurement, but not by the best measurement. So it turns out that Democrats aren’t as wordy as a Russian novelist. Who knew? We find his claim Barely True.”

The New Republic’s Jonthan Cohn surveys the health reform landscape and asks, “Should We Laugh? Cry? Or Both?” He portrays the upcoming weeks as sure to be painful for progressives:

Victories are more likely to come in the form of ground not conceded than ground gained. Every day that legislation doesn’t get worse is a day to cherish.

That may not sound like much to celebrate. But to get a bit of perspective, glance over to the other ideological corner–where the right, and many of its kindred special interests, are going absolutely crazy.

Hot Air’s Ed Morrissey looks at a new Rasmussen poll that finds the lowest level of public support thus far: “The more people see of ObamaCare and the way Nancy Pelosi and Harry Reid have to force it through Congress, the less they like it.  Rasmussen’s latest survey on the legislation shows support for the bill reaching its nadir, 38%, with an 18-point deficit from public opposition,  which is 56%.  It’s the first time in Rasmussen’s surveys of likely voters that support for Barack Obama’s signature agenda item has dropped below 40%.” Rasmussen consistently found lower levels of public support throughout the debate.

Grace-Marie Turner: “The cost of health care is indeed the top issue, and the American people understand that new taxes never will be enough to pay for Reid’s or Pelosi’s reform plans.”  She offers a list of signs that there is “turbulence ahead” including a new public opinion poll and Senators’ statements before the vote.

The Washington Post’s Ezra Klein explains why the vote doesn’t make things eaiser: “During that debate, they will need to call cloture votes in order to amend the bill. After that process is finished, there will be another cloture vote to begin voting on the bill. At this point in the history of the United States Senate, Harry Reid pretty much needs to call a cloture vote before he can sneeze. It’s all cloture votes, all the time. And the fact that Reid won today’s vote doesn’t mean he’ll win tomorrow’s.”

Heritage’s Brian Darling gives an example of how the Senate process could be injected with even more hot political issues: “This process may go in one of two directions. It is possible that Reid uses the amendment process to buy just enough votes to pass the bill through targeted special interest amendments. … Scenario two kicks in if opponents of the bill play hardball. If opposing Senators offer non-germane amendments like the legislation to restore the 2nd Amendment in the District of Columbia or a resolution of disapproval for Attorney General Eric Holder’s decision to try Kahlid Sheik Mohammed in federal courts.”

And Wonk Room’s Igor Volsky made an interesting catch — he finds Sen. Blanche Lincoln, who has pledged to oppose a bill with a public option — in a bit of a bind. Her website says she supports it.

Monday, November 23rd, 2009

New Mammogram Recs Spark Passions Across Spectrum

Although the Senate is poised to hold a key vote to begin debate on its health overhaul bill tomorrow night, bloggers are focused instead on debating the new recommendations from the U.S. Preventative Services Task Force for mammograms and breast self exams.  Commentators are hinting that the new recs could lead to rationing, while others think the public has been poorly informed all along.

Economist Austin Frakt thinks the new recommendations could cause some unintended complications for health practitioners: “My experience suggests that two-year intervals are tricky, and I speculate that behavioral factors could lead to actual intervals that are much longer. … Is it possible that annual screenings are preferable just for behavioral reasons? I think it is at least plausible that the answers are “yes” to both of these. This would seem to be a good topic for behavioral economists. (I know a few…stay tuned.)”

Health journalism booster and critic Gary Schwitzer says people should have been more familiar with the USPSTF, adding “I think journalists have failed badly in explaining this work. …  Since they’re an independent group of experts from across the country, they have no PR machine like the American Cancer Society does. So it’s easy for the ACS to rule the airwaves and the columns when they disagree with something the USPSTF states.”

The Washington Post’s Ezra Klein writes, “Suffice to say, you could hardly imagine a better example of why cost control is so hard: This was a recommendation from an institution with no actual power that was based entirely on accepted medical evidence. Cost was not a component in the analysis. This is simply the data on whether mammograms make sense for most women between 40 and 50, not whether they’re “worth” doing as opposed to other expenditures.”

Hot Air’s Allah Pundit isn’t convinced by arguments that the USPSTF is small and its recommendations are optional and not connected at all to cost: “Beyond that, though, even if the panel’s role is small now, why would anyone trust the feds not to expand it over time as rationing became more urgent to limit costs? Everyone understands that the [health overhaul] program will end up costing vastly more than the early projections indicate; there’s no reason to think that inertia towards growth wouldn’t also apply to agency responsibilities.”

Critical Condition’s Hans Kuttner looks at what the Secretary of Health and Human Services would do with recommendations like this under the House health bill:

The HHS secretary can decide to cover something that is not recommended (e.g., routine mammography for women ages 40 to 49), but she could not decide to take away coverage of something the task force recommended. (Senator Reid’s plan is similar.)

The much more important point is that the HHS secretary would have plenary power to decide what helath insurance must cover. Not just preventive services, but all services. That is the essence of political health insurance and what distinguishes the system of private health insurance we have now from a system of political health insurance.

Heritage’s Edmund Haislmaier agrees, saying that giving more force to these types of recommendations could reshape the system so that the “eventual result will be that the only medical care paid for through private health insurance will be the specific, items and services required by federal regulations promulgated by HHS. At that point, Congress will have effectively nationalized the entire American health insurance system under the supervision of the Secretary of HHS — regardless of whether or not it also sets up yet another government health insurance program in the process.”

Time’s Karen Tumulty reacts to the panels’ recommendation that women not do their own breast self exams, acknowledging her own history with breast cancer scares:

So it would seem I’m the perfect example of a person who shouldn’t have had mammograms, or even examined my own breasts. But am I sorry I’ve had the information I’ve had through mammograms and self-exams? Not for a second.

That’s why I think these scientists are pinheads. Pink ribbons are lovely, but women who want information should have it. And I would remind Swampland readers of the important lesson we all learned from Carly Fiorina. Information is power, ladies, and don’t let some scientific panel tell you it isn’t.

And with new recommendations calling for fewer pap smears out today from the The American College of Obstetricians and Gynecologists, the furor is likely to continue.  NPR’s Scott Hensley asks about the timing of the two reports as the Senate readies to take up its health bill:

“It’s just pure coincidence that these guidelines have been released now,” Dr. David Soper, the Chairman of ACOG’s Gynecology Practice Bulletin Committee, told NPR.

They new guideline has been in the works for years and reflects evolving scientific evidence that shows, for instance, the risks of cervical cancer developing in young women is quite low. Indeed, the vast majority of abnormalities found on Pap tests in very young women clear up on their own.

Friday, November 20th, 2009

Reaction to Senate Bill

The Senate finally released its merged health overhaul bill, sending the blogosphere a specific document to pour over.

The action took off when Democratic staffers announced the Congressional Budget Office’s assessment: $849 billion over ten years, a federal deficit reduction of $127 billion, and coverage for an additional 31 million Americans. Director Douglas Elmendorf offers a brief overview on his blog and is careful to note the uncertainties in some of the estimates.

Here’s what various folks are saying:

Hot Air’s Allah Pundit is very unimpressed, and argues that a CBO score matters only “when it’s bad:”

Another week, another “scoring” of a bill that (a) looks nothing like what it’ll look like in its final form and (b) almost certainly has been crafted to hide certain key costs (a la “doctor fix” in the House bill) to improve its “score.” Realistically, the only time a CBO score matters is when it’s bad: Were this to come in at over $900 billion or be judged a deficit-buster over the long term, it would be rejected for failing to meet the White House’s baseline demands. But this one just makes the cut, so look for the obligatory back-pat in this weekend’s presidential message about it being a “fine starting point” or an “encouraging beginning” or whatever. Reid managed to come up with a bill that isn’t too expensive … for Barack Obama. Congratulations.

The New Republic’s Jonathan Cohn compares the Senate’s offering with the House-passed bill.  Cohn seems cautiously optimistic, although he admits it’s “worse than the House:”

But, again, the Senate was never going to pass the House bill. Realistically, the question going forward was whether Majority Leader Harry Reid was going to be able to improve what came out of the Senate Finance Committee–and move it closer to what the Senate Health, Educaiton, Labor, and Pensions Committee produced. And there it seems pretty clear that he did, mostly. The early consensus among experts (and, again, this is pending further analysis) is that the new Senate bill boosts financial support for people purchasing health insurance. And, of course, it has a public insurance plan.

It’s not huge progress. But given the political pull to the right from conservative Democrats and independent Joe Lieberman, any progress is an accomplishment. And Reid clearly deserves credit for that.

The Washington Monthly’s Steve Benen thinks some Democratic holdouts should be satisfied: “it’s worth taking a moment to remember that center-right Democrats, who’ve been complaining about this initiative all year, have very little to complain about right now. Indeed, they should be thrilled — Senate Majority Leader Harry Reid (D-Nev.) has put together a reform package custom made to give the so-called “moderates” just about everything they said they wanted.”

Jacob Goldstein of the WSJ’s Health Blog lists the key tax provisions in the Senate bill, which include a tax on high-end health insurance plans and an increase in the payroll tax for high-income earners.

Insure Blog’s Henry Stern is nonplussed with the bill’s estimated savings: “That bears repeating: if (and that’s a big if) it really meets expectations, Sen Reid’s baby will cut, over 10 years, the equivalent of one month’s deficit. Color me underwhelmed.” (Italics/bold Stern’s).

The Washington Post’s Ezra Klein disagrees, looking at the bill’s cost provisions in the three decades following its passage.  “In the second decade, however, …savings from Medicare and Medicaid, paired with the excise tax (which CBO says “is effectively a reduction in the existing tax expenditure for health insurance premiums”) and a handful of other changes, leaves the government spending no more on health care than it otherwise planned to. That’s impressive stuff. And it implies, of course, that in the third decade, the federal commitment actually goes down relative to expectation. The curve, as they say, is bent.”  Klein goes on to argue that getting these cost controls in the bill was part of a “grand bargain” that would not have passed without coverage expansions.

Critical Condition’s Kathryn Jean Lopez posts a message from the National Right to Life Committee on the bill’s abortion provisions.  The anti abortion group says: “Regrettably but predictably, Reid rejected the bipartisan Stupak-Pitts language.  Instead, Reid has sought to please the militant minority that demands funding of abortion through federal programs, even though substantial majorities of Americans believe that abortion should be excluded from government-funded and government-sponsored health programs.”

Amy Allina of Raising Women’s Voices takes a look at the abortion provisions from the other side of the issue:

Senator Reid rejected the calls of antichoice activists to add the House-passed ban on abortion coverage in the exchange.  For the most part, the Senate bill confirms current law on access to abortion, as the Senate Finance bill did.  To respond to the concerns of antichoice Democrats, Reid’s bill spells out more specific accounting guidelines for the segregation of public and private funds to ensure that no federal money would be used to pay for abortion care.  It would allow insurers to offer abortion coverage to women in the exchange, including women who choose the public option if the Secretary of HHS ensures that federal money is not being used to pay for the services.  It also confirms that states would be allowed to pay for abortion services on their own, if the federal government decided not to include them in the public option.

Wonk Room’s Igor Volsky made a table comparing the House and Senate bills, saying, “The merged Senate legislation has lower affordability standards, covers less people, invests less in prevention, does not require all large employers to provide health insurance, and includes a weaker public option. But the bill goes further in controlling health care spending and reducing the deficit.”

And you can always follow the action on Twitter.  A selection of this morning’s many thousands of tweets below.

tweets

Thursday, November 19th, 2009

Senate CBO Score Expected This Afternoon

http://www.kaiserhealthnews.org/Cartoons/Senate.aspx

Citizens of the blogosphere are twiddling  their  thumbs waiting for the Congressional Budget Office to release a final score of the Senate health overhaul bill, which many expect when Majority Leader Reid meets with the Democratic Caucus at 5 p.m. today.  In the meantime, many can’t resist guessing the outcome.

Perhaps in preparation for today’s release, Former Speaker Newt Gingrich, R-Ga., sent a letter to Speaker Pelosi, Majority Leader Reid and President Obama. Gingrich and his 50 cosigners ask the Democratic leaders to “slow down…open up…don’t break the bank.” Critical Condition’s Tevi Troy has the letter (pdf), saying “it’s worth a read.”

The Washington Post’s Ezra Klein says, contrary to claims from some Republicans that they will repeal a health reform bill if elected in 2012, “There’s just not much precedent for changes in partisan power ending in the repeal of large pieces of recently passed legislation. In part, that’s due to the nature of the Senate: Repeal requires 60 votes as surely as passage.”

Wonk Room’s Igor Volksy (who includes a shot of Reid praying) rounds up the latest rumors on how the Senate may rush to pass the bill:

Democrats are also indicating that they may “short-circuit the legislative process” to pass health care reform by December 18th, the last day Congress is in session. “The most talked about method is end running the formal conference committee process in favor of some sort of mini-conference. Democratic officials in the White House and Congress are envisioning an end game similar to the way the $787 billion stimulus package came together with congressional leaders and White House aides hashing out the differences behind closed doors.”

The New Republic’s Suzy Khimm reports on another piece of the soon-to-come bill.  According to Khimm, “Amid all the concern about subsidy levels in health care reform comes word that Senate Majority Leader Harry Reid is, in fact, going to boost the financial assistance available to Americans buying health insurance. The problem? It’s not the group who needs help the most–and it may come at the expense of those who do.”  Reid is expected to lower the maximum percent of income for middle-income earners and raises the percent of income spent on insurance for low-income earners.

Commentators on the right are likely to have their frustration piqued even more — Heritage’s Brian Darling explains objections to even beginning debate:  “The bottom line is that Senators will be voting to proceed to a bill on Friday that they have yet to see and will have little time to read before the first critical vote. Sadly, the secretive procedure used to roll out this legislation has severely restricted the rights of Americans to participate in this process.”

And in other news, Conservative columnist Ross Douthat uses his new blog on the New York Times’ site (where his column runs) to put in his two cents on the health bills: “That means that 10 years and hundreds of billions into health care reform, two-thirds of the uninsured will have coverage — but the remainder, 18 million strong, will be paying more and getting exactly nothing in return. We’ll be effectively taxing a third of the uninsured to cover the rest. Liberals, of course, will say this just proves that we just need to spend billions more on subsidies. But I say that it makes Tyler Cowen’s alternative approach seem vastly more attractive.”

Wednesday, November 18th, 2009

Waiting On The Senate

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.

Tuesday, November 17th, 2009

On Taxes, Filibusters and The Simpsons

Bloggers have been speculating what Senate Majority Leader Harry Reid is up to, in terms of health bills, and over the possibility of a filibuster.

The Associated Press broke the news this morning that Reid is considering higher payroll taxes on those making more than $250,000 per year. Jacob Goldstein reacts on the The Wall Street Journal’s Health Blog that “Whatever Reid settles on, his bill could be significantly amended once it reaches the Senate floor. And if the Senate does pass a bill, it will have to be reconciled with the House bill. And the House has very different ideas about how to pay for health care — the House bill has a new tax on individuals with incomes over $500,000 and families with incomes over $1 million, and no tax on high-value health insurance plans.”

Bob Laszewski gives high praise to another idea floating around the Senate – an independent commission to control health costs– “the best health care idea all year.” 

The New Republic’s Suzy Khimm explains we could be waiting a while for a bill from the Senate, where “it’s likely to be a much longer slog. Due to differences between House and Senate rules, there’s plenty on the Senate side that could delay the bill for weeks, or even months, prompting Senate Majority Leader Harry Reid to announce that the final bill won’t pass until Christmas, at the earliest.” Khimm gives an overview of the variables setting the schedule.

Time’s Karen Tumulty notes, “things get exponentially more complicated in the Senate. There the ideological balance among Democrats is closer than in the liberal House, and the rules allow amendments that could send the bill in almost any direction. Most crucially, it will take a supermajority of 60 votes — exactly the number Reid has in his Democratic caucus — to progress in the face of a GOP filibuster.”

 
Elsewhere, Louise Norris of Colorado Health Insurance Insider hosts a Simpsons-themed Health Wonk Review, a biweekly roundup of health policy blogging.

Thursday, November 12th, 2009