Consumer Power Report Preventive Rationing?

Published October 10, 2011

I’m sure you all recall the story that grabbed headlines from 2009 when the U.S. Preventive Services Task Force (USPSTF) came under fire for suggesting women in their 40s and 50s not get mammograms.

Last week, the USPSTF announced a similar recommendation change for early detection of prostate cancer. The group changed its review from an I (for inconclusive) to a D, indicating the task force believes in discouraging men from being tested for prostate cancer regardless of their background or family history. You can read the draft recommendation here.

Reuters reported:

“Prostate cancer remains the second-leading cause of cancer death in the United States,” Dr. Scott Eggener, a surgeon who specializes in prostate cancer at the University of Chicago, said.

He said while not perfect, PSA screening has definitely saved lives, noting that widespread PSA screening in the United States has resulted in a 30 percent decrease in death rates when adjusted for men’s ages. Several European clinical trials have also shown PSA screening saves lives, Eggener said.

“Put simply, when PSA screening is used, fewer men develop metastatic prostate cancer or die from it,” he said.

The real problem here is the level of power the USPSTF is coming to yield under President Barack Obama’s health care law. As it did in the mammogram case, the task force is making a utilitarian recommendation based on the “greatest good” for the broadest number of people. That’s all well and good ā€“ as long as you’re not outside of that group.

In the context of this argument, Ben Zycher’s latest piece about comparative effectiveness reform CER and other issues applies. It’s not the recommendation that I really dispute ā€“ it’s that it effectively becomes a mandate that overwhelms the ability of individuals to make their own decisions.

New research from the Pacific Research Institute shows that the CER process now being implemented will reduce research and development investment by $10 billion per year. This would yield a loss of 5 million life-years annually.

If we assume $100,000 to be the value of an expected life-year, the economic cost of this reduced medical innovation would be $500 billion per year, a figure substantially greater than the U.S. market for pharmaceuticals, devices and equipment.

The federal government does not have patients. It has interest groups, a reality that allows it to trade patient well-being against larger subsidies for other constituencies.

Moreover, the time horizons of policymakers are short, while the technological fruits of investment in medical innovation lie years in the future. Accordingly, the adverse effects of current policies will emerge during the tenures of future officials.

This is one powerful reason that health care decisions should be made outside the Beltway.

That’s a sentiment we should get behind ā€“ and not just as a matter of principle or messaging, but as a matter of policy.

— Benjamin Domenech



Reuters reports:

U.S. men who have surgery for prostate cancer seem to fare better if they have private insurance rather than public coverage through Medicare or Medicaid, a new study finds.

Researchers determined that among more than 61,000 men who had their prostates removed to treat cancer, those with private insurance had fewer complications from surgery and were less likely to die in the hospital.

Men covered by Medicare or Medicaid were more likely to need a blood transfusion to treat blood loss: almost eight percent and 11 percent, respectively, had a transfusion, compared with just over five percent of men with private insurance.

Their overall risk of surgical complications was also higher, researchers report in the journal Cancer.

After surgery, 13 percent of Medicare patients had a complication, such as heart or breathing problems or incontinence. That compared with just under 10 percent of men with private insurance.

There were similar gaps when the researchers looked at men covered by Medicaid, the government insurance program for the poor: 13 percent had some type of post-surgery complication.

Few men in the study died, but the risk was higher for those on Medicaid, 0.3 percent of whom died in the hospital.



Grace-Marie Turner reacts to Friday’s vague 297-page report from the Institute of Medicine on essential health benefits:

Since the federal government is mandating that people purchase health insurance and will spend trillions of dollars in taxpayer subsidies, it therefore must define what qualifies as an acceptable policy. Deciding what will be in this “essential benefits package” is going to be a long, painful process that the political system is ill-equipped to handle.

The IOM advisory panel didn’t specify down to the level of which tests and procedures must be covered — HHS will do that. Instead, the IOM urged officials to use the benefits offered by a typical small employer plan as the basis for the government plan.

That sounds like a reasonable start, but this is only the first shoe to drop for this particular Obamacare centipede. The IOM recommended that the Obama administration detail by next May which specific benefits should be required in order to give health plans time to prepare for the major rollout of insurance coverage the following year.

This is very new territory in which the federal government — not employers or individuals — will decide what private health plans must cover. The IOM says the treatments should be cost-effective and also “demonstrate meaningful improvement” over current services and treatments — a very high bar. The IOM recommended that if the services don’t meet these and other criteria, they could be excluded from the benefits package. And that, of course, will lead to another level of government rules.

This is just what the American people feared. Of course cost-benefit analyses are important — employers and others buying health insurance make those judgments every time they purchase a policy. But how many of us want the government to decide?

SOURCE: National Review Online


Linda Gorman has a useful report on Medicaid block grants, outlining some key facts about waiver requests and the costs per enrollee.

State and local government Medicaid spending is projected to rise rapidly from $130 billion in 2009 to $357 billion by 2020. Federal Medicaid spending is projected to increase from $254 billion in 2009 to $574 billion by 2020. Total Medicaid spending is expected to rise to $930 billion by 2020 and will account for 20 percent of all U.S. health expenditures.

There are two major reasons for this growth. One is that the federal government matches all state spending on federally allowed Medicaid services. This encourages excess spending. The second reason is the program’s complexity. There are seven specific groups of people that state Medicaid plans must cover, and any combination of nine optional populations states have the option to cover. There are 13 mandatory service categories that must be covered and states can add any combination of 17 optional services.

States can also apply for federal Medicaid waivers that allow them to test policy innovations, to limit enrollees’ choice of individual provider, and to provide long-term care services in a community setting.

Waivers, state spending differences, coverage of mandatory and optional populations and services combine to ensure that no two states have exactly the same Medicaid program. For example, as of July 2007, maximum annual income Medicaid eligibility thresholds for a family of three with one working parent ranged from $3,360 in Louisiana to $47,232 in Minnesota. Medicaid payment rates also vary. In 2001, for example, fees to a physician performing an appendectomy ranged from $160 in New York to $799.87 in Nevada. Thus, the average cost per Medicaid enrollee was $5,163 in 2007, but varied from $3,168 in California to $8,796 in Rhode Island.

SOURCE: National Center For Policy Analysis


This is very depressing news.

At a time when many infectious diseases are making a comeback, about 13% of parents are skipping or delaying their children’s immunizations and following an “alternative” vaccination schedule that puts kids at serious risk, a new study says.

And many parents who follow their pediatricians’ advice have doubts about vaccines’ safety, according to a study in Monday’s Pediatrics. For example, even among parents who fully vaccinate their children, 28% believe that an alternate schedule — which spaces out vaccines to avoid giving several shots at once — is safer, the study says.

Health officials are concerned about the trend. Unvaccinated people have fueled an outbreak of measles, which sickened nearly 200 people in the first eight months of this year, according to the Centers for Disease Control and Prevention. The USA also has battled outbreaks of whooping cough and mumps in the past two years.

The study’s results reflect widespread skepticism and confusion about vaccine safety, fueled partly by a 1998 study in The Lancet linking vaccines to autism that has since been revealed to be fraudulent, says Ari Brown, a doctor and spokeswoman for the American Academy of Pediatrics. “I was stunned at the high number of parents who choose a selective vaccination schedule,” she says. “That number is much higher than the number of parents who do this in my office.”



In Science, Andrew Grove, former CEO of Intel, writes in support of Heartland’s Free to Choose Medicine approach to FDA reform.

The biomedical industry spends over $50 billion per year on research and development and produces some 20 new drugs. One reason for this disappointing output is the byzantine U.S. clinical trial system that requires large numbers of patients. Half of all trials are delayed, 80 to 90% of them because of a shortage of trial participants. Patient limitations also cause large and unpredicted expenses to pharmaceutical and biotech companies as they are forced to tread water. As the industry moves toward biologics and personalized medicine, this limitation will become even greater. A breakthrough in regulation is needed to create a system that does more with fewer patients.

SOURCE: Science Magazine


Avik Roy outlines questions on health care for each candidate. I wish someone would actually ask these! The one for Santorum is particularly good. But here are the ones for the current top three candidates in the RCP average of national polling.

Governor Romney: You’ve repeatedly stated that the individual mandate is needed as a matter of “personal responsibility” so that taxpayers aren’t paying for the care of others. But in Massachusetts, under your plan, the state has reduced uncompensated care by $250 million a year, and increased insurance subsidies by over $800 million a year. Doesn’t that mean that, under your plan, there are more free-riders today than there were before?

Governor Perry: You believe that states could do a better job of running Medicare and Medicaid than Washington does. But Texas has the highest proportion of uninsured residents in the United States. If Washington wasn’t standing in your way, how would you achieve universal coverage in Texas?

Mr. Cain: You haven’t spoken at all about what you would do to rein in Medicare and Medicaid spending. Where do you believe that entitlement reform ranks in terms of priorities for the new President? If you believe it ranks highly, why have you not proposed a single idea to address the problem?

SOURCE: Forbes


Drugmakers fear becoming “captive suppliers” for distressed governments.

When cash-strapped Greece last year told Danish drug maker Novo Nordisk A/S it planned to cut the prices it paid for certain insulins by more than a quarter in an effort to slash its spending, Lars Rebien Sorensen, the company’s chief executive, responded by halting deliveries of the products.

The cut-off lasted a few weeks, until Greece agreed to less-hefty price reductions. Novo Nordisk continued supplying lower-cost insulin to the country throughout, and says the insulin it stopped shipping was never in short supply because Greek pharmacies had reserves.

But the decision didn’t endear Mr. Sorensen to Greeks or pharmaceutical-industry watchers, who blasted the company on blogs and diabetes-themed Web sites, calling the move “brutal blackmail” and a “violation of corporate social responsibility.” Some Novo Nordisk employees also raised concerns, Mr. Sorensen said during a weekend interview in London. Like many companies in Scandinavia, Novo Nordisk says it has a strong commitment to ethics. “How can this be patient-oriented?” he recalls some of his employees asking of the Greek situation.

The 57-year-old Dane says he went to “great lengths” to explain the company’s position, replying to letters of complaint from distressed patients and also interacting with his own employees. Novo Nordisk, he says, cannot be a “captive supplier.”

SOURCE: Wall Street Journal