CSNbbs

The left's focus in their bid to take over health care was never the quality of care. They would focus on access and on costs but never how good the care was.

And it's no surprise. Saying things like "In the United States we have some of the best cancer survival rates in the world" might hurt a cause who's tag line became "you have to pass the bill to know what's in the bill".

Well here is one of the first, but certainly not the last, of the government making healthcare "more efficient" by making it less effective.

http://nypost.com/2015/11/24/obamas-new-...ar-on-men/

Quote:If you’re at risk of prostate cancer — in other words, if you’re male — the best place to be is the United States, where survival rates are highest in the world. But not for long, if the Obama administration gets its way in curtailing a test that flags prostate cancer before it spreads.

The administration wants to penalize doctors who routinely order the PSA blood test. Under a proposed policy, those doctors will get demerits for being considered over-spenders, while doctors who skip the test will be rewarded with a high “quality” rating from the government — and be paid more.

...

The task force — 16 government appointees — tried to argue that the test does more harm than good. Some men with high PSA scores undergo retests and biopsies only to find out they don’t have cancer. Or they endure the side effects of radiation and surgery even though their cancer is slow-growing and not life-threatening.

The task force claims the test’s “harms” outweigh the “benefits.” Not so fast. Of course it’s distressing to get a call that you need to get retested because of a high PSA score, but that “harm” is nothing compared to being told you have cancer that could’ve been caught and stopped years earlier.

...

In truth, the Obama administration is more concerned with cutting care than preventing cancer deaths. Guided by that warped philosophy, the task force told women in their 40s not to get mammograms, and advised women 50 and over to settle for a mammogram every two years, instead of annually.

The task force’s crass calculation was that 1,900 women in their 40s have to be screened to save one life. Not worth it, they said.

Fortunately, cancer physicians and patient-advocacy groups rebelled against that nickel-and-diming. That was in 2009. They need to mobilize again to defeat the assault on prostate-cancer screening.

This is how single-payer and single-provider systems achieve cost savings. The hell with quality, let's cut costs. This is discussed openly in the literature.

How to square this with those study results that suggest those systems get better results? Two simple explanations. One, where those systems do a better job is in preventive stuff, keeping well people well. In any kind of statistical study, you get far more bang for the buck by giving everybody a typhoid shot than you do by doing a spectacular open-heart surgery. Works great until you're the one with the heart attack. Two, what they basically do is to fix the amount of care they are going to provide, called supply management, regardless of actual need. We budget ten heart surgeries this year, because that's how much money we were given to spend. If twelve people need surgery, we tell the last two to take a number and wait. And of course, as long as we continue to under budget, the backlog gets longer each year. Here's where that becomes significant in the statistics. In our system, we are trying to treat the patient, he or she dies, that's a bad health care "outcome." In the single-payer/single-provider system, the patient wasn't in the system at time of death, he or she was at home holding a number, so that's not a bad "outcome." At least not statistically, although the patient is obviously just as dead.

Bismarck resolves both these issues. There is a universal component that provides the preventive care that a single-payer/single-provider system does, and a fee for service component where you can go when you actually get sick.

(11-26-2015 03:54 AM)Owl 69/70/75 Wrote: [ -> ]This is how single-payer and single-provider systems achieve cost savings. The hell with quality, let's cut costs. This is discussed openly in the literature.

How to square this with those study results that suggest those systems get better results? Two simple explanations. One, where those systems do a better job is in preventive stuff, keeping well people well. In any kind of statistical study, you get far more bang for the buck by giving everybody a typhoid shot than you do by doing a spectacular open-heart surgery. Works great until you're the one with the heart attack. Two, what they basically do is to fix the amount of care they are going to provide, called supply management, regardless of actual need. We budget ten heart surgeries this year, because that's how much money we were given to spend. If twelve people need surgery, we tell the last two to take a number and wait. And of course, as long as we continue to under budget, the backlog gets longer each year. Here's where that becomes significant in the statistics. In our system, we are trying to treat the patient, he or she dies, that's a bad health care "outcome." In the single-payer/single-provider system, the patient wasn't in the system at time of death, he or she was at home holding a number, so that's not a bad "outcome." At least not statistically, although the patient is obviously just as dead.

Bismarck resolves both these issues. There is a universal component that provides the preventive care that a single-payer/single-provider system does, and a fee for service component where you can go when you actually get sick.

Owl,

I'd argue they "get better results" for two reasons.

1 - They weigh success differently.
2 - Societal differences between us and them skew stats (violence, obesity, ...)

(11-26-2015 09:38 AM)Bull_In_Exile Wrote: [ -> ]

(11-26-2015 03:54 AM)Owl 69/70/75 Wrote: [ -> ]This is how single-payer and single-provider systems achieve cost savings. The hell with quality, let's cut costs. This is discussed openly in the literature.
How to square this with those study results that suggest those systems get better results? Two simple explanations. One, where those systems do a better job is in preventive stuff, keeping well people well. In any kind of statistical study, you get far more bang for the buck by giving everybody a typhoid shot than you do by doing a spectacular open-heart surgery. Works great until you're the one with the heart attack. Two, what they basically do is to fix the amount of care they are going to provide, called supply management, regardless of actual need. We budget ten heart surgeries this year, because that's how much money we were given to spend. If twelve people need surgery, we tell the last two to take a number and wait. And of course, as long as we continue to under budget, the backlog gets longer each year. Here's where that becomes significant in the statistics. In our system, we are trying to treat the patient, he or she dies, that's a bad health care "outcome." In the single-payer/single-provider system, the patient wasn't in the system at time of death, he or she was at home holding a number, so that's not a bad "outcome." At least not statistically, although the patient is obviously just as dead.
Bismarck resolves both these issues. There is a universal component that provides the preventive care that a single-payer/single-provider system does, and a fee for service component where you can go when you actually get sick.

Owl,
I'd argue they "get better results" for two reasons.
1 - They weigh success differently.
2 - Societal differences between us and them skew stats (violence, obesity, ...)

I think your point one is my point two, and your point two is my point one. I don't see any disagreement between us.

The same thing that goes wrong with every damn thing the government controls. No innovation...no cost containment.

War on men.

Yet try to defund tax dollars from ripping live babies from a uterus, and the liberals get all butthurt.

You can't have freedom and government controlled health care.

The what works best and how much it costs stuff is all bull.

This is something I deal with daily. The PSA debate is a valid one, but one to be had between a doctor and patient, not the Feds and patient. I have the elevated PSA biopsy discussion 5 times a day probably. I have patients who have levels 4 times normal with multiple negative biopsies. Then I have guys with a PSA less than half of normal with a nodule and prostate cancer. PSA screening has done wonders to catch prostate cancer before it spreads. The number of patients who are diagnosed at stage 4 fell off a cliff with the discovery of PSA testing.

What's funny is that I hear all the time that poor doctors are being forced to do "defensive medicine" out of fear of evil trial lawyers like me, then I hear crap like this complaining about doctors being prevented from doing those same screenings on healthy people. Which is it?

Obamacare has cost controls that punish hospitals with high readmittance rates, or do unnecessary screenings on patients to drive their bills up. Given that we spend almost twice as much per capita on health care than other first world countries, with no better health outcomes (in many areas, worse), and far higher uninsured rates with tens of thousands dying each year for lack of health care access, I'd say it's not the worst idea.

Especially when only one out of 1,000 men who are screened would actually benefit from the exam, while most will have to deal with side effects that can range from incontinence and impotence, to stroke and death. The American Cancer Society recommends the findings of the Obama admin's task force.

If a patient really wants it the doctor won't be penalized. The MD should explain the positives and negatives and let the patient make an informed choice. Given the harsh side effects the doctors shouldn't make it routine however.

(12-01-2015 10:42 AM)Max Power Wrote: [ -> ]What's funny is that I hear all the time that poor doctors are being forced to do "defensive medicine" out of fear of evil trial lawyers like me, then I hear crap like this complaining about doctors being prevented from doing those same screenings on healthy people. Which is it?

Actually it's both. Any diagnosis code comes with its own set of 'approved' tests which are paid and any others are not. Unfortunately, not all patients present to the ED with a diagnosis code stapled to their shirt. Doctors sometimes have to make educated guesses.

Lawyers don't usually get involved unless someone is seriously harmed/dead... and often in those situations, the diagnosis isn't as easy as we'd like to think it is. Someone presents to the ED with Syncope, but they're 75 and live alone... so nobody really knows what happened except the somewhat incoherent patient. The standard tests come back negative and the patient normalizes... so the hospital sends them home... because the tests approved for those known symptoms came back negative. They fall again and die, so you sue them. Only later do we learn what the patient's real problem was, but the medical standard of care designed by the government was followed. The hospital has a choice... follow the government's protocol, or administer tests that they know they won't get paid for (and now might get dinged for) to avoid the potential lawsuit. Under the law, they should follow the rules they are given and generally not be liable for what happened to her, but put a dead body in front of a jury and anything can happen.

Quote:Obamacare has cost controls that punish hospitals with high readmittance rates, or do unnecessary screenings on patients to drive their bills up. Given that we spend almost twice as much per capita on health care than other first world countries, with no better health outcomes (in many areas, worse), and far higher uninsured rates with tens of thousands dying each year for lack of health care access, I'd say it's not the worst idea.

You think hospitals do unnecessary screenings 'to drive their bills up'?

You don't understand hospitals.

This WAS the case in the 80's, because the government's rules were that they paid a percentage of the billed services... bill 100,000... get 70,000. Bill 70,000... get 49,000. Today, the situation is 'diagnose this code, get $10,000... REGARDLESS of how much you spend to treat that patient'. What do you think that encourages?

Quote:If a patient really wants it the doctor won't be penalized.

This isn't remotely true at all. 'What the patient wants' isn't part of reimbursement. It MAY be a part of 'quality' of care/patient satisfaction, but not standard of care... i.e. we are forced to offer counseling, 'no cost' (to them) nicotine patches etc to ALL smokers, regardless of what they are here for or get our reimbursement nicked. They can decline and we can document that and not get nicked, but that's asking the hospital to act as your PCP, when the whole point of the ACA is that you now have a PCP to do those things. Next that is coming is obesity/diet. We'll be sending nutritionists to all obese patients homes. We're already ordering 'home health' WHETHER IT IS NECESSARY OR NOT (talk about unnecessary tests) for anyone with certain diagnoses in order to avoid being nicked for readmissions. Spend $1,000 nine times to avoid losing $10,000 once.

In case anyone missed it, the author of this opinion found in Rupert's NY Post is none other than Betsy McCaughey.

http://www.theatlantic.com/technology/ar...ong/23254/

The liar behind the Clinton health plan defeat:

Quote:She claimed that the bill would make it illegal to go outside the government plan for coverage or pay doctors on your own. If a doctor took money for such outside-the-system services, she said, the doctor could go to jail. That was a flat-out lie

...and the promoter of the equally dubious death panels.

Quote:McCaughey has been at it again this year -- twice, in fact. First was with an early, equally false claim that to compile "comparative effectiveness" data about medical care -- which drugs had which effects, which surgical procedures led to which results, the sort of data collected routinely about education, air safety, and everything else -- would lead to a Big Brotherish intrusion on individual medical decisions. That one seemed to get knocked out of contention fairly early. Then she was back with the "death panels" argument.

Not exactly the person who's opinion should hold much weight.

And here's a good unbiased article on the matter. In short, this decision is being made by panels of experts. It's not being made by Obama and Congressional democrats behind closed doors.

Quote:Potential harms and benefits of screening

The task force last published recommendations on prostate cancer screening in 2008. At that time, it concluded that men over 75 should not be screened and that there was not enough evidence to recommend for or against screening in younger men.

The new USPSTF recommendations, published early online May 21, 2012 in Annals of Internal Medicine, are based largely on reviews of two large clinical trials of prostate cancer screening that have been published since 2008.

The main goal of prostate cancer screening is to reduce deaths due to prostate cancer. But the studies showed that the number of men who avoided dying of prostate cancer because of screening after 10 to 14 years was very small. In addition, the PSA test often produces false-positive results that lead to more testing, including biopsies, which can have their own side effects, according to the USPSTF.

Prostate cancer often grows so slowly that many men who have it detected during screening might never need treatment. Treatment itself can often have unpleasant, and sometimes long-lasting, side effects. One of the problems with prostate cancer screening is that it cannot determine which prostate cancers are aggressive and need treatment, and which are not likely to cause problems. As a result, most men diagnosed with prostate cancer also get active treatment.

The task force noted that nearly 90% of men with PSA-detected prostate cancer go on to have surgery, radiation, or hormone therapy. Up to 5 in 1,000 men will die within 1 month of surgery, and at least 20% and 30% of men getting surgery or radiation therapy will have serious long-term side effects such as urinary incontinence, erectile dysfunction, or bowel dysfunction. Hormone therapy is also associated with erectile dysfunction, breast enlargement, and hot flashes.

Task Force Recommends Against Routine Prostate Cancer Screening

(12-01-2015 10:42 AM)Max Power Wrote: [ -> ]What's funny is that I hear all the time that poor doctors are being forced to do "defensive medicine" out of fear of evil trial lawyers like me, then I hear crap like this complaining about doctors being prevented from doing those same screenings on healthy people. Which is it?

Obamacare has cost controls that punish hospitals with high readmittance rates, or do unnecessary screenings on patients to drive their bills up. Given that we spend almost twice as much per capita on health care than other first world countries, with no better health outcomes (in many areas, worse), and far higher uninsured rates with tens of thousands dying each year for lack of health care access, I'd say it's not the worst idea.

Especially when only one out of 1,000 men who are screened would actually benefit from the exam, while most will have to deal with side effects that can range from incontinence and impotence, to stroke and death. The American Cancer Society recommends the findings of the Obama admin's task force.

If a patient really wants it the doctor won't be penalized. The MD should explain the positives and negatives and let the patient make an informed choice. Given the harsh side effects the doctors shouldn't make it routine however.

There's a difference between preventative medicine and defensive medicine. A regular PSA is preventative, not defensive.

A key paragraph in the article is as follows:

Quote:The administration wants to penalize doctors who routinely order the PSA blood test. Under a proposed policy, those doctors will get demerits for being considered over-spenders, while doctors who skip the test will be rewarded with a high “quality” rating from the government — and be paid more.

However, she provides no source. Does anyone have a source for this?

(12-01-2015 01:28 PM)Redwingtom Wrote: [ -> ]In case anyone missed it, the author of this opinion found in Rupert's NY Post is none other than Betsy McCaughey.

So when you can't refute anything they say, or anyone with specific knowledge that essentially corroberates what she says, attack some OTHER opinion she had, based mostly on lies like 'what the definition of is is'. Under Canada's healthcare system, her description is essentially true, and since Hillarycare never made it that far, we're left to merely debate what the details would have looked like. Heck, we still don't know what Obamacare looks like in total.

(12-01-2015 01:40 PM)Redwingtom Wrote: [ -> ]And here's a good unbiased article on the matter. In short, this decision is being made by panels of experts. It's not being made by Obama and Congressional democrats behind closed doors.

No, but Obama and Congressional Democrats made the decision behind closed doors to leave such decisions up to this panel as opposed to having it be a decision between a patient and their doctor as they always claim in public.

I must say, I find it funny that in one post, you talk about the 'lie' of 'death panels' and then in the very next one, you note one of the many such panels (deciding based on percentages and not on the individual situation) present in the bill.

An interesting topic for sure...especially for me since I turn 50 next year.

And this new breakthrough that they're using at the Cleveland Clinic may make a lot of this discussion moot.

Quote:A new screening tool for prostate cancer has been shown to offer better accuracy than the test currently used by most physicians in the United States. The new test, called the 4Kscore™ test (OPKO Lab), offers various advantages over the more commonly used prostate specific antigen (PSA) blood test.

The new test improves on these common issues with the PSA blood test:

- Isn’t specific to cancer; detects a variety of prostate issues
- Doesn’t account for a natural tendency for PSA levels to rise with age

These factors increase the PSA blood test’s false positive results, says Andrew Stephenson, MD, Director of the Center of Urologic Oncology at Cleveland Clinic’s Glickman Urological and Kidney Institute. They are the reason why many men go on to have a prostate biopsy when they don’t really need one.

New Blood Test Helps You Avoid Unnecessary Prostate Cancer Biopsies

(12-01-2015 03:02 PM)Hambone10 Wrote: [ -> ]

(12-01-2015 01:28 PM)Redwingtom Wrote: [ -> ]In case anyone missed it, the author of this opinion found in Rupert's NY Post is none other than Betsy McCaughey.

So when you can't refute anything they say, or anyone with specific knowledge that essentially corroberates what she says, attack some OTHER opinion she had, based mostly on lies like 'what the definition of is is'. Under Canada's healthcare system, her description is essentially true, and since Hillarycare never made it that far, we're left to merely debate what the details would have looked like. Heck, we still don't know what Obamacare looks like in total.

(12-01-2015 01:40 PM)Redwingtom Wrote: [ -> ]And here's a good unbiased article on the matter. In short, this decision is being made by panels of experts. It's not being made by Obama and Congressional democrats behind closed doors.

No, but Obama and Congressional Democrats made the decision behind closed doors to leave such decisions up to this panel as opposed to having it be a decision between a patient and their doctor as they always claim in public.

I must say, I find it funny that in one post, you talk about the 'lie' of 'death panels' and then in the very next one, you note one of the many such panels (deciding based on percentages and not on the individual situation) present in the bill.

But your second part exposes the problem I have with the author. Nowhere does she provide a source for her insinuations.

While yes the panel says the test is overused and has issues with false positives and doctors ordering extra unneeded procedures as a result, nowhere does she provide anything that says doctors cannot still do whatever they and the patient choose to do.

Sure, it could exist...but I'd like to see it before I believe her fears. In doing just a modicum of research, it's quickly apparent that the medical community is fairly divided on the best course of action here. Excuse me if my first reaction isn't one of trashing the ACA and the Obama administration. The article, could have easily have been written objectively. It wasn't. And to me, that's telling.

(12-01-2015 03:06 PM)Redwingtom Wrote: [ -> ]An interesting topic for sure...especially for me since I turn 50 next year.

And this new breakthrough that they're using at the Cleveland Clinic may make a lot of this discussion moot.

Quote:A new screening tool for prostate cancer has been shown to offer better accuracy than the test currently used by most physicians in the United States. The new test, called the 4Kscore™ test (OPKO Lab), offers various advantages over the more commonly used prostate specific antigen (PSA) blood test.

The new test improves on these common issues with the PSA blood test:

- Isn’t specific to cancer; detects a variety of prostate issues
- Doesn’t account for a natural tendency for PSA levels to rise with age

These factors increase the PSA blood test’s false positive results, says Andrew Stephenson, MD, Director of the Center of Urologic Oncology at Cleveland Clinic’s Glickman Urological and Kidney Institute. They are the reason why many men go on to have a prostate biopsy when they don’t really need one.

New Blood Test Helps You Avoid Unnecessary Prostate Cancer Biopsies

except that it currently wouldn't be covered, and won't be covered until the government says it should be. It doesn't make the conversation moot at all, it merely changes the 'object' of the discussion from THIS test to some other.

This is a red-herring argument, Tom. OF COURSE there are advances in detection and screening every day, and we should always use the most effective and least intrusive means available... but even here, there is no 'one size fits all' solution, and the decision is being made one time by a panel of experts based on probabilities and statistics, not on the actual specifics of any individual case.

(12-01-2015 03:16 PM)Hambone10 Wrote: [ -> ]

(12-01-2015 03:06 PM)Redwingtom Wrote: [ -> ]An interesting topic for sure...especially for me since I turn 50 next year.

And this new breakthrough that they're using at the Cleveland Clinic may make a lot of this discussion moot.

Quote:A new screening tool for prostate cancer has been shown to offer better accuracy than the test currently used by most physicians in the United States. The new test, called the 4Kscore™ test (OPKO Lab), offers various advantages over the more commonly used prostate specific antigen (PSA) blood test.

The new test improves on these common issues with the PSA blood test:

- Isn’t specific to cancer; detects a variety of prostate issues
- Doesn’t account for a natural tendency for PSA levels to rise with age

These factors increase the PSA blood test’s false positive results, says Andrew Stephenson, MD, Director of the Center of Urologic Oncology at Cleveland Clinic’s Glickman Urological and Kidney Institute. They are the reason why many men go on to have a prostate biopsy when they don’t really need one.

New Blood Test Helps You Avoid Unnecessary Prostate Cancer Biopsies

except that it currently wouldn't be covered, and won't be covered until the government says it should be. It doesn't make the conversation moot at all, it merely changes the 'object' of the discussion from THIS test to some other.

This is a red-herring argument, Tom. OF COURSE there are advances in detection and screening every day, and we should always use the most effective and least intrusive means available... but even here, there is no 'one size fits all' solution, and the decision is being made one time by a panel of experts based on probabilities and statistics, not on the actual specifics of any individual case.

1. Never said or claimed this was a silver bullet.
2. Again, what proof do you have that there are any repercussions to doctors and patients ordering the PSA test anyway...other than the opinions expressed by this one noted ACA opponent?

(12-01-2015 10:42 AM)Max Power Wrote: [ -> ]What's funny is that I hear all the time that poor doctors are being forced to do "defensive medicine" out of fear of evil trial lawyers like me, then I hear crap like this complaining about doctors being prevented from doing those same screenings on healthy people. Which is it?

It's both. Doctors have been forced to practice defensive medicine to avoid evil trial lawyers like you (you meant "evil" sarcastically, I suppose, but I didn't). What Obmacare is doing is using economic force to try to get them not to do so, but still leaving the malpractice liability in place. What happens ultimately is that the resulting risk versus reward calculus will become unappealing to our brightest and best, who will go become ambulance chasers or something. That's fine if you don't care about quality, and single-payer/single-provider systems typically don't.

Quote:Obamacare has cost controls that punish hospitals with high readmittance rates, or do unnecessary screenings on patients to drive their bills up. Given that we spend almost twice as much per capita on health care than other first world countries, with no better health outcomes (in many areas, worse), and far higher uninsured rates with tens of thousands dying each year for lack of health care access, I'd say it's not the worst idea.

Your "given that" statement is actually quite misleading. By the criteria applied in some academic studies, there is some suggestion that what you say might be true. But let's look a bit closer at the reality. Single-payer and single-provider systems typically do a better job of keeping well people well, but a poorer job of treating sick people. And at the end of the day, you get more bang for the buck for giving tetanus shots than for performing open heart surgery. That part of centralized systems is good. Their level of care for sick people is not. That's why I like Bismarck, which is the only approach that does good jobs in both areas. And it's cheaper than the US--more expensive than single-payer/provider, but that's because they are actually doing some health care and that costs money. Another point is the way those statistics are kept. In a single-payer/provider system, you go to the doctor, you need heart surgery, they tell you to take a number and come back in 18 months. If you die before that date, then you were not in the system when you died, and therefore you are not counted as a bad outcome. In the US, we try to do the surgery, and if you don't make it, then that's a bad outcome.

One other thing, a lot of the sound bytes criticizing the US system reference the WHO study that ranked the US "37th best" in the world. Actually, no it didn't. That study wasn't about being the best, quality was actually a very minor (roughly 20%) component of the ranking. What's perhaps more interesting is that whatever it did measure, it was biased heavily toward small, even tiny, systems. The top 10 included Andorra, San Marino, Malta, Singapore, and Oman, and Monaco was 13th. And on the other hand, the US ranked 1st among countries over about 125 million population (including some single-payer/single-provider systems that ranked behind us), 2nd among countries with over 80 million, and 4th among countries with over 60 million. And the three ahead of us at that point (Japan, Germany, France) are all Bismarcks.

Quote:If a patient really wants it the doctor won't be penalized.

Under Obamacare, actually no. And not under single-payer/provider. True under Bismarck. The doctor-patient relationship exists under Bismarck, but has been replaced by edicts of unaccountable bureaucrats in the others.

Quote:The MD should explain the positives and negatives and let the patient make an informed choice. Given the harsh side effects the doctors shouldn't make it routine however.

Agree. That's not what happens under single-payer/provider, and that's not what will happen under Obamacare. It is what happens under Bismarck. That's why they are the best systems in the world.