Tag Archives: Health Care

Saturday Links

Adult ADHD: Why so common (I’m looking at you, law school colleagues).

On the Next Justice: Questions to ask, and what we shouldn’t bother asking.

Can exercise be as effective as drugs in treating depression?

Linda Greenhouse on the implications of immigration jurisprudence.

Just in case you still care about Romney’s relationship to health care.

Michigan college offers money-back guarantee on getting a job.


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CNN poll shows that 25% of Americans want this health care bill to pass.  In other words: 75% of Americans want the bill to fail.
Turn up the ear piece Obama – because you are not listening to the American people.

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Breasts: Victims of Sexist Policy or Beneficiaries of New Research?

For decades doctors have urged women to get frequent mammograms starting in their forties. When it comes to breast cancer—the second deadliest cancer for women—doctors have always advised women that early detection saves.

Today the U.S Preventive Services Task Force, a panel within the Department of Health and Human Services, marked a sharp withdrawal in policy promoting breast cancer awareness. According to new Task Force recommendations, women don’t need mammograms until they’re into their fifties. Women should hold off on mammograms until they hit 50, and even then they should cut back from the previously-recommended two mammograms annually to just one exam every other year.

Wait, WHAT?! Isn’t this the same Task Force that sounded an urgent alarm just six months ago, when statistics showed a slight decline–only 1%–in annual mammograms among women in their forties?  The same Task Force that cried out that women in this age bracket were risking their lives if they forgo annual exams?

The downward trend, however slight, has breast cancer experts worried. Mammograms can enable physicians to diagnose the disease at early stages, often before a lump can be felt. “When breast cancer is detected early, it often can be treated before it has a chance to spread in the body and increase the risk of dying from the disease,” says Katherine Alley, medical director of the breast health program at Suburban Hospital in Bethesda.

The U.S Preventive Services Task Force, an independent panel of experts working under the Department of Health and Human Services, recommends that women older than 40 get a mammogram every one to two years. The task force finds the test most helpful for women between ages 50 and 69, for whom it says the evidence is strongest that screening lowers death rates from breast cancer. Other groups, including the American Medical Association, suggest a more rigorous schedule, saying the test should be done every year; insurers often pay for annual tests.

But experts say they are seeing gaps beyond two years in many cases. Carol Lee, chair of the American College of Radiology’s Breast Imaging Commission and a radiologist at the Memorial Sloan-Kettering Cancer Center in New York, says many women understand that they need to have a mammogram but don’t go back for repeat tests after the first one. In Bethesda, Alley said she has even heard anecdotal reports of breast cancer survivors forgoing recommended mammograms.

How could breasts have changed so much in six months? Or is it women in their forties who have changed? Ah, that’s right too—it was health care that changed. A mere six months after panicking over a mere one percent decline in mammograms among the forty-something set, today the Task Force issued an abrupt about-face:

“We’re not saying women shouldn’t get screened. Screening does save lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.
“Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.”

No, ladies, neither breasts nor women have changed in the last six months. What’s changed is that the Department of Health and Human Services is an agent of an administration suddenly responsible for paying for these exams once ObamaCare passes.  This public health care omnibus claims it will shoulder the cost of preventative exams. Mammograms represent the quintessential “preventative exam.” But rather than pay for the care doctors have long urged women to demand for themselves, the government is simply pressuring health officials to redefine what women need.

Government-rationed health care will put a strain on resources like doctors and hospital space. Many providers will prove eager to avoid dealing with government-imposed conditions, red tape, and poor compensation rates. But rather than stand up and defend women’s efforts to protect themselves with preventative care, this government panel simply manipulates doctors’ advice to redefine what women need.  In fact, while more than half of the doctors behind these new recommendations are women, none are oncologists.  Nor is the Task Force a research organization; instead, it’s part of an agency under the Executive branch of the government, responsible for neither health nor research but rather implementing policy:

The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each preventative service, reaches consensus about the net benefit for each preventative service, and issues a recommendation.


At least we know what bias to expect.  This is not a group of doctors acting on behalf of one patient at a time.  It’s a group of policy-minded clinicians attempting to ration a tax-funded government pot among every American needing care.  Women in their forties may not be ObamaCare’s top priority.  But advising women to stop getting checked redefines reckless and brings to light insidious danger women face under the public option.

Evidently the Department of Health and Human Services knows which side of its bread is buttered under the new health care bill! This administration promised to prioritize life-saving preventative care.  Instead, less than two weeks after ObamaCare passed in the House, public health officials have begun rolling back decades worth of doctors’ wisdom.

So the elderly won’t be the first to get thrown under the public health care bus — it’s women.

At The New Agenda.

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Capps Amendment

The Government, Abortion and Your Tax Dollars

Charmaine Yoest’s op-ed, “Tax Dollars Shouldn’t Fund Abortion” (op-ed, Oct. 14) blatantly misrepresents the amendment I offered to health reform legislation now before Congress.

My amendment would maintain the status quo on federal funding of abortions by extending current law forbidding federal dollars from being used to pay for abortion, except in the cases of rape, incest or to protect the life of the woman.

My amendment allows plans in the Health Exchange to offer abortion coverage, but requires that those services to be paid for only out of premiums paid by consumers. No federal dollars may be used. This is the same principle currently used with Medicaid, which must follow the Hyde Amendment: No federal dollars may be used to pay for abortion services in Medicaid, but the 17 states that opt to cover the procedure can do so by paying for it with state dollars.

This is hardly a “radical departure from the status quo.” In fact, it is an extension of the status quo.

Rep. Lois Capps (D., Calif.)

Santa Barbara, Calif.

Charmaine Yoest states that the Capps Amendment “would make abortion coverage a part of the public option, funnel tax dollars to private health plans that cover abortion, and ensure that every area of the country will have at least one health insurance plan that covers elective abortion.” Ms. Yoest worries that the federal government is poised to enter “the business of funding the destruction of unborn human life.”

We’re already there. Planned Parenthood performs 62 abortions (305,310 abortions in 2008) for each adoption it facilitates. Planned Parenthood survives partly on tax dollars and government contracts that pay directly into this abortion giant’s operating fund. In the 2007-08 fiscal year, $350 million in “government grants and contracts”—those are our tax dollars—padded these controversial coffers.

Controversial choices deserve a hearty debate. Government’s intrusive fingers do not merely threaten to dictate the terms of that debate, as Ms. Yoest suggests. We are already there.

Kathryn Ciano

Arlington, Va.

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Aetna Cancer

My name is Kat, and I love Insurance law.

I realize it’s unhip to buck the hue and cry trend over reform, but I keep thinking about reforming what we’ve already got, on a market level. The operative premises are:

1. The goal is not to get as many people insured as possible; it’s to get as many people care as possible.  That lawmakers keep framing the debate as the former represents, I think, a major oversight.

2. Market evolution suggests that what exists is exactly what we want.  “Reform” is to throw a stick in the spokes of a bicycle the entire market is riding in tandem.  It’s dangerous and foolish, but #1 prevails so this thought experiment is about doing something.

3. This experiment is strictly about insurance, which is to say the articulation of finance and law.  Obviously (!) the answer to health care reform is tort reform.  But I will save torts for another day.

So.  The thing that makes Insurance fascinating is that it’s a) private; and b) a sophisticated contract between sophisticated parties.

Insurance has nothing to do w/ outsourcing one’s well-being.  W/ issues like public safety, we blithely outsource decisions regarding protection to Big Government, and we squirrel away military bases largely away from metropolitan areas, but we rely on that protection just the same.

Insurance is not outsourced; it is not unseen.  We make an active choice to join a private network.  We pay frequently, and big bucks for that safety net.  It’s a contract and a long-term commitment.  From the start we know that if we break that contract we’ll be faced with risk, uncertainty, and we’ll likely have to pay dearly for our own accumulated liability when looking to replace that K relationship.

The way the safety net works is that we all pay in and hope we never have to pull out.  When we pull out it’s because we’ve had a problem, an illness, an accident.  Everyone’s certainty and well-being is bolstered by this paid-in community.

Problems can arise, of course.  If the community itself quakes, as in the aftermath from hurricane Katrina, then the entire safety net falters.

Many of these quakes are fascinating (see the operative payout system from the World Trade Center’s layered insurance K’s for a great example).  But as with any market system, the key is to create a strong core.  Insurance law is about creating incentives for insurance companies to cement solid financials.  This way, when disaster strikes, companies can and will pay out, and they will do it properly.

Because we’re pursuing a single goal — getting as many people care as need it, and getting that care properly — we need to examine the problem.  First, most uninsured Americans aren’t uninsured bc they can’t afford it; they’re uninsured bc they choose not to keep insurance.

Not keeping insurance is a perfectly valid choice.  Perhaps not the most sophisticated choice, but it’s a valid choice nonetheless.  Indeed, for those healthy or wealthy enough not to fear uncertainty, those thousands of dollars a year saved on unrealized insurance premiums can certainly fund any problems encountered later in life.

It’s for those endgame problems that insurance companies collect such high premiums.  Yes, it sounds expensive to pay in now, but consider the cost of therapy later on.

When a patient undergoes chemotherapy, for example, one incidental cost covers daily vials to replenish or replicate lost immunity when white blood cells falter.  Each vial costs over three thousand dollars.  Add to this the other major non-incidental costs, and insurers’ high premiums come into stark perspective.

It makes sense that insurers would be so diligent about keeping pre-existing conditions out.  But what if there were some provision to cover cancer patients, rather than simply dropping them at the first loopholed opportunity?

The way the system works now is that an insured keeps paying roughly similar premiums over the course of his insurance.  Those premiums rise under certain conditions, but by and large insurance companies simply let patients pay a deductible up to the cost of a treatment.  Insurance companies pay strict attention to which treatments patients pursue, and the companies govern when and how patients may try a given route.

What if insureds had an option to switch from, say, Aetna to a wholly-owned subsidiary, like Aetna Cancer, upon diagnosis?  Patients would pay much higher premiums upon switching, but they would also gain a huge array of better options.  Treatment centers closer to home, for example, or a more permissive range of experimental treatments.

Would companies go for this?  Financially it likely makes sense.  If I know Aetna allows me to switch and maintain this option if I get diagnosed, I may well choose this company over one I know will keep me on a strict plan if I get cancer.  So the market would likely respond favorably by buying more regular Aetna, and possibly paying higher premiums all along, to preserve that right to Aetna C.

What about preexisting conditions?  I can’t help but think I’d pay more for Aetna, to preserve switchability, if I know cancer runs in my family.  The entire market response may well correspond to each respondent’s anticipated risk.

How would this change Aetna’s screening diagnostics for hopeful insureds?  Aetna would have to consider the fact that each insured will have the option to pay more later in life and get a better range of choices.  May Aetna change the point at which a condition becomes “preexisting”?  Can a company do that, legally?

Do insurance companies ask for detailed family history now?  Is it harder for adopted folks to get insurance?  If someone has an insuppressible family history and is denied insurance because of it, does that constitute discrimination?  If a healthy person w/ a family history of heart disease and a predilection for beef is denied, is that discrimination on a too-loose definition of “preexisting condition”?

The major benefit of letting people switch to better subsidiary coverage is that doctors would still get paid.  This wouldn’t accomplish the same sort of wave to better care that we’d get w/ tort reform, but it would slightly loose our grip on doctors’ shorter hairs such that they wouldn’t be quite so unwilling to touch a patient — or, perhaps more insidious, to medicate a patient rather than treat.

More to come.  This is interesting.

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Swine Flu: Threat or Technique?

Who’s afraid of the swine flu?

Since school started this fall every one of my professors has warned us of the swine flu procedures in place. Evidently health specialists predict that schools will close for weeks at a time as students fall in TB-like numbers.

I attend a law school attached to a sometimes-climbing, occasionally-inept university. Today students received an email advising i part:

Another simple way to prevent contracting or spreading influenza is to exercise good personal hygiene and avoid contact with others if you become ill:

1. Cover your mouth and nose when you cough or sneeze.
2. Wash your hands frequently with soap and water.
3. Avoid touching your eyes, nose or mouth.
4. Avoid close contact with people who are sick.
5. Stay home when you are sick and avoid public or social settings.
6. Practice good health habits; Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Normally I chuckle at fear-mongering techniques as a shepherding advice.  The specific draw of H1N1 hits a nerve though; it seems to be the year of the 18-30 year old.  This demographic bolstered and elected our President; this demographic suffered the most in this economic crisis; and it is this demographic experts predict will bear the brunt of whichever pandmic finally hits — avian or swine or fear.

What do you think?  Swine flu, a pandemic problem for our inchoate working class?  Solution to the employment crisis, when we all suddenly find temp-to-perm jobs?  Or, more likely, intentional fear-mongering to keep health — and thus health care — at the forefront of voters’ minds?

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Lawmakers pushing to add the prefix “Kennedy” to the health care bill have grasped the late Senator’s passing as an opportunity to refresh flagging interest in the reform.

What Congressmen think this means:

“KennedyCare” advocates hope to capitalize on the Lion’s brain cancer as an illustration of one ailment subject to health care.  Ideally this soldier’s falling will refresh waning interest in Kennedy’s last stand:

[T]he real question raised by Kennedy’s death is whether it can help rally fellow Democrats who have wavered on certain aspects of health-care reform such as a public insurance option.

KennedyCare advocates see Teddy as a unifying figure immune to party lines.  The health care debate knows no partisanship.  Stance on gov’t health care has less to do with party lines and rests more in a person’s faith in individuals’ ability to make personal decisions based on the inevitable tradeoffs in life versus faith in the state’s heavy handed effort to relieve us of our choice.

What this actually means:

Those who hope to memorialize Kennedy with a health care bill named for him cite his death as one that could have been postponed with enhanced medical care.  But Kennedy was a Senator.  He enjoyed the Senate health insurance plan — notably different from the plan Senators offer private individuals — and was wealthy enough to afford the best treatments in the world.

Responding to this argument, Senator Grassley said that in countries with government-run health care, Kennedy “would not get the care he gets [in the US] because of his age.”  Instead, the government would decide to spend health care resources on younger people “who can contribute to the economy”:

GRASSLEY: In countries that have government-run health care, just to give you an example, I’ve been told that the brain tumor that Sen. Kennedy has — because he’s 77 years old — would not be treated the way it’s treated in the United States. In other words, he would not get the care he gets here because of his age. In other words, they’d say ‘well he doesn’t have long to live even if he lived another four to five years.’ They’d say ‘well, we gotta spend money on people who can contribute more to economy.’ It’s a little like people saying when somebody gets to be 85 their life is worth less than when they were 35 and you pull the tubes on them.

Using a colleague’s death to revive a political agenda cheapens the agenda and reflects horrific disrespect for the departed.

Disrespect for life is what frigthens KennedyCare opposition most.  Ted Kennedy was not a symbol; he was a man.  He died a lonely death, and spent the last months of his life suffering from a painful medical condition.  If colleagues cared about their fallen comrade at all they would not begin using his death as a tool even before Kennedy’s funeral.

This attitude reflects opponents’ precise objection to the health care bill.  We are all men, not statistics.  Sweeping statistics that fail to account for self-reporting and “unseen” errors (like the fact that most of the “uninsured” Americans are students who choose to save their money and pray for no accidents) reduce everyone to sheep, helpless except under the nanny hand of our shepherd.

Kennedy personified this exact bias in his private life.  He touted health care reform from his fortunate, wealthy position that kept him immune to what he deemed good enough for “the masses.”  Indeed Kennedy’s reliance on his family’s influence infamously kept him immune to what any other private citizen would have endured under similar circumstances.

Health care reform in its current form will fundamentally change the relationship between individuals and the state.  Naming this sweeping bill after a paternalistic favored son eager to pay forward his father’s protective wing perpetuates the dark underbelly of politics.  The wealthy will always angle for power and more wealth.  The poor will seldom surpass strict thresholds set by their fortunate peers.

Kennedy would not have traded his position of influence for the position of those he was trying to help.  Senators cling to the idea that they always “know best.”  Had Kennedy truly believed in the sacrosanct plight of those trying to make ends meet, he would have borne their struggle inasmuch as it fell on him to bear.  But when he had an opportunity to learn how the other half lives, he ducked responsibility — and the obligation to try to save one life — to hide behind his father’s coattails.

I sincerely hope Ted Kennedy finds forgiveness for his errors, as I hope we are all forgiven.  But again: forgiveness is not ours to give. Exploiting a senator’s death does not gloss the choices he made in life.

Unfortunately, naming a critical bill after this symbol of political corruption simply memorializes the very disrespect for life that fuels opposition and, indeed, partisan politics at large.

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