Medicine
In a previous post, I argued that debates about the inclusion of a "public option" for health insurance in the reform bills taking shape in the U.S. Congress obscured the critical issue that elected officials have been reluctant to tackle: cost control. Extending insurance coverage to everyone is a moral imperative, but doing so will do little or nothing to hold down the rising price tag of health care, which is driven in large part by the proliferation of "care" that is unnecessary or harmful. In a New York Times editorial earlier this week, David Leonhardt observes that opponents of cost control use "scare stories" to falsely assert that cutting spending always means hurting patients:
Hospitals that practice more intensive medicine, to take one example, get no better results than more conservative hospitals, research shows. And while the insured receive better care and are healthier than the uninsured, the lavishly insured - those households with so-called Cadillac plans - are not better off than households with merely good insurance.
Yet every time Congress comes up with an idea for cuttting spending, the cry goes out: Patients will suffer! You're cutting bone, not fat!
How can this be? How can there be billions of dollars of general waste and no specific waste? There can't, of course. The only way to cut health care costs is to cut health care costs and, in the process, invite politically potent scare stories.
The trouble is, while disease advocacy groups such as the American Cancer Society can trot out endless legions of men whose lives have been "saved" by screening for prostate cancer, for example, you won't hear anything from the much larger numbers of men who have suffered permanent impotence or urinary incontinence due to surgery for prostate cancers that may never have affected their health. (A recent analysis in the Journal of the National Cancer Institute estimated that over 1 million additional men have been diagnosed and treated for prostate cancer in the U.S. since the introduction of PSA screening in 1986, and even under the most optimistic assumptions, only 1 in 20 of these men actually benefited from treatment.)
It's completely understandable that men who undergo treatment for cancer and suffer adverse effects from their treatment want very much to believe that their lives have been saved and that the harms they suffered were worth the cost. Doctors who detect and treat those cancers want to believe this too. In a phenomenon that has been called "a system without negative feedback," all of the incentives in U.S. health care conspire to encourage excessive testing and treatment for individual patients. Only by paying attention to health on the population level can we get a better perspective. Resources are limited, and given this fact, it makes no sense to squander resources on care that doesn't work, or care that hurts more people than it heals. Scare stories about cost control make for good headlines, but the story that scares me is what would happen if health reform passes without it.
- Psa Redux: The Uspstf Finally Recommends Not Getting It!
. The US Preventive Services Task Force (USPSTF), the independent group of physicians and scientists who make recommendations to the government, medical community, and American people on the value of screening tests, recently came out with a new recommendation...
- Psa Screening: “one Of Medicine's Great Success Stories"?
. Guest blog by Robert Ferrer, MD MPH I spent 2 days at home recently with the H1N1 flu and caught up on some of my newspaper reading. In the Oct 11, 2009 New York Times Magazine, (p.38) was an advertising supplement, "Health and Wellness Outlook Special...
- Psa Screening: What Is The Value?
Two studies published in the New England Journal of Medicine on line on March 18, 2009 regarding the use of prostate-specific antigen (PSA) screening for prostate cancer have been getting a lot of coverage in the popular media, including NPR and the New...
- Writing Persuasive Public Health Narratives - Part 2 Of 2
This is the second of two posts updating a short essay on public health leadership that I wrote last summer. Part 1 is available here. ** Strong public health narratives can foster a culture of “macro” medicine, much as executives in business organizations...
- Book Review: "overdiagnosed" And The Paradox Of Cancer Survivorship
According to the National Cancer Institute and the Centers for Disease Control and Prevention, the number of cancer survivors in the U.S. has increased dramatically in my lifetime, from 3 million in 1971 to 11.7 million in 2007. From 2001 to 2007 alone,...
Medicine
Ignore health reform scare stories
In a previous post, I argued that debates about the inclusion of a "public option" for health insurance in the reform bills taking shape in the U.S. Congress obscured the critical issue that elected officials have been reluctant to tackle: cost control. Extending insurance coverage to everyone is a moral imperative, but doing so will do little or nothing to hold down the rising price tag of health care, which is driven in large part by the proliferation of "care" that is unnecessary or harmful. In a New York Times editorial earlier this week, David Leonhardt observes that opponents of cost control use "scare stories" to falsely assert that cutting spending always means hurting patients:
Hospitals that practice more intensive medicine, to take one example, get no better results than more conservative hospitals, research shows. And while the insured receive better care and are healthier than the uninsured, the lavishly insured - those households with so-called Cadillac plans - are not better off than households with merely good insurance.
Yet every time Congress comes up with an idea for cuttting spending, the cry goes out: Patients will suffer! You're cutting bone, not fat!
How can this be? How can there be billions of dollars of general waste and no specific waste? There can't, of course. The only way to cut health care costs is to cut health care costs and, in the process, invite politically potent scare stories.
The trouble is, while disease advocacy groups such as the American Cancer Society can trot out endless legions of men whose lives have been "saved" by screening for prostate cancer, for example, you won't hear anything from the much larger numbers of men who have suffered permanent impotence or urinary incontinence due to surgery for prostate cancers that may never have affected their health. (A recent analysis in the Journal of the National Cancer Institute estimated that over 1 million additional men have been diagnosed and treated for prostate cancer in the U.S. since the introduction of PSA screening in 1986, and even under the most optimistic assumptions, only 1 in 20 of these men actually benefited from treatment.)
It's completely understandable that men who undergo treatment for cancer and suffer adverse effects from their treatment want very much to believe that their lives have been saved and that the harms they suffered were worth the cost. Doctors who detect and treat those cancers want to believe this too. In a phenomenon that has been called "a system without negative feedback," all of the incentives in U.S. health care conspire to encourage excessive testing and treatment for individual patients. Only by paying attention to health on the population level can we get a better perspective. Resources are limited, and given this fact, it makes no sense to squander resources on care that doesn't work, or care that hurts more people than it heals. Scare stories about cost control make for good headlines, but the story that scares me is what would happen if health reform passes without it.
- Psa Redux: The Uspstf Finally Recommends Not Getting It!
. The US Preventive Services Task Force (USPSTF), the independent group of physicians and scientists who make recommendations to the government, medical community, and American people on the value of screening tests, recently came out with a new recommendation...
- Psa Screening: “one Of Medicine's Great Success Stories"?
. Guest blog by Robert Ferrer, MD MPH I spent 2 days at home recently with the H1N1 flu and caught up on some of my newspaper reading. In the Oct 11, 2009 New York Times Magazine, (p.38) was an advertising supplement, "Health and Wellness Outlook Special...
- Psa Screening: What Is The Value?
Two studies published in the New England Journal of Medicine on line on March 18, 2009 regarding the use of prostate-specific antigen (PSA) screening for prostate cancer have been getting a lot of coverage in the popular media, including NPR and the New...
- Writing Persuasive Public Health Narratives - Part 2 Of 2
This is the second of two posts updating a short essay on public health leadership that I wrote last summer. Part 1 is available here. ** Strong public health narratives can foster a culture of “macro” medicine, much as executives in business organizations...
- Book Review: "overdiagnosed" And The Paradox Of Cancer Survivorship
According to the National Cancer Institute and the Centers for Disease Control and Prevention, the number of cancer survivors in the U.S. has increased dramatically in my lifetime, from 3 million in 1971 to 11.7 million in 2007. From 2001 to 2007 alone,...