Wednesday, October 21, 2009

Lots of big items

In the wow category, the American Cancer Society has said the following

"We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

This is a big deal. And what he is really saying is in some cases there are no benefits to screening practices, in others there are more costs than benefits, and in some the costs of any benefits are very large. Of course in some cases, there are clear benefits. The key is getting straight what things we do work and what doesn't. This is a big deal. I agree that there are dangers of going from screening definitely always works to the other ditch of it never works. A paper published in JAMA drove this announcement. The newspaper notes that:

"In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

If breast and prostate cancer screening really fulfilled their promise, the researchers note, cancers that once were found late, when they were often incurable, would now be found early, when they could be cured. A large increase in early cancers would be balanced by a commensurate decline in late-stage cancers. That is what happened with screening for colon and cervical cancers. But not with breast and prostate cancer."

There is a scheduled Medicare payment formula change in how Medicare pays docs that comes about next year and would drop doc fees. The Senate had wanted to restore the fees to current levels and add a bit, but doing it over 10 years would cost about $250 Billion. Harry Reid wanted to do it on its own and not as part of health reform, but Repubs and some Dems said no. So, that appears to be stopped. Repubs say they want to do the increase but also want to pay for it with cuts somewhere else. We will see. Generally, Medicare needs profound reform in how doctors are paid, away from fee for service. But, that will take time. Sounds like they may do a short term solution (say for next two years) which seems reasonable, especially if a real Independent Medicare commission is created in reform to look comprehensively at this issue.

Republicans in the last day or so have started talking about malpractice reform and it 'not being too late' to add it to the discussion. This is the surest sign yet they believe a bill is inevitable and are now trying to influence it. The CBO said it will save $51 Billion over 10 (with it being a nationalized mix of reforms already tried in some states). This report was good news/bad news for republicans and those who think malpractice reform will save lots of money....CBO for first time estimated a cost of defensive medicine.....but the estimate is much lower than some other estimates. Here is Newt Gingrich saying this morning add this into health reform and that CBO low balls the estimate. If Dems really wanted to be sneaky they should immediately adopt the CBO proposals and agree with Repubs that CBO has low balled cost savings and ask them to join them in saying that adding this to Baucus will reduce the deficit by HUNDREDS OF BILLIONS of dollars. Mr. Gingrich gives a range of savings from defensive medicine of $160-$210 Billion PER YEAR! CBO says $51 Billion over 10 years. If it were $200 Billion per year, then adding this to Baucus would mean that it would reduce the deficit by about (lets be conservative) $1.5 Trillion over 10 years......

I think CBO has it about right, but would be happy to be wrong.

But, I also think malpractice reform should be added in....because we need to save where we can, we need to give the docs a victory to bring them along, and because we need to take the 'what about defensive medicine' retort to any cost saving proposal that doesnt' work out (meaning docs will now blame defensive medicine without addressing the issue).

I have written about this here. And the first question I posed in my column on last Friday, appears to have been answered: looks like the Republicans may play. And adding malpractice reform to any bill will solidify conservative Dems support, and of course, the docs.

No comments:

Post a Comment