Archive for April 27th, 2012
At at website called Respectful Insolence, Orac takes on the misconceptions and lies regarding the PPACA (“Obamacare”), focusing on “death panels” and “rationing.” It’s a fact-filled article sprinkled with excellent links. This brand new article is called “No, Virginia, cancer care in Europe doesn’t suck, contrary to what a recent paper implies.” Here’s an excerpt:
Indeed, most of the resistance to the Patient Protection and Affordable Care Act (PPACA), otherwise known in popular parlance as “Obamacare,” has been fueled by two things: (1) resistance to the mandate that everyone has to buy health insurance, and (2) the parts of the law designed to control the rise in health care costs. This later aspect of the PPACA has inspired cries of “Rationing!” and “Death panels!” Whenever science-based recommendations are made that suggest ways to decrease costs by reevaluating screening tests or decreasing various tests and interventions in situations where their use is not supported by scientific and clinical evidence, whether by the government or professional societies, you can count on its not being long before these cries go up, sometimes eve from doctors themselves in the form of Ayn Rand-worshiping libertarian doctors who think that Medicare is unconstitutional, that doctors’ autonomy should be virtually unlimited, and that there should be in essence no constraints on them.
My perspective on this issue is that we already “ration” care. It’s just that government-controlled single payer plans and hybrid private-public universal health care plans use different criteria to ration care than our current system does. In the case of government-run health care systems, what will and will not be reimbursed is generally chosen based on evidence, politics, and cost, while in a system like the U.S. system what will and will not be reimbursed tends to be decided by insurance companies based on evidence leavened heavily with business considerations that involve appealing to the largest number of employers (who, let’s face it, are the primary customers of health insurance companies, not individuals insured by their health insurance plans). So what the debate is really about is, when boiled down to its essence, how to ration care and by how much, not whether care will be rationed. Ideally, how funding allocations are decided would be based on the best scientific and clinical evidence in a transparent fashion.
This article punctures the flawed methodology of another recent study that slams all government health care based on prostrate and breast cancer outcomes without taking into account the “lead-time bias.” Here’s the issue with LTB: “aggressive screening can lead to more patients having a diagnosis of cancer for a longer period of time even without any real improvement in survival [this leads to] more overdiagnosis, which will inflate the apparent survival time after a cancer diagnosis in the population.”
The article links to a stunning set of graphs At Incidental Economist showing that the U.S. isn’t getting anything for all of that early diagnosis and high tech cancer treatment. And this is the health care system that we tout as the world’s best. Another case where evidence is inconvenient. If you really want to get pissed off at the insanity of our lawmakers, check out this article at Incidental Economist(“Public health prevention fund: On the chopping block once again“), which points out that fact that our preventative health system is atrophying and the reasons for this horrific development.
Glenn Greenwald points out Barack Obama’s hypocrisy when he asserts that he cannot stop the federal government from prosecuting sick people with prescriptions. He said everything but this (with sums up his idiotic position): “Sorry, but I’m only the highest ranking law enforcement officer in the United States.” Here’s an excerpt from Greenwald’s insights on Obama’s crackdown on medical marijuana:
“As an emailer just put it to me: “Interesting how this principle holds for prosecuting [medical] marijuana producers in the war on drugs, but not for prosecuting US officials in the war on terror. Or telecommunications companies for illegal spying. Or Wall Street banks for mortgage fraud.”
That’s about as vivid an expression of the President’s agenda, and his sense of justice, and the state of the Rule of Law in America, as one can imagine. The same person who directed the DOJ to shield torturers and illegal government eavesdroppers from criminal investigation, and who voted to retroactively immunize the nation’s largest telecom giants when they got caught enabling criminal spying on Americans, and whose DOJ has failed to indict a single Wall Street executive in connection with the 2008 financial crisis or mortgage fraud scandal, suddenly discovers the imperatives of The Rule of Law when it comes to those, in accordance with state law, providing medical marijuana to sick people with a prescription.”