Digging deeply into death panels and rationing

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.

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The danger of sitting too much

How dangerous is it to sit too much?

[P]eople who sat more than 11 hours a day had a 40% higher risk of dying in the next three years than people who sat less than four hours a day. This was after adjusting for factors such as age, weight, physical activity and general health status, all of which affect the death risk. It also found a clear dose-response effect: the more people sat, the higher their risk of death. The results are part of the Sax Institute's 45 and Up Study, the largest ongoing study of healthy aging in the Southern Hemisphere. It compared the self-reported daily sitting time of 222,497 Australian adults 45 years or older with their likelihood of death in the next three years.
And there's also an American study:

[M]en who sat more than six hours a day during the years of the study (1993 to 2006) were 18 percent more likely to die than those who sat for three hours or less. The death rate for women who sat more than six hours day was 37 percent over those who were seated three hours or less.

Check out this short video urging people to avoid prolonged sitting.

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What would happen without public funding for family planning?

How important is it to publicly fund family planning? Consider the following information from a mass emailing I just received from Guttmacher Institute:

Publicly funded family planning services play a crucial role in improving maternal and child health, helping women and couples achieve their fundamental childbearing goals and achieve economic security for themselves and their children. These efforts save almost $4 for every $1 invested and help avert almost two million unintended pregnancies per year, which would otherwise have resulted in 860,000 unintended births and 810,000 abortions. Without these services, the number of unintended pregnancies and abortions occurring in the United States would be nearly two-thirds higher among women overall and among teens; the number of unintended pregnancies among poor women would nearly double.
The email included this link for additional information on this topic of public funding. Consider the information provided by Guttmacher under the heading: "WHO NEEDS CONTRACEPTIVE SERVICES?" • The typical American woman, who wants two children, spends about five years pregnant, postpartum or trying to become pregnant, and three decades—more than three-quarters of her reproductive life—trying to avoid pregnancy. • About half of all pregnancies in the United States each year—more than three million—are unintended. By age 45, more than half of all American women will have experienced an unintended pregnancy, and three in 10 will have had an abortion. • There were 66 million U.S. women of reproductive age (13–44) in 2008. • More than half of these women (36 million) were in need of contraceptive services and supplies; that is, they were sexually active and able to become pregnant, but were not pregnant and did not wish to become pregnant. The number of women in need of contraceptive services and supplies increased 6% between 2000 and 2008. And consider the following, under the topic, "Who Needs Publicly Funded Service: • Among the 17.4 million women in need of publicly funded contraceptive care, 71% (12.4 million) were poor or low-income adults, and 29% (5 million) were younger than 20. Four in 10 poor women of reproductive age have no insurance coverage whatsoever. Guttmacher offers a wealth of statistics here.

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Big shake

It was the middle of the afternoon and my family and I (my wife and I have two teenaged daughters) were in the car headed for home. We agreed that this would be a junk food moment, something we don't do often. The two items most mentioned in the car were french fries and a chocolate shake. "Hey, there's a White Castle up ahead," I mentioned. I pulled up and ordered the "large chocolate shake" and some fries. None of us drink soft drinks, though we had all heard that there were some large serving sizes out there. What emerged from the window nonetheless startled all of us: A 44-ounce chocolate shake. We hauled it home and split it among the four of us. By the time we all gave up on it, there was still a bit left. Which inspired me to check the White Castle nutrition website. This 44-ounce drink is 1030 calories including 210 calories of fat (White Castle's large strawberry shake is as much as 1,300 calories in many regions). I'm not writing this to single out White Castle--many fast food joints offer similar fare. It was a worthwhile anthropological adventure, though, to see what (I assume) some people drink all on their own. PS. We all enjoyed the shake.

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