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Posted 8/1/2012 3:26 PM (GMT 0)
BillinChicago posted this link yesterday, but it was buried deep in a thread, and I doubt if many guys saw it there.  I thank BillinChicago for posting the link yesterday, and I think it deserves broader attention.

Some might say it's political.  I dispute that.  It's simply one well known physician's prediction of how the Affordable Care Act, now the law of the land, will change the way we approach PSA testing and other medical tests and screenings.  I think many folks will be quite surprised by what Dr. Hsieh says will happen, even in the case of men who want the PSA test and who are willing to pay for it out of their own pocket.

Here's the link:  http://www.forbes.com/sites/realspin/2012/07/05/is-president-obamas-prostate-gland-more-important-than-yours/

Another Bill, not "in" but "near" Chicago

Posted 8/1/2012 4:36 PM (GMT 0)
Let's see, how does one reply to this political post without being political? But I think it deserves a response.

It must be nice to merely worry about how our PSA tests will be paid or not paid.

Meanwhile, you have plenty of folks totally without insurance. These are not deadbeats. Think of the folks who got laid off from their jobs and too young for MediCare. Now, saddle them with PC or some other major illness and it is a major disaster financially.

It is a national disgrace that we are the only industrialized country without nationalized health care. Obama finally had the guts to tackle the issue.

Perhaps someone can contribute to this discussion in a more general, non-political manner.

Mel

Posted 8/1/2012 5:02 PM (GMT 0)
This is heading for a lock-down, so what the heck...(although my comment here is, I believe, a humanistic and non-political viewpoint)

Soapbox time:

I recently learned the new term, a "wallet biopsy," as a metaphor for how our current health system examines for the presence of an insurance/Medicare card inside one's wallet before proceeding (or at least until those without insurance are sick enough or old enough for government benefits to kick in).

Ours (the US) is a nation of extremes, the the uninsured frequently denied even the most basic care while the well-insured often are "overtreated."  Our medical system fails to provide care when care is needed, and fails to stop expensive, often unnecessary and frequently harmful interventions, even in situations when science proves those interventions are the wrong thing to do.  Doctors aren't trying deliberately to harm patients; rather, our system is too lazy to insist that care be based on science rather than profit or best guesses.  Our doctors are sleepwalkers, not evildoers.

Patient education is a key to change.  Patient advocate support is crutial, but many are blinded to the facts because of their own "cancer hysteria."  One voice not blinded is that of Fran Visco, a breast cancer survivor and president of the National Breast Cancer Coalition; she said:  "We pour so much money into overtreatment.  All of that could be channeled into getting more people care."

Off soapbox.

 

Post Edited (Casey59) : 8/1/2012 11:24:46 AM (GMT-6)

Posted 8/1/2012 5:12 PM (GMT 0)
Just another article - from the Right - resorting to scare tactics. Care is already heavily managed for those of us fortunate enough to have insurance in the USA, whether people realize it or not. This I know, all too well, from working in healthcare for the past 25+ years.

On a more positive note, I just passed the one-year post-op mark last year. Doing the 1-year PSA test next week. Completely continent; ED slowly improving; life is good.
Posted 8/1/2012 5:12 PM (GMT 0)
. . . last week, is what I meant to say!
Posted 8/1/2012 5:21 PM (GMT 0)

compiler said...
Think of the folks who got laid off from their jobs and too young for MediCare. Now, saddle them with PC or some other major illness and it is a major disaster financially.

I know full well what you are saying. At age 62 I had heart surgery, two months later was diagnosed with PC, and a month after that lost my job due to a plant closing. That was three years ago and I'm still untangling financial problems but I was lucky that I was able to retire as of the plant closing and be eligible for Social Security and a pension. Without Social Security and the pension, there would be no way at all to afford COBRA coverage even for only myself on unemployment compensation. Of course, having had heart surgery shortly before I lost my job guaranteed that no insurance company would offer me any coverage at all except as COBRA coverage. COBRA coverage expires after 18 months so then I had to go into a high risk state program or have no coverage at all. The state program was over $600 per month with a $5,000 deductible for only myself until I became eligible for Medicare.

Like I said, I was lucky that I had some options to fall back on but there are far too many people who just are cast aside by the current system.

Can I get political about healthcare in the United States? Don't even ask.
Posted 8/1/2012 6:02 PM (GMT 0)
Well, I'm sort of amazed that we can't discuss this article without broadening it out into accusations agaist the Right, or the Left, or advocacy of universal healthcare, or an indictment of the American medical system.  Sorry I brought it up.  Sure, lock it down so we can't ACTUALLY DISCUSS THE ARTICLE.

I don't think the point of debate in the article is "universal health care."  Nor is the point whether or how PSA tests will be paid for.  The point really is, will men have access to the test at all after the full ramifications of the USPSTF recommendation of a grade of D for the test are brought to bear, and when the Accountable Care Organizations' oversight discourages physicians from recommending the test.  Hey, it's the law of the land and it is what it is, so the only question for me is, what are its ramifications for PSA testing?

Whether or not one thinks the Affordable Care Act is a good idea is a much different issue, but there are surely going to be surprises when it's implemented, and this looks like one of them.  At least I found it surprising.

And I personally don't care if it's called "Obamacare," "Bushcare,"  "Clintoncare" or "Reagancare."  This is a significant change in the way medical care is delivered, and it deserves discussion.

Posted 8/1/2012 6:07 PM (GMT 0)
FWIW, I think insurance should be a tool to manage the risks of needing high cost health care. I don't think screens and preventive care good things to be included in insurance packages.

I'd much rather see screens and preventive health turned over to the Walmarts of the world who know how to mass market (and that means educate) and to drive down unit costs to make the service affordable.

We're headed in inexactly the wrong direction where were competing stuff in insurance packages e.g. PSA v Contraception for example, when neither really needs to be insured. They're affordable, and can be made more affordable by the right folks.
Posted 8/1/2012 6:15 PM (GMT 0)

Clock,  Thanks for posting the link and trying to get things back on track.  I would like to know if Dr. Hsieh's opinion of the ACA and its impact on PSA testing is reasonably correct.  Has anyone on the forum read the ACA rules as they are currently written?  If Dr. Hsieh is correct, then we are looking at some significant changes down the road for PSA screening. 

Carlos

Posted 8/1/2012 6:29 PM (GMT 0)
FWIW, the organization Dr Hsieh co-founded and publishes in (FIRM, Freedom and Individual Rights in Medicine) is one of the "resouces for Tea Party activists" sites, advertised as "ammunition against government-run health care."

Full disclosure.
Posted 8/1/2012 6:29 PM (GMT 0)
I, for one, do not want the government deciding what tests I can get. That is not to say we don't need healthcare reform in the US, we do. But reform should not automatically mean we give up our rights to make our own decisions. Clearly, there are many here who believe that PCa is over treated and I support their right to decide for themselves how they wish to proceed. However, I do not support anyone else making that decision for me.
Posted 8/1/2012 6:38 PM (GMT 0)
Lets keep politics out of it and just use the numbers and not wishful thinking or moral issues of what should be right. This is Reality:

Medical costs currently account for about 16% of our total GDP of $17 trillion dollars. For persective if we spent $1 every second it would take 36,000 years to spend $1T, or stacked in dollar bills the stack would reach to the moon and back. The health care act will cost $1.2T over 10 years by the CBO and that's conservative.

Our 2012 budget is $3.8T and the health care act will add at least $.1

T to this starting in 2014.

Our total revenues are $2.5T and we have a deficit of $1.3T which is added every year to our $16T debt.

Entitlements, SS, Medicare and Medicade, pensions and debt (mandatory spending) is $2.5T; exactly equal to revenues These are also governed by automatic increases.

All other government programs, defense, welfare, infrastructure ect are 1.3T of which the entire cost is borrowed.

Income tax is currently $1.2T in revenue.

Mel,

You are the math prof so please solve the following problem.

What will our debt be in 2020?

At 4% interest when will our debt exceed our individual income tax revenues? At 6%?

At what debt level will people stop lending us money? 120% of GDP; 150% of GDP? (Greece and Spain are at about 90%).

It's not a problem of what we want or what we should do or for that matter what is right? It is simply that we have run out of our ability to pay for everything that we currently have and will soon run out of the capability of borrowing. The numbers are unstainable and just to get to a balanced position income taxes would have to rise about 130% or all spending outside of entitlements cut to zero. Neither of these will happen. Growing out of it is also unreasonable as no country with a 100% debt to GDP has ever grown more than 2%.

I don't have an answer, but adding more spending on medical or any other programs is only making the problem worse.

Here's my one political statement.

"We are on the Titanic and one side is adding more people to the boat while the other side is arguing about the fares each passanger is having to pay".

 

Posted 8/1/2012 6:47 PM (GMT 0)

FrackMe said...
I, for one, do not want the government deciding what tests I can get. That is not to say we don't need healthcare reform in the US, we do. But reform should not automatically mean we give up our rights to make our own decisions. Clearly, there are many here who believe that PCa is over treated and I support their right to decide for themselves how they wish to proceed. However, I do not support anyone else making that decision for me.

So instead you want the insurance companies a for profit business deciding on your tests. The real death panels are behind insurance company doors. Plus they are under pressure more than any government board as to lower costs at sometimes all costs. No to mention their xmas bonuses may be riding on it. It's embarrassing as we still have a for profit healthcare, with millions falling through the cracks meanwhile the population of Cuba is 100% covered.
Posted 8/1/2012 6:52 PM (GMT 0)
Billnchicago makes a great point. Screeningslike PSA, blood pressure, cholosteral are common, low-tech and inexpensive. Why add the huge administrative cost to get someone else to weite a $20 check? Zufus goes monthly to a walk in lab and gets his PSA test done.

Inspector, don't worry about getting coverage because preexisting conditions haven't been a problem since HIPPA came in 15 years ago so long as you didn't have a break in coverage. You will be able to go from your COBRA to an individual plan with no pre-existing problem so long as you do it promptly.

Obama's prostate is not worth more than my radiation and HT ablated one, as neither is currently for sale. The Affordable Care Act (who the Hell named this thing??) does not block Americans from paying directly to ptoviders for services. Some other countries (Canada) block the private payment. Thus in the future if my insurance doesn't cover my PSA test, I will go to the lab and pay directly. If our rules ever get to the point that I can't pay directly then I will travel to any number of countries that provide for my paying for the service. What do you think Canadians do now?? For serious stuff they come to the US or go places like Bumrungard Hospital in Thailand. We will no doubt do the same. I can see a weekend in Nassau for fun and sun and golf and gambling......and a PSA test, if our system won't allow it.

More importantly is the communication to consumers as to what and how they should screen. Screening should go the way of $29.00 Jiffy Lube oil changes. The real key will be in the care and treatment rationing, whether it is government induced, insurer induced, or market induced.....probably a mixture of all just like now. The tragedy will be in two areas in my opinion. First, by dumbing people down so that they don't do the proper screening and only find problems when it is too late to effectively treat, and second, by witholding and/or delaying treatments due to age, where the treatment could have extended lifespan reasonably and/or improved greatly quality of life.

My greatest concern regarding the changes to our health insurance regulations is the expectation that we won't be able to attract the sufficient numbers of bright people to become doctors that the system will need. Say what you want about the overpayed arrogant doctors you may be sending money to....just wait until you don't have them and see what that will be like.
Posted 8/1/2012 6:53 PM (GMT 0)
the health insurance issue is a moral issue.

I pay over $1200 a month for my coverage and I wouldn't consider it great coverage.

I just spent a year in Italy where there is universal care and in some regards, better care. Italy doesn't even have money for trash removal these days but they believe in this moral issue.

that said, with increased immigration, even European countries with a history of an enlightened approach to health issues/care are starting to debate economic realities.

As far as this author and his affiliation to the Tea Party, snicker...

John, if you're so concerned about our budget, what about the billions spent on "Star Wars" program, on the military, on aide to so called partners like Pakistan? There's a lot of waste and many, if not most, probaly have a long list of waste that comes before the richest nation in the history of mankind having 30+ million citizens uninsured.
Posted 8/1/2012 6:53 PM (GMT 0)
JohnT, healthcare was up to 17.3% of GDP in 2009, and rising...

Growing healthcare costs are unsustainable.  If we don't get better management strategies and more cost-efficient processes (PC management, included!), this will become one more of the many straws that finally breaks the back of the economy.

One knowledgeable source wrote, "This is medical gluttony.  The ironic thing is that people are talking about rationing.  We have got to think about the rational use of medicine in order to avoid rationing medicine."    (prize given to the first HW member who can figure out who said this)

Posted 8/1/2012 6:54 PM (GMT 0)
No FrackMe, you missed my point all together. I want cheap preventive health care and cheap testing. I think the best way to drive down costs is turn it over to people who know how to make things cheaply and Walmart comes to my mind. I want these services so cheap there is no need to have insurance to pay for them. Big retailers also know how to market this stuff better too.

My daughter is on Medicaid and the Doc is not available to her 24/7. She's been using the nurse at our local Walgreens and it's been working well. It's what got me thinking that a whole lot more health care should be offered by retailers who know how to drive down costs.

I don't want to be in a situation were some unknown committee is doing cost-benefit analysis on the tradeoffs. I want cheap healthcare instead and I'll decide my tests and screens.
Posted 8/1/2012 6:57 PM (GMT 0)
Ziggy,

No insurance company has ever told me that I can't have a test ordered by any of my doctors. I have had many different insurance companies over my life, so it's not a question of just being lucky. Moreover, no insurance company has the power to tell me what I can or can't do, only whether or not they will pay for it. The government, on the other hand, can order a test off limits.
Posted 8/1/2012 6:59 PM (GMT 0)
"It's medical gluttony," said Dr. Otis Brawley, chief medical officer of the American Cancer Society.

"The ironic thing is that people are talking about rationing. We have got to think about the rational use of medicine in order to avoid rationing medicine," he said.

I want the little stuffed bear.
Posted 8/1/2012 7:02 PM (GMT 0)
Additionally, yes everyone in Cuba id covered, same in China and Malaysia. I lived in bith of those places and learned that just because you are covered doesn't mean you get treated. Same goes in the UK....lived there too. Watched a co worker wait over 9 months to get a hysterechtomy only to see it delayed further because she got diagnosed with breast cancer in the waiting period. The two conditions threw the Health Service minions for such a loop that by the time she did get routine treatment she was metastatic.

Universal care is not a panacea and the lack of it is not a problem. Access and cost control (as JohnT points out) are the keys. Study France's system that combines universal public care with private insurance and payment ability to see what migt be most effective. everyone pays about 20% of their income and significant deductibles for treatment, but as I understand the population does have good access to very good treatment.
Posted 8/1/2012 7:05 PM (GMT 0)

BillinChicago said...
No FrackMe, you missed my point all together. I want cheap preventive health care and cheap testing. I think the best way to drive down costs is turn it over to people who know how to make things cheaply and Walmart comes to my mind. I want these services so cheap there is no need to have insurance to pay for them. Big retailers also know how to market this stuff better too.

My daughter is on Medicaid and the Doc is not available to her 24/7. She's been using the nurse at our local Walgreens and it's been working well. It's what got me thinking that a whole lot more health care should be offered by retailers who know how to drive down costs.

I don't want to be in a situation were some unknown committee is doing cost-benefit analysis on the tradeoffs. I want cheap healthcare instead and I'll decide my tests and screens.

No what you want is more cheap untrained labor doing medical tests. I remember years ago when I had Kaiser. I rarely ever saw a doctor it was usually a nurse or physician's assistant. Meanwhile my dog was seeing a doctor a vet yes but still a doctor for far less than I was paying to see less trained medical personnel for myself. Thus there are ways to drive down costs now. Get rid of the insurance companies, explain why their CEOS have walked away with Billion dollar golden parachutes for what???? They are parasites what do they contribute and how much administrative costs are duplicated or quadrupled when you figure in all the individual billing departments? Put us on one payer like most of the other advanced nations and you won't need to Wal-Mart our healthcare.
Posted 8/1/2012 7:08 PM (GMT 0)
The NHS in England provides the majority of care in England, not all care.

I lived there and go there for work multiple times a year. My mother also had a hysterectomy there followed by hormone treatment. She also had open heart surgery for free and actually had the Queen's surgeon perform it. All free. Waiting periods are an issue, but technically the waiting is supposed to be on non urgent issues. Of course there are problems, but I rather live through that problem compared to what my U.S. friends who have lost employment in the last few years have had to go through.
Posted 8/1/2012 7:11 PM (GMT 0)

FrackMe said...
Ziggy,

No insurance company has ever told me that I can't have a test ordered by any of my doctors. I have had many different insurance companies over my life, so it's not a question of just being lucky. Moreover, no insurance company has the power to tell me what I can or can't do, only whether or not they will pay for it. The government, on the other hand, can order a test off limits.

I had my saturation biopsy turned down by my insurance. There were 4 of us that did back then two were later allowed I was one. The two others were stuck with only radical treatment options after that. Just because you've had no problems sure doesn.t speak for a majority. In fact there's nothing quicker to change ones political beliefs on this matter is for them or a loved one to get a serious illness and then they learn how good their insurance really is. Most are qutie disappointed. You may have it well as do I but we are not the rule.
Posted 8/1/2012 7:15 PM (GMT 0)
Sure looks and smells like political talk in disguise here. Amazed its not been locked down.

Was amused when the republican nomineee was in Israel a few days ago, bragging about the health care system in Israel, was he unaware that it is 100% socialized?

As the richest country on the planet, and just my personal opinion, 100% of our citizens need coverage, regardless of which label a person wants to call it.

As far as Medicare goes, now that I have been on it for a full year, I have zero complaints. I am seeing the doctors I want to see, never having to wait for appointments, and no tests or scans are being denied to me. More than I can say for when I was on Blue Cross prior to the Medicare. And none of my doctors are complaining either.

david
Posted 8/1/2012 7:16 PM (GMT 0)

JNF said...
Additionally, yes everyone in Cuba id covered, same in China and Malaysia. I lived in bith of those places and learned that just because you are covered doesn't mean you get treated. Same goes in the UK....lived there too. Watched a co worker wait over 9 months to get a hysterechtomy only to see it delayed further because she got diagnosed with breast cancer in the waiting period. The two conditions threw the Health Service minions for such a loop that by the time she did get routine treatment she was metastatic.

Universal care is not a panacea and the lack of it is not a problem. Access and cost control (as JohnT points out) are the keys. Study France's system that combines universal public care with private insurance and payment ability to see what migt be most effective. everyone pays about 20% of their income and significant deductibles for treatment, but as I understand the population does have good access to very good treatment.

when comparing other countries it must be long established industrial democracies. I hope to god a nation of our wealth has it better on this than Malaysia. I'm sure you can say so comparing Somalia too, But what about Germany, Sweeden Canada , and yes the UK. Ask anyone from the UK would they rather have our system if they aren't rich and none would switch.
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