The furor about the new breast screening guidelines has made Sarah Palin’s comments about “Death Panels” very pertinent as the Senate debates health care reform. First, the United States Preventive Service Task Force (USPSTF) recommendations have been attacked as rationing and defended by Kathleen Sebelius, the Secretary of the Department of Health and Human Services, who denied that the guidelines were anything but advisory. However, a study of the pending legislation shows she is lying. The bill, if passed would empower the same commission as the official body to determine what would be covered by health plans.
1) The USPSTF will be renamed as the “Task Force on Clinical Preventive Services” – TFCPS (Section 3171, pages 1318-1319)
2) The TFCPS shall “review the scientific evidence related to the benefits, effectiveness, appropriateness, AND COSTS (emphasis DrRich’s) of clinical preventive services” and determine whether those preventive services ” meet the Task Force’s standards for a grade of A or B.” (Section 3131, page 1292).
3) If the TFCPS determines that a preventive service has achieved a grade of A or B, “the Secretary shall ensure that the [service] is included in the essential benefits package under section 222.” (Section 3143, page 1307).
4) The “essential benefits package” will cover “preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services recommended for use by the Director of the Centers for Disease Control and Prevention.” (Section 222, page 106).
And finally, the kicker:
5) “All recommendations of the Preventive Services Task Force and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this Act, shall be considered to be recommendations of the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3131 and 3132 of the Public Health Service Act, as added by subsection (a).” (Section 3171, page 1319).
So, to summarize: The USPSTF, to be renamed the TFCPS, will review the clinical science AND THE COSTS of preventive medical services and give them a grade based on those findings. The grade will determine whether a preventive service is covered or not. Services that receive a grade of A or B will be covered, otherwise, not. Most strikingly, the current activities of the USPSTF – including its new recommendations on breast cancer screening and coronary artery screening – will become official healthcare policy, and will directly determine coverage, as soon as the new healthcare reform plan is passed.
Sebilius is lying.
Here are the recommendations:
The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.
Grade: C recommendation.
Note that only grade A and B will be funded.
The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
Grade: B recommendation.
The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
Grade: I Statement.
Grade I (insufficient information) will NOT be funded.
The USPSTF recommends against teaching breast self-examination (BSE).
Grade: D recommendation.
The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
Grade: I Statement.
Once again Grade I doesn’t get funded but “clinical breast examination” means the doctor’s exam to me. So we don’t get paid for breast exams.
The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Grade: I Statement.
Once again, Grade I doesn’t get funded.
In a post on another blog a couple of days ago, I predicted that pap smears will be treated the same way. Screening is costly because the doctor might find something. The Congressman in Florida who says the Republican health plan is to ask patients to “die quickly” might be interested in his own party’s plan but I doubt he cares.
I didn’t expect to be proven right so quickly.
New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.
The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.
Yes, we can’t have that “potentially harmful treatment” can we ?
And so we go skipping along the road to health reform.
Tags: health care, medicine
I have a buddy who hates Palin and truly believes she’s an idiot.
(I know… I know… who doesn’t?!)
The thing is, as his key point to support the premise he always goes straight to this whole “death panel” business.
Now… understand… I’m not talking your average American moron. My buddy has neither my academic credentials (such as they are) nor does he do 1/50th of the news reading/watching/listening that I do, but he has a top notch NY suburban Catholic School education (back in the 70’s when standards were still fairly high) and he has his bachelors and masters in Lighting Design, has taught at Parsons School of Design, and is in fact one of the foremost Lighting Engineers in the world and owns one of the most prestigious Lighting firms in NYC – and thus the world.
(I note all this just as background to buttress the point that this guy is no dummy.)
So… back to the “death panels…”
This friend – as bright as he is, and even in terms of background knowledge of history, politics, economics, social policy, etc., he’s far beyond the average American dunce – just CAN’T get it through his thick skull that by “death panels” Palin (and others) were making a point about RATIONING.
He can’t – or rather, he won’t, he refuses to – acknowledge that as care and treatment are rationed inevitably more people will die simply based upon the realities of MATH!
I mean take this whole mammography debate. One figure I heard bandied about the other day (it doesn’t matter if it’s absolutely accurate or off by some percentage; I’m referring to it in order to make a point) was that if the “new proposed standards” were to go into effect, it’s projected they’ll be 81% as effective in leading to early detection, treatment, and survival rates as the present standards. So… 100% minus 81%… my buddy can’t seem to follow the logic of what this means in terms of… er… DEATHS.
No doubt all of you reading this have friends, family, colleagues, associates, and other folks you know who share MY friend’s boneheaded refusal to “do the math” and acknowledge what this means in terms of deaths.
God help this once great country.
BILL
Of course, we have rationing. Every individual cannot have access to whatever medical benefit they demand, regardless of its cost or its efficacy? What if women in their 30s, without risk factors, demand mammograms because the data show that a very small fraction of them would benefit? See http://bit.ly/656CwP
There is a difference between price and rationing. Look at the definition. My point is that the Democrats’ legislation purports to determine what will be done by controlling reimbursement. That might be OK if people were allowed to pay for those services not covered. It is not clear this will be the case. Medicare will not permit you to provide services that are not allowed and charge for them. The same philosophy seems to be in this legislation yet they will spend more money and provide less care. Today, on the This Week program, the Democrat, Debbie something-something, was lying about these guidelines. She was saying they were “advisory” only when the Commission is clearly empowered in the bills.
To have a sustainable health system, we must go back to paying for routine care ourselves and using insurance for major illness. That is the opposite approach to this bill.
“Of course, we have rationing.”
Of course we do, Dr. Kirsch; the discussion revolves around the proper mechanism for rationing and focuses upon which “side” of the debate presents a more honest portrayal of what their proposals will lead to.
In short… as far as the average Democratic politician spins his or her support of the various bills under serious consideration none of these bills will lead to FURTHER rationing as compared to what the average insured middle class American has to deal with at present.
In short… that’s bull; that’s a lie.
Did you Dr. Kirsch (or did you Mike) happen to catch “This Week With George Stephanopoulous” this morning? If not, you should either read the transcript or view the video online.
Senator Tom Coburn, MD, and Congresswoman Marsha Blackburn using both facts and logic attempted to explain to former Bill Clinton aide George Stephanopoulous, Congresswoman Debbie Wasserman Schultz, and Senator Ben Nelson why the Democrats approach to health insurance and health care “reform” has it all ass backwards and will make things worse instead of better.
I write “attempted to explain” because none of the three Democrats seemed able or willing to recognize reality when it hit them in the face.
God help this once great nation.
BILL
Ahh… Mike!
(*GRIN*)
As you know, I read posts in sequence and OBVIOUSLY my previous post was written prior to my reading your 9:20 am post.
I note that “great minds think alike” with regard to this morning’s “This Week.”
Wasn’t that just AMAZING….?!?!
Did you note how when Coburn was trying to explain to Wasserman-Schultz that MEDICARE actually has a proposed treatment reject rate approximately twice that of private insurance that ‘ol George just shrugged and immediately tried to re steer the discussion towards abortion?
Or how about when Blackburn was quoting the actual exact in context language of the bill as it would apply to how decisions of the USPSTF would actually end up having the effective last word on options for the average American? Even though it was obvious that Stephanopoulous KNOW Blackburn was absolutely correct and that Wasserman-Schultz was basically… er… lying… Stephanopoulous insisted on acting the part of “neutral” observer in the sense of allowing LIES to be presented to his audience as the moral equivalent of TRUTH.
It’s disgusting, doc. The MSM are by and large biased AND incompetent. And since the average American relies upon the MSM for his or her worldview…
Again… God help this once great nation.
BILL
Actually, I think Stephanopolis does a good job and I watch his show instead of Fox News which is on at the same time. The woman was lying and I wonder if we will see her on that show again. He has to know that she was lying.
“Actually, I think Stephanopolis does a good job…”
Compared to what baseline – MSNBC?
Seriously, Mike, I “hear” what you’re saying and I recall many establishment Republicans and even conservatives having the same attitude towards the late Tim Russert, but like Russert was, Stephanopoulous is biased and over time the more subtile “tilting” of a Stephanopoulous or a Russert is far more insidious and thus dangerous than more transparent bias.
I gave you not just one, but TWO examples from yesterday’s “This Week” supporting my contention. Care to dispute my examples and analysis?
Don’t get me wrong. I too have seen “Steph” ask insightful, probing, and even mocking questions of liberals and democrats; it’s just that he’s FAR more prone to “go on the attack” when it comes to conservatives and Republicans while at the same time – GENERALLY SPEAKING… one show to the other… one year to the next – showing a willingness to follow the spin lead of fellow democrats.
Hmm… perhaps I simply adhere to higher standards.
BILL