Commenting on “Do We Really Have to Cut Back on Healthcare Spending?”

This is a great overview of the facts and clearly
demonstrates the urgent need for evidence-based medicine.  No matter what
form health care reform takes in the future, the issue of cost has to be
addressed.  However, I believe that a significant key to solving the
puzzle of spiraling cost is an active and educated consumer of health
care. 

To begin the process of developing such a consumer, there
must be financial “skin in the game.”  How often does a consumer of
non-health care goods purchase a car, home or a computer without asking the
price of the item?   All would demand a Rolls Royce if someone else
paid the vast majority of the bill.  Admittedly, when it comes to health
care, the information needed for efficient purchasing is not sufficiently available
and is more complex than that necessary for purchasing simple consumer
goods.  However, this is not an excuse for lack of consumer participation
and decision-making in the economic process of health care.

Have you noticed that most discussions of health care
reform are supply-side and payer driven?   This is yet another
indication of the passive role that consumers take in our health care
system……..like children with parents who know better who make the major
decisions for us.

-Barbara E. Rodin, Ph.D

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If We Mandate Insurance, Should 20-Somethings Pay Less?

Should insurers be able to offer less expensive policies to the young and healthy? Or should they be required to offer the same benefits to everyone at the same price?

In states where insurance is mandated, should twenty-somethings get a break? In a post on Health Care Policy and Marketplace Blog Robert Laszewski addresses these questions. He begins by focusing on a report  just released by the health insurance trade association (AHIP). The study looks at state health insurance reforms of the 1990s that tried to eliminate discrimination by insisting that insurers must sell “individual” policies to people who are not covered by an employer or another group without discriminating on the basis of health, age or gender. According to the AHIP, these reforms have had some “unintended consequences.”

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Screening for Prostate Cancer: Before Medicare Pays, Patients Need to Know More About Risks

Roughly two-thirds of all men on Medicare are screened for prostate cancer. Most feel they have no choice. After all, this year more than 27,000 American men are likely to die of the disease. When men are asked about their fear of cancer, a survey from the Harvard Risk Management Foundation reveals that prostate ranks at the top of the list. Colon cancer, which kills roughly as many men in the U.S. each year, ranks number seven. There is something about prostate cancer that pushes buttons. No wonder so many men sign up for the “PSA” test which measures levels of prostate-specific antigen in the blood.
But the truth is that current research offers no proof that widespread screening and early diagnosis saves lives. What we do know is that patients who are tested and treated may suffer life-changing side effects that outweigh the uncertain benefits of early detection.

In June the National Cancer Institute made its position clear: “Screening tests are able to detect prostate cancer at an early stage, but it is not clear whether this earlier detection and consequent earlier treatment leads to any change in the natural history and outcome of the disease.” The U.S. Preventive Services Task Force agrees.

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Wall Street, Cancer and the FDA: A Cautionary Tale

Only in America do physicians who evaluate new drugs need bodyguards. You may have read about the brouhaha surrounding Provenge, a vaccine designed to extend the lives of men suffering from late-stage prostate cancer. In March, a Food and Drug Administration (FDA) advisory panel voted 13 to 4 to recommend approval. The next day, shares of Dendreon, the drug’s sponsor, doubled. But shareholders did not celebrate for long. Two of the dissenting votes were cast by the panel’s two prostate cancer specialists: Sloan-Kettering’s Howard Scher and the University of Michigan’s Maha Hussain. And they did not just vote “no”—following the hearing, both wrote to the FDA arguing that Dendreon offered no solid evidence that Provenge works.
   
The FDA listened. And in May it told the company it wouldn’t approve the drug until it had more data. That is when the two oncologists began receiving threatening e-mails, phone calls, and letters. Many were anonymous

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