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Should People Who Don’t Take Good Care of Themselves Pay More for Health Insurance?
When healthcare reformers talk about making health insurance fair, some suggest that people who don’t take care of themselves really shouldn’t expect the rest of us to pay for their folly. They point to a study published in 2002 showing that, each year, the average smoker needs an extra $230 worth of inpatient and ambulatory care. “Problem drinkers” require an additional $150; obesity adds $395 to the annual bill, while simply being overweight costs an average of $125 a year. (According to researchers about one in three Americans are overweight while in one in five is obese).
Asking those who puruse less-than-healthy lifestyles to pay higher healthcare premiums seems, on the face of it, a simple matter of equity. But one needs to ask: what will be the effect? And where do we draw the line?
update, Aug. 29 Prostate Cancer Screening
UPDATE, AUGUST 29: In the August 29 issue of the Journal, Cancer, the American Cancer Society changed its recommendation about prostate cancer screening, saying that “Because the current evidence about the value of testing for early prostate cancer detection is insufficient to recommend that average-risk men undergo regular screening, the ACS recommendations emphasize shared-decision making.” The ACS goes on to say that PSA testing should be “offered” to men beginning at age 50, but not “recommended” to them. Instead doctors should discuss the “potential benefits, limitations and harms associated with testing” and then let the patient decide. (See post below on prostate cancer and Dartmouth’s "shared decision-making progrm." ) Finally, in the August 29 issue of Cancer, the ACS says that its prostate cancer advisory committee considers it “inappropriate” for doctors either to “recommend” PSA testing or to “discourage PSA
testing.” In other words, the ACS seems to acknowledging that we just don’t know whether early detection and treatment does any good.
Update–Gardasil for Boys?
A study published today in the journal Cancer suggests that cancers of the tongue and tonsils may be associated with the HPV virus that is linked to cervical cancer. The theory is that boys may contract the cancer through oral sex. No surprise, the media is now asking: "Should boys be vaccinated with Garadasil too? (See my post below on Direct-to-Consumer advertising recommending Gardasil, a vaccine the against some cases of cervical cancer, for girls.)
The Wall Street Journal’s Health Blog takes a cautious approach pointing out, first, that "HPV’s connection to to oral cancer isn’t as clear-cut as its role in cervical cancer," though a New England Journal of Medicine article published earlier this year suggested a strong association. Moreover, while Merck and its rival GlaxoSmithKline (which is also developing a vaccine for cervical cancer) have done some research on using their HPV vaccines in boys, they have even less data for boys than they have girls. Finally, "this form of cancer is rare. . . .So for the time being, the vaccine, which costs $360 for a three-dose regimen, seems unlikely to be given to boys."
The Journal’s healthblog also notes that one of the study’s two authors "has worked as a consultant for GlaxoSmithKline."
Drug-Maker’s Direct-to-Consumer Advertising—“Half-True”?
Earlier this month the FDA announced that the direct-to-consumer ads Merck has been using peddle its new cervical cancer vaccine, Gardasil, are “half-true . . . information currently being advertised could mislead the public.”
But “don’t get too excited that the U.S. Food & Drug Administration has regained its sanity,” says blogger Bill Sardi.
“This is the FDA in Thailand,” he explained. (Sardi picked up the news in the Bangkok Post)
Before taking a closer look at precisely why Thailand’s health officials are concerned about Merck’s ads—and why our own FDA isn’t raising a red flag– let’s step back and review our own government’s policy on drug ads that are beamed directly to you and me.
Jacob Hacker on “Sicko” –and Employer-Based Insurance
You know that Michael Moore’s “Sicko” is being taken seriously by the medical community when you see it reviewed in The New England Journal of Medicine. The issue that came online last week contains Jacob Hacker’s take on the film—as well as his prescription for national health care reform.
Hacker calls the first half of the film “ruthlessly efficient,” declaring that, “along with Al Gore’s global-warming warning, An Inconvenient Truth, Sicko may well be remembered as our generation’s Silent Spring or The Jungle — propaganda, in the best sense of the word, that pricks our collective conscience about problems that are hidden in plain sight.”
But as a political scientist (Yale) and New America Foundation fellow, Hacker is dissatisfied that, in the second half, Moore doesn’t offer a better solution to the crisis. This may be asking a bit much of Moore. My theory is that a film-maker, like any other artist, need only raise the right questions, (however abstractly), spurring his audience to think—and to imagine.
That said, Hacker’s point that Moore ignores the best model for reform by never mentioning Medicare is a good one: “He talks about the post office, the fire department, public education — but not the one public program that most resembles the ‘free universal health care’ he extols.
“That’s too bad,” says Hacker, “because the Medicare model is the not-so-secret weapon in the campaign for affordable health care for all. Today, many advocates of national health insurance have wisely started calling for Medicare for All’ rather than their old rallying cry, ‘Single Payer.’”
Hacker’s right. To many Americans, “single payer” evokes images of long lines—not to mention the Specter of Socialism. Medicare, on the other hand, represents the Promised Land –that point in time when you no longer have to worry about whether or not you have health insurance, or whether it will cover what you need. Medicare is hardly perfect, but not a few seniors breathe a huge sigh of relief when they finally find themselves in the warm embrace of the second-most-popular federal program in the U.S. (Social Security comes first.)
But Hacker doesn’t think we’re ready for “Medicare for All.” Instead, he suggests that “For now, the best step may be to require employers either to provide their workers with good private coverage or to enroll them, at a modest cost, in a new public program modeled after Medicare. Workers enrolled in this new public framework could be asked to pay a modest premium on top of employers’ contributions, based on their income, and they could be allowed to enroll in qualified private plans — as people with Medicare coverage can today. No doubt many employers would seize the opportunity to obtain inexpensive coverage for their workers, which would give the new public insurance plan a large, diverse enrollment and a great deal of leverage to contain costs and improve care.”
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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UnitedHealth Care vs. the Kids
Wednesday night, the House voted 225–209 to pass a bill that would, in the words of a Wall Street Journal editorial, “steal nearly $50 billion from Medicare Advantage, the innovative attempt to bring private competition to senior health care” in order to beef up the State Children’s Health Insurance Program (SCHIP), a program that delivers health care to poor children.
SCHIP is scheduled to expire September 30; the House bill would renew the program while expanding it to include another 5.1 million children at a cost of an extra $50 billion over five years. The bill’s backers propose to fund the legislation by increasing the federal cigarette tax by 45 cents while simultaneously paring the premium that Medicare pays private insurers who provide Medicare to seniors. The goal of the bill, reformers say, is to ensure that all children in the United States have health insurance. The Wall Street Journal’s editors see things otherwise: “Democrats apparently want to starve any private option for Medicare,” the editorial concluded.
Rupert Murdoch hasn’t yet weighed in, so I decided to take a look at the proposal. Would the legislation really make it impossible for private sector insurers to continue to offer needed benefits to seniors?
I began by looking at insurers’ finances only to discover that the health care insurance industry is, in fact, facing rough weather ahead. While the cost of providing health care continues to climb, more and more employers are backing away from providing health care benefits for their employees. Others are raising premiums and co-pays to a point that some workers can’t afford to participate in the plans. This means that insurers are losing customers.
As a result, one might expect that insurers’ profits would be falling. One would be wrong
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