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The Right Prescription
Scared of Obamacare’s IPAB? Meet the USPSTF!
Those unelected boards are coming into their own, making decisions for doctors and patients alike.
In the fight over Obamacare, one of the hottest points of contention has been the Independent Payment Advisory Board (IPAB), an unelected body with powers so broad that it has been called a “super-legislature” by some, and a potential “death panel” by others. Major policies set by the IPAB will have the force of law unless they are explicitly blocked by Congress. The usual order, of course, is that Congress is supposed to make the laws and bureaucrats are supposed to follow them.
Another nasty ingredient in the alphabet soup of Obamacare is the United States Preventive Services Task Force (USPSTF). This is “an independent group of national experts in prevention and evidence-based medicine.” Formerly a sleepy quasi-governmental body charged with making recommendations about public health screening, under Obamacare the USPSTF will determine whether your doctor will be able to diagnose you with diseases.
The USPSTF first made headlines in 2009 when it encouraged women under the age of 50 to forgo mammogram screening for breast cancer. Only after an outcry from women’s and cancer advocacy groups did Health and Human Services Secretary Kathleen Sebelius beat a hasty retreat, distancing her department from the USPSTF recommendations.
More recently, the USPSTF advised against use of the prostate specific antigen (PSA) test. The routine screening of all men over the age of 50 via PSA testing was originally thought to have revolutionized the detection and treatment of prostate cancer. Prior to the development of this test, prostate cancer was almost always detected after it had already spread—too late to do anything other than manage the pain and complications it causes. The medical community understandably embraced PSA testing, which allowed the disease to be detected in its early stages.
An unqualified success story? Hardly. PSA testing detected far more cases of prostate cancer than had been seen before. Many men suddenly being diagnosed with (and treated for) prostate cancer would, prior to PSA testing, have died of other causes, blissfully unaware that they had cancer. The question, though, has been this: Who benefits from early treatment, and who is better off left alone? Early on, there was no way of knowing, so to be on the safe side, nearly all cases were treated—which meant that some men suffered complications from treatments that they didn’t need. About that, the USPSTF isn’t wrong.
Money also entered the picture. A damning article in the Wall Street Journal in 2010 revealed that some large urology groups were setting up lucrative radiation treatment centers to which they referred nearly all their patients. All this at a time when responsible urologists were developing and following observation protocols to monitor the severity of the disease, only stepping in to treat in those cases that showed signs of starting to advance.
What does all of this have to do with the USPSTF? A blanket declaration that primary care providers shouldn’t screen for a particular disease tells patients that they are really better off not knowing whether they have it or not. If you do happen to be the unlucky bloke whose lethal cancer could have been prevented by early detection, well, that’s tough luck.
You’re probably wondering whether, under Obamacare, the USPSTF’s recommendations are binding. The answer is yes and no. Medicare and other insurers are required to provide treatments or services given an “A” or “B” grade without cost to the patient. The law is silent when it comes to services with grades of “C” or “D,” which explains why Kathleen Sebelius got away with backpedaling on the USPSTF’s mammography guidelines in 2009, saying that they were “just recommendations.” For the moment, Medicare still pays for an annual PSA screening.
But technocrats of the future might well offer a radically different interpretation of the law’s silence. For instance, as “pay for performance” measures are introduced, there may be negative ramifications for doctors who frequently order tests assigned a “C” or “D” grade.
The USPSTF includes the requisite disclaimers, including the caveat that doctors should exercise judgment and discuss the pros and cons of various tests with their patients. This seems reasonable, but the reality is that few non-specialists have either the knowledge or the time for such discussions. As Obamacare takes effect and physicians come under increasing scrutinty for their adherence to official protocols (set, of course, by panels like the USPSTF), even this level of individual judgment may drop by the wayside.
About individual judgment: When President Obama had his physical last year, he made an “informed patient request.” Guess what it was? Yes, indeed…he was screened for prostate cancer with a PSA test, in spite of the fact that the USPSTF’s recently published (and well-publicized) draft recommendation statement recommended against it. The President’s physicians were fully aware of this recommendation, which is why the weasel words of “informed patient request” were used. You see, a busy president had done his homework and decided on his own to request a PSA test. He apparently went through with it even after his own government agencies advised him that the test was worthless. Right.
Legislation was introduced last year to reform this task force. The USPSTF Transparency and Accountability Act would have brought some balance to the panel. Among other things, the act would have required knowledgeable specialists to be present on the task force. At present, the USPSTF is making decisions without any input either from specialists who work with these diseases on a daily basis or from patient advocacy groups. The act would would have also made the process by which task force members are appointed more transparent. (Currently they are chosen by an agency head who is in turn appointed by the HHS Secretary.) But most importantly, the bill would have prevented Medicare from denying coverage for medical tests based on the USPSTF’s opinions. Unfortunately, with Democrats still in control of both the White House and the Senate, the chances a bill like this will see the light of day are slim.
The take-home point is not about prostate cancer or PSA testing. We should certainly hope that medical science will continue to refine the answers to questions about exactly who needs a given test or a given treatment. We should hope that better tests and less invasive treatments will be developed. In a few decades we will look back on current medical practices and shake our heads, just as medical professionals now look back with disbelief at things that were done routinely in the 1960s.
The point isn’t even about the questionable medical judgment of the USPSTF. Rather, it is that we are only beginning to discover the implications of Obamacare, under which unelected boards like the IPAB and the USPSTF will have the unprecedented power to dictate what were once doctor-patient decisions. Nancy Pelosi famously said that we would just have to pass the Obamacare bill in order to find out what was in it. About that, she wasn’t lying.
Image: Creative Commons
Letter to the Editor View all comments (55) | Leave a comment
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Aristocat| 2.27.13 @ 6:15AM
Obamacare is designed to destroy not just the entire health care system of American, but to destroy the economy by adding a multi-trillion entitlement to a budget that is already Trillions in debt and running deficits of over $1.5 Trillion per annum.
The House can kill Obamacare any time it wants by cutting off funding for implementation, but Boehner is a secret Democrat who is helping Obama destroy the country.
MelvinNC| 2.27.13 @ 11:46AM
A POST FOR THE USELESS
I have been called many things, and many names, but after a lifetime of serving my Country, and getting up at 5:00 in the morning thereafter, I am now called a, "BURDEN." As I reach 55 years, somewhere someplace, by someone has calculated my further worth to society.
My net worth is no longer deemed by my character as a human being, now I am just a fact or a figure on some bureaucrats balance sheet.
My body is broken and old beyond its years of the extreme physical demands placed upon it. There isn't a joint, ligament, muscle or bone that doesn't ache or hurt.
Sadly, as Ayn Rand prosed in her book, "Anthem," I am to be interned into the, "Home of the Useless." By some unapologetic, uncaring, and unknowing IPAB board who sit upon their raised dais, in a unseen cold dark building to pass judgment upon my life.
There was a time in mans life that his or her life was judged by the grace of God, now mans life is to be judged by men who have elevated themselves as God.
TLP| 2.27.13 @ 2:32PM
Have you considered Medical Marijuana?
You should.
MelvinNC| 2.27.13 @ 3:27PM
All it did was make me hungry for pepperoni sticks.
TLP| 2.27.13 @ 4:09PM
Hilarious.
Purp| 2.27.13 @ 4:06PM
The Insurance Companies' Boards already got your number ... and you can't vote them out.
There never was time you were judged by the Grace of God on Earth ... you just finding that out now?
if you can't hack it, then are judged unfit.
CJW| 2.27.13 @ 5:42PM
Purpie the Village Idiot posted:
1. "Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
2. purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
3. In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
4. Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born.
5. purpie believes that a 20% cut in the tax rate will INCREASE his 0% rate to 8%.
6. purpie also posted one of the female bloggers here should just lay back and enjoy the rape.
Purp-arnie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
markenoff| 2.27.13 @ 10:01PM
1. Insurance companies don't make law
2. I can choose a different insurance company
3. Once the feds say you can't get test "x" it gives the insurance company an excuse not to cover it. Are you so dense that you don't understand that Obamacare has the insurance companies and the feds in it together?
Appleby| 2.27.13 @ 6:45AM
As long as most government employees are male, and the majority are Baby Boomers, anything at all that spotlights the wee-wee will be mandatory. Judging by the commercials that attend every sporting event, there is a pandemic of droopy wee-wees, and plenty of folks dedicated to eradicating this epidemic in their lifetimes. Should anything threaten that most vital of all weapons, men should have no fear that armies of doctors will be mobilized to make sure the flag continues to fly.
As for the mammagram, you'll notice precisely how much space that got in this article. These will be limited to cases in which it is necessary to preserve the rights of men to view 38DDs on long stemmed young beauties who adorn their elderly arms. I predict that sooner or later women over 40 will find it very difficult to get any kind of medical care at all, unless they are high up in government or the movies.
Jacob McCandles| 2.27.13 @ 8:34AM
The amount of money spent on breast cancer research is 50 times that of prostate cancer.
TLP| 2.27.13 @ 10:54AM
And, more men die EVERY YEAR of Prostate Cancer, than do Women, from Breast Cancer.
Where's our Fluckeing Ribbon?
Stephie| 2.27.13 @ 11:22AM
Well, get that prostate checked on a yearly basis! If you're like my husband, you don't go see your physician unless your near deaths door or you wife has made the appointment for you and drives your ass to said physicians office! (said in humor & jest)
TLP| 2.27.13 @ 2:34PM
I have my wife check it, all the time.
But, thank you for asking.
markenoff| 2.27.13 @ 10:05PM
That must be why Purpie doesn't worry about his. He has multiple anonymous, one night "doctors" checking his on a regular basis.
SUBVET| 2.27.13 @ 11:40AM
Tim...........ever pass a kidney stone ???? and the hens say giving birth is painfull.
I say it's like Valentines day the door only swings "one way".
Jacob McCandles| 2.27.13 @ 12:23PM
I don't guess there will ever be a ribbon for prostate ca. It's just not hip to support the men's causes. No Prostate 5k runs or anything.
Moe Blotz| 2.27.13 @ 1:44PM
Have youse not heard of "Moevember"? Hockey players and some football types grow a moustache in November for prostate awareness. When Green Bay played our hapless Phluffya Iggles, I saw Aaron Rodgers and coach McCarthy sprouting "moes" on their upper lips. The Phluffya Pholders go all in for the month of November and generate a few quid for prostate cancer victims.
TLP| 2.27.13 @ 2:35PM
Are you sure it wasn't for Freddie Mercury Day?
TLP| 2.27.13 @ 2:36PM
And, it's the Filthydelphia Eagles.
Moe Blotz| 2.27.13 @ 11:20PM
Von Mises, Jr. and Albert Constantine, Jr. will back me up on the Phluffya bit, a pronunciation given us by the late Wilson "entry device" Goode. The Movember bit is serious and the Canadians have a chapter as well. Put it in your search engine.
markenoff| 2.27.13 @ 10:03PM
And we have half as many prostates as they have breasts!
markenoff| 2.27.13 @ 10:02PM
In case you haven't noticed government offices at all levels are primary staffed by African American females even on military posts.
Jacob McCandles| 2.28.13 @ 1:06AM
I can hear the collective gum snapping now!
Bill Hussein O'Stalin| 2.27.13 @ 7:00AM
The article hints at something ever more ominous.
Appointees to these positions may be industry reps who desire people to get sick for Nazi type experimentation.
It's all too possible when the government controls the system and it's already happened in the past with LSD experiments and the Tuskegee syphilis experiments. The Tuskegee experiments went on for 40 years.
The public is stupid and believes this is all about their health care. Soon, they will become guinea pigs. Let's hope John Roberts family goes first.
"Hey, it's only a tax."
Jacob McCandles| 2.27.13 @ 9:12AM
I never underestimate the potential evils of centralized power, but I don't think the government has any interest in researching what makes us better.
TLP| 2.27.13 @ 10:57AM
Am I the only one who sees "A Pale Rider" when I look at Frau Sebelius?
Jacob McCandles| 2.27.13 @ 12:15PM
Somebody here said a Nazi uniform would suit her just perfectly. That says it all. I try to imagine her doing something kind, or saying something funny, or being a regular human. But I can't do it, therefore she is a monster. A hideous, evil, rotting pile of beaurocrat.
PetePatriot| 2.27.13 @ 12:46PM
She always reminds me of the Cryptkeeper.
Gary B| 2.27.13 @ 2:04PM
No doubt about it, she's as bad as they get. Wouldn't be surprised if she's one of Obama's handlers.
Stormy| 2.27.13 @ 9:11AM
I had PSA tests annually for several years. When it got elevated to the point that my primary care physician had some concern and referred me to a urologist. The urologist performed a biopsy, and sure enough, I had early state of prostate cancer. I was fortunate to have had treatment and after five years, I am totally cancer free. I have annual PSA tests to check to against any return. I owe my life to PSA. My radioactive oncologist said that PSA is the best predictor they have against prostate cancer. Any man is a fool not to have the test, even if they have to pay out of their pocket.
squalis| 2.27.13 @ 9:33AM
That should be "radiation" oncologist, unless he is carrying some radium in his pocket.
squalis| 2.27.13 @ 9:31AM
That should be "radiation" oncologist, unless he is carrying some radium in his pocket.
Kwan| 2.27.13 @ 9:43AM
While the Democrats like to call themselves Progressives once this ObamaCare fiasco gets up and running "regressive medicine" will probably be the most popular term to describe this looming disaster. As physicians abandon the health care field in droves patients will soon have the unsettling experience of being examined by someone with the title of Government HealthCare Worker, who will be reading a medical dictionary trying to determine what illness your symptoms represent while he examines you. While Obama tries to solve the nation's energy problems with the rather primitive solutions of wind and sun, might we expect similar primitive solutions in the healthcare field like using leeches to "bleed a patient", or the recitation of incantations used by Kenyan witch doctors to drive an evil spirit from the body of the affected patient. This Orwellian ObamaCare is all about the collectivization and equalizing of the population, conditioning the citizens to accept sub-standard SchlockCare as the norm.
squalis| 2.27.13 @ 9:53AM
Not to worry, the lawyers can still sue over SchlockCare.
TLP| 2.27.13 @ 2:38PM
Who are they gonna Sue?
It's GOVERNMENT Health Care.
TLP| 2.27.13 @ 2:39PM
Good Luck with that.
squalis| 2.27.13 @ 7:37PM
Government controls, providers left holding the bag.
Gary B| 2.27.13 @ 2:08PM
Kwan,
Can you call yourself "progressive" when you're merely the latest gang to implement the same government healthcare program that's failed everywhere it's been forced on hapless populations? More evidence this has nothing to do with the health of our citizens and everything to do with tyranny.
Kwan| 2.27.13 @ 3:27PM
Leftist Newspeak (up is down, backward is forward) is designed for the gullible morons that haven't caught on to the fact, that when Obama's lips are moving that's a sure sign that he's lying.
Gary B| 2.27.13 @ 9:13PM
That's what they used to say about that murdering bastard, LBJ.
wrongheifer| 2.27.13 @ 10:12AM
I will not sign up for or participate in this fiasco called obamacare...This regressive medicine is setting us all up for the great 'culling of the herd...' Death is indeed coming to the US under the guise of care. Find an underground doctor now.
Purp| 2.27.13 @ 4:07PM
Puhlease ... take the scare tactics and conspiracy theories to Drudge where they belong.
CJW| 2.27.13 @ 5:43PM
Purpie the Village Idiot posted:
1. "Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
2. purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
3. In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
4. Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born.
5. purpie believes that a 20% cut in the tax rate will INCREASE his 0% rate to 8%.
6. purpie also posted one of the female bloggers here should just lay back and enjoy the rape.
Purp-arnie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
markenoff| 2.27.13 @ 10:07PM
Everyone will have health insurance. The challenge will be getting medical care.
Jim Adcox| 2.27.13 @ 1:08PM
If it weren't for this dratted global warming, we could put the elderly on ice floes and let them float away, and all our problems would then be solved! Right, Tsarina So-bully-us?
E B | 2.27.13 @ 4:01PM
The implications are not lost in the medical field, however. That's why older doctors are retiring and more promising students choose different careers than Medicine. You can barely make a living as a doctor any more when taking all the debt (with high interest rates) into account and delayed incomes - about 10 years after an undergraduate degree before earning a normal salary (which are now lower than any time in the last few decades).
www.conservativemormonmom.blogspot.com
Purp| 2.27.13 @ 4:09PM
And you think that has to do with Obamacare? Not a chance turkey.
That has been going on for years and Obamacare hasn't even hardly begun.
Look elsewhere for the cause - 'cause that dog don't hunt.
JD| 2.27.13 @ 6:21PM
Indeed, ObamaCare is only the latest in a long line of Leftist harm.
Purp| 2.27.13 @ 4:11PM
Oh, Puhlease, repeat it over and over again ... what she said was "But we have to pass the bill so you can find out what is in it, away from the fog of all this controversy"
With all the demagoguery over the bill, she was right.
Even the Chief Justice of the Supreme Court supports Obamacare.
Not exactly the same when you put the entire quote on record, now is it?
JD| 2.27.13 @ 6:22PM
Uh, no, it's still exactly the same. And it's how Democrats treat all of their ideas. They freely experiment on us, but if a non-Democrat proposes anything at all, Democrats are quick to demand that impossible standards of proof of safety be met before proceeding.
That is because they are dishonest.
Purp| 2.27.13 @ 6:29PM
Naw, off your meds, aren't ya?
You Lost, that's all that matters. The nasty, greedy, STUPID party (Bobby Jindal, not me) lost and continues to lose.
markenoff| 2.27.13 @ 10:13PM
Because actually reading the bill to find out what was in it is too difficult for Dems.
"What good is reading the (health care) bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?" — John Conyers (D-MI)
Now we're starting to find out what's in it.
CJW| 2.27.13 @ 5:43PM
Purpie the Village Idiot posted:
1. "Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
2. purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
3. In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
4. Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born.
5. purpie believes that a 20% cut in the tax rate will INCREASE his 0% rate to 8%.
6. purpie also posted one of the female bloggers here should just lay back and enjoy the rape.
Purp-arnie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
markenoff| 2.27.13 @ 10:41PM
Kathleen Sebelius is the kindest, bravest, warmest, most wonderful human being I've ever known in my life.
Aristocat| 2.28.13 @ 2:27AM
You need to get out more, Markie...