Zoom-In on ObamaCare

Thursday, Sept. 26, 2013, 9am to 10:30 at the Meeting Room (behind the fireplace)

Three topics were selected from the 9/19 meeting for more discussion.

1) Free preventive care, a good thing or just more opportunity for over-diagnosis

Here is a TED Talk which explains the problem of over-diagnosis.

Excerpts from Overdiagnosed : making people sick in the pursuit of health:

More diagnosis may make healthy people feel more vulnerable—and, ironically, less healthy. In other words, excessive diagnosis can literally make you feel sick. And more diagnosis leads to excessive treatment—treatment for problems that either aren’t that bothersome or aren’t bothersome at all. Excessive treatment, of course, can really hurt you. Excessive diagnosis may lead to treatment that is worse than the disease.
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overdiagnosis can occur only when a doctor makes a diagnosis in a person who has no symptoms referable to the condition. While this can happen when a doctor stumbles onto unexpected diagnoses in the course of an evaluation of unrelated conditions, generally it happens because doctors seek early diagnoses—either as part of an organized screening effort or during routine exams. Thus, overdiagnosis is a consequence of the enthusiasm for early diagnosis.
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As we expand treatment to people with progressively milder abnormalities, their potential to benefit from treatment becomes progressively smaller.

ObamaCare mostly ignores the warnings of this book, but has tried to curtail two of the most egregious examples of over-diagnosis, mammograms for women under 50 and prostate PSA screening for men. Both have met resistance, but the women were more successful then the men in reversing these recommendations.

Here is a list of current free preventative services based on recommendations from the US Preventive Service Task Force and the Institute of Medicine. The USPSTF gives grades, A to D, on the effectiveness on preventative services. Services with a grade of A or B are free under ObamaCare. Mammograms for under 50 was given a C, while PSA screening was given a D. Under political pressure, free Mammograms were extended to women of age 40. PSA screenings are still disallowed. Eight additional services for women, in the IOM report but not recommended by the USPSTF, were also given free status. This includes the infamous free contraceptions.

2) The 30 million Uninsured, do we need Single Payer?

The Kaiser video that we saw in our last meeting brought attention to the 30 million left uninsured even when ObamaCare is fully implemented. We thought that these were undocumented immigrants, but we were wrong. From a Kaiser Foundation report on the uninsured:

The majority of uninsured people (80%) are native or naturalized U.S. citizens. Although non-citizens (legal and undocumented) are about three times more likely to be uninsured than citizens, they account for less than 20% of the uninsured population. Non-citizens have poor access to employer coverage because they likely have low-wage jobs and work for firms that do not offer coverage. Further, until recently, states were precluded from using federal dollars to provide Medicaid or CHIP coverage to legal immigrants who have been in the U.S. less than five years. In 2009, states were given the option of extending Medicaid coverage to children and pregnant women who previously would have been subject to the five-year ban. By January 1, 2012, 24 states had adopted the option to eliminate the waiting period for lawfully-residing immigrant children, and 18 states had adopted the option for lawfully-residing pregnant women.18 Undocumented immigrants will remain ineligible for federally funded health coverage under the health reform law.

Regardless, of who the uninsured are, the group expressed a support for Single Payer, presumably because it would give universal coverage. But this is not necessarily the case as explained in this report on Single Payer:

Importantly, the term “single payer” is different from “socialized medicine” and “universal health care.” Socialized medicine refers to a system like the National Health Service of the U.K., in which the mechanisms of delivery of health care are owned by the government.
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The term “universal health care”, in a general sense, refers to providing every citizen of a country with health insurance. Although universal health care connotes a national public insurance program to some people, there are in reality a variety of ways of achieving universal health care, some of which are predominantly public, and others of which use a mixture of public and private elements. Single payer is one way of achieving universal health care, but other ways include the multi-payer systems of Germany and Japan.

We already have Single Payer without universal coverage; it is called Medicare. The few politicians that have backed Single Payer use US business competitiveness as justification. Our politics is such that Universal Health Care for humanitarian reasons is a harder sell. If universal coverage is the true goal, it might be easier politically to give insurance companies a role in a multi-player system.

3) ObamaCare politics

So why are the Republicans so willing to tank the economy to end ObamaCare? Paul Krugman says that the Republicans has become the Crazy Party because it lost control of its base. But then why is the base acting crazy. Here are my guesses, you can add your own:

• They are really just crazy
• They are not crazy, but act crazy to win a game of Chicken
• They want to create financial panic to recover the loss in their gold investments