A number is not automatically a statistic, especially when it's a rough calculation based on 7-year old OECD data.
Dr. David Gratzer, a physician and senior fellow at the Manhattan Institute, has come under fire for his estimation of prostate cancer survival rates in the UK as compared to the US which was picked up by the Rudy Giuliani campaign for a radio spot endorsing his plan to revamp health care. In the spot, Rudy says, "I had prostate cancer five, six years ago. My chance of survival prostate cancer--and thank God I was cured of it--in the United States: 82%. My chances of surviving prostate cancer in England: only 44% under socialized medicine." Actually, his chance of survival depends upon the grade of his particular prostate cancer. The way this is worded, it metaphorically paints Rudy as representing the average case of prostate cancer.
Politics aside, this latest article published on the City Journal Web site shows that this was a quick and dirty calculation of survival based on prevalence and mortality data. Therefore, it should be identified as such and should not be confused with a formal study of survival.
According to OECD data published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43 percent survived.
This "snapshot" way of looking at survival, as Gratzer calls it, shouldn't be touted as a statistical representation of survival especially when better data exist. And the folks who write ad copy for a presidential candidate should realize that any mathematical machination will be fact checked almost immediately.
Intuitively, I can believe that the US might have better screening programs, provide more access to chemotherapeutic agents, but this needs to be borne out by reliable study.
Gratzer cites the journal Lancet Oncology in saying that the current study of 5-year survival for prostate cancer in America is 99%, while the European average is 78%. British data were incomplete.
This is not meant to be an indictment of the free market approach to health care. Gratzer's most recent book, published just over a year ago, is "The Cure: How Capitalism Can Save American Health Care." It just goes to show though.
UPDATE: I believe this is the citation for the 78% number:
Lancet Oncol. 2007 Sep;8(9):784-96. Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. Verdecchia A, Francisci S, Brenner H, Gatta G, Micheli A, Mangone L, Kunkler I; EUROCARE-4 Working Group.
From its abstract:
The European mean age-adjusted 5-year survival calculated by the period method for 2000-02 was high for testicular cancer (97.3% [95% CI 96.4-98.2]), melanoma (86.1% [84.3-88.0]), thyroid cancer (83.2% [80.9-85.6]), Hodgkin's disease (81.4% [78.9-84.1]), female breast cancer (79.0% [78.1-80.0]), corpus uteri (78.0% [76.2-79.9]), and prostate cancer (77.5% [76.5-78.6]);...
This is also the citation used by Betsy McCaughey at the National Center for Policy Analysis who Gratzer is quoting in his blog post.
"Reforming Health Care: Four Solutions from the United States Congress" was hosted by The New School yesterday here in NYC. Five members of Congress spoke about the four competing plans they are hoping might provide better health care while controlling unsustainable cost increases, declining quality, and the growing number of Americans who have no insurance or are underinsured. [I outlined the details of these plans in the previous blog post.]
It all comes down to this: do you trust the private insurers, the free market or the government to be the major factor in leading this effort? Some panelists talked about the idea of creating a health care plan that was uniquely American. Except for the single-payer solution which seeks to replicate the idea used in most industrialized nations, the mandatory private insurance plan and the free market plan would be unique to this country. But, they are untested and would be experimenting with the largest expense in the American economy as well as the personal care health of its citizens.
If there were an underlying theme to all these plans it would be the effort to break the link of healthcare insurance to employment. Tax incentives to individuals will play a major role except, of course, in the single payer model. Common to all these plans is the notion that each individual would have to take on a new level of responsibility to understand and accept preventive measures including improving diet and following an exercise regimen.
Bob Kerry, the president of The New School and former governor and senator from Nebraska, served as the moderator. and opened the event by discussing what he faces as an administrator for the health care benefits for his employees. He felt a responsibility in helping these people navigate their way to a reasonable solution to health care.
He said that this would be the first year that the baby boomers would be seeking Medicare benefits.
Kerry provided a personal perspective on some of the Senators. He mentioned Oregon Democratic Senator Ron Wyden's connection to New York by way of his wife's family ownership of the Strand bookstore.
He talked about Tom Coburn's practice in obstetrics, delivering over 4,000 babies in Oklahoma. The program for this event says, "...Senator Coburn had pledged to serve no more than two terms in the Senate and to continue to care for patients."
The first presenter was Ron Wyden and he talked about his involvement, along with Republican Senator Bob Bennett from Utah, in creating The Healthy Americans Act which will provide all Americans with the ability to enter a private health insurance plan of their choosing.
Wyden provided this quick calculation to underscore the waste that is endemic in our present system: with a yearly budget of $2.3 trillion for a population of 300 million, this would result in physicians taking care of 7 families while they received a salary of $200,000.
The beginnings of his plan came from the idea that the average American would want the same plan that members of Congress had.
Central to this plan is the concept selecting participants and creating pools that insurers could use to dilute risk. He told Kerry that as an administrator for his school, he would be removed from the process since it would be up to the private insurer to build a pool from any number of businesses or private individuals.
He later mentioned during the panel discussion that he wanted to talk with the American people to find out what they thought about their personal responsibility in participating in a plan where private was mandatory. This seems to be the biggest objection that he encounters.
He told of his conversation with a skier from Bend, Oregon who said he didn't have health insurance. Wyden said he pointed to the mountain and asked what would happen if he had an accident. The skier said *then* he would buy health insurance.
Here's a video where Wyden talks about his encounter with the skier:
Tom Coburn, MD, Republican senator, talked about his Universal Healthcare Choice and Access Bill that would be market driven. He said that the American health care system has never been fully exposed to the free market forces that would allow competition to moderate cost.
To illustrate this he asked, "Why is it that only doctors know who the bad doctors are?" He believes that transparency is needed so that individuals can make informed choices for their health care.
This would place consumers in the driver's seat for determining how they could negotiate for the best plan available. Those consumers who don't choose to try to bargain for the best plan would be eligible to buy into a default plan for their state.
His next point was about economies of scale. For an example, he talked about a woman who enters any hospital and requires a laparoscopic cholecystectomy (gallbladder removal using small incision surgery) which he said would normally cost $25,000. Instead, he offered the possibility that there could be a center of excellence where most patients with gall bladder disease would be sent. The insurer could then negotiate an arrangement where a discount is sought by giving payment up front, perhaps bring down the cost to $4,000. He said that this type of bargaining, leverging volume with discounts should be encouraged. It's interesting that Bob Bennett also underscored this point.
He talked about incentivizing risk by creating high risk pools that insurers could bid on. For instance, a patient with diabetes would have a higher level of reimbursement. Insurers who could contract companies that specialize in chronic disease management could serve these high risk patients more cost effectively
This incentivizing is also aimed at what he calls upfront health care or preventive medicine. He talked about approaching parents about providing better dietary option for their children, eliminating the caloric dense foods high in fats and high fructose corn syrup. This brought about one of the few rounds of applause for the panelists.
Coburn told Kerry that our healthcare system is an oligopoly in that not enough insurers can participate in the healthcare market. He wants to expose the healthcare market to more free market forces.
Unlike Rudy Giuliani and Mitt Romney, but in agreement with John McCain, he favors a plan where the consumers are not limited by state mandates and can choose plans anywhere in the US. I wonder if he would go so far as allowing re-importation of pharmaceuticals as a cost saving measure for consumers.
As an example, he mentioned that a 26-year old man can purchase a year's worth of health insurance in Kentucky for $650, while in New Jersey that same fellow would need to spend $7,250. You can seen in the video below that Kerry responded by saying that public companies have an obligation to shareholders to provide highest return and this might be a conflict in providing the lowest premiums in a free market. Richard Burr jumped in and mentioned that there might be another insurance company with a similar product that would be willing to provide less to its shareholders to expand its reach. He added Congress was able to increase competition and transparency thereby reducing costs with the Medicare Part D. He said premiums decreased by 28% and pharmaceutical costs lowered by 33%. Kerry then asked why this didn't prove that a government run single-payer plan could increase competition and negotiate lower costs. Not included in this video clip is Coburn's response where he said that Congress needed to borrow money to keep Medicare afloat, putting the burden on future generations. His plan for healthcare reform is intended contain costs right from the start.
Richard Burr, Republican senator from North Carolina, talked about his Every American Insured Health Act which would also utilize the free market to drive down the cost of premiums.
He illustrated to need for the individual to pick and choose plans by talking about his 22-year old son who had to leave coverage under Burr's health care plan. To continue with a similar plan would have cost $5,400. He called his son college and asked if they had made arrangements for health insurance coverage. He reasoned that having a population of young and mostly healthy students would give the school in negotiating better premiums for this pool. As it turned out his son was able to enroll in a plan where the premiums were $1,400.
Finally, John Conyers, Jr., Democratic Representative from Michigan, made his case for a single-payer plan, The United States National Health Insurance Act where government would fund private providers. It would replace the 1600 private health insurance providers with one governmental agency that would administer all health care entitlement programs.
Conyers cited the massive overhead the currently burdens health care spending including the advertising, CEO salaries and other expenses of companies supplying products and services. His plan would allow the government to negotiate these expenses down.
The question arises if the government can effectively bid down prices as well as operate a beauracracy efficiently.
Kerry asked if all those ads you see in the subway, coaxing people to sue their doctors would continue under the single payer plan or would special efforts be taken to address tort reform. Conyers said that this was not part of his plan, and would have to be addressed by the judiciary committee of Congress.
Conyers related the story of a woman who had gone to an ER and was told that she needed a lifesaving operation at that moment, but would first have to provide $500 upfront. She later told Conyers that that was the only bad check she had ever written.
He said he was tired of all horrors stories of people being turned away from ERs illegally.
There was little time for questions from the audience, since the congressmen were on a tight schedule. I was disappointed by the first two questioners who were health care professionals and essentially asked how they would benefit from these plans. Questions about access to the pool of health care dollars continue to be in the mind of many. It's time for the people expecting better care to speak up.
The main participants are authors of four major
pieces of healthcare legislation now making the rounds in Congress: the
Healthy Americans Act, Bob Bennett, U.S. Senator, Utah (R) and Ron Wyden, U.S. Senator, Oregon (D); the Every American Insured Health Act, Richard Burr, U.S. Senator, North Carolina (R); the Universal Health Care Choice and Access Act, Tom Coburn, MD, U.S. Senator, Oklahoma (R); and the United States National Healthcare Insurance Act, John Conyers Jr., U.S. Representative, Michigan (D).
Bob Kerry, the former democratic senator from Nebraska and now president of The New School, will lead this discussion. He will also represent the National Commission for Quality Long-Term Care which he co-chairs with Newt Gingrich.
Essentially, these plans fall into 3 categories:
Free-market solution: tax breaks will make private health insurance plans purchased by individuals competitive with employer-based coverage which already benefits from tax relief. This also includes making out-of-pocket healthcare expenses tax deductible. Reforming Health Saving Accounts regulations which mandate the user purchase a high deductible plan will make this plan more attractive.
Reversing regulations that prohibit buying health insurance in other states, will allow the consumer to shop for the best deal nationwide. It's interesting to note that for all the Republican presidential candidates, only John McCain supports this. Romney is against it, while Giuliani would only consider a plan that would phase in a nationwide health insurance market. McCain is also the only one to support the re-importation of prescription drugs.
Guaranteed, mandatory participation in a private plan: favored by the Democratic candidates, it gives each person more choices ("choice" is the new buzz word) requires that the government monitor and ensure participation by all individuals. These plans can also use tax incentives, as well as reversing the Bush tax cuts.
Single payer: this will embrace and extend the current entitlement programs, bringing them under one umbrella of one government agency which will provide payment to private providers.
Here's a little background on the initiatives to be presented at today's forum:
guarantee private health care coverage for all Americans
establish cost containment measures to save $1.48 trillion over 10 years
be fully paid for with the $2.2 trillion currently spent on health care
mandate that insurance will no longer be tied to employment
stipulate a 2-year transition period where employers who provide healthcare benefits would be required to convert their workers' health care premiums into higher wages; those employers who don't offer healthcare benefits would have to make phased-in "Employer Shared Responsibility Payments; after 2 years all employers would be required to make these payments
require all employees to purchase private healthcare coverage
subsidize the premiums for those who live below the poverty line
subsidize the premiums on a sliding scale for those between the 100% and 400% poverty line
establish state-based Health Help Agencies (HHAs) which would guide individuals in enrolling in private plans in their state. It assumes that the "HHAs would ultimately lower administrative costs by coordinating payments from employers, individuals and the government."
stipulate that insurance companies be required to cover everyone regardless of health status such as a pre-existing condition, and would not allow coverage cancellation or raising the premiums
verify participation in a private insurance plan any time someone interacts with local, state or federal government
provide incentives to insurance companies to keep their subscribers healthy using, for example, wellness programs for nutrition counseling and tobacco cessation
reimburse private physicians for investing time in chronic disease management and prevention
use free market strategies to give Americans the resources and rights to purchase health care
end the tax code discrimination against those who cannot get insurance through their employer by using a flat tax break: $2,160 per individual, and $5,400 per family
encourage individuals to take an active role in managing their health and health care purchasing options
strengthen federal disease prevention programs while demanding results and accountability. "Seventy-five percent of the total health expenditures are spent to treat these largely preventable chronic diseases [heart disease, cancer, stroke, COPD and diabetes]
provide MediChoice tax rebates to shift tax breaks from businesses to individuals; $2,000 for individuals, $5,000 for families
create a national market for health insurance, opposing the current regulations that mandate purchasing coverage in your own state
offer states the option to design their own Medicaid programs that would best serve their beneficiaries
provide more health care choices to veterans and American Indians
reform medical malpractice by solving disputes through mediation and impartial medical experts
establish a single payer healthcare system utilizing a national health insurance card and ID number
eliminate all co-pays or deductibles
"create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories"
reduce overall annual healthcare spending by over $50 billion in the first year
will save $150 billion on paperwork and $50 billion by using rational bulk purchasing of medications
mandate that all employers pay a 3.3% payroll tax per employee while eliminating their payments towards private health plans (currently employers pay on average 8.5% of payroll towards health coverage
prohibit private insurers from selling coverage that is similar to the benefits of this plan; additional benefits can be offered
annually set reimbursement rates for physicians, health care providers
negotiate prescription drug prices
allow this conversion to take place over a 15-year period, will proposed funding of $1.86 trillion per year through the sale of US treasury bonds
repeal the Bush tax cut of 2001
The National Commission for Quality Long-Term Care co-chaired by Kerry and Gingrich presents very general guidelines such as "empowering individuals and families." I didn't see any specific initiatives for attempting to enact these goals on their Web site.
This was the response when Hillary Clinton was asked about the punitive measures that would be a part of her healthcare insurance plan. This could be one scenario.
Granted, there are many questions to be answered and details to be worked out in this very early part of the presidential race. But, this possibility doesn't address the self-employed. What government measures will be needed to survey this sector?
She'll be making an official announcement in Iowa today, but from what I'm hearing it will mandate that everyone have a health insurance plan. This is certainly not a single payer plan, and it's a step back from government involvement that was proposed in her plan back in '93.
The Hillary plan is supposed to analogous to mandatory car insurance, but I don't think they can have punitive actions against those who don't have coverage and must have emergency treatment.
And since the HHS is not expected to allow importation, this means it won't be vetoed by the President.
Both measures were amendments to a larger drugs bill sponsored by Massachusetts Democrat Ted Kennedy and Wyoming Republican Michael Enzi, Anna Wilde Mathews writes
in today’s WSJ. That bill will re-authorize the mechanism by which drug
companies fund FDA review of new drugs, and could also give the agency
new powers to monitor the safety of drugs already on the market. A
final version of the bill could also create a regulatory pathway for
approving generic biotech drugs.
Dr. Kolodner has served in the interim as National Coordinator since September, 2006.
Dr. Kolodner joined HHS from the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA), where he was Chief Health Informatics Officer. In that role, he was chief advisor to the VA’s Under Secretary for Health on information technology issues and oversaw the development of the VA’s renowned electronic health record, VistA . Dr. Kolodner’s long-standing interest in computers and his training as a psychiatrist led to his early involvement with VA’s efforts to use automation in support of mental health care and subsequently his leadership in coordinating clinical record access across al clinical disciplines.
There are many who are hoping that VistA will be adopted by the private sector.
