I now believe that all the bills going through Congress to reform healthcare should be stopped. They are worthless. Not that I liked them much prior to me writing this but what happened just recently has proven that this whole thing is a sham. I have ALWAYS said that unless Americans can wrap their heads around rationing care than this system is unfixable. There just isn't enough money. And without patients having to pay out of pocket then they would have no incentive to curtail spending or shop around. The U.S. Preventive Services Task Force, which is the most unbiased panel of experts around, made the recommendation to move the age to start getting mammograms from age 40 to age 50. We primary care docs have been using all the USPSTF recommendations for years and I am sure we will use this opinion as well. This recommendation will also save billions of dollars as well. That was before the political uprising by special interest groups trying to denigrate the USPSTF and all that they stand for. What does the present Administration do? Sebelius has made it " clear these recommendations are not ours". WTF! You frauds. This was a litmus test to see how our government could handle the tough calls like mammogram screening and they already failed! This only proves that they will do nothing to slow the cost of healthcare in the future. They will only find new ways to tax others to pay for it.
Oh, by the way, here is what the American College of Radiology (whose members stand to lose a lot of money) says about the USPSTF:
The American College of Radiology (ACR) is pleased to see that Secretary Sebelius has reaffirmed that mammography is a vital and lifesaving tool in the battle against breast cancer. We strongly urge women and providers to continue to adhere to the current American Cancer Society and American College of Radiology policies regarding mammographic screening. Additionally, as the Task Force is referenced in health care reform legislation as a significant factor in determining which preventative services may be offered under government "insurance exchanges" outlined in the legislation, we ask that the Secretary officially ask the Task Force to rescind their mammography recommendations in order to avoid confusion as health care reform moves forward. We also urge HHS to include in the USPSTF experts from the areas on which they will be advising lawmakers and submit their recommendations for comment and review to outside stakeholders in similar fashion to rules enacted by the Centers for Medicare and Medicaid Services. A more inclusive process can only benefit Americans as we seek to improve our health care system.
That's funny because the ACR had no problem with the USPSTF when they recommended abdominal ultrasounds for male smokers for screening for AAAs. Hmmm.
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It is no defense of a guild's economic interests to be more than a little skeptical of the USPSTF. This organization is funded by HHS, whose head has a vested interest in ramming through socialized care. Whether Obamacare passes or not, the sort of recommendations from the Task Force may be used to constrain doctors to certain preferred behaviors out of fear of malpractice suits or govenment non-payment for not toeing the line.
Doug we may differ philosophically here; I mistrust the government on almost every tun, and the use of task forces or other approved "expert" or "non-biased" panels to come up with economically convenient decisions should be expected. Of course Sebelius at al are frauds, but we shold be remiss not to suspect the USPSTF, NIH, IOM, and every other governmet-funded entity that alleges independence.
Last week, Mammogate gave a big win to politics and a scorching defeat for evidence-based medicine. This country wants is all. Folks want every medical benefit they desire, even if there is questionable science behind it. The USPSTF is probably the most objective group in the country. Yet, their findings are trashed by those who disagree with their guideline revisions. Even the federal government who appoints the task force, through them under the bus. Should we believe the American College of Radiology instead, despite their flagrant conflict of interest? Health care reform didn't just take a huge step backward last week, it was pushed. See http://bit.ly/656CwP
Michael that's the point - the USPSTF is deemed objective, yet they are funded by the federal government, which has an obviously vested interest in controlling all of health care and in "cost conscious" ways. Your critique of the ACR is on-target, but federal government funding should automatically invite suspicion.
Kevin Pho linked to a great blog this morning (http://www.kevinmd.com/blog/2009/11/aggressive-cancer-screening-recommendations-patients.html) in which Amy Tuteur argues that in early stages of a screening learning curve, very broad screening is good. That's how we learn what screening helps and what doesn't. One of two things have to happen, though (or both). Either people have to accept that those standards may be narrowed. And the insurance companies would cover the "experimental" early broad screening, even though we know that it is still a learning curve thing. That way, we can calm the hysteria about getting screened in the first place and minimize the blowback when the recommendations are narrowed.
Pat, I acknowledge your point, but I maintain that the USPSTF is much more objective than the advocacy groups and medical societies that have obvious conflicts of interest. The USPSTF folks, in contract, have no personal financial stake in the outcome. This is not quite true for the American College of Radiology, for example. What alternative to the USPSTF would you recommend? www.MDWhistleblower.blogspot.com
Excellent question Michael, and I have to admit, a stumper. I fear any appointed (Self- or otherwise) panel will quickly begin to place their own agenda at the core of their work. I would like to dream that this would have been the real work of the AMA, but we know how that turned out. The IOM? No, they bombarded us all with safety-as-self-justification to the end of screwing us all with stupid maintenances of certification. The NIH? Same crowd, different name. I'd like to offer the individual disciplines, but most here are as likely to trust them as much as I trust the gov't, admittedly with good reason. I don't believe in bitching without a viable alternative, but I truly don't have an answer here.
Pat,thanks for your response. We agree. We're observing and participating in a massive tug of war, where dozens of stakeholders are pulling in different directions. No one wants to let go.
www.MDWhistleblower.blogspot.com
This is a test.
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