Obamacare Just Saved The U.S. Economy From Contraction

[Tom Sawyer]

I do agree the young -> old subsidy in the current system is wrong.

Do you guys understand how insurance works?

The whole thing is predicated on someone subsidizing someone else.

But it's reasonable to charge the premium that corresponds to the risk pool you're in.

The current system makes insurance a bad deal for the young, is it any wonder they're reluctant to sign up??

This risk pool you should be in is "citizen of the country". Insurance is always a bad deal for those who don't use it ... until they find they need it.

 

[ksen]

I do agree the young -> old subsidy in the current system is wrong.

Do you guys understand how insurance works?

The whole thing is predicated on someone subsidizing someone else.

But it's reasonable to charge the premium that corresponds to the risk pool you're in.

The current system makes insurance a bad deal for the young, is it any wonder they're reluctant to sign up??

Except young people don't seem reluctant at all to sign up.

 

[Sabine Grant]

The basic problem here is that the conservatives aren't willing to admit there has been a problem with health care. You had insurance before, you have insurance now. No benefit, any extra spending is pure waste. You are claiming extra medical spending, you must be simply wasting money. Why???

Anyone who understand anything about US healthcare regardless of ideology knows that the US spends dramatically more than other countries and does not get appreciably better outcomes.

The news that more money will be spent on more insurance and more tests that probably won't result in appreciably better outcomes should not generally be taken as a positive.

Please explain how and why more access to early detection tests "won't result in appreciably better outcomes".

Which aspect do you dispute?

1) The US spends more money.
2) The US does not get appreciably better outcomes.

I am not sure why Sabine expects you to explain her narrow and unproven exception to these generalities.

Are you implying that early detection tests do not contribute to early diagnosing , consequently less costly treatments and a more positive prognosis of curability? Are you not aware that awaiting for the onset of symptoms to diagnose cancer signifies a higher increase of advanced stages and lower remission rate if not elimination of a prognosis of curability. To add the higher incidence of metastatic malignancies when detected at a later stage.(let alone the increased cost of treatments)? Are you implying that colonoscopies as one illustration among others of the undeniable benefits of early detection tests do not affect positively colon cancer survival rates but also do not prevent the development of colon cancer?

http://www.health.harvard.edu/blog/...nefits-of-colon-cancer-screening-201309206691

Are you also implying that early detection and diagnosing of a variety of conditions is not dependent on medical tests? Are you and dismal expecting improvements in human health by dismissing and ignoring the vital importance of early detection?

Dismal and you have yet to demonstrate that greater access to tests do not produce "appreciably better outcomes". You both need to know that the actual experts in human health disagree with you.

As the Harvard study concluded :

The biggest challenge for colon cancer screening is getting people to have the available tests. About 50,000 Americans die of colon cancer each year—many of these can be prevented with early screening. I am hopeful that this research and public health messages will help colon cancer screening become more widespread.

I suppose "many of these" deaths which can be prevented via reliance on colon cancer screening are also part of "narrow and unproven exceptions"? Let's examine other alleged "narrow and unproven exceptions" regarding reliance on early detection screening/tests :

http://www.ncbi.nlm.nih.gov/books/NBK20938/

Cancer screening and early detection have major importance in the survival of patients with many cancers. A feature common to most of the more prevalent cancers, i.e., cancers of the skin, breast, cervix, endometrium, ovary, testis, colon and rectum, prostate, and lung, is that prognosis generally is better and treatment more successful if the disease is detected when still localized. Secondary prevention of cancer is distinguished from primary prevention in that it is an intervention focused on (1) detecting and treating early invasive disease and thus preventing death from cancer; or (2) altering the natural history of the disease by identifying precursor lesions known to be predictive of eventual malignancy and treating them, thus preventing progression to invasive disease.

Do you and dismal have any understanding that cost of out of pocket versus cost covered by Insurance has played a major role in preventing millions of under insured and non insured Americans from having access to early screening? Thus increasing the number of people susceptible to develop a condition which will require more complex and higher cost treatments?

First it is not germane - general propositions on spending for insurance and testing is "general", not unconditional or unqualified. Pointing out a specific instance of a kind of test where more spending might 'result in appreciably better outcomes' is a bit of a straw-man.

To millions who can now afford early detection screening/tests, it is not a "straw man". It means the removal of a long standing obstacle to prevention and increased survival rates if not prospect of curability.

Second, her loaded exception is speculative and unproven; what evidence is there that more insurance spending on 'early detection tests' appreciably improves outcomes for the population?

See the links above. If necessary, I will provide more medical data pointing to early detection screening resulting in " prognosis generally is better and treatment more successful if the disease is detected when still localized".

It is somewhat of a parallel universe in this thread to view comments which demonstrate such ignorance regarding the relation between early detection and better prognosis and more successful treatments. Cost effectiveness of course being demonstrated via extended remission and curability. Obviously, fewer repeated treatments will be necessary with a prognosis of extended remission and/or curability prompted by the condition being detected in early stages and treated early.

It' rather like being expected to explain how God could not do good and could not exist, before making a case that God actually exists and actually will do good.

Rhetorical thimble rigging?

While you are wasting my time questioning what anyone with basic insights in the vital importance of early screening/testing is aware of.

 

[bilby]

I do agree the young -> old subsidy in the current system is wrong.

Do you guys understand how insurance works?

The whole thing is predicated on someone subsidizing someone else.

But it's reasonable to charge the premium that corresponds to the risk pool you're in.

The current system makes insurance a bad deal for the young, is it any wonder they're reluctant to sign up??

The risk pool is 'human beings'.

If you want to subdivide the risk pool into smaller sub-pools, then why not go the whole hog, and have each individual pay for his own, and only his own, medical expenses. Surely it does not need to be spelled out why that is a bad idea?

The bigger the pool, the better. You can't make a bigger pool than 'everybody'.

 

[maxparrish]

The basic problem here is that the conservatives aren't willing to admit there has been a problem with health care. You had insurance before, you have insurance now. No benefit, any extra spending is pure waste. You are claiming extra medical spending, you must be simply wasting money. Why???

Anyone who understand anything about US healthcare regardless of ideology knows that the US spends dramatically more than other countries and does not get appreciably better outcomes.

The news that more money will be spent on more insurance and more tests that probably won't result in appreciably better outcomes should not generally be taken as a positive.

Please explain how and why more access to early detection tests "won't result in appreciably better outcomes".

Which aspect do you dispute?

1) The US spends more money.
2) The US does not get appreciably better outcomes.

I am not sure why Sabine expects you to explain her narrow and unproven exception to these generalities.

Are you implying that early detection tests do not contribute to early diagnosing , consequently less costly treatments and a more positive prognosis of curability?

No, I am directly stating that your not addressing his general propositions regarding the poor link between more social spending for insurance and tests vs. actual outcomes for the population and as such you were switching subjects; you shifted the subject to defending one specific and small category of spending, a subset of testing, 'early detection tests', as if that were his general point. Whether or not more there is a link between more spending for early detection tests and outcomes is not really germane to the broader argument because I suspect is a small part of insurance spending.

Now if you want to change the subject to early detection tests as an exception to his general observations on spending, fine. But remember that 'an exception' is not the same as a challenge to his general proposition (which is why he asked exactly which of his two factual points you were objecting to).

Are you not aware that awaiting for the onset of symptoms to diagnose cancer signifies a higher increase of advanced stages and lower remission rate if not elimination of a prognosis of curability. To add the higher incidence of metastatic malignancies when detected at a later stage.(let alone the increased cost of treatments)? Are you implying that colonoscopies as one illustration among others of the undeniable benefits of early detection tests do not affect positively colon cancer survival rates but also do not prevent the development of colon cancer?

http://www.health.harvard.edu/blog/...nefits-of-colon-cancer-screening-201309206691

Are you also implying that early detection and diagnosing of a variety of conditions is not dependent on medical tests? Are you and dismal expecting improvements in human health by dismissing and ignoring the vital importance of early detection?

Dismal and you have yet to demonstrate that greater access to tests do not produce "appreciably better outcomes". You both need to know that the actual experts in human health disagree with you.

As the Harvard study concluded :

The biggest challenge for colon cancer screening is getting people to have the available tests. About 50,000 Americans die of colon cancer each year—many of these can be prevented with early screening. I am hopeful that this research and public health messages will help colon cancer screening become more widespread.

I can't speak for Dismal on your specific concern on early detection testing, but what I am saying is that you have yet to demonstrate that greater insurance and/or social spending on 'early detection tests' will significantly improve population outcomes.

This is NOT a disagreement between 'testing and not testing', nor is this a discussion about how testing can improve a particular person's well being. No one disputes that up to a certain level and frequency, testing can improve a patient or potential patient's outcome.

BUT we are speaking of an entire population. There is already plenty of testing in the US (in many categories, far more than elsewhere). In fact, many critics of American medicine say there is way too much diagnostic testing done just to cover their butts legally, and to get considerations from labs (which they may have part interest in). Hence, it may be a contributor to the alleged poor link between spending and outcome.

And while I have no firm opinion on the testing matter, the potential disagreement is between current levels of testing in the population as a whole and the efficacy of even more spending for it. After all, it will ONLY result in significantly better outcomes for a population if spending actually ends up providing additional appropriate testing and that is given to the appropriate population at the appropriate time, and if that testing is not rendered ineffective by the law of diminishing return (i.e. excessive testing to cover a providers butt or line his pocketbook). In other words, "Will more than current spending on early tests make a detectably significant difference outcome?" The answer is "it depends" and "maybe".

Finally, as a general point, one should note that the rational behind testing and/or preventative medicine as "saving money" may or may not be true. If a person drops dead for lack of testing and preventive medications, his medical costs are zero. Perhaps not an outcome we desire, but worth remembering.

 

[maxparrish]

As Obama and other supporters have pushed a particular myth of preventive testing and medicine saving money, I think it overdue to a bit of debunking:

5. Preventive care does not save money (in the aggregate)

THE PRESIDENT: … because there’s no reason we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. That makes sense, it saves lives; it also saves money … and we need to save money in this health care system.

Here is the key sentence from CBO Director Dr. Douglas Elmendorf in a letter he sent to Rep. Nathan Deal last Friday:

CBO: Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.

Dr. Elmendorf eloquently explains why:


CBO: But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. Even when the unit cost of a particular preventive service is low, costs can accumulate quickly when a large number of patients are treated preventively. Judging the overall effect on medical spending requires analysts to calculate not just the savings from the relatively few individuals who would avoid more expensive treatment later, but also the costs for the many who would make greater use of preventive care. As a result, preventive care can have the largest benefits relative to costs when it is targeted at people who are most likely to suffer from a particular medical problem; however, such targeting can be difficult because preventive services are generally provided to patients who have the potential to contract a given disease but have not yet shown symptoms of having it.

Finally, Dr. Elmendorf makes a key point (also on his blog):

CBO: Of course, just because a preventive service adds to total spending does not mean that it is a bad investment.

It may save lives, but it does not reduce spending...just the opposite.

http://keithhennessey.com/?s=preventive

 

[Togo]

Anyone who understand anything about US healthcare regardless of ideology knows that the US spends dramatically more than other countries and does not get appreciably better outcomes.

The news that more money will be spent on more insurance and more tests that probably won't result in appreciably better outcomes should not generally be taken as a positive.

Please explain how and why more access to early detection tests "won't result in appreciably better outcomes".

Which aspect do you dispute?

1) The US spends more money.
2) The US does not get appreciably better outcomes.

I am not sure why Sabine expects you to explain her narrow and unproven exception to these generalities.

Are you implying that early detection tests do not contribute to early diagnosing , consequently less costly treatments and a more positive prognosis of curability?

No, I am directly stating that your not addressing his general propositions regarding the poor link between more social spending for insurance and tests vs. actual outcomes for the population and as such you were switching subjects;

I'm rather more interested in where the assertion, bolded above, that more spending on tests won't improve outcomes actually comes from. Is it substantiated in some way, or is it just a hand-waving generalisation?

 

[GenesisNemesis]

Your proposal amounts to letting them die.

You expect max to have any sense of compassion?

 

[Loren Pechtel]

I'm rather more interested in where the assertion, bolded above, that more spending on tests won't improve outcomes actually comes from. Is it substantiated in some way, or is it just a hand-waving generalisation?

Actually, it makes a lot of sense. Preventative care can avoid death from some things but it doesn't avoid all causes of death. Death comes one per person and a good portion of medical spending is on someone's final illness.

The benefit of preventative care is people living longer.

 

[Sabine Grant]

The basic problem here is that the conservatives aren't willing to admit there has been a problem with health care. You had insurance before, you have insurance now. No benefit, any extra spending is pure waste. You are claiming extra medical spending, you must be simply wasting money. Why???

Anyone who understand anything about US healthcare regardless of ideology knows that the US spends dramatically more than other countries and does not get appreciably better outcomes.

The news that more money will be spent on more insurance and more tests that probably won't result in appreciably better outcomes should not generally be taken as a positive.

Please explain how and why more access to early detection tests "won't result in appreciably better outcomes".

Which aspect do you dispute?

1) The US spends more money.
2) The US does not get appreciably better outcomes.

I am not sure why Sabine expects you to explain her narrow and unproven exception to these generalities.

Are you implying that early detection tests do not contribute to early diagnosing , consequently less costly treatments and a more positive prognosis of curability?

No, I am directly stating that your not addressing his general propositions regarding the poor link between more social spending for insurance and tests vs. actual outcomes for the population and as such you were switching subjects; you shifted the subject to defending one specific and small category of spending, a subset of testing, 'early detection tests', as if that were his general point. Whether or not more there is a link between more spending for early detection tests and outcomes is not really germane to the broader argument because I suspect is a small part of insurance spending.

Now if you want to change the subject to early detection tests as an exception to his general observations on spending, fine. But remember that 'an exception' is not the same as a challenge to his general proposition (which is why he asked exactly which of his two factual points you were objecting to).

Are you not aware that awaiting for the onset of symptoms to diagnose cancer signifies a higher increase of advanced stages and lower remission rate if not elimination of a prognosis of curability. To add the higher incidence of metastatic malignancies when detected at a later stage.(let alone the increased cost of treatments)? Are you implying that colonoscopies as one illustration among others of the undeniable benefits of early detection tests do not affect positively colon cancer survival rates but also do not prevent the development of colon cancer?

http://www.health.harvard.edu/blog/...nefits-of-colon-cancer-screening-201309206691

Are you also implying that early detection and diagnosing of a variety of conditions is not dependent on medical tests? Are you and dismal expecting improvements in human health by dismissing and ignoring the vital importance of early detection?

Dismal and you have yet to demonstrate that greater access to tests do not produce "appreciably better outcomes". You both need to know that the actual experts in human health disagree with you.

As the Harvard study concluded :

The biggest challenge for colon cancer screening is getting people to have the available tests. About 50,000 Americans die of colon cancer each year—many of these can be prevented with early screening. I am hopeful that this research and public health messages will help colon cancer screening become more widespread.

I can't speak for Dismal on your specific concern on early detection testing, but what I am saying is that you have yet to demonstrate that greater insurance and/or social spending on 'early detection tests' will significantly improve population outcomes.

This is NOT a disagreement between 'testing and not testing', nor is this a discussion about how testing can improve a particular person's well being. No one disputes that up to a certain level and frequency, testing can improve a patient or potential patient's outcome.

BUT we are speaking of an entire population. There is already plenty of testing in the US (in many categories, far more than elsewhere). In fact, many critics of American medicine say there is way too much diagnostic testing done just to cover their butts legally, and to get considerations from labs (which they may have part interest in). Hence, it may be a contributor to the alleged poor link between spending and outcome.

And while I have no firm opinion on the testing matter, the potential disagreement is between current levels of testing in the population as a whole and the efficacy of even more spending for it. After all, it will ONLY result in significantly better outcomes for a population if spending actually ends up providing additional appropriate testing and that is given to the appropriate population at the appropriate time, and if that testing is not rendered ineffective by the law of diminishing return (i.e. excessive testing to cover a providers butt or line his pocketbook). In other words, "Will more than current spending on early tests make a detectably significant difference outcome?" The answer is "it depends" and "maybe".

The significance difference outcome will be reflected by the reality that you now have folks who were previously either non insured or under insured and had restricted access to testing if no access at all, a category who can now benefit of access to testing. You speak of the general population as if health care professionals can accurately diagnose without relying on tests. From a simple Strep test to a complex imaging procedure. It is as if you expect such health care professionals to practice medicine without reliance on various testing protocols to reach an accurate diagnosis. And again, anyone who has basic insights into the practice of medicine ought to know that an accurate diagnosis is indispensable in order to treat a condition efficiently.

In the domain of oncology alone, it is medically impossible to identify specific types of breast cancer without a biopsy. A biopsy alone is scripted based on 3 different categories of procedures : fine needle aspiration or core needle or excision ("open surgery"). The recommended category will be based on what the previous imaging procedure will reveal. It is medically impossible to stage without an imaging procedure. The "general population" is not exempted from those absolute medical necessities because it is the "general population". And what applies to BC types applies to ALL cancers. I challenge you to find an oncologist with any credibility who would claim that he/she can establish an accurate diagnosis via the mere observation of symptoms.

Finally, as a general point, one should note that the rational behind testing and/or preventative medicine as "saving money" may or may not be true. If a person drops dead for lack of testing and preventive medications, his medical costs are zero. Perhaps not an outcome we desire, but worth remembering.

As if a Western high tech nation like the US is supposed to undertake health care reforms based on saving money by letting people die when their condition can be treated early with the prospect of curability if not prevented from reaching acute phases via the use of prophylactic treatments.

Is it that difficult to comprehend the intimate connection between a health care system promoting curability and positive prognosis and the long term cost effectiveness? A cured individual will not necessitate chronic medical care. Same with an extended in remission individual.

Then of course there is the reality of non diagnosed conditions(thus untreated) which affect the quality of life and resulting diminished productivity of the working force. If you somehow *think* that untreated ailing workers as part of the "general population" will not have an impact on the economy, you are sorely mistaken.

Those who doubt or question the effectiveness of preventative medicine for the general population as well as long term cost reducing must have forgotten how the ultimate tool of prevention, immunizations or vaccines, have in fact prevented epidemics which would have disabled the working force.

Further, as I work in geriatrics, there is no doubt in my mind that Medicare saves money with 65 and above category when their PCP encourages both flu and pneumonia immunizations. The cost effectiveness produced by such preventative medicine protocol is reflected by the difference between Medicare being billed for a vaccine and several days of hospitalization resulting from respiratory complications affecting non immunized seniors.

Why anyone would *think* that the variety of preventative medicine protocols would not have similar benefits on the "general population" is yet to be explained. Of course it would take a highly educated health care professional to engage in such "explanation" while scrutinizing every single protocol. Are you up to the task?

 

[coloradoatheist]

Here's an article on it. http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129

the answer is, it depends. There was a big flap a while ago when the CDC came out and recommended a change in cancer screening for women and said that they should do it less often or wait later in life to get it done.

 

[Sabine Grant]

I'm rather more interested in where the assertion, bolded above, that more spending on tests won't improve outcomes actually comes from. Is it substantiated in some way, or is it just a hand-waving generalisation?

Actually, it makes a lot of sense. Preventative care can avoid death from some things but it doesn't avoid all causes of death. Death comes one per person and a good portion of medical spending is on someone's final illness.

The benefit of preventative care is people living longer.

The actual benefit of preventative care is to reduce the long term cost of medical care provided to patients whose conditions could have been prevented from worsening or developing to an acute or chronic phase if detected early. Further and that directly applying to genetic testing, what do you think is more cost effective :

1) A genetically induced high cholesterol factor tested and treated early via prophylactic treatments

or

2) Non detected, non diagnosed and the affected person developing several years later an acute cardio vascular disease necessitating bypass surgery?

Mind you I could cite a multitude of conditions which if diagnosed and treated early will prevent an acute or/and a chronic status necessitating then emergent medicine at a very high cost.

 

[Loren Pechtel]

I'm rather more interested in where the assertion, bolded above, that more spending on tests won't improve outcomes actually comes from. Is it substantiated in some way, or is it just a hand-waving generalisation?

Actually, it makes a lot of sense. Preventative care can avoid death from some things but it doesn't avoid all causes of death. Death comes one per person and a good portion of medical spending is on someone's final illness.

The benefit of preventative care is people living longer.

The actual benefit of preventative care is to reduce the long term cost of medical care provided to patients whose conditions could have been prevented from worsening or developing to an acute or chronic phase if detected early. Further and that directly applying to genetic testing, what do you think is more cost effective :

1) A genetically induced high cholesterol factor tested and treated early via prophylactic treatments

or

2) Non detected, non diagnosed and the affected person developing several years later an acute cardio vascular disease necessitating bypass surgery?

Mind you I could cite a multitude of conditions which if diagnosed and treated early will prevent an acute or/and a chronic status necessitating then emergent medicine at a very high cost.

The screening will reduce the spending on heart surgery. That's not the same thing as reducing the spending overall--when you save someone from one malady you increase the chance they die from other maladies. (Which is why the cancer rate has gone way up in the last century--those cancer victims previously died of something else first.)

 

[Togo]

I'm rather more interested in where the assertion, bolded above, that more spending on tests won't improve outcomes actually comes from. Is it substantiated in some way, or is it just a hand-waving generalisation?

Actually, it makes a lot of sense.

No doubt, although 'making sense' and 'being true' aren't the same thing. But what I was interested in is whether it was substantiated in some way. maxparish was making a big fuss about Sabine's statements being unproven, yet the original statements on which she was commenting came, as far as I can tell, out of thin air.