Althouse: Sebelius is rebellious...

१८ नोव्हेंबर, २००९

Sebelius is rebellious...

... against the death panel.

३८ टिप्पण्या:

Jason (the commenter) म्हणाले...: It's nice to know that the Obama administration plans to run our healthcare not on what doctors or scientists recommend, but entirely on political concerns.

Isn't that what she's saying? "Don't worry about what those scientists and doctors are saying, women are too powerful a voting block for us to cut any services to them, even ones that are harmful."; १८/११/०९, ३:४३ PM
vbspurs म्हणाले...: What happens if you aren't a member of a powerful voting bloc then? You get screwed?

Cheers,
Victoria; १८/११/०९, ३:४५ PM
Ron म्हणाले...: Hi Vic! xxxooo!; १८/११/०९, ३:५० PM
Scott म्हणाले...: Can you get death panel at Menards?

If so, I bet you can save big money!

(Captcha phrase: snesca); १८/११/०९, ३:५१ PM
garage mahal म्हणाले...: I volunteer for the Breast Panels. The early screenings, that is.; १८/११/०९, ३:५६ PM
I'm Full of Soup म्हणाले...: God, she must be dumb. It's as if she stepped right into an obvious Republican trap and took the bait!; १८/११/०९, ३:५६ PM
Jason (the commenter) म्हणाले...: vbspurs: What happens if you aren't a member of a powerful voting bloc then? You get screwed?

Even the people in the powerful voting block are getting screwed if the doctors and scientists are correct. That's what makes it so ridiculous. The expert panels are only being used to rubber-stamp political decisions that are already decided on.; १८/११/०९, ४:०१ PM
Shanna म्हणाले...: You know, the biggest oddity out of these recommendations seems to be the advice not to self exams. In reading some of the NY Times articles, the data for this came out of Russia and China and the data for some of the other recommendations came from England and Sweden. Is there any reason we're not seeing American studies of these things? Because we do have pretty different health systems than those other countries. How do we know the data is comparable?; १८/११/०९, ४:०५ PM
KCFleming म्हणाले...: "The U.S. Preventive Services Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government."

Holy sphincter Batman! That was the fastest reversal of policy known to modern man.

"Um, no, no, no this was never going to be policy. Uh uh. What makes you think that??? Geez, it's just advice! Lighten up! We're not gonna actually follow it or anything!!1!"

And lordy, don't we have evidence now that national health care (as I and others already predicted) will be completely decided on political grounds over scientific merit.

And oh noes! That independent group has nothing whatsoever to do wid' us gummint folks! No sir!

Waaait a minnit!
Isn't the USPSTF at a dot gov site?
Yep.
"Public Law Section 915 mandates that AHRQ [Agency for Healthcare Research and Quality] convene the USPSTF to conduct scientific evidence reviews of a broad array of clinical preventive services, develop recommendations for the health care community, and provide ongoing administrative, research, technical, and dissemination support."; १८/११/०९, ४:११ PM
traditionalguy म्हणाले...: Sebelius is a Woman who has women friends and women family members. She is stressed out enough already by her career requiring her to lie her head off For The Cause night and day without this fresh doubt about what Obama seeks to accomplish to make us happy serfs. Even serfs would rather live than die, it seems.; १८/११/०९, ४:१४ PM
Fred4Pres म्हणाले...: No kidding, Sebelius, Rahm and Obama are smart enough to know they just gave Laura Ingraham some serious arguments on how everything Sarah Palin said was true.; १८/११/०९, ४:३३ PM
Bill White म्हणाले...: Silly perfessor! It's not a death panel, it's a death task force. COMPLETELY different things.; १८/११/०९, ४:३४ PM
KCFleming म्हणाले...: These are only Death guidelines.

Absolutely no reason to fear they'll be actually implemented or anything.

The USPSTF has always been filled with therapeutic nihilists. I never understood why they don't understand that actually implementing their guidelines completely forestalls progress on these very issues because they have eaten the seed corn.; १८/११/०९, ४:४४ PM
Triangle Man म्हणाले...: I never understood why they don't understand that actually implementing their guidelines completely forestalls progress on these very issues because they have eaten the seed corn.

What? Which issues are forestalled?; १८/११/०९, ४:५६ PM
Original Mike म्हणाले...: What happens if you aren't a member of a powerful voting bloc then? You get screwed?

You betch'a!

(did I spell that right?); १८/११/०९, ४:५९ PM
Original Mike म्हणाले...: What AJ said. (3:56); १८/११/०९, ५:०० PM
अनामित म्हणाले...: ही टिप्पणी लेखकाना हलविली आहे.; १८/११/०९, ५:०० PM
अनामित म्हणाले...: Sebelius: "The U.S. Preventive Services Task Force is an outside independent panel of doctors and scientists who make recommendations."

That is a a baldfaced lie. They're not "outside." They're "inside."

The USPSTF is a government panel, created by the federal government, staffed by the Secretary (or her subordinates) and overseen by the US Department of Health and Human Services.

Its website ends in .gov

http://www.ahrq.gov/clinic/uspstfab.htm

They are the part of the US Government that makes recommendations on what medical tests the government should pay for.

This is a government panel recommending cuts in mammograms that would result in thousands of additional cancer deaths for women if their advice to not seek early detection were taken.

Why? To cut costs.

It's Sebelius' death panel. She's just mad at them for making it painfully obvious to even the casual observer what they're up to when we're not looking.

They want to let women die instead of paying to detect their breast cancer.

Letting them die is cheaper.; १८/११/०९, ५:०५ PM
KCFleming म्हणाले...: "What? Which issues are forestalled?"

Screening.

If no screening is done, no research can be done on screening.

They've called the end of the game for mammograms under 50 and over 75. How will new technologies replace simple x-rays, once the routine process is dismantled?

Incremental improvements cannot be studied, because they won't be covered and would have to be doe as research.

Leapfrog discoveries would have no concurrent comparison cohorts except to old studies, because screening is no more. Only much smaller numbers would be done, because of the expense of research studies, weakening the results.

It would be far better to make the goal for the under-50 women: Meet the same diagnostic threshold (~1:1330) as seen in those aged 50-75 years.; १८/११/०९, ५:१७ PM
Christy म्हणाले...: Is this the Obama Administration's version of tort reform? Lay down national protocols that, if followed, render the individual physician, hospital, insurance company ... non liable?; १८/११/०९, ५:३९ PM
Phil 314 म्हणाले...: Pogo;

If no screening is done, no research can be done on screening.

Please tell me you're joking.

(And since until recently no one had been recommending Breast MRI as a screening tool that's why the research wasn't done, right?); १८/११/०९, ५:४८ PM
KCFleming म्हणाले...: Breast MRI was compared to mammograms as a screening tool.

Moreover, the mechanism by which the USPSTF is able to say that finding 1:1330 is fine but 1:1900 is bad is unclear.

But it certainly relies on some very subjective criteria. It's emotion given the sheen of science.
It's bullshit.; १८/११/०९, ६:३२ PM
sort of runic rhyme म्हणाले...: I'd listen to another Sibelius were I to have cancer.; १८/११/०९, ६:५२ PM
अनामित म्हणाले...: Maybe the government will follow what Joe Biden just described as "inexact science" when determining what a doctor should do.

Joe Biden - the gift that keeps on giving.; १८/११/०९, ७:०६ PM
caplight म्हणाले...: Nothing in this regard will be implemented with out the approval and cooperation of the Susan G Koman Foundation and all the other manifestations of the pink ribbon movement.; १८/११/०९, ७:२१ PM
Methadras म्हणाले...: This woman ranks a close second to Pelosi and Barbara Boxer as one of the dumbest women on earth.; १८/११/०९, ७:४४ PM
janemariemd म्हणाले...: Cool off people!!

As a conservative, woman physician who has spent years reading the US Preventive Services Task Force recommendations, I am disgusted by the many right-wing bloggers and commenters attacking this latest guideline as an alleged tool of the proponents of rationing and Obamacare (I don't mean Althouse here, but am deeply disappointed by the hysterical finger-pointing on other blogs I had heretofore liked).

Folks, this recommendation is the result of extensive review of the many breast cancer screening trials that have been conducted to date. Those have clearly shown that the population benefit of screening women aged 40-49 with annual mammograms is pretty small, and definitely less than that for older women. The newest guideline asserts that the decision to screen in the younger age group "should be an individual one and take into account patient context, including the patient's values ...". This is a perfectly reasonable statement. I don't expect this guideline to change current practice much.; १८/११/०९, ११:०७ PM
John Thacker म्हणाले...: janemariemd:

But surely you still agree that this is a useful preview of what will happen if the current health care bill gets passed? The savings in the bill are only achieved by making cuts recommended by task forces like this.

If you think that the cuts are a good idea, then you can see by this furor that they'll never happen, and hence the savings in the bill are a lie.

I actually agree with you and think that the cuts are probably a good idea, and that the real problem is not that we'll get these cuts but that we won't. Either way, the bill is a lie.; १९/११/०९, १२:०८ AM
janemariemd म्हणाले...: John Thacker:

For the record, I think all of the bills under consideration are awful and hope they don't pass. But there are serious problems with the way healthcare is delivered and paid for in this country (I don't know anybody who wouldn't agree with that statement).

I have read some of the articles related to this US Preventive Services Task Force (USPSTF) recommendation, and the conclusions to be drawn are more complicated than were publicly announced. There WAS a small improvement in survival for women aged 40-49 who had mammograms versus those who did not, but the benefit was larger for women who were 50 and older. The authors are looking at the issue from a population standpoint, NOT a societal standpoint. About 1000 or so women age 40-49 have to be "invited" to screening for one life to be saved, which is alot of mammograms, with the downstream consequences and expense of false positives, etc. That is, they are trying to make some statements about what we as a society might gain with a policy of population-wide breast cancer screening.

I'm not sure I can say this is a preview if Obamacare passes, but I am pretty comfortable with how the USPSTF reviews the literature and produces their guidelines. Unfortunately, we don't have good data on outcomes for alot of what doctors do, and that is what worries me.

I think you are right--advocacy groups will scare politicians into not cutting where the best case might be made for it, and the cuts will instead hurt those without a voice (if there are cuts at all).; १९/११/०९, १:१६ AM
MDIJim म्हणाले...: What janemariemd said. This is not about "death panels". It is about how health reform will bankrupt the country. The promises to bend the cost curve are lies. Politicians never had and never will have the intention to rein in the devastating moral hazard created by the ways in which this country pays for health care and regulates medicine. They don't have the guts to take on provider groups like the American Collage of Radiology when they scare patients; and they don't have the guts to take on the trial lawyers when they hold professionals to ever higher standards of practice.; १९/११/०९, ४:१९ AM
KCFleming म्हणाले...: "janemariemd said...
Cool off people!! ...This is a perfectly reasonable statement. I don't expect this guideline to change current practice much."

A conservative would recognize
1) This is exactly how socialized medicine tries to ration.
2) The outcry and sudden reversal is exactly how socialized medicine fails to ration, bending science to political pressure.
3) This "won't change practice much" ONLY if individuals retain choice, which disappears under socialized healthcare.
4) The USPSTF made their decisions based on their idea that "the goal of a screening program is to efficiently maximize the number of life-years gained". That's one goal, but not the only goal. Indeed, only a medicl economist would make that conclusion. Many many patients would not.; १९/११/०९, ६:४३ AM
traditionalguy म्हणाले...: The latest raison d'etre of a collectivist public health model is as always based upon the greatest good for the greatest numbers. The 45 year old argument about prescribing antibiotics has the same outcomes attached to it. Allowing the use of antibiotics on patients that are not critical and will probably recover without them is said to endanger the public by adding to the mutation of pathogens that are miracle drug resistant. So for the greater good, we will withhold antibiotics in most cases. If some die, they die, but we are saving future generations say the collectivist noble persons The sick patient is said to be a surly wing nut for asserting that he has an individual right to life superior to the collectives rights that need his death right now. That is the outcome we are voting on in Congress. Unless you and your family are members of the New Socialist Aristocrat Class to whom these rules will not apply, this Death Panel Filled Bill can get you killed, you betcha.; १९/११/०९, ७:१९ AM
Phil 314 म्हणाले...: But surely you still agree that this is a useful preview of what will happen if the current health care bill gets passed? The savings in the bill are only achieved by making cuts recommended by task forces like this.
The USPSTF was created in 1984. I would suspect given how long it takes to review a major guideline that its latest review of mammography started prior to the election of Obama.

And I will return to a common message: Unless you believe there are unlimited resources, is it not reasonable to recommend those intervention that are proven to have the intended beneficial outcomes versus those that do not?

Finally, I'm really struggling with the outrage of conservatives. As I understand conservatism it would want health care decisions independent of the government. So a government-funded task force has stated the evidence for screening mammography for women under 50 is weak. That leaves intact the ability of an individual and her physician to discuss what course they themselves want to take. I would think a conservative would say "OK this USPSTF has recommended this. And I understand other private entities have seen the evidence the same. But still this will be a choice made not by the government but by the individual"; १९/११/०९, ८:१० AM
master cylinder म्हणाले...: Arent y'all the same crowd who wants to ration abortions? incohernet. Selective outrage is all we've got here.; १९/११/०९, ८:२४ AM
KCFleming म्हणाले...: " I would suspect given how long it takes to review a major guideline that its latest review of mammography started prior to the election of Obama."
So what?
The concern is not over the conclusions reached, but over how the guideline would be used in a nationalized system.

"Unless you believe there are unlimited resources...
False choice.
The salient question is:
Who decides?
This depends on who pays.
If Sally pays, maybe she'll opt for the test, maybe not.
If the gummint pays, her choice matters not a whit.

"intervention that are proven to have the intended beneficial outcomes"
Proven? In what way?
Why the cut-off from 1:1330 cancers found per mammagram (therefore yes), but not 1:1900 MMGs (therefore no). Huh?
Beneficial? In what way?
"Efficency"? "Added life years"?
Why are those the only criteria?

"But still this will be a choice made not by the government but by the individual"
You're assuming the recommendations won't become mandated by the government. USPSTF recommendations frequently (but not always) get taken up by Medicare.

The question is, will private medicine be permitted under nationalized healthcare in the US"
It's not allowed in other nations with national systems.

You're making pretty big assumptions.
Conservatives generally recognize your assumptions to be poorly founded.; १९/११/०९, ८:३८ AM
Phil 314 म्हणाले...: Pogo;
If this is part of a "Democratic plot" to restrict what care is provided and what is not, then you will be glad to know that so far they haven't done a very good job of "connecting the dots".

For example this very same devious entity, USPSTF, has not recommended prostate screening in men under 75 (that includes PSA). See recommendation here and yet the government-run socialized medical program, AKA Medicare, pays for PSA with no co-insurance. See here.; १९/११/०९, ९:३४ AM
KCFleming म्हणाले...: "so far they haven't done a very good job of "connecting the dots."

Correct.
"So far" being the operative term.
Their admitted aim has been to enact a nationalized system just like Canada's Medicare or the NHS.; १९/११/०९, ९:५१ AM
Beaverdam म्हणाले...: J.M.md above says screenings only identify 1 in 1000....
What crap. Ever been that 1 in 1000? I have. I love all 5 of the MDs that saved my sorry ass, but these guys are callous. Caring but callous. They see so many dead men walking that they lose touch. I used to chat with a 28 year old breast cancer victum during chemo. God rest her soul.; १९/११/०९, १२:२७ PM