I haven't been around for most of this thread so maybe it's been mentioned. I see two problems here. Cologuard detects colon cancer. You already got it. A colonoscopy is 99% about removing those polyps that might become cancerous someday. (Not all colon cancer is related to those polyps though. Katie Curic's husband had a different kind.) If you pay for a colonoscopy, and that's OK, if anything happens, something goes wrong and you need a night or two in the hospital, your regular insurance might not cover that because in their eyes you didn't need the procedure. That's gonna cost! Each policy would be different of course but I would want to know "what's my downside?"
Judge Strikes Down ACA's Required Coverage Of Preventive Care
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I haven't been around for most of this thread so maybe it's been mentioned. I see two problems here. Cologuard detects colon cancer. You already got it. A colonoscopy is 99% about removing those polyps that might become cancerous someday. (Not all colon cancer is related to those polyps though. Katie Curic's husband had a different kind.) If you pay for a colonoscopy, and that's OK, if anything happens, something goes wrong and you need a night or two in the hospital, your regular insurance might not cover that because in their eyes you didn't need the procedure. That's gonna cost! Each policy would be different of course but I would want to know "what's my downside?"
I think the primary goal of preventative care is extending health and life. Whether it saves money is secondary.
The NYT link didn’t work for me, but the Reuters article was really interesting. It seems counterintuitive, but I can see from a purely economic standpoint given the ratios quoted in the article how it could be more expensive to administer tests to lots of people who end up testing negative. I guess the flip side is that if a person who didn’t have risk factors, got tested anyway and managed to extend his or her life, I imagine that person would be all for preventative testing.
Montecfo
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Yes. Some of these tests are compulsory not because they make sense economically, but because the electorate or some portion thereof perceives a benefit.
Obviously all free testing would be of benefit to me individually, if cost (which we as taxpayers also bear) was not a consideration.
Obviously all free testing would be of benefit to me individually, if cost (which we as taxpayers also bear) was not a consideration.
There is a real question in my mind whether the judge, who is better known for partisanship than scholarship, made the right decision on the Appointments clause (among other things). Not an expert but It's hard to see how a volunteer panel of experts who meet a few times a year to make explicily non-political recommendations need individual Senate approval. The bad part is all the stress and uncertainty it injects in peoples' lives for however long it takes to sort this out.
Long-standing preventive services are generally not impacted. The task force did change screening colonoscopy to age 45. It could revert back to age 50.
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target2019
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"You gets what you get." I never understood people who could laugh off monumental decisions and sea change.
Then I graduated to Stage IV. As someone above mentioned, just start your important decisions with that, and try to understand coverage, and lack of, for life-saving preventative procedures. The U.S. system makes little sense to me, when compared to treatment and costs of the best global systems.
Then I graduated to Stage IV. As someone above mentioned, just start your important decisions with that, and try to understand coverage, and lack of, for life-saving preventative procedures. The U.S. system makes little sense to me, when compared to treatment and costs of the best global systems.
athena53
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Actually, they're not. Many tests carry risks themselves. If your intestine gets pierced during a colonoscopy you can get a fatal infection; if a vein is cut during an angiogram you can bleed out. Colonoscopies aren't recommended after a certain age because the lining of the intestines thins out.
There's also the cost of false negatives- more testing and anxiety for the patient. I'm 70 and apparently don't have to get Pap smears anymore.
I'm all for preventative testing when it makes sense- that's 99% of my medical appointments- but not every test does. I have some osteopenia in my hips and haven't gone back for a follow-up scan (have added supplements and weight-bearing exercises in the meantime) because I will not take the bone density meds. If you're not going to do anything with the results, why do the test?
The problem with all the studies showing the rate of finding cancer is low, if you are the one they find cancer in, then screening is well worth the cost to society from your viewpoint!
Several studies show the complication rate seems to be a bit lower that the rate at which cancer is found, not what I was expecting and trying to show. Their is not a lot of detail on age, and one study I found said, for ages 40 to 49, "the The low yield of screening colonoscopy in this age group is consistent with current recommendations about the age at which to begin screening in persons at average risk" I don't know what the current recommendations are, but as I read that, it means it is not recommended.
https://pubmed.ncbi.nlm.nih.gov/12050337/
Re: Colonoscopies, "Recently, the perforation rate, as reported in large studies, ranges from 0.005-0.085%. The perforation probability after colonoscopy does not decrease over time in either the West or the East. Other studies have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337013/
The incidence of Colon Perferation ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopy interventions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811793/
"The low yield of screening colonoscopy in this age group is consistent with current recommendations about the age at which to begin screening in persons at average risk.
https://pubmed.ncbi.nlm.nih.gov/12050337/
"Colon cancer is found during only in about 40 out of 10,000 screening colonoscopies, Dr. Sand said." 40 / 1000 = 0.4%
https://www.honorhealth.com/healthy-living/are-all-colon-polyps-precancerous-or-worse
bmcgonig
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Colon cancer is one of the few cancers that you can almost 100% avoid because of colonoscopies.
retiredtillwepart
Dryer sheet wannabe
Just another reason to go to a Single Payer system that is not sloppy.
djsander
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The company I retired from medical insurance allowed one colonoscopy every year 100% covered no matter what the diagnosis or reason. Our joke was you could get one every year whether you wanted it or not. That was somewhat unusual. I had one polyp on my first one so was set up for another in 5 years. When the time came the same facility insisted I had to pay $600 before hand because I was high risk and this was diagnostic and not fully covered. We went round and round and finally the insurance company and our company patient advocate convinced them that it was 100% covered regardless of the reason. They still stubbornly agreed and made me verify that I was responsible if the insurance didn’t pay. I really don’t know what the issue was with the facility as they usually get a breakdown of allowed amounts from the insurance company ahead of time.
Really?
After watching a love one die of colon cancer and 3 years or misery battling it I question this.
As a society I'm will to toss a few dollars into to the pot if that is really was it takes and your statement is true.
Montecfo
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No one wishes illness on anyone. The question is whether treating the illness or preventing it is more cost effective.
The answer is often it costs more to prevent. That does not say it is a bad idea in all cases. It is valuable info to know though for policy makers.
Read the articles. It is math.
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By that premise, one would refuse cancer treatments to a Stage 4 patient, or hospice care to someone in their final months. Odds are they won't make it, and the cost won't prevent or cure anything.
I get that none of these businesses are charities, but the words "Health" and "Care" together, mean something. Or should
USGrant1962
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Upthread folks suggested that preventive care was always cost effective, which I've read many times over the years is not true. That doesn't mean the money shouldn't be spent to improve population health - but don't pretend it always saves money, which is some people's premise.
jimbee
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Post #43 describes what actually triggered the case. Apparently the actual cause isn't relevant.
See also post #66. I don't know how to quote 2 posts.
There are at 2 costs associated with screening tests.
Economic costs and the morbidity/mortality costs of screening.
If I give colonoscopies to 100,000 people, then I will kill some people as a result of the screening and put a larger number in the hospital with the complications of a perforated bowel.
Screening tests are not 100% reliable.
There are false positives( the test says you have the disease when you do not) and false negatives.
PSA screening for prostate cancer is an example of a screening test with a high false positive rate.
More definitive tests for prostate cancer( biopsy) have a risk of complications and death.
The issue of screening is far more complex than the narrative of greedy insurance companies.
Turbo29
Full time employment: Posting here.
target2019
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
“…A society, or all mankind, should study the consequences that are likely to result from each decision that is possible at the present time. By making appropriate selections today, society can influence its future, rather than wait for the inevitable to occur. The individual, too, can consider what sort of person he wants to become, and what goals he wants to achieve, before making a choice between various alternatives. He can set out to produce a certain future for himself, instead of feeling that his life is completely determined by forces over which he has little control.”
Allen Tough from The Adult’s Learning Projects
Allen Tough from The Adult’s Learning Projects
ShokWaveRider
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Those who have seemingly unlimited free healthcare just love to limit it for those who do not. It is shameful really.
Found a site that does a deep dive into the weeds for this topic.
Exactly which no-cost services did hack judge O'Connor strike down yesterday? It's complicated.
https://acasignups.net/23/03/31/exa...oconnor-strike-down-yesterday-its-complicated
Exactly which no-cost services did hack judge O'Connor strike down yesterday? It's complicated.
https://acasignups.net/23/03/31/exa...oconnor-strike-down-yesterday-its-complicated
It's not the math
I read the articles. Twice. It’s not the math, but it might be the reading.
As a finance guy, you might have your arms around the differences between cost saving, cost effectiveness and cost benefit. I didn't and the CDC website helped me better understand the articles you cited. https://www.cdc.gov/policy/polaris/economics/index.html. The Times article says that two of the required ACA services (childhood immunizations and counseling adults in the use of aspirin) were “cost saving” and an additional 15 (which were not defined) were “cost effective.” https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html The Reuters article is similar. https://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 It says that the U.S. Preventive Services Task Force (the group that the trial court found was unconstitutional) didn't include screening for ovarian and testicular cancer in their recommendations because it had no health benefit. So it seems like they weren't just rubber stamping preventative measures.
Neither article says that the ACA's requirements are not cost-effective or a waste of money. They say, and we probably all agree, that we should select only high-risk people for screening, that some alternative programs show promise, and that not every preventative measure is effective. They also say, as do other commenters here, that this is not a simple dollars in, dollars out exercise. Cost-effectiveness isn't always the right yardstick.
BR
I read the articles. Twice. It’s not the math, but it might be the reading.
As a finance guy, you might have your arms around the differences between cost saving, cost effectiveness and cost benefit. I didn't and the CDC website helped me better understand the articles you cited. https://www.cdc.gov/policy/polaris/economics/index.html. The Times article says that two of the required ACA services (childhood immunizations and counseling adults in the use of aspirin) were “cost saving” and an additional 15 (which were not defined) were “cost effective.” https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html The Reuters article is similar. https://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 It says that the U.S. Preventive Services Task Force (the group that the trial court found was unconstitutional) didn't include screening for ovarian and testicular cancer in their recommendations because it had no health benefit. So it seems like they weren't just rubber stamping preventative measures.
Neither article says that the ACA's requirements are not cost-effective or a waste of money. They say, and we probably all agree, that we should select only high-risk people for screening, that some alternative programs show promise, and that not every preventative measure is effective. They also say, as do other commenters here, that this is not a simple dollars in, dollars out exercise. Cost-effectiveness isn't always the right yardstick.
BR
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