Prevention Is No Cure
Gottlieb, Scott
"PREVENTION IS NOT A CURE" BY SCOTT GOTTLIEB, M.D. Doctors and millions of women gasped recently when a group of Danish researchers announced that annual mammograms might not, after all, decrease...
...S.H...
...J.M...
...Your superior sound quality comes from the Class-D receiver in the EarMate-63...
...Social-minded liberals felt that high deductibles priced poor families out of the market...
...After education, it is the largest program in most state budgets...
...CAT scans and MRIs are no problem...
...Nature turns out to be one tough adversary...
...They typically followed the model of the Kaiser Foundation, often control-ling their own doctors and hospitals...
...Medicaid covers a fifth of all American children...
...Thank you...
...True, Medicaid is rife with waste...
...But the business plan never worked, because the tests were often more costly than the treatments.You can't give every coughing smoker a CAT scan: it's too expensive.You have to wait for cancer to grow big enough to be seen on an ordinary chest X-ray, by which time it's often The high cost of diagnosis kills managed care...
...It was sold to Wall Street as a cost-saving alternative to episodic care, even though there wasn't any medical evidence to prove that this economic fiction really worked...
...could avert costly health problems...
...These firms built their businesses around the premise that inexpensive tests, coupled with regular checkups...
...they tended to focus on things like dental coverage and free eyeglasses for the elderly, ignoring the kinds of costly preventive measures that might have made a real difference...
...In 2000, Medicaid HMOs covered 14.2 million beneficiaries, or 42 percent of 26 THE AMERICAN SPECTATOR • MARCH/APRIL 2002 Revolutionary Hearing Aid—Free Information Soft Hearing Aid with Remarkable Sound...
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...Such physicians are precisely the ones that managed-care companies sought to drive out of their networks...
...This hopeful finding—at least hopeful for those concerned about health, and not state coffers—is conditioned on a few assumptions...
...WAGES OF SIN BY AMITY SHLAES How elastic is sin...
...For state finance types, watching those budgets go from surplus to deficit has been as painful as nicotine withdrawal...
...The problem is certainly big enough...
...S.M...
...But, as the authors note, youngsters' access to autos is more limited than that of adults, so the elasticity is likely a real phenomenon...
...On the plane of common wisdom, the story also makes sense: Addiction would not be addiction if you gave it up because it cost an extra dollar...
...and U.S...
...We can therefore expect steep reductions in youth smoking in Alaska, Hawaii and NewYork—states where the tax is $1 a pack or more...
...H. T. - Stoughton, WI "I love the way the soft shell canal fits...
...Contrary to common belief, managed care wasn't conceived as a cheaper alternative to the fee-for-service indemnity insurance of medicine's go-go years, when insurers cheerfully paid for all the health care doctors Dr Scott Gottlieb is a physician at Mount Sinai Hospital in New York and editor of the Gilder Biotech Report...
...Health care economist Kleinke cites a little-noticed study published in 1998 in the Journal of theAmerican Medical Association, which found a direct relationship between physician scores on board exams and the intensity of resources they order for patients...
...Ethel, LA "I find it a great help...
...Good care costs even more...
...Moreover, higher prices for cigarettes not only reduced the purchase of cigarettes by smokers but also deterred young non-smokers from taking up smoking...
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...Canton, OH "Your aid is as good as or better (certainly smaller) than previous one I had had fitted...
...Doctors and millions of women gasped recently when a group of Danish researchers announced that annual mammograms might not, after all, decrease deaths from breast cancer...
...In other words, precisely what managed care promised, and failed, to deliver...
...Address LCity/Sta e/Zip...
...Nearly every aspect of preventive care crashed upon the rocky shore of added costs...
...I can even order home nurses and health aides...
...Brinkley, AR "I like the way it fits in the ear...
...So, many are now pushing their governors and legislatures to get them a quick cash fix by hiking cigarette excise taxes...
...HMOs like US Healthcare and Oxford Health Plans went public and raised gobs of money...
...Suddenly, preventive medicine was chic...
...Compare to hearing aids over $1,000 & decide which is best for you...
...HMOs look like an easy answer...
...It's just that with today's technology, this kind of medical care costs more, not less...
...too late...
...The smart money should be shorting them...
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...PREVENTION IS NOT A CURE BY SCOTT GOTTLIEB, M.D...
...J 0 0 the total Medicaid population, up from coverage of 9 million beneficiaries in 1995...
...Calls to expand the HMO idea into a centralized, federal system scared the Nixon White House...
...Health care costs money...
...And by the time most really dangerous diseases sprout, patients would probably be covered under Medicare...
...The biggest is that young people are not "butt-legging"—cadging cigarettes in the black or grey markets or driving out of state for cigarettes...
...But the evidence here is at least a little smoky...
...I've never heard of a Medicaid "utilization review manager...
...in 22 states to raise tobacco taxes...
...Hard to believe, but in the 1970s, people actually paidthemselves—a significant portion of their own health insurance...
...These are useful lessons for law-makers wringing their hands over rising Medicaid costs.The bureaucratic bluenoses in charge of Medicaid are convinced that offering managed care to the chronically ill poor can break the costly, medically unwise dependency on emergency rooms...
...All this makes sense given that a $1 increase in the price of a pack of cigarettes represents a significant percentage of many a teenager's budget, especially during weak economic times...
...It helps pay for a third of all U.S...
...Private insurers hound us at every turn...
...I like it so well I am going to order one for my left ear...
...prescribed...
...All this isn't to say that preventive medicine doesn't have a place, or that aggressive care can't stave off disease...
...R.C...
...Managed care began as a social movement seeking an alternative to the poor treatment that liberal policy wonks said patients were receiving under the old system...
...In the 1990s, Frank J. Chaloupka of the University of Illinois and Michael Grossman of the National Bureau of Economic Research looked at youth smoking following tobacco tax increases in a number of states.They found that "large increases in cigarette excise taxes would lead to sharp reductions in youth smoking...
...A body of economic literature suggests cigarette demand can be elastic, at least among the young...
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...Not very, if you believe America's state governments.They are the ones wagering that citizens love a sin cigarette smoking so much that their desire for cigarettes will not change no matter the taxes levied on cigarettes...
...Or, to put the matter in economic terms, they think demand will be relatively inelastic...
...Nature turns out to be one tough adversary It wasn't supposed to be this way...
...births and two-thirds of nursing home residents...
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...Not executives at managed-care health companies—they'd already seen that harsh reality coming...
...In the process, medical care is being transformed from a symptom-based art into an objective science, saving lives at reduced cost...
...Medicaid patients routinely get expensive tests and treatments that I know are not available to my patients carrying penny-wise private insurance...
...They assume demand is inelastic...
...Better-educated doctors are more cognizant of the spectrum of clinical problems potentially affecting a patient...
...Medicaid HMOs such as Centene and Amerigroup have been some of the hottest stocks on Wall Street...
...Mammograms were a favorite example of an effective prevention tool...
...And the trend to cigarette sin taxes is global: the European Union has proposed a tobacco tax increase worth more than a dollar per pack...
...Even the HMOs didn't believe their own rhetoric...
...Words can't explain the joy of hearing again...
...Ironically, HMOs have abandoned their prevention-is-cheaper business model just as the new biodigital medicine is making it possible...
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...And in some cases, doctors have charged, people died as a result...
...Patients were routinely denied ordinary but expensive tests and treatments, as plans tried to clamp down...
...If you ignore them long enough, the cancer will become another insurer's problem...
...Osteoporosis screening and prevention turn out to cost more than pinning a few fractured hips...
...Thank you for helping me hear again...
...Chaloupka and his colleague 28 THE AMERICAN SPECTATOR • MARCH/APRIL 2002...
...In the end, the truth is that it was never in the industry's interest to tryto prevent diseases they would never need to pay for...
...Kleinke points out in his book Oxymorons: The Myth of a U. S. Health Care System, with the average person changing health insurance every three years, HMOs had no incentive to pay for expensive medicine to prevent a disease that wouldn't manifest itself for another ten years.Why spend money ferreting out pre-malignant polyps that wouldn't make themselves manifest as colon cancer for another decade...
...But it is important to remember that the states' wager on inelasticity is born of a nasty dependence of their own: the dependence on ever-increasing state budgets...
...As costs rose, "utilization reviews" became commonplace...
...As Denver-based health-care economist J.D...
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...In New Mexico, this year alone, $$50 million of the state's estimated $131.6 million budget shortfall in Medicaid is due to higher-than-budgeted costs in man-aged care...
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...Older smokers were less responsive, especially, it seems, women...
...They order more diagnostic tests to rule them out...
...The indemnity plans were indeed expensive, with much of the cost borne by consumers in the form of high deductibles...
...Most of these early HMOs failed, only to be resurrected in the 1980s as a cure for rising health care costs...
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...Until cheap and efficient screening tools become available—gene chips that can scan your blood for the telltale signs of small cancers, such as one developed at the National Institutes of Health that scans for colon cancer—vigilant doctors and good care are going to remain expensive...
...Diagnosis and treatment are moving from the visible sphere—a lump on the breast, a hacking cough—down into the biochemical microcosm of DNA...
...You can write the rest—health care has steadily deteriorated ever since.The managed care plans started to hemorrhage, as costs exceeded their neat estimates...
...Martin Feldman of Salomon Smith Barney found 45 bills proposed Amity Shlaes is a columnist for the Financial Times...
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...state budgets into which such increases would be written are static ones, which assume a certain rate of tax revenues...
...HMOs—health maintenance organizations—were created as a cheaper alternative...
...The result was the HMO Act of 1973, ushering in the early nonprofits that were the forerunner to today's money-minded managed care behemoths...
...Kids in Kentucky and Virginia (with taxes less than 10 cents) will, by contrast, puff away...
...And paying to treat runaway breast cancer cases is cheaper than screening every woman with annual mammograms...
...Cigarettes are dirty, but not too dirty for states to make money from them...
...But it is doubtful that managed-care plans can do any more for Medicaid's woes than they could for the private market...
...Thankfully, these tools are at hand...
...HMOs can bring short-terms savings by squeezing out some of the most obvious excess and changing habits of patients who overuse expensive services like the emergency room...
...This, he says, comes on top of excise tax increases in five states last year...
Vol. 35 • March 2002 • No. 2
