The proposals in Congress are based on cutting costs in the delivery of heathcare in large part based upon savings from prevention. Unfortunately, while prevention is important to improving your health it is unlikely to save money. Multiple studies have repeatedly shown that few preventative measures truely produce cost savings. The following is from an article by Dr. Steven Teutsch MD,MPH an expert in the field.....

Healthcare costs continue to skyrocket[1] and the solution appears to be simple: prevention. But how cost-effective is prevention? Does it really save money?
First, let's be clear about what cost-effectiveness means. In the simplest terms, it is the value of a preventive service -- the costs incurred as a result of that service divided by the health outcomes achieved.[2] The costs incurred include patient costs for travel, the healthcare costs, as well as any follow-up and treatment costs. The outcomes are best expressed as those that patients care most about -- such as years of life saved -- but more and more analyses also include quality of life. There are other kinds of economic evaluations, such as cost benefit analysis and cost analyses, but these won't be considered here.
We often hear that something is cost-effective. Something that is cost-effective, however, is not necessarily cost-saving. After all the consequences are accounted for, very few services of any kind save more money than the cost incurred. Childhood vaccines are among the rare examples that actually are cost-saving.[3]
Many other preventive services are cost-effective -- that is, they provide reasonable value. Though there are no firm cut-offs, generally a service that costs less than $50,000 per life-year saved is considered a good value, and those over $100,000 per life-year are generally not considered cost-effective.
So why are preventive services rarely cost-saving? The main reason is that while everyone incurs the cost of the preventive service and follow-up, the health and financial benefits generally only accrue to the individuals who would eventually have the disease or injury. In addition, most preventive services are only partly effective. Even a well-established test such as mammography screening reduces breast cancer deaths by less than 20%. In some cases, the rate of false-positive tests can be high. As many as 85% of positive mammograms are fortunately false-positives, but each positive mammogram requires a woman to have careful additional examination(s) and many need biopsy.[4]
Although it is unrealistic to expect clinical preventive services to save money, many do provide excellent value. A recent analysis by the National Commission on Prevention Priorities[3] identified the most effective and the most cost-effective clinical preventive services. Among the services at the top of list are aspirin to prevent heart disease; childhood immunization; screening and counseling for tobacco use and problem drinking; screening for colorectal cancer, cervical cancer, vision impairment, blood pressure, and cholesterol; and pneumococcal and influenza immunization.
Cost-effectiveness analyses themselves can also help shape the delivery of these services by providing information on the value of services for people in different risk groups or how often services should be delivered. Many of these services are inadequately provided to the American people and provide a great opportunity for improvement. To accomplish this requires the commitment of payers and physicians, as well as knowledgeable patients.
Even though I have focused on clinical preventive services, ie, services provided from a clinician to an individual patient, many of the most effective interventions occur at the population level. These include things such as systems to assure access to healthcare, laws and regulations to limit access to tobacco and assure clean air, programs to reduce toxic exposures, interventions to reduce risky behaviors, health education programs and messages, and creation of healthy environments and the availability of healthy foods. In addition, there are major opportunities to address some of the leading causes of disease and injury, such as income disparities, and long-term threats like global warming and ecosystem destruction. Studies of the cost-effectiveness for many of these interventions are badly needed.

Important information about the current proposal in Congress and what it means for all Americans.

This is a flawed plan that is being pushed through Congress without enough discussion of the potential effects on the US economy as well as our healthcare system!

The following appraisal from rep. Boehner discusses some of the important concerns.


Mon Jul 20, 3:40 am ET
By House Republican Leader John Boehner (R-Ohio)
Middle-class families are struggling every day with rising costs of housing, food, transportation, and taxes. But for many, rising costs of health care are the most devastating of all. That’s why Americans’ top priority during the ongoing health care debate is a plan that will reduce costs. Unfortunately, the government takeover of health care offered by the Washington Democrats will not reduce costs; instead, it will dramatically increase costs – for your family, America’s small businesses, and all taxpayers.
Last week, Douglas Elmendorf, the director of the nonpartisan Congressional Budget Office (CBO) sent shockwaves through Washington when he told Congress that the Democrats’ plans would make health care more costly. Throughout this debate, President Obama has spoken of the need to “bend the cost curve” or drive health care costs down. During a congressional hearing, however, Mr. Elmendorf testified that the Democrats’ plans would have the opposite effect, saying that under their proposals, “The curve is being raised” and costs would “significantly expand.” That’s because the Democrats’ plan adds a new layer of taxes, mandates, and bureaucracy on top of the current system. If that’s not bad enough, the Democrats’ plan cuts Medicare and takes away choices for millions of seniors. What does all of this mean? Higher costs for the medicine and treatments you need. Not only will the Democrats’ government-run health care plan raise your costs, but it also will raise costs for our nation’s employers – particularly small businesses. At the heart of their proposal is a small business tax that, for tens of millions, means diminished job security. The National Federation of Independent Businesses warns that the small business tax and mandates in the Democrats’ plan will destroy 1.6 million jobs – one million of them in small businesses alone. And according to methodology developed by Dr. Christina Romer, the chair of the White House Council of Economic Advisors, the government takeover would cost Americans 4.7 million jobs over the next 10 years. With our economy at its weakest since the Great Depression and unemployment soaring far beyond the levels promised by the Administration, why would Congress promote policies that make jobs even more scarce?In addition to warning that the Democrats’ plan will raise health care costs, the Congressional Budget Office also has projected that the House Democrats’ proposal would increase the deficit by another $239 billion over the next 10 years. And even though the President continues to claim that those who like their current health care plans can keep them under the Democrats’ proposal, independent analysts disagree. One analysis shows that 114 million Americans may be forced off their current coverage and onto a government-run plan as a result of the House Democrats’ legislation. That means more costs to the taxpayers. The bottom line: while Democratic leaders continue to claim that health care legislation must be “paid for,” the House Democrats’ bill is not. Instead, it will force us to borrow more from China and countries in the Middle East and stick our children and grandchildren with the tab. Faced with the Democratic bill’s extraordinary costs to families, small businesses, and taxpayers, House Majority Leader Steny Hoyer (D-MD) suggested last week that Democrats should go “back to the drawing board.” I agree, and that’s why House Republicans have offered real reforms that would lower health care costs. Our plan roots out waste, fraud, and abuse in the system and reforms medical liability rules that cost families millions each year – millions that line the pockets of trial lawyers at the expense of patients and doctors. It lets small businesses band together through associations and purchase health insurance for workers at a lower cost, just like large corporations and unions do. It offers incentives to help Americans who do not have access to quality health care get the coverage they can afford, while giving states tools to design programs that make health care coverage more affordable. And it reforms regulations so insurance companies compete for your business and you can shop around for the best coverage and price.Health care reform is too important to rush through a flawed proposal that will raise costs – the opposite of what the American people want. After the Obama Administration insisted that Congress rush to enact a “stimulus” bill that – by any objective account – has not created the jobs that were promised, Washington cannot afford to make that same mistake on health care. Nonetheless, it appears Democratic leaders will stubbornly try to ram through this bill before Congress leaves for the August break with little debate or discussion, even as many rank-and-file Democrats express serious concerns about what a costly government-run plan would mean for families and small businesses. It’s time for Democrats to scrap their government takeover of health care and work with Republicans on a plan that gives more Americans access to affordable coverage.
Rep. John Boehner (R-Ohio) is the House Minority Leader and a leading voice in the Republican party. He is currently serving his 10th term representing the 8th Congressional District of Ohio.

Government run health plans

The phase government run healthcare should cause all Americans to "perk up their ears" Medical care needs to return to a relationship between a patient and their physician. The healthcare system in the US needs to evolve and changes are neccesary. The entire system however should not be abandoned. Americans do have the best healthcare in the world and virtually unlimited and immediate access to it. Currently in Canada there is a 6 month wait list for many diagnostic tests. Waiting lists similar to this in the US may occur if there isn't careful deliberation about healthcare reform. US mortality figures and life expectancy forecasts are often used to "evaluate" the quality of care in the US healthcare system. The truth is life expectancy in the US is greater than in countries with government controlled healthcare.

The following is an expert from a recent (July 2009) article in Investors Business Daily:

• Government-run health care produces better results.

The biggest potential lie of all. America has the best health care in the world, and most Americans know it. Yet we hear that many "go without care" while in nationalized systems it is "guaranteed."

U.S. life expectancy in 2006 was 78.1 years, ranking behind 30 other countries. So if our health care is so good, why don't we live as long as everyone else?

Three reasons. One, our homicide rate is two to three times higher than other countries. Two, because we drive so much, we have a higher fatality rate on our roads — 14.24 fatalities per 100,000 people vs. 6.19 in Germany, 7.4 in France and 9.25 in Canada. Three, Americans eat far more than those in other nations, contributing to higher levels of heart disease, diabetes and some cancers.

These are diseases of wealth, not the fault of the health care system. A study by Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa found that if you subtract our higher death rates from accidents and homicide, Americans actually live longer than people in other countries.

In countries with nationalized care, medical outcomes are often catastrophically worse. Take breast cancer. According to the Heritage Foundation, breast cancer mortality in Germany is 52% higher than in the U.S.; the U.K.'s rate is 88% higher. For prostate cancer, mortality is 604% higher in the U.K. and 457% higher in Norway. Colorectal cancer? Forty percent higher in the U.K.

But what about the health care paradise to our north? Americans have almost uniformly better outcomes and lower mortality rates than Canada, where breast cancer mortality is 9% higher, prostate cancer 184% higher and colon cancer 10% higher.

Then there are the waiting lists. With a population just under that of California, 830,000 Canadians are waiting to be admitted to a hospital or to get treatment. In England, the list is 1.8 million deep.

Universal health care, wrote Sally Pipes, president of the Pacific Research Institute in her excellent book, "Top Ten Myths Of American Health Care," will inevitably result in "higher taxes, forced premium payments, one-size-fits-all policies, long waiting lists, rationed care and limited access to cutting-edge medicine."

Before you sign up, you might want to check with people in countries that have the kind of system the White House and Congress have in mind. Recent polls show that more than 70% of Germans, Australians, Britons, Canadians and New Zealanders think their systems need "complete rebuilding" or "fundamental change."

A rush to pass a government healthcare plan may put America on the critical list

The following is from Chritina Wijfjes-Smit of the Phoenix Examiner. It adresses the "need" felt by the administration to ramrod through legislation that will affect every American.

The push from the Obama administration to pass a government healthcare plan, before the August recess, has a growing number of Americans feeling uneasy. Without knowing specifics or even an estimated cost we are being asked to support a bill that has yet to have a final draft. To make such an important decision, one that will affect the entire country, without all the facts is simply irresponsible.

On Thursday, Douglas Elmendorf, director of the Congressional Budget office said, "In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs." In other words it will drive us deeper into debt.

Cost is the biggest issue of healthcare reform. Before we pass a bill we have to know the bottom line. We have to know how we will pay for it. We also need to know the affects a proposed bill will have on the individual citizen, small business owners, doctors and hospitals. In order to make a decision on the best path to healthcare reform we must be able to read, debate and examine a detailed, tangible bill. For all that to be accomplished in two weeks is, in a word, impossible.

Healthcare reform is needed. But we must remember that our current system has been in place for decades and there simply is no easy fix. What is the hurry? Is this administration willing to pass a deficient bill so they will appear expedient? If so what will be the cost? By rushing to pass flawed legislation, President Obama runs the risk of making things worse rather than better. By enacting reform for the sake of reform we put the American people and their healthcare into jeopardy. We need to take a step back and allow for the time needed to put together a reform bill that the American people can understand and embrace. If we continue on this hurried unstable path mistakes will be made, mistakes that hurt instead of help, mistakes that may very well place Americans and their healthcare in critical condition.

For more on this topic:
Paying for the comprehensive healthcare overhaul
Reform of healthcare in the U.S.
Arizona’s proposed health-choice bill HCR2014

For more information:
Health reform, www.healthreform.gov

Health care for members of congress

In spite of all the discussions about changes needed in our health care system the fact remains that what ever changes occur they will not apply to any of our Congress members. They have assurred that they maintain their own separate system outside of the system they are establishing for all other Americans. This is outrageous and generally hidden from the public! Members of Congress should receive their healthcare through the same system as all other Americans. We encourage you to make your wishes known to your Senate and House of Representative members.

Metro Heart Group

This is the first session of the Metro Heart Group blog about health care reform for our patients and the general public