They were confusing before, but this proves that they’re quite insane.
TEA Party rally to burn Perriello in effigy
The Star-Tribune was the newspaper to break the embargo, but something this asinine deserves to be mocked as quickly as possible.
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Danville’s Tea Partiers have officially lost their minds.42 comments to Danville’s Tea Partiers have officially lost their minds.Leave a Reply |
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I agree with the sentiment of the tea partiers in that I am very, oh SO VERY disappointed with Congressman Perriello’s health care vote. BUT to burn in effigy???DEFINITELY extreme and out of line. Silly. I have written, e mailed, left phone message with his office, and will not give him my vote(did not the first time , either) next fall.
But burning in effigy is something I think of in third world countries and such.
I suspect he feels the burn already without any stunts.
Well, it is their first amendment right to do it…and my first amendment right to say it is stupid.
Oh brother.
You know, people are very upset with Perriello & Pelosi. Every vote they make costs us money or liberty or both. I, too, have called, written, emailed Perriello to no avail. His staff just tells me I am wrong about everything (meanwhile, I actually read these bills–do you think the hip, arrogant staffers do that?)
Will being burned in effigy cause Perriello to pay attention? nah, he will only pay attention when we show him the door next November.
Robert Hurt for Congress!
Kelley,
you are very right. They are not listening to us at all….they essentially said earlier in the year that we are not worth listening to, remember?
That’s expected…our next representative perhaps will.
Somebody else in 2010!
Yep, they have officially played right into democratic hands. No rational person will want to be associated with this group after this. It’s not too late for them to reconsider, which I hope they do. They had a opportunity to make a difference, unfortunately stunts like this will only hurt their cause.
I so agree. This is a stunt and only feeds the image of so called “right wing wingnuts” that the so called mainstream press loves to propel.
But I also know we are being ignored and all the calls, letters, etc are seemingly to no avail.
I still do not care for this approach, but, hey, I also DO NOT CARE for what is being pushed down on us all!
Things may get even more dramatic before this is all over.
Believe me Mary, they will not ignore us on election day 2010.
I wish I knew what “liberties” were being threatened. Frankly, I feel a lot safer than I did during the prior administration, which showed a pretty scary contempt for the Constitution and Bill of Rights. Attorney General Alberto Gonzales, while still White House counsel, wrote that the “Constitution is an outdated document.” And Supreme Court Justice Antonin Scalia said he cringes every time someone calls the Constitution a “living document.” “Oh, how I hate the phrase we have: a ‘living document,'” Scalia said. “We now have a Constitution that means whatever we want it to mean…We can take away rights just as we can grant new ones. Don’t think that it’s a one-way street.” Bush proposed seven amendments to the Constitution in just a five year period while members of Congress proposed some 11,000 amendments during the previous decade, including the repeal of the right to bear arms.
While in office Bush claimed an inherent power to imprison American citizens whom he had determined to be this country’s enemies without obtaining a warrant, letting them hear the charges against them, or following other safeguards against wrongful punishment guaranteed by the Bill of Rights. Under his administration, the government engaged in inhumane treatment of prisoners that amounted to torture, and when Congress passed legislation to ban such treatment, he declared he would simply interpret the law his own way. Although the Constitution says treaties are the “supreme law of the land,” the president abrogated them on his own. And, as we now know, he ordered a secret program of electronic surveillance of Americans without court warrants.
Instead of bemoaning some imagined “loss of liberties” we should be counting ourselves lucky we got out of the last eight years with any left at all.
Mr. Miller: what part of the Healthcare bill that Perriello voted for mandating the purchase of health ins or receive a fine is constitutional?
also, I would feel safer if all terrorists were meeting their 72 virgins.
You are required to have insurance on your automobile or pay a $500 fee. Is that constitutional?
Mr. Miller,
That is a completely ludicrous argument spouted straight from George Soros and the Daily Kos’ talking points. The fact is people without automobiles are required to purchase such insurance. Whether you want to acknowledge it or not, owning an automobile is a choice and luxury, and the government rightly regulates the privledge of issuing a license to drive. Breathing and living is not however a luxury. If I don’t have a choice about living, and must pay for this insurance or go to jail, that IS a denial of liberty and property confiscated from me by the government. Sorry, I pay for my health insurance, I don’t want to pay for yours or anyone else’s thank you very much.
That said, just because you can say or do something doesn’t mean that you should. That’s my take on effigy.
I do not think the previous administration was perfect . Spending was out of control then also, the financial crisis we have now was being pushed along by all sorts of things such as the lending practices of Fannie Mae and Freddie Mac. A lot of chickens are coming home to roost. But I do tire of the constant refrain of “the last eight years”. I am more concerned about what is happening NOW.
I , for one, am a HECK of a lot more worried about the next 8 years than I have ever been in my 54 years. I see a return to pre 9-11 mentality that is very worrisome.
Back to the topic of the health bill and Perriello voting for it…BAD move. This thing will be a HUGE ship to try to turn back around once it leaves the port.
I’m sure you most likely have health insurance through your employer or your spouse’s employer or perhaps you pay for your own insurance. So I fail to see how you would be affected by any law demanding a penalty for being uninsured. But what about old Joe Wigglesworth? What if he decides to not be insured? He can just pay as he goes. After all, what are emergency rooms for? But what if something catastrophic happens to Joe? Worse yet, what if something catastrophic happens to his wife or children? He may be facing tens of thousands of dollars’ worth of tests, surgeries and therapies. There are plenty of places where he can get all this for free or at a very low cost…but who actually is paying for that? You? Me?
Someone who simply cannot afford health insurance—someone self-employed for instance—but who wants it ought to be able to get an affordable policy. But someone who willfully turns their back on being insured is counting on one of us to pick up all or part of the tab. Why should we do that?
I’m going to attend. You best to believe!
Ron, you know…I AGREE with almost all you said in your last post. I am an RN and am pretty familiar with the health care system as I got my license in 1975. Where we differ is I know that this plan is NOT the way to improve health care, improve access or lower cost. It needs to be done calmly, systematically and not shoved through, using a model that is failing miserably everywhere it is being used.
So we are not that different in the goal….but very different I suppose on how to get there. Have you actually taken time to read any of the bill? I have spent an obscene amount of time trying to do just that and it is beyond reason. A nightmare that will make the current problems pale in comparison, IMO.
Anyone who suggests that an automobile is an unnecessary luxury in today’s world is being disingenuous. (And I used “unnecessary” deliberately since it is the definition of “luxury”.) Anyone who thinks their car is on a par with their HD television or Italian shoes must also think it is unnecessary. So give it up, then. But how do you now plan to get to work? to church? to the doctor? to friends and relatives? Public transportation? Here? Perhaps you intend to depend on the kindness of friends and neighbors who are silly enough to indulge in unnecessary luxuries? Aside from most likely losing friends real fast, it kind of underscores the fact that this “luxury” isn’t quite so unnecessary after all, doesn’t it?
I don’t quite understand all the people who are in such a swivet over losing some alleged “liberty” they don’t exercise now and never have any intention of excercising (and I hope they don’t even try for a moment to make me believe that they would be willing to abandon their health coverage)…yet were silent while liberties and rights were being taken away from them in wholesale lots during the last administration. Where were their voices when, for example, their rights to privacy and due process were deemed irrelevant?
I like your reasonable tone, Mary. What alternative solution would you suggest is the best one to support?
Ron,
Again, the argument is simply ridiculous. There are many people who don’t have cars and drivers licenses and therefore don’t have to pay for automobile insurance. Just because you find having a car to be a necessity doesn’t mean that everyone does. Everyone does however have lungs and hearts and brains (unless your a lawyer or congressman…haha) and therefore compulsory health insurance is a demand that you pay for the privledge of being alive. I am all for health reform believe it or not, just not this. Demanding that I pay for something or else go to jail is a CONFISCATION OF PROPERTY and therefore an affront to liberty.
First, I would like you to cite the Article and Clause in the United States Constitution that allows the Federal Government in ANY way to pass this legislation in the first place. Specifically, I would like you to defend the Federal Government’s interest in the healthcare decisions of 300 million people in this country and the “compulsory payment” clause of HR 3962.
Second, would you be so kind as to give me one example of a Federal program that is “deficit neutral”, since you and the Democrats seem so good at being compassionate with MY hard earned money? The CBO has ALREADY said that the numbers don’t work.
Finally, to answer your question about who’s going to pay for these people who go to the hospital without insurance, things need to change, but the people I DON’T want to pay for it are my daughter’s grandchildren. Its very simple. My money is my money, if you want to be compassionate, I suggest that you be compassionate. Quit demanding that the government use my paycheck to make your heart rest easy.
Ron,
Millions of Americans in NYC live their entire lives without ever owning or operating an automobile. Just thought I’d throw that in there.
I feel that this is something long overdue….health care reform. I feel much of the problem STARTED with the creation of Medicare, Medicaid,,,,even Social Security. But I am realistic enough to know we can most likely NEVER put that genie back in the bottle.
So, to move forward, I think the changes must be made step by step…..not a massive one time overhaul. One of the first things that needs to be addressed is tort reform. which is not popular with lawyers, and they have quite a power in lobbying against that. We should INCREASE competition between the health care companies, not DECREASE it and basically eliminate private insurance companies by what this bill would do. The government plan would run private out of business in a fairly quick time, I believe. We should be able to “shop” for health insurance across state lines, much as we do for car insurance.
The thing that has driven cost up through the years is actually in part from all the govt. regulations and bureacracy already in place ! IF there was some way to get back to more of a doctor -patient relationship without all the interference we already have from govt. and health insurance companies. THIS BILL will only worsen that , instead of help and so I see it a terrible turn in the wrong direction.
More competition and choice(allowing companies to compete interstate) , tort reform, and tax incentives, health savings accts….these all are steps in the right direction.
I’m amused by the notion that more government involvement in health care will somehow result in a more efficient, more cost-effective system. If government can somehow lower the cost of health care, why can’t they lower the cost of government?
I so agree, jaydeebee! THAT is what just blows me away. What is that definition of insanity…to keep doing the same thing, over and over, with the same bad results?
When we see what has happened to Medicare, Medicaid, Social Security, and on and on….oh my. Health care is in the mess it is today due to over intrusion of government, IMO.
Even IF this bill were to insure people who do not have care, lower some costs, etc….with the HYPERINFLATION we will have when the govt. has to start printing worthless dollars…(to help to stop the bleeding, so to speak)….no one, and I mean NO ONE will be better off and we will all feel pretty sick.
“Millions of Americans in NYC live their entire lives without ever owning or operating an automobile. Just thought I’d throw that in there.”
Well, that’s quite true and I know many of those very people. But, then, a car is hardly a necessity in NY, either. Ask someone in, say, Los Angeles if their car is a luxury or a necessity. Heck, try to get anything done around here without one.
Mary wrote: “So, to move forward, I think the changes must be made step by step…..not a massive one time overhaul. One of the first things that needs to be addressed is tort reform. which is not popular with lawyers, and they have quite a power in lobbying against that. We should INCREASE competition between the health care companies, not DECREASE it and basically eliminate private insurance companies by what this bill would do. The government plan would run private out of business in a fairly quick time, I believe. We should be able to “shop” for health insurance across state lines, much as we do for car insurance…IF there was some way to get back to more of a doctor-patient relationship…More competition and choice(allowing companies to compete interstate), tort reform, and tax incentives, health savings accts…these all are steps in the right direction.”
All very good ideas indeed! Can’t really argue against any of them!
Now why didn’t someone come up with something like that eight years ago, for goodness’ sake?
ROn…the idea of health savings accounts has in fact been around for some time, but the democrats have never allowed it to be a real plan with tax incentives for actually doing so…
Interstate competition is also an idea that has been around for some time…
How long have conservatives fought for tort reform and been rebuffed by liberals?
Come on, sir…surely you are not saying that conservatives have not been pushing many of these ideas for some time?
“Now why didn’t someone come up with something like that eight years ago, for goodness’ sake?”
Are you kidding? There have been folks trying to get tort reform since the 1980’s, the left would have no part of it!
Even when the Republicans had control of the House and Senate, which they did until 2000? It always seems to be someone else’s fault, doesn’t it?…
The truth is, of course, that the Republicans did in fact achieve meaningful tort reform in 2005. But tort reform, I will point out, is just one of the many changes Mary suggested. Let’s not forget everything else on her list…
Anyway, so far as any counterplan the Republicans have to make, we have Sen. Jindal’s cheery little pronouncement to cling to:
[From the Boston Globe] WASHINGTON – Even as Republicans pummel President Obama’s health care proposals, some GOP leaders worry their party is being hurt by a Democratic counterattack: Where is your plan?
Republican leaders chose not to draft their own comprehensive bill, focusing instead on attacking Democrats’ plans as too costly and bureaucratic. Some prominent Republicans now fear they are getting tagged as the “party of no,” and they want the GOP to offer more solutions to the nation’s health care problems.
Louisiana Governor Bobby Jindal, a potential GOP presidential contender in 2012, said it’s time for Republicans “to pivot and say, in addition to emphasizing what we oppose, here are our proposals’’ for health care.
The Senate Finance Committee wrapped up work at about 2 a.m. yesterday on the latest version of the sweeping overhaul. Obama hailed the development as a milestone, declaring, “We are now closer than ever before to finally passing reform that will offer security to those who have coverage and affordable insurance to those who don’t.’’
But Republicans are nearly unified in opposition. Senate Republican leader Mitch McConnell warned that the bill the Finance Committee plans to give final approval next week would have “a dampening effect on what is already clearly a very, very difficult economic situation.’’
He told reporters that Republicans have not offered their own bill because “we’re not in the majority. The majority has the responsibility to go forward.’’ Republicans will offer numerous amendments, including efforts to limit medical malpractice suits, when a health care bill reaches the Senate floor this month, he said.
I take it all back. I was wrong. The Republicans have indeed proposed their own alternative health care plan!
Of course, it would insure fewer people and cost more, but what the heck.
http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_th.html
Ron Miller please lay off the Kool-Aid.
I think a big problem is that NOW we happen to be in a royal financial mess. NOW may not just be the time to do anything major that will likely further worsen said financial mess.
I agree…it DOES often seem that it is always blame the other side….and a lot of time gets wasted and little gets accomplished.
NONE of the things I mentioned are original. The reason I know about them in large part is that Republicans have been touting them for years and were met with blow back. I DO think that it seems that opportunities were often missed.
So, mistakes have been made. Chances missed. So, now…do we just want to do some big, dramatic thing just so we can say we DID SOMETHING? Even if it is by far, NOT the thing to do? I think not..
There was a WONDERFUL article on the Op/Ed page of the Richmond Times Dispatch today by Robert Samuelson. I will see if it is up on the site and try to link it…might be able to see it at http://www.inRich.com
I meant to post parts of it here today but life got in the way. I highly recommend trying to find it and read it.
I listed an incorrect web site….it would be http://www.timesdispatch.com…..not the inRich one I listed.
I am not seeing that particular op/ed on the web site, unfortunately.
Hard to summarize Mr. Samuelson’s piece on here briefly. He well states many of the issues I see with the current bill that is said to be health care reform.
and I messed up the hyperlink! forgive me…
http://www.timesdispatch.com
A well-reasoned response, Will!
Copied below is a very balanced explanation of the pros and cons of the Republican health plan, from PolitiFact.com
There’s a lot to be said for the GOP plan—don’t get me wrong, there’s no question about that—but, as the Boston Globe pointed out, it will cover about 1/10 as many people and ultimately cost a lot more money (according to the CBO the Democratic bill would reduce the deficit by $104 billion over 10 years, compared with $68 billion for the Republican bill).
——————————————————————-
GOP health care reform: A simple explanation
By Louis Jacobson
Published on Thursday, November 5th, 2009 at 4:39 p.m.
House Republican leader John Boehner says the GOP health plan will lower costs and expand access.
With the House of Representatives nearing a vote on the Democrats’ health care reform bill, Republicans this week unveiled their own version, a much smaller bill (219 pages vs. the Democrats’ 1,990) with a more limited scope. It relies on bedrock GOP principles of consumer choice, no tax hikes, limited government involvement and caps on lawsuits. But it would have limited impact. Where the Democratic bill is projected to reduce the number of uninsured people by 36 million by 2019, the GOP bill would reduce it by only 3 million.
Here’s an overview of the Republican plan and how it differs from the Democratic version:
• More limited reach for the federal government. This is perhaps the biggest difference between the two bills.
Consistent with Republican complaints that the Democratic bills represents a government “takeover” of health care, the GOP bill has no public option — that is, no government-run insurance program, or anything remotely like it. Nor does the GOP bill include an expansion of the federal-state Medicaid health insurance program for the poor. The House Democratic bill has both.
The GOP plan has no health care exchange, the government-run marketplace for people who are now uninsured, and it has no Health Choices commissioner, the new post that would run the exchange. And consistent with Republican fears of government moving toward a system of deciding what treatments patients can receive, the GOP plan, unlike both the House and Senate Democratic bills, does not foster “comparative effectiveness” research that tries to determine which treatments are the most effective.
• No new taxes. Living up to a key Republican principle, the GOP bill would not impose any new taxes. By contrast, the House Democratic bill would impose a surtax of 5.4 percent on married couples earning in excess of $1 million annually, or individuals making more than $500,000 a year. Under the Senate Finance Committee bill, certain health plans that offer comparatively generous benefits would be taxed. Those taxes would go to subsidies to help low-income people buy health insurance and other health care expansions.
• No cuts to Medicare. Republicans, who have seized on proposed Democratic cuts to Medicare Advantage, would not touch the government health care plan for senior citizens. By contrast, both Democratic bills would cut Medicare Advantage and reduce the growth in Medicare payments by a total of roughly $400 billion over 10 years. Many of these cuts would involve Advantage plans, which are private plans operating under the Medicare system. These plans are reimbursed by the federal government at a higher rate, and Republicans maintain that seniors who belong to these plans would see reductions in benefits under the proposed cuts. But Democrats seeking places to cut costs see Medicare Advantage plans as a target, arguing that they are essentially subsidized to an unnecessary degree by regular Medicare beneficiaries and ordinary taxpayers. They have said the cuts in the growth of Medicare payments will not hurt benefits.
• Medical malpractice reform. Republicans have long sought to curb medical malpractice lawsuits, which they say needlessly raise health care costs. The Republican bill curbs malpractice lawsuits by capping noneconomic and punitive damages and making changes in the allocation of liability. The Democratic bill does not.
• Favoring consumer choice over a guaranteed safety net and minimum benefits. The Republican plan would try to expand coverage and reduce costs voluntarily, primarily by increasing consumer options, rather than the Democratic method of using government leverage (such as mandates, penalties and subsidies) to corral more uninsured Americans into obtaining coverage.
The Republican bill would allow Americans to buy health insurance across state lines, something that is currently not allowed, and would allow small businesses to pool insurance coverage through trade associations, an option only allowed for larger companies and labor unions today. The bill would also expand the use of health savings accounts, which allow allow people to use pre-tax dollars to pay medical expenses. None of these programs would be mandatory.
Finally, the Republican bill would offer aid to states to establish “high-risk pools,” groups of sicker (and thus more expensive) patients who typically have trouble finding insurance today because of restrictions on pre-existing conditions. It would also boost state-based reinsurance mechanisms that can help insurers that find it too costly to insure such pools.
Democrats, by contrast, would make a more strong-armed effort to reduce the uninsured. Whereas the Republican bill would offer incentive payments to states that manage to reduce premiums and the number of uninsured, Democrats would make everyone purchase insurance coverage or else pay a stiff penalty if they don’t. Businesses of a certain size would also have to provide health coverage for their workers or face a penalty. And the Democratic bill would establish minimum benefit packages and expand existing safety net programs such as Medicaid.
The Congressional Budget Office, a nonpartisan group that estimates the cost of legislation, has confirmed that the bill is quite inexpensive in comparison to the Democratic approach.
The CBO found that the insurance provisions of the Republican bill would cost about $61 billion between 2010 and 2019 — a far cry from the $1.06 trillion cost during the same period under the Democratic bill. But when new revenues and spending cuts are factored in, the Democratic bill would reduce the deficit by $104 billion over 10 years, compared with $68 billion for the Republican bill.
The CBO also confirmed that the cost of health insurance premiums would fall under the Republican plan, partly because of the medical malpractice reforms. In the market for individually purchased insurance policies, premiums would fall by 5 percent to 8 percent by 2016. For smaller businesses, premiums would fall by 7 percent to 10 percent. And in the large group market, for larger employers, they would fall by up to 3 percent.
Critics have focused on a few aspects of the bill:
• It doesn’t do much to reduce the uninsured population. By 2019, the number of uninsured would drop by 3 million, leaving 52 million nonelderly Americans uninsured. That means 83 percent of legal non-elderly residents would have insurance coverage by 2019, roughly the same as it is today. The comparable coverage rate for the Democratic bill is 96 percent. The Democratic plan would reduce the uninsured by 36 million, leaving 18 million without coverage.
• It might reduce consumer protections. The flip side of several of the Republicans’ new consumer options is a decrease in regulation. If insurance policies are sold across state lines, critics say, there could be an incentive for insurers to locate in the least-regulated states, allowing them to scale back coverage. And the Republican bill, unlike the Democratic bills, doesn’t specifically bar insurers from excluding pre-existing conditions, even though that policy has broad support in both parties.
• Its idea of boosting high-risk pools for sicker patients may not be effective. The states that have tried high-risk pools in the past have not found them to be popular, largely due to the high costs for the consumer. In theory, experts say, such pools could be subsidized enough to make premiums low enough to be attractive. But it would be expensive to do so, and many experts say the Republican bill doesn’t provide enough money to make them work. The Republican plan calls for $25 billion in funding through 2019.
• It misses an opportunity to trim Medicare spending. Health care experts have long pointed to the need to rein in the growth of Medicare spending, because if nothing is done, it could eventually eat up an enormous share of the federal budget. The Republicans’ current stance of protecting Medicare Advantage may be politically popular among senior citizens, but critics say it allows the most generously reimbursed portion of the Medicare system to continue unabated, effectively delaying the fiscal day of reckoning for the program. (While the Democrats do propose cutting Medicare Advantage, and while they would impose permanent reductions in certain payment rates to the tune of $229 billion over 10 years, some critics have called their approach too timid as well.)
Thanks for the above post, Ron…very helpful.
IMO, the new guidelines that were announced yesterday for breast cancer screening by the government are an example of the type of rationing that is only beginning. The American Cancer Association and many other breast cancer groups and specialists have already come out against the new guide lines that decrease screening.. For example, they now are saying wait till 50 for first mammogram, not 40, and have every other year, not annually.
Here we go on the rationing. This will lead the insurance companies most likely to refuse to pay for earlier or more often screening . Unnerving for me, a woman in my 50’s who has lost close family and friends to the disease and has had some , so far, false alarms.
I know what you mean about rationing. But insurance companies have already been doing it for years. Any time anyone in this forum has had a procedure or even a prescription denied by their insurance company, they have suffered from this. My wife is absolutely uninsurable because of “pre-existing conditions”…even if we wanted to insure her for everything but what the pre-existing condition was related to. It’s as though the company is saying they won’t cover your broken leg because you are being treated for acne. I’m absolutely certain the insurance companies would jump onto any reason not to cover your mammograms…but they’ve always been very good at finding reasons not to pay out a penny more than they are forced to. In any case, trust me: this is a worry for us, too. My wife had breast cancer 19 years ago.
As always, things are more complicated than they seem. For instance, the AMA has come out against the post-50 ruling…but only a very few years ago had itself recommended that women not undergo screening until after the age of 50. So who is right if even the AMA is unsure?
And while we are talking about insurance companies and other vested interests, don’t forget that mammography is a very profitable industry. This is worth keeping in mind when one looks at which organization is doing the protesting. The American Cancer Society is one thing, the AMA and the insurance companies are another.
Too, the new guidelines offer a potential relief that could save women from endless stress, false positives and perhaps needless procedures. Thousands of women every year go through incredible stress from false scares, including the trauma of unnecessary biopsies.
And it’s worth keeping in mind that the new guidelines are for the general population, not those at high risk of breast cancer because of family history or genetic issues.
I’m not arguing for or against the ruling…only making the point that it may be more complicated than it first appears.
So we know who to write to:
The agency responsible for the mammogram recommendation is the U.S. Preventive Services Task Force. Its primary care partners include the American Academy of Family Physicians, American Academy of Pediatrics, American Academy of Physician Assistants, American College of Obstetricians and Gynecologists, American College of Physicians, American College of Preventive Medicine, America’s Health Insurance Plans, the Canadian Task Force on Preventive Health Care, the National Committee for Quality Assurance, and the Pan American Health Organization.
Contact:
Therese Miller, Dr.P.H.
Project Coordinator
Center for Primary Care, Prevention, & Clinical Partnerships
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Phone: (301) 427-1585
Fax: (301) 427-1597
E-mail: Therese.Miller@ahrq.hhs.gov
The individual members of the task force are:
Bruce N. Calonge, M.D., M.P.H. (Chair)
Chief Medical Officer and State Epidemiologist
Colorado Department of Public Health and Environment, Denver, CO
Diana B. Petitti, M.D., M.P.H. (Vice Chair)
Professor of Biomedical Informatics
Fulton School of Engineering
Arizona State University, Tempe, AZ
Susan Curry, Ph.D.
Dean, College of Public Health
Distinguished Professor
University of Iowa, Iowa City, IA
Allen J. Dietrich, M.D.
Professor, Community and Family Medicine
Dartmouth Medical School, Hanover, NH
Thomas G. DeWitt, M.D.
Carl Weihl Professor of Pediatrics
Director of the Division of General and Community Pediatrics
Department of Pediatrics, Children’s Hospital Medical Center, Cincinnati, OH
Kimberly D. Gregory, M.D., M.P.H.
Director, Maternal-Fetal Medicine and Women’s Health Services Research
Cedars-Sinai Medical Center, Los Angeles, CA
David Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
Professor of Health Services and Adjunct Professor of Pediatrics
University of Washington, Seattle, WA
George Isham, M.D., M.S.
Medical Director and Chief Health Officer
HealthPartners, Minneapolis, MN
Michael L. LeFevre, M.D., M.S.P.H.
Professor, Department of Family and Community Medicine
University of Missouri School of Medicine, Columbia, MO
Rosanne Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy
Mount Sinai School of Medicine, New York, NY
Lucy N. Marion, Ph.D., R.N.
Dean and Professor, School of Nursing
Medical College of Georgia, Augusta, GA
Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine
Associate Director, Center for Healthcare Policy and Research
University of California Davis, Sacramento, CA
Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P.
Dean and Distinguished Foundation Professor in Nursing
College of Nursing & Healthcare Innovation
Arizona State University, Phoenix, AZ
Wanda Nicholson, M.D., M.P.H., M.B.A.
Associate Professor
Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD
J. Sanford (Sandy) Schwartz, M.D.
Leon Hess Professor of Medicine, Health Management, and Economics
University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA
Timothy Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center
University of Minnesota, Minneapolis, MN
Very true about the “rationing” we have long seen and experienced in private insurance. Most all of us who have been around long enough and had any care needs know about that. I surely do not want that to really kick in to the levels they experience in the UK. When in England for a month in 2005, I made it a mission to talk with folks that crossed my path there regarding the NHS. The lack of services, waiting periods, was just unbelievable to me, in a country of such wealth of history and intelligent thought and world leadership. I found myself very thankful to be an American and have the health system we have,pocks and all. I was glad we had not succumbed to a nationalized system like they suffer under.
Good to have all that info of contacts regarding this new guideline .
I’ve done a little more research into the USPSTF recommendation. While the timing of their announcement, in the middle of the health care debate, was probably ill-conceived (to say the least), the research itself was begun several years ago. (In fact, an expert panel brought together more than a decade ago by the National Institutes of Health had reached similar conclusions, only to be overturned after touching off intense criticism. So this is hardly anything new.) So, just to be fair, this recommendation can’t really be pinned on anything having to do with present health care proposals or the current administration.
And one thing that mustn’t be lost in all the fuss: The task force is not saying women should not get screened or should be denied screening if they want it. The task force is just saying that women should weigh the risks and benefits individually and make a decision for themselves.
By the bye, here are the studies on which the USPSTF recommendation was based: http://www.annals.org/
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It’s funny…I have many British and Canadian friends whose opinions of their health care systems are just exactly the opposite of those of the people Mary talked to. This is by no means meant to suggest that the people she talked to were wrong or that the people I know are right, only that it may not be as simple as we think.
This report seems to be a pretty fair assessment of the health care situation facing the US and other industrialized nations: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447691/
In relation to the conversations Mary and I have had with friends who live in some of these other countries, the report has this to say:
“In all 4 nations [France, Great Britain, Germany and Canada], citizens record high (though not unreserved or uncritical) satisfaction with their health care systems. No one views national health insurance as a big mistake and wants to start over. The vices of the US system—40 million uninsured people, an additional (and sizable) number with inadequate coverage, wide disparities in access and quality—are thought to overwhelm such modest and distinctive virtues as more extensive integration of services and more advanced analytic capacity. The foreign systems’ costs are routinely and rhetorically said to be in ‘crisis.’ The systems themselves are not.”
I think we simply cannot depend on either her ability or mine to be effective interviewers. We are each probably going to hear what we want to hear and it’s always too easy to ask leading questions even if one tries not to. And no matter how good something may be, there are always going to be people who are going to gripe. Almost everyone in the States, for instance, grumbles about paying so much for first-class postage—in spite of the fact that we have some of the cheapest postage rates in the world and some of the most efficient service. The only possible thing I can offer in my favor regarding what I’ve heard from my Canadian and British friends is that it was entirely unsolicited. They’d heard about our health care issues and offered their opinions on their own, without any prodding from me.
The author of the report goes on to make this interesting summary of the present situation:
“American public opinion voices no small dissatisfaction with the US system and considerable support for major, even fundamental, changes in it. The rub, however, is that this grousing does not yield a clear mandate for anything very different from the status quo. Despite years of intense opinion polling, policymakers remain unsure precisely what people are upset about (beyond the impossibility of enjoying ready access to fine care at minimal cost) and what they think would work better. Nor is this so odd after all: the same political leaders who quietly pushed arcane payment reforms in public programs have generally declined to launch searching public discussions of the big and touchy redistributive and regulatory issues and tradeoffs on which health reform turns. Bill Clinton’s unavailing and politically painful effort to break the pattern reaffirmed it instead. A perplexed public has therefore come to view health care reform as something like shopping for shoes: ‘We think we are in the mood to buy a health care reform today but not that style or fit, so keep showing us others.’ The technical opacity of the debate, not to mention continuing skepticism of anything ‘made in Washington,’ inhibit grassroots mobilization, citizen education, and other key concomitants of vigorous pluralist politics. No one seems to have a clue how to make well-documented dissatisfaction kindle a political fire under health reform.”
And he concludes with this:
“This latter proposition generally eludes US health policy. Save on rare occasions—for example, the New Deal and the Great Society—when issues of economic and social justice dominate the national agenda, fights over the alleged evils of new central powers quickly upend debate on the ends of reform, health or other. At least in the health sphere, actions may speak louder than words—Medicare, Medicaid, Children’s Health Insurance Program, and other public programs control roughly half the dollars in the health care system, after all—but political protocol requires proclaimed allegiance to an official ideology of market forces and less government even as reformers quietly and incrementally add a new piece of managed care regulation here, expansion of public coverage to another income category there. Much of this (abundant) public action originates in the states or evolves from complex sharing of initiatives, funds, and powers between the national and state governments. Fifty states are a more daunting tableau than 10 provinces, but the United States might infer from the Canadian system that universal coverage in a federal system can be managed by 5 succinct principles, not 50 volumes of the Federal Register. Unfortunately American reformers have been more inclined to admire Canada’s ‘single-payer’ financing than its much more instructive central/provincial accommodations. Where this self-denying activism, this stealthy state leadership, leads is anyone’s guess. Perhaps the present pattern—one step forward, one step back, and the nation counting itself lucky if the number of uninsured does not exceed 40 million—will persist. Perhaps incrementalism will proceed and the nation will awake one day to find that enough programmatic pieces are in place to sustain near universal coverage if only the money and leadership can be summoned to add a few more beneficiary categories and raise income thresholds a few more notches. Perhaps another 1932 or 1964 waits right around the corner, and ‘real’ health reform may suddenly arrive on waves of social indignation and political innovation. At this point, however, cross-national learning disappears into the depths of national character.”
The recommendations may not say women cannot get screening IF THEY CHOOSE, but once these standards are the norm, then insurance companies,,,and Medicaid and Medicare will refuse to pay for screening that does not fit the recommendation….so many or most will not be able to do it. It is not as if my health care premium will go down as a result of the cut in service.
I also think that many who are “for” the health care bill…they may be pretty frustrated about it a few years in. I hope I am wrong because I will be approaching 60 by then….not the best demographic to be in !
Well, nothing’s set in stone yet. There’s been a lot of criticism from various medical organizations so the whole thing may wind up being reversed just as the 1997 proposal had been. I have a feeling that’s what’s going to happen here, too.
Even if not, the solution to your concern might be something as simple as making it against the law to deny payment for mammograms.
(By the way, it was pressure from Congress and the American Cancer Society that caused the reversal of the 1997 NIH decision. According the Report I quote later in this post, “the ACS has close connections to the mammography industry….in its every move, the ACS promotes the interests of the major manufacturers of mammogram machines and films, including Siemens, DuPont, General Electric, Eastman Kodak, and Piker. The mammography industry also conducts research for the ACS and its grantees, serves on advisory boards, and donates considerable funds. DuPont also is a substantial backer of the ACS Breast Health Awareness Program; sponsors television shows and other media productions touting mammography; produces advertising, promotional, and information literature for hospitals, clinics, medical organizations, and doctors; produces educational films; and, of course, lobbies Congress for legislation promoting availability of mammography services. In virtually all its important actions, the ACS has been and remains strongly linked with the mammography industry, while ignoring or attacking the development of viable alternatives.” So who, at the bottom line, is most concerned with your well-being: the NIH and USPSTF or the ACS?)
Even mammograms themselves are a kind of trade-off. They are done by X-ray and the resulting radiation exposure causes 1 death for every 2,000 women screened annually starting at age 40 with each mammogram alone increasing the risk of breast cancer by 2 percent. This means that after ten years you will have increased your risk of breast cancer by 20%. (In fact, one study found 75 percent of breast cancer cases were due to past exposure from medical radiation.) I have to ask the obvious question: how many cancers detected by mammograms were caused by the mammograms themselves?
And are mammograms as effective as advertised? In a Swedish study of 60,000 women, 70 percent of the mammographically detected tumors weren’t tumors at all. These “false positives” often led to unnecessary and invasive biopsies. In fact, 70 to 80 percent of all positive mammograms do not, upon biopsy, show any presence of cancer. At the same time, mammograms have a high rate of missed tumors, or “false negatives.” One study showed that in women ages 40 to 49, one in four instances of cancer is missed at each mammography. Even the National Cancer Institute (NCI) puts the false negative rate even higher at 40 percent among women ages 40-49. The National Institutes of Health reports that mammograms miss 10 percent of malignant tumors in women over 50. My wife’s breast cancer was not detected by mammography.
I realize that there is plenty of anecdotal evidence for the effectiveness of breast X-rays (and why does the industry prefer “mammogram” to “X-ray”, one wonders?), this is still, after all, anecdotal.
To this end, one might consider these excerpts from a long report published in the International Journal of Health Services (published in 2001):
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Mammography screening is a profit-driven technology posing risks compounded by unreliability. In striking contrast, annual clinical breast examination (CBE) by a trained health professional, together with monthly breast self-examination (BSE), is safe, at least as effective, and low in cost. International programs for training nurses how to perform CBE and teach BSE are critical and overdue.
Contrary to popular belief and assurances by the U. S. media and the cancer establishment–the National Cancer Institute (NCI) and American Cancer Society (ACS)–mammography is not a technique for early diagnosis. In fact, a breast cancer has usually been present for about eight years before it can finally be detected. Furthermore, screening should be recognized as damage control, rather than misleadingly as “secondary prevention.”
Radiation from routine mammography poses significant cumulative risks of initiating and promoting breast cancer…Contrary to conventional assurances that radiation exposure from mammography is trivial–and similar to that from a chest X-ray or spending one week in Denver, about 1/ 1,000 of a rad (radiation-absorbed dose)–the routine practice of taking four films for each breast results in some 1,000-fold greater exposure, 1 rad, focused on each breast rather than the entire chest. Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening, usually from ages 40 to 50.
As early as 1928, physicians were warned to handle “cancerous breasts with care-for fear of accidentally disseminating cells” and spreading cancer. Nevertheless, mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, as yet undetected breast cancers.
Overdiagnosis and subsequent overtreatment are among the major risks of mammography.
That most breast cancers are first recognized by women themselves was admitted in 1985 by the ACS, an aggressive advocate of routine mammography for all women over the age of 40: “We must keep in mind the fact that at least 90 percent of the women who develop breast carcinoma discover the tumors themselves”.
Mammography is a striking paradigm of the capture of unsuspecting women by run-away powerful technological and pharmaceutical global industries, with the complicity of the cancer establishment, particularly the ACS, and the rollover mainstream media. Promotion of the multibillion dollar mammography screening industry has also become a diversionary flag around which legislators and women’s product corporations can rally, protesting how much they care about women, while studiously avoiding any reference to avoidable risk factors of breast cancer, let alone other cancers.
Screening mammography should be phased out in favor of annual CBE [clinical breast examination] and monthly BSE [breast self-examination], as an effective, safe, and low-cost alternative, with diagnostic mammography available when so indicated.