Obamacare Helped More Americans Spot Cancer Early

THURSDAY, Dec. 21, 2017 (HealthDay News) -- Obamacare has likely saved lives by increasing the number of cancers caught at an early stage, a new study suggests.

States that participate in the Affordable Care Act's expansion of Medicaid have experienced an increase in overall cancer diagnoses, particularly early stage diagnoses, compared with states that rejected expansion, researchers found.

"It's been well-established that catching cancer in its early phases increases the likelihood of successful treatment and reduces the chances of death," said lead researcher Aparna Soni.

"We found that states that participated in Medicaid expansion experienced much greater increases in cancer detection," said Soni, a doctoral candidate at the Indiana University School of Business in Bloomington.

The study findings indicate that cancers may go undetected if people lose their health insurance due to any rollbacks of the Affordable Care Act (ACA), said Dr. Ahmedin Jemal of the American Cancer Society. He is vice president of surveillance and health services research.

The issue is timely with passage in Congress this week of a massive tax reform bill. That bill included the elimination of the individual mandate, which had forced most uninsured Americans to enter into ACA health insurance "pools" or face a penalty. However, it did not affect Medicaid expansion under Obamacare.

For the new study, Soni and her colleagues examined cancer registry data from 2010 through 2014 to estimate changes in county-level cancer diagnosis rates in states that expanded Medicaid. The data involved people aged 19 to 64 years in 13 states and included 611 counties. Nine of the states expanded Medicaid by 2014.

The researchers found that Medicaid expansion has been tied to a 6.4 percent increase in early stage cancer diagnoses, or about 15 additional cancers detected for every 100,000 people.

The increase in early stage diagnoses largely occurred in those aged 35 to 54 with cancers that are easiest to detect, such as breast and colon cancers, the findings showed.

The overall cancer diagnosis rate increased by 3.4 percent, compared against states that didn't expand Medicaid under the ACA. This was largely driven by increases in detection among people aged 45 to 54 and among those with prostate cancer, the study authors said.

"One of the key objectives of the ACA was to increase early cancer detection by improving access to care, particularly for low-income and vulnerable populations," Soni said.

"We can see from our study that people who have health insurance are able to get their cancers detected early, because they can afford to go to the doctor," she continued. "If you're uninsured, perhaps you'd put it off until it's too late."

In the long run, the ACA could produce savings for the health care system by helping people catch their cancers at an early and more treatable stage, Soni added.

"Treatment tends to be more expensive the later the cancer is caught, because later-stage cancers require more advanced and costly therapies," Soni explained.

This was an analysis I did before the bill was passed, and was relatively early on in the development stages of the abomination. It shows what the bill did was reduce the amount being given by Medicaid for diagnostic tests such as those done in Radiology. I know it is long, but this is a complicated subject! I didn’t change the wording of the post to the present/past tense, just remember it was written back around 2009-2010 sometime, I think:

NOTE: DON’T LET THE LEGISLATIVE GOBBLEDY_GOOK SHOWN BELOW SCARE YOU AWAY FROM READING THIS POST: I PUT IT THERE FOR A SPECIFIC REASON)

I was trying to figure out what is going to happen with physician compensation because I heard from a physician that all specialties, brain surgeons and dermatologists, will be paid the same. So, I tried to look through it, and in the process stumbled across how they plan to reduce both payment AND availability of imaging resources (such as CT, MR, etc.)

This is pissing me off, and really, it is beginning to make me burn. Look at how this thing is written. I copied the section below right out of the document. Look further down for my explanation if you are interested.

***************************************
***************************************
SEC. 1147. PAYMENT FOR IMAGING SERVICES.
10 (a) ADJUSTMENT IN PRACTICE EXPENSE TO RE11
FLECT HIGHER PRESUMED UTILIZATION.—Section 1848
12 of the Social Security Act (42 U.S.C. 1395w) is amend13
ed—
14 (1) in subsection (b)(4)—
15 (A) in subparagraph (B), by striking ‘‘sub16
paragraph (A)’’ and inserting ‘‘this paragraph’’;
17 and
18 (B) by adding at the end the following new
19 subparagraph:
20 ‘‘(C) ADJUSTMENT IN PRACTICE EXPENSE
21 TO REFLECT HIGHER PRESUMED UTILIZA22
TION.—In computing the number of practice
23 expense relative value units under subsection
24 (c)(2)(C)(ii) with respect to advanced diagnostic
25 imaging services (as defined in section
VerDate Nov 24 2008 23:22 Jul 14, 2009 Jkt 079200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H3200.IH H3200 jlentini on DSKJ8SOYB1PROD with BILLS
274
•HR 3200 IH
1 1834(e)(1)(B)), the Secretary shall adjust such
2 number of units so it reflects a 75 percent
3 (rather than 50 percent) presumed rate of utili4
zation of imaging equipment.’’; and
5 (2) in subsection (c)(2)(B)(v)(II), by inserting
6 ‘‘AND OTHER PROVISIONS’’ after ‘‘OPD PAYMENT
7 CAP’’.
8 (b) ADJUSTMENT IN TECHNICAL COMPONENT ‘‘DIS9
COUNT’’ ON SINGLE-SESSION IMAGING TO CONSECUTIVE
10 BODY PARTS.—Section 1848(b)(4) of such Act is further
11 amended by adding at the end the following new subpara12
graph:
13 ‘‘(D) ADJUSTMENT IN TECHNICAL COMPO14
NENT DISCOUNT ON SINGLE-SESSION IMAGING
15 INVOLVING CONSECUTIVE BODY PARTS.—The
16 Secretary shall increase the reduction in ex17
penditures attributable to the multiple proce18
dure payment reduction applicable to the tech19
nical component for imaging under the final
20 rule published by the Secretary in the Federal
21 Register on November 21, 2005 (part 405 of
22 title 42, Code of Federal Regulations) from 25
23 percent to 50 percent.’’.
24 (c) EFFECTIVE DATE.—Except as otherwise pro25
vided, this section, and the amendments made by this sec-
VerDate Nov 24 2008 03:06 Jul 15, 2009 Jkt 079200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H3200.IH H3200 jlentini on DSKJ8SOYB1PROD with BILLS
275
•HR 3200 IH
1 tion, shall apply to services furnished on or after January
2 1,
***************************************
***************************************

The following two paragraphs below show what the BULL$HIT above boils down to in normal english, and what it actually MEANS. This just steams me.

“SEC. 1147. PAYMENT FOR IMAGING SERVICES.
ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION
In computing the number of practice expense relative value units under subsection the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment.”

(I am no expert on this, but downloading a Powerpoint Presentation, and looking around at various critiques of the way practice expense is calculated, INCREASING the presumed rate of utilization drives DOWN the amount of money you get paid. I am a genius. I assumed that, but figured I better check it out...)
END RESULT: LESS MONEY FOR IMAGING, FEWER SERVICES OFFERED.

“Section 1848
ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS.
The Secretary shall increase the reduction in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging from 25 percent to 50 percent.”

(What this means is that from now on, if you do a CT of the Abdomen AND a CT of the pelvis without moving the patient, you now get paid 50% less rather than 25% less. This is huge, and just one example of how they are going to cut billions of dollars a year in costs. The scumbags will say with a straight face that they aren’t rationing, but if you don’t get paid for the service, you either don’t do the service, or you go broke)
END RESULT: LESS MONEY FOR IMAGING, FEWER SERVICES OFFERED.

According to the Association of American Physicians and Surgeons (at this link: http://www.aapsonline.org/ this is an organization that advocates for physicians, not like the AMA which is advocating for liberalism) these sections above up to a reduction of 4.3 billion dollars a year in money to be paid for imaging. If someone interprets that some different way, please let me know...but if you bring in 45 million more people and reduce the money you pay...gee whiz, what is the end result?

Now, I wasn’t born yesterday, and I know why they are doing this, but this is our healthcare we are talking about, and they have deliberately tried to bury as much of it in incomprehensible legalese as they can get it. It made me madder and madder as I tried to go through it.

THEY DON’T WANT ANYONE TO READ AND UNDERSTAND THIS.

This conversation I contrived is a much more likely one in our future; I see THESE kinds of "discussions" going on much more than saving people who have some terrible disease! Here is what will happen first:

******************************************
HOSPITAL SCHEDULER DISCUSSING A FUTURE APPOINTMENT: "I'm sorry sir...we cannot schedule that appointment for you in November 2010 to have that melanoma removed because you have not undergone your mandatory annual counseling after age 65...oh, of course you are right. I know you are only 62, but they did move the age down again this year...we have an opening in three months with the counselors office...would you like that?"

******************************************
This above conversation is fully expected, but It will not be the people you will be FORCED to talk to in order to receive your care, nor the intentional delays in care that will be the most insidiously evil facets of this. It will be the conversations like this one below that will become commonplace that ONLY BEGIN to illustrate what it is all about: (Remember...this is satire!)
******************************************

FRIEND OF "JANICE" DISCUSSING "END OF LIFE COUNSELING" IN OBAMACARE : "Hi Jan, how are you? I heard your father is resisting counseling. It must be difficult, I know. There just seems to be so much of that lately. I know I am only 40 years old, but I don't understand why people like your father are so opposed to this.

I went with my mother to her counseling session, and while she was angry because she was supposed to have another five years before she had to go but they moved the age down again, she went anyway. I thought she was really rude to the counseling agent, who was just a young woman only doing her job. Hm.

Someone told me they are only hiring young women as counselors now, because the men who were doing it just got angry too easily and shouted at people to just "sign the damned papers". Hm. I tried to tell my mom why they have to do this, but she said they do it just to get rid of old people to save money.

The counseling agent gave my mom a copy of the book "Death is Joy". I read it, and it makes a lot of sense to me. Of course, when I was going to school, we didn't have to read it, but now they have required classes they take every year beginning in first grade.

Suzie is in third grade and is taking the course this year that deals with the chapter on keeping birth rates down, and Tommy is in his senior year where they cover the financial aspects of care for the elderly. He was so excited, he said that since they have implemented this national care program, the number of elderly people has dropped dramatically, so they can spend more money on programs such as monthly equality checks for the economically disadvantaged and reparations for the descendants of slaves. I think it is wonderful.

He asked me why so many elderly people are so selfish and refuse to accept counseling...I didn't really have an answer for him. Hm. Now, don't be defensive, I am not criticizing your parents.

I am just saying, it is a problem.

They had an hour-long program on PBS about this the other night, and they were saying how the people who are being selfish about this and refusing to take advantage of early exit programs that pay cash to their children are being so self-centered because they grew up in a time where everyone was self-centered and were interested only in money. You know, they showed films from the days of the capitalists where there were people who had what they called 'gas-guzzlers", and they used to make so much more money than they needed to live comfortably, so many people were going without health care because they were taking all the money..."

******************************************

Then, just wait until they pass legislation for a "Death Benefit" that will be paid to the families of elderly people. That will be the icing on the cake. It will be presented as a compassionate gesture to help the families with their grief, and will put at ease those people slated for "end of life" counseling. I can see the conversation on this as well:

******************************************
COUNSELOR: Thank you for coming in today, sir. Now, let's see...you have high blood pressure, rheumatoid arthritis but more importantly, positive genetic tags for vascular/heart disease, Alzheimer's, matricular degeneration and three types of cancer, prostate, esophageal and colon. Prostate and colon are very high. We see one of these two expressing itself in the next three years.

ME: Er...really?

COUNSELOR: Yes. This is all very scientifically based, and the results are incontrovertible. There is no mistake.

ME: Ahhh...could I speak to a doctor about this?

COUNSELOR: I am afraid not, sir. The rules are physicians are for direct care only, and nothing else. Federal Statue HCR23.1771-b mandates that I communicate this information to you, and inform you of the various options.

ME: But you don't know anything about medicine! You are a clerk, nothing more! How can I discuss this issue with you?

COUNSELOR: Sir, I have taken all the courses coming through High School, and attended the Life Counseling University courses offered by the government. I graduated in the top half of my class. I do understand the issues here.

ME: But...but...

COUNSELOR: Look, sir. You are getting old, and are soon going to be a burden on society. You don't have cancer right now, and can still think and get around, but for how long? You need to think about your children and their children. We offer a special financial compensation package that will help them bear the grief of your passing, to be paid out upon your death. With your approval, we emailed them an official forms packet before this meeting.

ME: I approved that?

COUNSELOR: Well, yes sir. The electronic copy is right here with your esignature (TURNS SCREEN TO FACE ME).

ME: I never signed that!

COUNSELOR: Sir, didn't you read the codocil that was automatically added at the bottom of your government supplied Will and Last Testament session that we finished up your first End of Life session you had with us last year? You did click the button that said "I approve all the changes" and you did use your voice authentication to say "I do approve".

ME: What! What is going on here? I...

COUNSELOR: Your two sons and your daughter who came in with you today have been in communication with our department on this. (Smiles) I think it is great that the government approves time-off pay for employees to attend these End of Life meetings for their parents. I'll call them in...

ME: Hey! I am not finished discus...

(DOOR OPENS, CHILDREN ENTER)

SON 1: Dad, I am so glad you signed up for the Early Exit Death Benefit. I was really behind on my tax payments for last year, and that will put me over the top...

ME: You...what?

SON 2: Yeah, dad. Billy is graduating from high school, and we want to send him to a quality college, but we could never afford it. But now we might...thanks to you.

Daughter: Oh, Daddy (tears in her eyes) I know none of us live forever, and I will miss you so much, but this money will allow me to pay th license fees to the government so I can open my dream business! Without you...

ME: HEY! WTF is going on here? I am not "ready to die", I feel pretty good, I could live for another twenty years! I didn't sign that damned thing, they just threw all this stuff in front of me! This is effing stupid! (TURNS TO COUNSELOR) Look, I don't know what kind of crap you set in motion, but undo it. I didn't sign up for this.

COUNSELOR: (PRIGGISH, TIGHT LIPPED LOOK ON HIS FACE) Sir...you have already been scheduled for next year, and your family has been paid that benefit in advance as the law allows. We cannot undo it. See the text that you signed (TURNS SCREEN) states explicitly that this if final and cannot be remanded...

ME: (SMASHES SREEN WITH HAND) LOOK! I DON'T GIVE A RAT'S ASS IF YOU HAVE TO BURROW THROUGH THE WIRES BACK TO THE CENTRAL COMPUTER SYSTEM YOURSELF, USING YOUR SLIMEY PENCIL NECK AS A LEG TO DO IT SO YOU CAN UNDO THIS ROYAL F*CKUP ON YOUR PART...

COUNSELOR: (HAND CUPPED OVER SPEAKER, EYES ON ME, WHISPERING) We have a 22-22 in here...get in here right away...

DAUGHTER: (WAILS) How could you be so selfish?

SON 1: Great. I might as well go down to the Tax Police right now to get fitted for the volunteer industry uniform...

COUNSELOR: How am I going to tell Billy he can't go to the Barack Obama University? How?

DOOR OPENS, BURLY UNION GUYS IN BLACK COVERALLS RUN UP TO ME AND TASE ME. ALL GOES BLACK

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