President Obama’s health plan is a recipe for early death and prolonged suffering for Americans. The rationing protocols are being established to save money for “the collective” at the expense of the individual. A perfect case study of Obama’s assault on life and health is the administration’s denial of payment for Prostate cancer screening tests (as will be described here for the case of “Mr. H”). The coming prostate cancer epidemic also exposes the lie that “expert panels of doctors” can be trusted to create best practice guidelines for Americans. These so called expert panels are merely technocrats drunk with power who provide political cover for the immoral degradation of American medicine that is known as Obamacare. The proof can be seen in what will become a common scenario again in medicine not seen routinely since the early 90’s: widely spread prostate cancer causing paralysis and early preventable death in thousands of American men (pictured here, with each dark spot representing a tumor).
Mr. H. presented to a St. Petersburg hospital in November complaining of terrible pain in his neck and back. An MRI scan and a full skeletal scan revealed that he had tumors scattered throughout his body. They were discovered to have begun in the Prostate and were now dangerously close to pinching the spinal cord in his neck causing permanent paralysis from the neck down (pictured here with red arrow showing spinal cord compression). Mr. H. will now be given “palliative” radiation treatment throughout his body which will be debilitating and costly itself. It also may fail to prevent the growth of tumors against the spinal cord, leading to paralysis. This may lead Mr. H to have an urgent, massive and highly risky reconstructive procedure of his spine in a cancer patient who will then have only months to live. No doubt, this surgeon will be discouraged from doing this operation as it will be deemed to be “futile” and Mr. H. will likely be encouraged to live out his final weeks and months paralyzed, bedridden and miserable under hospice care. All of this could have been prevented with a PSA screening test. However Mr. H’s Medicaid covered care did not set him up for screening. This will be the case for ALL American men in coming nationalized health insurance, as PSA will not have to be covered as an “essential health benefit under Obamacare. Welcome to Obama’s vision of “access to high quality care for all”. In fact, under the Obamacare denial of PSA testing, only the wealthy will have access to this important cancer prevention tool as they will be the only ones able to afford the test.
I am now a neurosurgeon in practice for about 15 years and haven’t seen cases like this routinely since training in the late 80’s and early 90’s. It was then that patients were not screened for prostate cancer with the PSA blood test which became common in the early 90’s. PSA (Prostate specific antigen) testing has revolutionized the early detection of prostate cancer in men and was associated with decreased death rates from Prostate cancer in the U.S.. This was especially true when U.S. Prostate cancer survival rates were compared to those of the United Kingdom in 2004 where the PSA testing rate was about 6% compared to about 57% in America during that time period. In 2004 Prostate cancer death rates (“mortality”) had declined four times faster than rates in the U.K. since the introduction of PSA testing. The USA prostate cancer mortality (death) rate in 2004 was about 18% whereas it was about 27% in the U.K.! In other words Americans with prostate cancer live far longer and are far less likely to die than those in the U.K.. This is thanks to PSA screening and American medicine as a whole. Stories abound of how a “PSA test saved my life” like that of UCSF Patient Services Advocacy Committee Chair Stan Rosenfeld, Mayor Rudoloph Giuliani and others here.
President Obama likes to offer the illusion that his health plan is about providing more access to lower cost, higher quality care for all Americans, especially the poor. However Obamacare has really been about building political power by offering entitlements that gain votes through wealth redistribution. It is also about coming up with a way to ration care to save money for the government and insurance companies. Medicare especially needs help since it is part of a fundamentally bankrupt government program that is part of an $86 trillion unfunded liability (550% of GDP)! One of the approaches that will be used to save money will be the illusion that “expert medical panels” will conduct so called “comparative effectiveness research” that will establish what the government considers to be appropriate medical care. One such panel is the long established U.S. Preventive Services Task Force (USPSTF) which has been granted new and broad powers under Obamacare. This panel has long offered recommendations on testing to prevent medical problems such as cancer, but now has philosophically transformed into a cost-cutting panel. The PSTF is infamous for recommending that women under 50 should not have mammogram screening for breast cancer, leading to a controversial political move by HHS secretary Sebelius to reject their recommendation under enormous political pressure in 2009 (that will likely change in coming years). In October of 2011 the PSTF stated that NO man should have a PSA test to detect prostate cancer. They listed as their concern that positive PSTA results led to too many “inappropriate” biopsies and surgeries costing the “system” money and resulting in some avoidable complications. This approach basically takes a “population health” approach to medicine, considering the impact on the statistics of large groups of people and costs to the system, rather than the benefit for individual patients. This is evident in their statement: “Screening may benefit a small number of men but will result in harm to many others. A person choosing to be screened should believe that the possibility of benefit is more important than the risk for harm. The USPSTF assessment of the balance of benefits and harms in a screened population is that the benefits do not outweigh the harms.” USPSTF 7/17/12
The American Urology Association expressed “outrage” at the recommendations and continues to call for the screening tests. The AUA offers: “It is the PSA test that has allowed us to move beyond a time when men presented with high-grade, metastatic disease for which there were little or no treatment options beyond palliative care. In its earliest stages, most prostate cancers cause no symptoms; to say that only men with symptoms of prostate cancer should be tested will potentially result in a return to such a time.” Sadly, the transformation of medicine from a profession of trusted physicians to a group of government cogs was evident when the American Academy of Family Physicians agreed with the USPSTF recommendation against PSA testing. As the Sun Beam Times has long predicted, under Obamacare patients will no longer be able to trust their physicians who will embrace government guidelines for political reasons and to achieve bonus payments to comply with them. Next time you go to your family physician and they say that a PSA screening test is no longer needed, you should ask yourself if you can trust anything else they recommend to you. The recommendations of the AAFP are politically motivated as is openly admitted by AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., who says “because the Academy takes such an active role in the USPSTF process, supporting the final recommendations becomes much easier.” The co-vice Chair of the USPSTF is a family physician and active AAFP academic named Dr. Michael LeFevre, M.D., M.S.P.H.
The USPSTF is one of many expert panels under Obamacare that will be setting standards to officially deny medical care under the political protection of the “expert medical panel” model. This is a common model of emerging collectivism as described by Friedrich Hayek in “the Road to Serfdom” where technocrats are used by governments to impose government control on people and the “worst rise to the top”. Nearly all USPSTF members have been appointed during the Obama administration. They are appointed through the federal AHRQ (Agency for Health care Research and Quality) although they present themselves as independent of the AHRQ and the HHS (as in their disclaimer in published studies). The PSTF is an integral part of PPACA with their recommendations serving as the basis for what will and won’t be covered as “essential health benefits”. For instance, section 1001 of PPACA states that only those test that receive an “A” or “B” grade by the USPSTF will be paid for 100% by insurance in America. Those tests that the PSTF does not grant a grade of A or B to will be denied. This is straightforward rationing. The PSA test received a grade of “D” which officially means “Discouraged”
As attempts are made to implement Obamacare in America, it will be incumbent on doctors and others in health care to report on the many negative impacts on patients. Those in positions of influence in the medical community are morally bound to do all they can to fight against it. That includes working to insure that state-based health insurance exchanges are not established in your state. Other measures include insuring that better health care solutions are promoted in states so people can see the benefits of TRUE freedom-based medicine, versus the faux market of Obamacare that rations and turns doctors into cogs of the state that no patient can trust. The lives and health of Americans depends on doctors who still serve the patients standing up, pointing out the moral corruption of Obamacare that harms patients and saying “no”.