A couple of items. For about 25 years I’ve been saying and writing that routine PSA screening was a bad idea. For much of this time I was the sacrificial nay sayer at meetings devoted to the subject. You can read the several posts on this issue that I have written over the past 8 years. Finally, the risk/benefit ratio became so obviously unfavorable that The U.S. Preventive Services Task Force recommended that routine PSA screening be abandoned. So now the government always with our best interests at heart wants to punish doctors who continue the practice. This is the same mindset that wants to ban large sodas and put salt warnings on food – it’s New York City that’s the prime offender here. If both the doctor and the patient understand the risks and benefits of PSA screening, I see no reason to deny it.
The way to change practice habits is through both physician and patient education, not through ham handed government regulation of which there are so many that no one knows what they all are or to whom they apply. John Graham has the issue right in his blog post on the subject.
Two doctors who appear to be policy wonks who don’t practice medicine have another brilliant idea which they aver will save medicare a lot of money, as if anything medicare does has ever saved money. In a paper published online in the JAMA they recommend that medicare pay for drugs based on their therapeutic value. Exactly how this value will be calculated is not apparent from the article. The table below gives a flavor of what is being recommended (click on the chart to view it at a readable size). If you don’t understand it, I can’t help you. Though they don’t use the words, this is another attempt to fix prices. The history of price fixing of any kind is not salubrious. Which group or groups has sufficient information to know what the “right” price of a drug is?
The article contains some other interesting observations. “Although spending on prescription drugs has generally increased in line with spending on other healthcare services, in 2014 drug spending increased by 12.5% compared with 5% on all other parts of healthcare.” It appears that this value based approach is based on only one year when drug prices increased more than medical expenses in general. It seems that problem is not drug costs, which account for only about 10% of the nation’s medical bill, but rather the high cost of medicine in general.
If medical care went up 5% in 2014 that is more than twice the increase in GDP for that year – 2.4%. At that rate of increase medical costs will double in less than 14 years. Thus there are two things wrong with this opinion piece. One is the top down approach to costs the authors don’t like. The second is that they are looking at the wrong problem. The right one being how to slow the ruinous rise in medical cost. Doubless they will recommend another top down approach. Medicine’s economic woes are about to prove again Mancur Olson’s thesis that the only way to reform a giant system is for it to first collapse.