When Mammograms Lie: An article by Sharon Kirkey published on Canada.Com

When Mammograms Lie: How cancer can sneak past our greatest screening techniques

Just because the results of your mammogram are negative, doesn’t mean you don’t have cancer

By Sharon Kirkey, Postmedia News May 23, 2014 (CLICK THE LINK TO READ THE ARTICLE)

“Four months after her mammogram came back “normal,” Susan Quinn-Mullins discovered the lump herself, a smooth, hard mass on her left breast the size of a big marble. An ultrasound revealed a tumour nestled deep in dense breast tissue. It was stage 3 — aggressive, invasive breast cancer that was spreading to the surrounding lymph nodes…”

Breast Density Types

Breast Density Types

This interesting article not only chronicles the story of people who initially relied on mammography to check the health of their breasts but also serves as an incitement over the undue reliance on this as the sole modality. It also brings in some contra posing views on the debate over dense breast notification laws.

Breast Cancer is the number two killer of women in America, lung cancer is number one at the moment. The issue of dense breast related problems in imaging has been long known but for the most part hidden. It is a sordid tale in some ways. For years women have been told get a mammogram and you will reduce your chances of dying from breast cancer because, with mammography, we can detect the cancer early, smaller than you can palpate, feel with your fingers, the tumor. What has not been discussed is that we can further reduce your chance of dying from breast cancer because, for about half of all women, by adding additional screening techniques we can detect the cancer earlier than it can be seen on the mammogram. What has also not been discussed is that, for about half of all women, their breast biology so compromises the appearance of the mammogram that, without additional screening techniques, the probability of performing unnecessary follow-up diagnostic activities on benign structures is greatly increased.

Age Specific Breast IncidenceStartling Statistics

  1. Contrary to claims by many in the medical community, mammography is not the only method of early detection which has demonstrated a reduction of mortality from breast cancer. The same studies that many cite to support this position demonstrate that, finding cancers smaller, and before they have spread to the lymph nodes, significantly reduces mortality – regardless of the method used to detect those small early cancers.
  2. “While mammogram detects 98% of cancers in women with fatty – non dense – breasts, it finds only 48% in women with densest breasts.” (AreYouDense.com) This translates in to at least 100,000 invasive cancers in the US each year which could have been discovered at a meaningful earlier stage than that at which they were actually discovered.
  3. Even when the cancer is discovered in women with dense breasts, the clinical evidence suggests that it could have been found at about half the size (less than 1cm vs almost 2cm) and, more often, before it spread to the lymph nodes (less than 10% of the time vs 15% to 20% of the time), had an additional screening tool (ultrasound) been added to the mammogram.[i], [ii]
  4. Women with dense breasts whose cancers are found with mammography alone are 2.5 times more likely to die from that disease than women whose cancers are found with mammography and an additional screening method (30% 20 year mortality for cancers discovered at 15-19mm vs 12% 20 year mortality for cancers discovered at less than 10mm)
  5. 70% to 80% of cancers occur in women without major known risk factors[iii],[iv],[v] Most breast cancer risk analyses do not consider breast density, despite the fact that density is one of the strongest predictors developing breast cancer (Nancy has this stat).
  6. In addition to being a major predictor for developing breast cancer, “Breast Density is one of the strongest predictors of the failure of mammography screening to detect cancer” (AreYouDense.com)
  7. “Approximately 75 percent of women in their 40s have dense breasts. This percentage typically decreases with age – but half of all women aged 40 and older have dense breasts.” (Dense Breast Tissue Should Not Be Ignored, By David C. Weintritt, MD, FACS, Director Breast Care Institute Mount Vernon Hospital, Wednesday, October 24, 2012
  8. Dr Louise Eriksson and her colleagues from the Karolinska Institutet (Stockholm, Sweden) found that women with denser breasts had nearly double the risk of their cancer recurring, either in the same breast or in the surrounding lymph nodes, than women with less dense breasts. They warn that doctors should take breast density into account when making decisions about treatment and follow-up for these women. … “We found that if you have a PD at diagnosis of 25% or more, you have an almost two-fold increased risk of local recurrence in the breast and surrounding lymph nodes than women with a PD of less than 25%.” (The European CanCer Organisation (ECCO))
  9. In 2011, approximately 39,520 women were expected to die from breast cancer. Only lung cancer accounts for more cancer deaths in women. Page 6 of this report shows that the incidence rates for breast cancer have continued to increase but death rates have declined.(Breast Cancer Facts & Figures 2011-2012)
  10. Recent studies indicate that it is not just a family history of breast cancer but perhaps a history of ovarian and prostate cancer may also contribute to increase risk in women. (Susan G. Komen.Org)

Tumor Size at time of DiscoveryDisturbing Trend

Despite study after study indicating there are significant risks to women with dense breast tissue, and the fact that a significant number of women have dense breast tissues – 50% of the population on average – there are those who are seemingly working hard to obscure these facts. Perhaps it is simply they do not want to “panic” women but some people believe there is more afoot than just simple concern for women’s anxiety.

One question needs to be asked, “If this has been known for quite some time, why were women not informed?” Radiologists have known for decades that it was exceedingly difficult, in some cases close to impossible, to detect cancers in women with dense breast tissues. Yet few, if any, radiologists informed women of the significant deterioration in the ability to perform effective early diagnosis for these women. Interesting, because the argument for regular screening mammography has been for women to benefit from early detection. But how beneficial has it been if over 50% of those getting regularly screened were dense, and it was not possible, by relying on mammography alone, to find half of the cancers at an early stage in this population?

Over the past 10 years the movement to force notification to women who have dense breasts has been building. Advocacy groups like, Are Your Dense have been arguing publicly for this need. Yet, something so common sense and simple has taken quite a while for actions to begin to happen. It seemed so simple to approach state legislatures with information about how dense breast tissues are obscuring cancers and increasing the cancer risk and mortality of these women. One would have thought this was an easy decision! Just pass a law to require notification for these women! Simple, right? Evidently not. It has taken over 7 years for 16 states to pass such legislation. Why? In many of these states the law requires notification but ion only a few does it go beyond notification and require alternate screening methods to be disclosed and in even fewer do the states require insurers to pay for the additional screening methods.

Why is this so difficult? Why is it that some organizations have grasped the isolated studies that report breast density has no effect on outcomes when so many other studies point to effectiveness? Why do medical groups, such as those represented by www.breastdensity.info, present information which is factually untrue (“small studies (with screening ultrasound) have shown a modest increase in sensitivity”, when, in fact many, large, studies have shown a dramatic, and statistically significant, increase in sensitivity). Why do so many states listen to those physician groups who argue that the other screening methods do not provide significant value? Why do so many breast centers avoid whole breast ultrasound, the most cost effective secondary method, arguing that it has high false positive rates – it doesn’t, that it adds to the cost – it does by about $110.00, or that it significantly interrupts their workflow and decreases the number of screens that they can do in a day – some systems do this but other systems simply do not. Some cite the high cost of supplementary screening, referring to the use of MRI – a valuable and very capable, and expense diagnostic system – which is clearly not necessary for secondary screening, or the high labor costs associated with ultrasound screening. While MRI devices cost millions to purchase and maintain, effective automated screening ultrasound system reduces labor effort and start as low as $85,000 – for the BreastMapper system from Tractus Corporation, to about $300,000 for other automated screening ultrasound systems (such as the U-Systems be GE).

Governmental Dirty Secrets

While it may be slightly exaggerated to classify these as “dirty secrets,” many states have resisted the call to approve their dense breast notification bills because of legitimate concern over the rise in Medicaid costs due to the increase in early diagnosis and treatment of these breast cancers that otherwise today remains hidden. Logic dictates that earlier detection leads to lower cost of treatment. The cost of providing ultrasound screening to the 15 million women with dense breasts who receive mammograms each year is $1.8 billion, and yields a reduction of just $9,000 in treatment costs for the 200,000 women who are diagnosed with invasive breast cancer each year. This is what much of the literature and reporting indicates. But, for many states, struggling with already tight budgets—further strained due to the extensions under the Affordable Care Act – the costs are seen as significantly problematic. Screening costs are immediate, savings from screening are projected. It is true that the federal government will provide states with subsidies for increases in cost under the expansion rules in the ACA. Yet, this is limited to only the increase in costs associated with those patients that fall into the increased eligibility area, not regular patients that are now signing up due to the increased awareness. Nor is it true for those patients whose costs are increasing due to better diagnosis. California’s governor, Jerry Brown, vetoed his states dense breast bill for three years, only approving it in the last legislative session. As stated, many states have simply enacted a limited law that only requires physicians to provide their patients with a letter stating they have dense breasts – that’s it!

“Dear Ms. Smith, we have the results of your mammogram. It was normal. By the way you have dense breasts!”

The above quote, it a bit of hyperbole but not far from the truth in how many women are being informed of the problem with having dense breasts. First, the report did not tell the woman that she did not have cancer – it reported that her breasts were “normal”. Most patients interpret this to mean that they did not have cancer. They typically do not interpret it to mean that their breasts are “normal” for dense-breasted women and that “normally” the doctor couldn’t find a cancer on that mammogram if their life, much less the life of the patient, depended upon it. I have a lifelong friend, a nurse in Maryland, who after receiving her bi-annual mammogram received a notification that she had dense breasts. No, notice of what this meant to the ability of the mammogram to detect cancer in her breasts, no notice as to what option she may have to get a secondary effective screen for her dense breasts, not even a statement that she should seek a secondary screen! This is what is considered in many of these 16 states as effective notification. I think NOT!

What Should You Do?

First, if your state does not have a dense breast bill and you get a mammogram, ask the radiologist if you have dense breasts. If you do, ask, or perhaps demand is a better word, to have an automated screening ultrasound done! I mean, why not? We are told to demand this drug or that drug form numerous TV commercials that then proceed to tell us of all the dire side effects we can suffer from taking the medication. Why can’t we demand to have an automated screening ultrasound to detect cancer when the potential side effect of the screen is nothing more than 10 to 20 minutes of additional time? Don’t tell me there is the risk of a false positive! There may be! But which do you think is better? A false positive that can then be cleared up by an MRI, or a biopsy, or finding out a few years later that you have a stage 3 or 4 cancer that was undetected due to your dense breasts?

Second, if your state doesn’t have a dense breast notification bill find your local group(s) and get active to demand they address this issue. Check out www.areyoudense.com to find out more. If your state has a law but the law does not require anything more than the kind of notice in the quote above, go raise a little hell! It should at least require some notification of what dense breasts mean in terms of the efficacy of the diagnosis and what options are available to you to get further testing.

Third, after you have achieved these first two objectives, work to get your state insurance commissioner to mandate that automated screening ultrasound – for dense breasted women be approved and reimbursed by insurance companies offering coverage within your state. It is long past time for this issue to get resolved. I have seen a number of people devastated by breast cancer. My mother, mothers in law (more than one), friends, family, and neighbors. While mammography has been a very effective tool over the past so years at reducing deaths from breast cancer, it is now known that it is not as effective as we thought it was, or were led to believe. Let’s change this and get to the next plateau in the reduction of unnecessary death from this horrible disease.

Finally, do not wait for insurance reimbursement to get this, potentially life-saving, procedure. When it pays, insurance reimburses $100 to $150 for whole breast ultrasound. If you are denied coverage find a way to get $150. That is just five cups of coffee per month.

 

 

 

 

 

 


 

[i] Weigert, et al; “The Connecticut Experiment: The Role of Ultrasound in the Screening of Women With Dense Breasts”, The Breast Journal, Volume 18 Number 6, 2012 517–522

[ii] Bae, et al; “Breast cancer screening with US: Reasons for non-detection”, Radiol (2014) Vol 217:No 2, 369-377

[iii]      Colditz GA, Willett WC, Hunter DJ et al (1993) Family history, age, and risk of breast cancer. Prospective data from the Nurses’ Health Study. JAMA 270:338–343

[iv]      Gail MH, Brinton LA, Byar DP et al (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879– 86

[v]       Seidman H, Stellman SD, Mushinski MH (1982) A different perspective on breast cancer risk factors: some implications of the non-attributable risk. CA Cancer J Clin 32:301–313

Figure 1: American Cancer Society Surveillance Research
Figure 2: Stephen W. Duffy, MSc, CStat,* Laszlo Tabar, MD, Bedrich Vitak, MD, and Jand Warwick, PhD, “Tumor Size and Breast Cancer Detection: What Might Be the Effect of a Less Sensitive Screening Tool Than Mammography?”, The Breast Journal, Volume 12 Suppl. 1, 2006 S91–S95

 

Healthcare Reform 2.0 – Better Solutions Summary

Thomas W. Loker:

We have put together a summary of the Healthcare Reform 2.0 solutions. Please take a look and remember we are soliciting feedbalck and comments now. This will change.

Originally posted on Health Reform 2.0:

The ACA – ObamaCare is failing, and will surely fail, but not for the populist reasons being discussed so readily today!

Overview – Why We Still Need More Reform

We now expect significantly more from our country’s healthcare system – and by extension its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of Benjamin Franklin’s style of “compromise though tolerance as we once did. Everything we now attempt to do becomes locked in an all-or-nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of modifications, often in the form of rules and laws, to try to affect corrections to one part, or another, of this non-system. All…

View original 2,843 more words

John C. Goodman: Obamacare – A Costly Failed Experiment

Originally posted on Health Reform 2.0:

[testimonial author="John C. Goodman March 21, 2014 The Wall Street Journal]With Sunday marking the fourth anniversary of the Affordable Care Act being signed into law, it’s worth revisiting the initial purpose of the president’s signature legislation: Universal coverage was the main goal. Four years later, not even the White House pretends that this goal will be realized. Most of those who were uninsured before the law was passed will remain uninsured, according to the Congressional Budget Office…

…So four years into this failed experiment, what are the alternatives? Getting rid of the mandates, letting people choose their own insurance benefits, and giving everyone the same universal tax credit for health insurance would be a good start. More easily accessible health savings accounts for people in high-deductible plans is another good idea.[/testimonial]

Mr Goodman starts and ends his excellent article, A Costly Failed Experiment, with a clear and concise summary…

View original 954 more words

Health Reform 2.0 Site Launches

Aside

HealthReform20 site picFor some time, we have been working on taking the years of work and effort of understanding the issues that have plagued our healthcare system and why none of the legislation or proposals, so far, have been able to deliver on their promises.  When I was researching my last book, The History and Evolution of Healthcare in America, I came to the conclusion that many of the problems were rooted in most of our past decisions and fixes. What we now think of as a system is mechanically incapable of performing as one. Most of the things we believe about our healthcare system, and to a large part, the practice of medicine lives more in the land of myth and fantasy than reality.

I have written extensively about most of the issues and I have chronicled many of the deficiencies in the Affordable Care Act, aka ObamaCare. In the past few months I have been working with an increasing number of individuals, on both sides of the aisle, to find a more pragmatic — less partisan solution.

As a result of many of these meetings, speeches and various other activities we began to develop a white paper, recently published here. Initially, I thought this effort would produce some higher level recommendations and my role would be very limited. This has not been the case.  The more we have discussed the core principals, the more buy-in we have received on the general concepts.

This broad level interest has resulted in a commitment to provide a more focused location for interaction to see if we can’t cut through some of the rhetoric and get traction on fixing the fundamental issues that have plagued our healthcare market.  I don’t know if we will make any difference whatsoever, or if we can even get enough people to read and comment to make a difference at all.  I do know that we can try.

We have created a location called Health Reform 2.0 linked above to the graphic.  If you want to tell someone about it and what we are trying to do, here is the URL spelled out: http://healthreform2dot0.org. (that’s “two” dot “zero”)

We have pushed all of the earlier material that appeared on this site to this new location and we encourage you not just to visit the site but to also read the materials, and most importantly, lend your voice to the solutions by posting comments.  We will continue to cross post the articles on this site as they get published.

Thank you for your support on Healthcare: Crisis in America and I hope you will subscribe to this new site as well.

 

Sincerely;
Tom Loker

Article 4 – The Plague of Myths – Myth 3: We Can, and We Should, Live Forever!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

This is the fourth of a series of articles that are being published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!

We all want to live longer

It is clearly an historical ideal to live longer. We all, for the most part, desire not to die anytime soon. I am sure that for most of us it is a completely natural instinct to continue to live. We often find it morally abhorrent to want to die prematurely – like from suicide. It would be completely counter intuitive from what we know about the survival instinct, and the laws of natural selection to decide to become premature feedstock for the organisms that prey on us. Our individual desire to survive is primitive and persistent for most of our lives. And it is safe to say we have been built this way! Continue reading

Article 3 – The Plague of Myths – Myth 2: Healthcare, It’s Good for What Ails You!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the third of a series of articles that will be published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

Do our expectations of Healthcare match reality?

We have a large number of myths that govern our beliefs about our current Healthcare system – or non-system to be more accurate.  One of the larger set of myths that drive our perceptions of both the positives and negatives of our healthcare system are our beliefs and expectations as to what we should get from healthcare and the underlying medicine.  We believe, that modern medicine has cures for almost anything we face.  We believe that the continual research and discovery that has occupied much of the past 164 years has led to a firm and almost complete understanding of the science of disease, injury, and treatment.  We believe that there is little difference in cost between the things we need for survival and the things that we want to improve our lives.  We believe that the current methods of treatment and the discoveries we have made over the past 80 years are making us a stronger more robust species.  We believe that the doctor is typically the best and most qualified person to deliver the care we need. And we believe that in most cases going to the doctor is safe and leads to improvements in our health. These are just a few of the myths and misconceptions we have about the current state of medicine and what we should expect from our healthcare system. Continue reading

Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the second of a series of articles that will be published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

The Plague of Myths

There are many myths that pervade our beliefs and therefore underlying assumption about our so called healthcare system. We believe that;

  • We have a healthcare system,
  • We believe that we already have, or are very near to having, cures for almost everything,
  • We believe what is good for us as individuals is good for the human species,
  • When it comes to healthcare we think that what we want is the same as what we need,
  • We either believe only government should have the role of providing care or we believe that government should have no role at all,
  • We believe that America can afford it – whatever it is,
  • We believe that Employer Sponsored Insurance has been a good thing,
  • We believe Co-Pays and Deductibles have helped lower costs and reduce consumption, and
  • We believe many, many others myths as well.
  • We also believe that American Healthcare costs too much! Continue reading

Article 1: Introduction to the Real Healthcare System

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the first of a series of articles that will be published over the coming days and weeks. The series articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Published Articles

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

 We don’t have a system

When it comes to America’s, so called, Healthcare System, one of the biggest reasons that most of the attempts to “fix” our healthcare system have consistently yielded more unintended consequences than benefits is that we treat the symptoms of the disease not the disease itself. We have a number of misconceptions about our healthcare system and the first and foremost is that we believe that it is, in fact, a system.  It’s not!  It never has been.  What we think of as our healthcare system is really nothing more than a disjointed, tangled collection of practices, methods, procedures, policies, laws and guidelines that have been developed over the past 200 plus years.  Most of this collection of things were developed for the furtherance of one failing group or another.  Most were promulgated to preserve the business of individual practitioners – doctors, physicians, pharmacists, hospitals, pharmaceutical manufacturers, insurers, nurses, therapists, program sponsors, etc. With rare exception, many of this collection of things were not focused on the needs of the patient. Continue reading

What’s next for our Healthcare System: Leading to real fixes or total collapse?

A new approach is needed

It is now crystal clear that the methods, some would say madness, that we have promulgated over the past 200 years to define the mechanisms we needed in order to provide healthcare to Americans have worked both spectacularly, and miserably, depending on your perspective and measures.  America’s healthcare system has become a collection of practices, methods, and mechanisms that neither integrate nor properly manage the efficient, effective and appropriate level of care that citizens need nor does it provide an appropriate method to deliver the care we want.

How we got to this point

Tolerance-RealCompromiseDuring the same 200 years, our overall understanding of America and our expectations of services have materially shifted.  We now expect significantly more from our country – and by extension its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of tolerance in compromise as we once did. This has led to a frozen governmental structure where we are trapped between two ideological extremes. Everything we now attempt to do becomes locked in an all or nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of changes, often in the form of rules and laws, to try to affect corrections to one part of this non-system or another.  All of these approaches, in the parlance of medicine, have affected the symptoms of the disease but they have not cured the underlying fundamental problems.

We must identify and agree on the fundamental problems

In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Americans, we must first address the fundamental issues, disconnects, and problems of our historical non-system.  In order to begin to actually address the needed fundamental fixes – therefore deal with the disease not the symptoms – we need to first identify and agree on what the fundamental problems are.

Clearly, America is caught in this crossroads. Since we are now trapped between two ideological positions. It is because neither party can find ground for compromise because we have lost the art of tolerance that I often say, “The only thing that we, as Americans, tolerate today is intolerance!” The principal of tolerance was a key characteristic that made America the leader of the free world it became.

A series of articles

What follows over the next few days to weeks will be a series of articles in which we will lay out a set of principles, that encapsulate solutions for the issues and goals that have been laid out by both sides of this debate repeatedly over the past seven years, beginning with the authors first encounter with a major Senate bill in 2007, and as identified in the authors reading of every formative bill from each committee whose work ultimately contributed to, or argued against, the final legislation for better or worse since then.

For those of you that would like to cut to the chase and read the more academic whitepaper it is available here: HealthCare Reform – Beyond Partisan Divide Ver 1

There is a solution

The solution will require quite a bit of work, much debate and a healthy dose of tolerance. In the end, we believe we can find compromise that will yield a much Continue reading

Internet Scams: Thank God for the internet!

You just gotta love the people who sit around and think these things up! Over the past two days, I received two e-mails, the first (copied as sent below as Letter 1), was a very official looking letter from Mr. Edward Meyers who was polite enough to inform me that no less than the Government Accountability Office (GAO) of United States Government and also the International Monetary Fund (IMF) had instructed he, Mr. Edward Meyers, working on their behalf, to immediately within 72 banking hours – wow this must have been very important – to transfer to me the sum of US$45 Million. Nice!

—————————————————————————————————————

LETTER 1

From The Desk Of Mr Edward Meyers
Phone: +1 530 540 5419
Dear valued Customer,

My Name is Mr Edward Meyers, A citizen of the United States,52 years Old. I reside in Hobbs, New Mexico,My residential address is as follows;1320 Linam Street, Hobbs, NM 88242, USA,i work in the remittance department with Bank Of America in collaboration with Gulf General Investment here in New Mexico, United States Of America.

Am contacting you concerning your overdue payment of US$45 Million which have been endorsed for onward transfer to your destination depending on your choice to receive your full payment,you have the legal rite to indicate by return email, the preferable method to receive your payment within 72 Banking hours.

Bank Of America will be willing to receive your full  contact details in your next email,so as to furnish you with the necessary steps to deliver your funds within 72 Banking hours.

Considering the latest payment instruction we received few days ago from THE UNITED STATES GOVERNMENT ACCOUNTABILITY OFFICE(GAO) AND ALSO FROM INTERNATIONAL MONETARY FUND(IMF),You will not be required to pay for any money transfer charges until your funds are delivered to your bank account,but you must present valid and verifiable details of your payment to my office prior to the final release of your payment so as to indicate and assure that you are the rightful beneficiary to the funds in our custody.

Do not hesitate to call me on  my contact phone numbers given below for more details or send an email.

I will be expecting to hear from you urgently

Sincerely yours,

Mr Edward Meyers
For Bank Of America,
NM, USA.
Direct phone: +1 530 540 5419

(I have highlighted the errors in the letters in red)

—————————————————————————————————————-

Of course I thought, finally, the government is going to reimburse me my share of the profits from the car companies for those bail out loans Continue reading

To David Brooks: Its not just leaders its their point of origin

The Leadership Revival By David Brooks Article

The Leadership Revival
By David Brooks Article (click to read the original article)

I like David Brooks! He is one of the pre-eminent writers in this era and along with Charles Krauthammer one I try to read on a regular basis. Always thoughtful and cogent, his observations typically are well worth reading, educational and stimulating. Continue reading

4 Straight Years of Slowing Health Care Costs: Really?

man_question_mark

U.S. Marks 4 Straight Years of Slowing Health Costs(click to read the article) so blasts the headline from ABC News today, January 7, 2013. Like so much of the debate over Healthcare reform, many that read the article will walk away believing that things relating to healthcare costs are really improving—along with the economy. After all the article proudly says that the percentage that healthcare costs make upon of the Gross Domestic Product (GDP) has declined for the fourth straight year. This must be a good thing—one would think! But, like so much of the reporting Continue reading

HIV/AIDS: The face has changed but disease still wreaking havoc

The Gift of the Human Hand

The Ryan White Care Act—the prime funding source for HIV/AIDS treatment assistance—is due to sunset this year.  The strongest advocate for RWCA, Senator Ted Kennedy, not long before his death fought a hard fight to update the law.  The fight to update the law was unsuccessful due to a highly Continue reading

Half Full or Half Empty: Another Happy New Year!

It is often said, “A picture is worth a thousand words!” Perhaps, unlike no other time of the year this is best considered at the birth of another new year! We seem to go on each year, new resolutions in hand, gradually returning to our prior ways. Sometimes we may keep one of our new hard-one habits for a bit longer than normal, but for the most part we revert to who we were before—continuing to creep along at our own petty pace from day to day, with our sound and fury intact signifying nothing. Still, it is good to wonder and consider. It is, in retrospect, likely something we should all do more often than we do. At a minimum, maybe we should complete this one simple exercise each year whether we need to or not. Whether we are people who routinely see the glass half full, or half empty—in the end we will find gratification.

With this in mind I offer the following video. I hope it helps you in your own consideration find a ponderous start to your new year!.

From those of us at the Health Care: Crisis in America blog and www.loker.com

Happy New Year to you and yours and thank you for being a loyal reader in 2013 and for your consistent referrals to others to help in their considerations. You have helped this blog and twitter find more than 9,000 regular readers!

Value Based Insurance: it sounds so – “valuable”

Value based insurance, sounds so - valuable!

Value based insurance, sounds so – valuable!

Value Base Insurance Coverage, it sounds so — valuable. But is it really valuable? Is Value Based Insurance Coverage (VBIC) what you really want — what you may need? Well, perhaps, that simply remains to be seen. As we move through the implementation of the Affordable Care Act, ObamaCare, VBIC will become the next big thing we need to pay close attention to. You can be sure that soon this item will be getting quite a bit of ink as the potential ramifications become apparent.

Like so many things in life, the reality of this “value” based system may be fraught with unintended consequences for the individual and massive values and benefits for Continue reading

The ACA Exchange Poster Child – Covered California: Works for some, not for others

CoveredCaCalifornia, has long had the reputation as being one of the most progressive, or liberal, states in the nation. Often in a neck and neck battle with New York over who gives more free-stuff to its people at any given time, California long ago adopted the philosophy that what is good for some should also be good for all. The concept of income redistribution though higher taxes is not a new one for California residents.  Yet this state, nicknamed “the Golden State,” and home to Hollywood, Biotech, Oil and Silicon Valley fortunes often confounds because there are also strong anti-tax forces that from time to time rise up and limits California’s spending power through measures like Proposition 13. Continue reading

Obamacare Insurance Cancellation: Welcome to the #ObamaNation

Welcome to the ObamaNation where we know better than you!

Welcome to the ObamaNation where we know better than you!

The cancellation letters people are now receiving for their earlier choice based plans– you know the ones that President Obama said they could keep, PERIOD–out of courtesy and perfect declaration should open with this line,

“Welcome to the #ObamaNation where we know better than you!”

Those of us who have warned of these effects under the law, and a number of other predictable negative outcomes that are only beginning to show up, have been called fear mongers, and haters. The shouted counter argument becomes a diatribe of how this law is going to be so great. How it will provide insurance for so much less cost. How it will lower the cost to the nation and the individuals. How you will get whatever you want and have to pay almost nothing for it! Continue reading

Jay Carney’s recent statement may be quite revealing!

Recently, Gov’t spokesman, Jay Carney, said he could not answer questions about the exchange sites because, in his own words, “I’m not a computer expert and I don’t build websites!” But, he is the spokesman for the #ObamaNation, i.e. the Federal government.  So in this capacity as speaking for the Government or the president’s administration, he is admitting that they are not computer experts and they don’t build websites! Then why on earth did they take on the challenge to try to build this one.
I understand that they hired subcontractors to build its parts. But unlike most projects, they did not hire a contractor to manage the project, to take the pieces and integrate them into a cohesive final system.  This is the way virtually every other project the government does is handled.
 
Carney is correct, the government has no experience in computer engineering, architecture, design and development. They do not build websites! They spend most of their IT assets maintaining ever aging mainframes systems that cost huge amounts to keep running and are difficult, if not impossible, to interconnect with newer more efficient systems. So why did they try to take on such a role in this case?
 
Is it possible, that they simply did not want any third party to find out how the site would be used? Is there some “secret systems built into this massive infrastructure that the government doesn’t want people to know about? Is there some hidden data system slurping our information as some people have surmised? These would be something that any outside contractor would need to know about in order to build the system and have it work.  It could also explain why a system that should at most have 10s of millions of lines of code has 500 million.  Could it be that like the NSA’s recent incursions into the lives of American Citizens, there is a much bigger, “Big Data” game afoot that the #ObamaNation does not want Americans to find out?  Why else would a government, who admittedly is not computer programmers and does not build web sites decide to take on such a task in the first place.  Every part of their reputations were riding on the success of these sites. And clearly money was no object. There has to be a much bigger reason they did not want to bring in real experts to do the job!  Maybe the American People need to have someone come in and audit the code and find out just what else may have been afoot here!
 
Hey I’m just asking!!!

The ACA Exchange Connundrum

Aside

I have a friend, lets say she is in her 50s, a single mom and has been out of work for quite a while. She created her own business through hard work but has been unable to purchase insurance for a while.  She has one adult child that lives at home with her. I believe that she deserves affordable insurance and that she has a right to coverage regardless of her disease state.  From time to time, she gets frustrated with my positions on ObamaCare thinking that I am advocating for its repeal and that even the changes I speak of will harm her ability to get affordable insurance. This is not the case, but I can understand how she feels and why she feels this way. It is my friend and many others like her that need the very sections of ObamaCare that I think should stay in place and this is why I do not support a blanket repeal.

She is a very good person, intelligent and industrious. She is a strong supporter of ObamaCare. When Covered California, opened yesterday I went to the site to see what the new deal will be for people like my friend. It took two attempts to get into the site, although it was not a long wait, perhaps 20 seconds. My friend will be able to get insurance, as the law promises, and because of her circumstances she will be able to get subsidies as well. In fact according to the site (which provides estimates only) she has options under the Bronze plan that after subsidies she will be paying just $1.00 per month.  Yes, you read that correctly $1.00 per month for the premium. But she will also have a deductible of about $2500. before she gets to coverage. Some items are exempted from the deductible so in some cases she doesn’t have to pay anything.

I have not spoken to her but I would bet that she will think this is a good deal at this point. Depending on how the actual deductible plays out in her circumstances, she may or may not find this is a good deal 6 months from now. While this is a good deal for her, is this a good deal for most? Or the better question is this a good deal for America inclusively?  And, it is here that there is a rub. While the government is simply printing money out of thin air to pay for the bills, this new money still comes out of our pocket by reducing the real value of the dollar. And as we age, we disproportionately cost rise more and more for the care we need. From birth to age 70 we cost about $100,000 for care, and from 70 to 75, we cost about $500,000 for care.  The same curve happens from birth to 50.  So at mid 50s we cost significantly more than someone who is in late 20s early 30s. As a result those later life spiraling costs get disproportionately allocated to the younger insured. And the actuarials are not static numbers. Due to many factors they continue to rise and they will rise exponentially under the current rules. This is not due to greed, corporate profits, or expensive technology, it is due to simple mathematics. As we live longer that curve of costs goes ever higher. And under the current law the costs, are neither constrained nor controllable. They simply get reallocated.

I am truly very happy that my friend is able to get coverage, but I am also very concerned that we are hiding the overall cost and stacking increasingly unsustainable burdens on these future generations. The math is clear, even if we just don’t want to see it.  We not only are placing the rising cost burden on the young whose own costs will get exponentially higher as we continue to extend their lives beyond our own,  but we will also present them with a huge moral burden as well for while this generation will not create the death panels as promulgated buy the extreme edge of the republican party, the will have to made a determination of at what age quality of life care is suspended for elderly under government programs and their parents and grandparents own savings or additional private policies pick up the costs. Otherwise the cost for them in their early lives will be increasingly unpayable and the nations economy will collapse under the cost..

ObamaCare becomes DemoCare: Demolishes Middle Class!

DemoCare demolishes  America's Middle Class

DemoCare demolishes America’s Middle Class

The Affordable Care Act is often called ObamaCare but I think from now on it should be called “DemoCare” because it’s going to demolish care in America and along with that demolish America’s Middle Class.

There are quite a lot of things about the way this law works that make it undesirable.  Mostly, the causes are not in the debate that we hear so much about nor are they in the parade of facts that we are about to be inundated with over the next 90 days from those selling the benefits or arguing against them.  Like most debates the truth in the rhetoric is somewhere between the extremes. Continue reading

Dan Brown’s Inferno: A Coming Global Crisis?

Light summer reading

    Population Graph from "Inferno" by Dan Brown

Population Graph from “Inferno” by Dan Brown

In his latest book, Inferno, author Dan Brown explores a world where past symbols and artifacts from Dante Alighieri’s Italy, and his famous work The Divine Comedy, become the vehicle to unravel a diabolical and deadly plot of a modern day bio-terrorist. I originally grabbed this book because we were coming to the close of summer and I just finished working on a series of articles about the current issues of our healthcare system that will be appearing later this fall. Frankly, I was looking for a diversion from the complicated world of healthcare reform and Obamacare. I wanted a respite, a brief mindless romp in Dan Brown’s always entertaining world. Having read much of his prior work, I was confident that Mr. Brown would not let me down.

I found this work characteristically suspenseful, interesting, thought provoking and fun to read till I got to the following section which, in the story, lays the groundwork for the epic conflict between the antagonist, Bertrand Zobrist , a world renowned biochemist and leading geneticist and the protagonist, Elizabeth Sinskey, M.D. Continue reading

Orange Countey Register says, “Women’s deaths from painkillers ‘an epidemic'”: But, its nothing new!

Screenshot (4)To read the original article click here!

The rising rate of addiction for women in America seems at first blush a historically startling event. But its not! America has had a long, long history of dancing with the devils of hard drug addictions.

While the article calls these rates historically the highest, they factually are not. In the late 1800s and early 1900s, the addiction rate to cocaine, Continue reading

President Trumpets Obamacare Rebates as Deadline Approaches: Beware of Greeks Bearing Gifts!

President Trumpets Obamacare Rebates as Deadline Approaches - Time Swampland

President Trumpets Obamacare Rebates as Deadline Approaches – Time Swampland

Nought from the Greeks towards me hath sped well. So now I find that ancient proverb true, Foes’ gifts are no gifts: profit bring they none.” So observed the great philosopher and teacher Sophocles about 430 BCE.  Today we loosely translate this as, “Beware of Greeks bearing gifts!

No quote could be more apropos in regard to the supposed $500 million in insurance rebates being sent to 8 million Americans under #Obamacare. Like most ponzi schemes, at first blush this appears to be a great deal for America and Americans. Continue reading

States make ‘disturbing cuts’ to unemployment benefits: Ya’ll want it fixed? Just ask a redneck!

Unemployment BenefitsAn interesting article caught my attention this morning titled, States make ‘disturbing cuts’ to unemployment benefits, authored by Jake Grovum, Pew/Stateline Staff Writer. You can read the article by clicking the link of the photo above from the article.

The irony of this article, is that the continued stretching of unemployment benefits have, in the words on some economists, perpetuated unemployment. How can this be? people ask!

On the one hand, some people (how many I do not know — likely not the majority) just do not really seek work once they get on unemployment Continue reading

Women & Addiction: History replayed!

Drug Addiction in Women Article

http://www.usatoday.com/story/news/nation/2013/07/02/drug-overdose-deaths-women/2483169/

Ever since Samuel Hopkins Adams first exposed the evils of the patent medicine industry, in 1905 in a series of articles published in Colliers Weekly, it has been ‘patently’ clear that women have often historically been the prime target for the sale of prescriptive and Continue reading

Behold the Arrogance of Man!

Arrogance-diminishes-wisdom-

Perhaps Mr. Snowden is in the process of learning what both President Obama, and Joe Biden learned as they moved from the position of candidate to the top two executives in our government.

When you think you know something based on only a few of the facts and realities of the situations, you are free to speak and act more freely & criticize others in leadership with impunity, because you simply do not know the detailed reality of the situation.  If something goes wrong, there are myriad things that you can use as an excuse because you “didn’t know” this or that. Unfortunately, in recent weeks we have seen this lack of understanding or knowledge excuse played out way too much. Continue reading

Susan Rice: Dupe, fool or Conspirator?

Susan Rice Article

Susan Rice Article

As this story rapidly begins to unwind, I have to wonder about poor Susan Rice. For the first time in her life she gets the opportunity to address a national forum and elevate her creds and national visibility in order to move to her next career milestone.

I wonder if she ever asked herself, “Why is Hilary not doing this?” Was she so caught up in the moment that her ego prevented any cogitation? Did she really believe that her ‘friends’ in the #ObamaNation were recognizing her abilities and finally giving her, her just Continue reading

Tax Code Driving ObamaCare Implementation: California’s ACA Odyssey Preview

Click to access the Original Article by John Gonzales

John M. Gonzales reporting for the California Healthcare Foundation Center for Health Reporting wrote a must read article called, How the U.S. tax code will drive Obamacare implementation, starting April 15. I strongly suggest all read it.

The negative effects of Obamacare on costs and care were immediate, and the ongoing negative effects are just starting to be disclosed and to build. Yesterday, I participated at a Health Care Summit put on by Continue reading

Headlines Scream PC Sales Flop due to MS Windows 8: Really?

Aside


Sometimes I get to thinking that there are a lot of relatively young arrogant tech writers, which spend a lot of time floating agenda based premises in order to try to show some company that they need to get these writers permission before they try to succeed with anything.

But then I am not a conspiracy theorist.  But I can see how people jump to that conclusion.  There are no less than 10 articles today with basically the same headline that Microsoft and Windows 8 is a flop because it did not stop the erosion of PC sales and PC and Laptop sales are slowing as mobile devices Continue reading