Congressional Budget Office opines on prevention (at a 8th grade level)

An anonymous high school student, under the guise of the Congressional Budget Office, released a letter Friday to address how the CBO analyzed the budgetary effects of recent proposals to expand "government support for preventative care and wellness services" and to explain their findings.

The findings aim to establish a position that expanded preventative care and wellness services would actually ultimately INCREASE costs, as the expense of expanding the scope of these services would only offset a small percentage of the increased cost of performing them. As an example, they cite a study conducted by the American Diabetes Association, the American Heart Association, and the American Cancer Society which

"estimated the effects of achieving widespread use of several highly
recommended preventive measures aimed at cardiovascular disease
such as monitoring blood pressure levels for diabetics and
cholesterol levels for individuals at high risk of heart
disease and using medications to reduce those levels."

And while the study indicated that these measures would substantially reduce the probable cases of heart attacks and strokes, the savings would only offset about 10% of the increased provider costs.

It's frightening to me that this argument even exists. If preventative care costs exceed the savings that would be seen by avoiding serious conditions (and their associated procedures) shouldn't the take away be that preventative healthcare costs are too high? How expensive can it be to take a patient's blood pressure and give them medication? How are we having this argument at all without any mention of the benefits to quality of life?

The letter goes on to claim repeatedly that expanding government support for preventative care and wellness services would be redundant, as many insurers and employers are already providing those services at little or no cost to the employee/covered. Which is to say that insurance companies and employers have come to the conclusion that those services ARE beneficial (and cost effective) enough to provide. And have also managed to figure out the riddle to providing them, while staying economically viable.

Again, the logic escapes me. It's as if the CBO was tasked specifically with creating an argument against increased healthcare support, and this is the best they could come up with. Even ignoring their own previous findings, like the report they published 5 months ago that found that a bill (H.R. 1256) aimed at decreasing tobacco use (a wellness service) would result in a decrease of "11 percent among underage tobacco users and about 2 percent among adult users" over just a 10 year period. The overall savings involved in those reductions would have to be huge.

I'm convinced that someone assigned a word count to this letter, and said "create arguments and defend them until you've reach 3200 words".

Congressional Budget Office opines on prevention (at a 8th grade level)

White House Director of New Media gets it wrong.

White House Director of New Media Macon Phillips is taking heat for a seemingly innocuous blog post Tuesday morning on whitehouse.gov titled "Facts Are Stubborn Things" in which he suggests that Americans tattle on their neighbors.

His intentions are good. There is a ton of incorrect (if not blatantly fabricated) information circulating on the web about the President's Health Care Reform positions. The White House staff would certainly benefit from getting in front of this disinformation (like claims that the President's reform bill would eliminate current private health plans). But suggesting that if Americans "get an email or see something on the web about health insurance reform that seems fishy" that they should "send it to flag@whitehouse.gov" puts the administration in a very vulnerable position. And the criticism is already coming.

In a letter to President Obama, Senator John Cornyn (R- Texas) raises questions of First Amendment rights of free speech, warns that the policy raises "the specter of a data collection program" and calls for it's immediate end. And he's right.

I've not been shy about the fact that I'm in the tank for the current administration, and I'm constantly encouraged with it's adoption of new media communication methods, but I think Mr. Phillips is missing the boat on the spirit of the "open communication community" which is based on transparency and collaboration...not McCarthyism.

I'd propose that the White House expand their "New Media" department, and use a handful of TARP dollars to hire a dozen currently unemployed, new media savvy "watchdogs" to scour Twitter and YouTube, etc for posts about Health Care reform (or any other issues, for that matter). The White House would be well served to keep a finger on the pulse of the publicly posting public anyway.

White House Director of New Media gets it wrong.

Dear Orthopedic Surgeon,

The next time someone comes to you with complaints of severe localized pain in their legs (which is not resolved with rest) and tells you that they're a runner...please refer them for an MRI. You may find that they have developed stress fractures. What you see may look like the legs below. Notice that the leg on the left is normal, and the one on the right is "all banged up" looking.


You could also give them an x-ray, since you probably have one of those handy machines right in your office. If you do, inspect it carefully, as any injury may not be very noticeable. In which case you might be inclined to tell your patient that he has shin splints. Which doesn't really help anyone, and makes it seem like you received your "specialized training" from a Cracker Jack box.


Certainly don't refer him for a Bone Scan, as nothing but a compound fracture is going to show up. Which might also lead you to tell the patient he has shin splints. Which will result in subsequent unnecessary office visits, which will help keep healthcare costs high, and patient satisfaction at an all time low.

Dear Orthopedic Surgeon,

Anatomy of a broken healthcare system

A chronic leg injury flared up for me during an attempt two weeks ago to run the first 10k of this young running season and, after not being able to walk all weekend and getting gentle pressure from my wife, I decided to make an appointment to have it looked at. Called monday morning, and got an appointment within the hour...which is were the efficiency ended.

The Dr. sent me to a Radiologist down the street to have x-rays (which would be the third time i've had x-rays done of my legs in the last 3 years) and said he'd refer me to an orthopedic specialist. That was all Monday.

Five days later, the referral came IN THE MAIL, while I spent the week limping and wincing. But when I called that doctor to make an appointment, I was told that they don't take my insurance (Cigna).

So Monday (9 days after the injury) I found a doctor that did, and called my PCP back to make a referral to THAT doctor. And scheduled the next available appointment, which was today (13 days after the injury).

Went to the doctor today, and they couldn't find my xrays on the website that the radiology office uses, so we did that again (4th time). This doctor wanted me to go have an MRI.

Called my insurance company, and asked them if I needed a referral for that (I do). They advised that referrals for MRIs go through a company called MedSolutions, and that the doctor who ordered the test had to call for the referral.

Called the Ortho office back, and they said they couldn't ask for pre-authorization from Cigna until I made the appointment, and that it requires 5 business days for that process to happen.

Called MedSolutions to see which of the list of facilities would be in-network for my plan and got a fax machine.

Called Cigna back to get the actual phone number (after looking, and not finding it on their website).

Called MedSolutions and was told that they can only look up facilities by tax ID#, and that the doctors office should call with that info.

Called the Ortho office back and they said that they still needed me to call first, but happened to know that one of the local facilites honored my insurance.

Called the MRI facility and made an appointment for next Wed (18 days from the date of my injury)

Called the Ortho office back and told them when my appointment was. They advised that they needed five BUSINESS days, and that they couldn't promise me that the authorization would get done in time.

In the end, I'll be lucky if I have a diagnosis 3 full weeks after I injured myself, all the while i've been limping and in pain. And the lesson I learned is that next time, I'll just go to the emergency room.

Anatomy of a broken healthcare system