Unfortunately, Medicare Does Not Reimburse for Debate-Induced Despair

At last night's Republican debate, Newt Gingrich got asked about the fact that Medicare spends a huge amount of its funds on procedures in the last two years of patients' lives, much of which are pointless or even harmful. His answer was, essentially, that the government should pay for any medical procedure anyone wants, no matter if it works or even if it kills people. And more than that, the government shouldn't even endeavor to find out whether particular procedures work. "The most recent U.S. government intervention on whether or not to have prostate testing is basically going to kill people," he said (video here). He also weirdly described the recommendations as a "class action," I guess because, you know, trial lawyers! Or something. But the truth is that the recommendation of the U.S. Preventative Services Task Force isn't a "government intervention"; it's a recommendation. And it said what many doctors have believed for a long time: that PSA tests for prostate cancer are worse than useless. Here's why:

The P.S.A. test, routinely given to men 50 and older, measures a protein — prostate-specific antigen — that is released by prostate cells, and there is little doubt that it helps identify the presence of cancerous cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men who do have fast-growing cancer, the P.S.A. test may not save them since there is no proven benefit to earlier treatment of such invasive disease.

As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a "public health disaster."

As The New York Times Magazine reported last weekend, this report was delayed because the USPSTF was terrified that there would be a repeat of what happened two years ago, when their recommendation on mammograms caused a right-wing backlash, and their funding might be cut by congressional Republicans in retribution. So let's review the Republican position on health care, explained here by Gingrich but shared by pretty much everyone in the party:

  1. Health care in general, and Medicare in particular, are bankrupting our country.
  2. But government should never try to figure out which treatments are effective.
  3. Medicare should pay for any treatment anyone wants, regardless of whether it works or what it costs.
  4. If an insurance company refuses to pay for a procedure, that's their right as actors in the free market; if Medicare refuses to pay for a procedure, that's Washington bureaucrats trying to kill you.
  5. We need to cut Medicare benefits, because don't forget it's bankrupting our country.

If they could only repeal the Affordable Care Act, then their new innovative solutions to health care would surely solve all our problems.