Which parts of mandatory coverage do you propose getting rid of, @bluebayou, that won’t increase costs down the road as a result?
^^public health leaders know full well which covered items are cost-effective long-term and which are marginal and which are not. (And yes, there are plenty more to be studied.)
Of course, an attempt to reduce any type of screening, for example, would raise hackles from the respective medical society whose personal incomes depend of providing those (unnecessary) services.
Sounds like a punt, @bluebayou. You are specifically stating that is certain coverage mandated by ACA which would save money by getting rid of it. So, what, in your opinion given your claim, are they?
Mammograms as screening not only aren’t cost effective, they’re just plain not effective. They’d be the first in my crosshairs. (Cue the people bleating about mammograms discovering tumors. Sorry, not interested. I look at data, not anecdotes. Your anecdote is not going to convince me. Nobody talks about the breast cancer that mammograms cause.)
No one talks about the breast cancer mammograms miss either.
The annual blood work my doctor orders for my annual physical …sheesh…he checks tons of little boxes. I can’t imagine all of them are important to have annually.
While I have never missed an annual physical, I could see this going to every two years.
Ok, @“Cardinal Fang”. Thanks for a concrete example. 
And I could get behind a modification for mammograms. In fact, as many recommending groups suggest extending it out to every few years past 50 not every year and younger, I think it makes a lot of sense to cover them on a less frequent basis than the one allowed per year now. Maybe with an acceptation for those with extenuating/high risk circumstances. That sounds doable to me.
OK I’ll ask the stupid question… how to you detect breast cancer without mammograms? Or is it the frequency of getting them that makes it not cost effective?
@JustGraduate it’s complex. This is a fairly good overview: http://www.bcaction.org/2014/04/08/early-detection-does-not-save-lives/
There are many things associated with women’s health especially that are unnecessary. Like there is no reason to have a doctor’s appointment just for basic birth control.
And as much as we don’t like to talk about it, the vast majority of end-of-life care is useless and can even prolong suffering.
my step mom went in for hip replacement surgery at age 92. Complications ensued, and the bill to Medicare exceeded $250k.
Actually, the obvious one was too hot for me to handle… But CF and thumper stepped up with the example of mammos.
How about, (and contrary to popular opinion), annual physicals are not cost effective. (And that is why they were never covered by insurance companies, until mandated by the ACA.)
Bingo. A annual PSA is another one that is essentially useless. Even if prostrate cancer is found, the vast majority of guys will die of something else.
Granted, the latter is small dollars. But it is just one example that we are not willing to make the tough decisions and say, ‘we know with high probability that such a procedure is not cost-effective, so insurance just aint’ gonna cover it.’ If you like, pay out of pocket.
Why is birth control prescription only?
@bluebayou - re why is birth control prescription only…?
I think there are a few ingredients to this:
- desire to control women's sexualty (it used to be that bcp were limited to married women with husband permission, just a few decades ago)
- possible complications of hormone therapy
- physical skill needed to put in something like rods or the IUD or fit for diaphram (or to administer injections)
As you probably know, some simple barrier bc methods are otc, such as condoms for men and women, maybe some forms of the “sponge,” foam (which doesn’t work well I believe).
Obviously (1) is ridiculous as a consideration and (3) can’t really be avoided but perhaps an NP or similar can substitute for a doctor, which I believe already happens.
As for (2), this is something to think about. I know that estrogen/progesterone does need some medical advice, because for some women it can increase the risk of various cancers, stroke, blood clots, etc.
You are right to have us thinking about the fact that some medication, even if very potent (e.g. aspirin) is otc for really historical, not medical, reasons.
1 is ridiculous but it’s pretty much the reason that exams are still required for the pill. It’s also why the people who are most likely to benefit from anything other than the pill- young women- are the least likely to be allowed to get an implant or IUD. Doctors will routinely deny women these who haven’t had a child yet. It’s abhorrent.
Sure, there can be complications of hormone therapy but it’s pretty rare and if you start showing symptoms, then you go to the doctor. There are potential complications from any and all OTC meds.
My first implant had to go through my then-gyno and required a prescription and blah blah blah. The second one was just me calling the women’s health clinic at my U and asking for one. Went in and saw an NP. In and out in less than a half hour.
Bingo. If we really believe that annual physicals provide some good, why not save $$ and allow NP’s to conduct them en masse. Why does it have to be an MD at MD rates? (Rhetorical question!)
@bluebayou I don’t think all doctors routinely run tons of lab tests for annual checkups. I get several done but its due to conditions I have and risk factors specific to my health/genetics. Medication that makes it important to check liver and kidney functions annually for example. However, the younger and healthier members of my family don’t go through the gauntlet I do.
I agree that overall too many tests are done and I blame litigation for a lot of that so would exist with or without ACA. I would bet a lot of people don’t get annuals even know that they are covered. I do think some doctors are more pragmatic in what they ask for and for some it is a CYA.
Evidence for this claim? None of the analysis I’ve read supports it.
^If you don’t even live in the US, why do you care about the ACA?
Sort of…annual physical coverage for free was not mandated until ACA…but my employee health insurance covered physicals…but the schedule varied depending on age. I believe it was annual until age 18. Then it was every other year until some other age…when it went back to annual. I think it might have been age 60.
Cost of the annual physical was not zero…it was the same copay as any other office visit.
@roethlisburger - my family lives in the US and I may return one day. But why should that matter? You don’t go to Harvard, Penn, or Yale, yet [you seem happy to discuss them](Guardian article: "How did ‘less than stellar’ high school student Jared Kushner get into Harvard? " - #53 by roethlisburger - Parent Cafe - College Confidential Forums)…
If you count up the cost of birth control for all the women who want it, versus the cost of the unwanted pregnancies the birth control would prevent, birth control is cheaper and by a lot. The reason it’s not cost-effective for an insurer to provide birth control is simply that many women would buy it anyway.
If I get an annual physical (I don’t, because I don’t think it’s necessary) I see a nurse practitioner. NPs work with my doctor. I have no hesitation seeing an NP for minor things. We should remove barriers that prevent NPs giving care.