HPHWD

Via HuffPost/Pollster, Democratic pollster Mark Mellman offers his overview of where public opinion currently stands on the Affordable Care Act (aka Obamacare). Mellman cites figures of roughly 30% (Fox News poll) and 33% (CBS/New York Times poll) of Americans favoring full repeal of the ACA. These percentages, though far from a majority, are higher than the 25% of U.S. voters who favored repealing “all of it” in the 2012 exit polls.

So, where does this leave us with regard to the Oregon Health Study? I have no idea, actually. I am no expert on the bowels of Medicaid, and as I live and work in an extremely underserved region with devastating health inequities, far be it from me to claim that access to Medicaid in insignificant. In fact, as I argue at length, we need to be very careful in the implications we draw from the above evidence. First, it does not imply the moral insignificance of expanding access to health care services. No matter how we structure society, people will fall sick, and I have no hesitation in saying that we ought to care for them. But we should not confuse this ethical proposition with an empirical counterfactual, viz., that in a world in which we did expand such access we would see significant improvements in overall population health. Second, beware the false choice fallacy. There is no contradiction between collective action on the SDOH and expanding access to basic health care services.

If you thought U.S. doctors would never accept evidence-based medicine, consider this: Just last week, in a stunning about-face, the American Urological Association(AUA) announced that it no longer recommends routine annual PSA testing for men under 55.

Launch of the ACA’s controversial Independent Advisory Board– a panel charged with recommending ways to curb Medicare inflation — has been delayed until 2016. Does this means that the IPAB’s critics have won?

The key question here is how we should marginally revise our beliefs, or perhaps should have revised them all along (the results of this study are not actually so surprising, given other work on the efficacy of health insurance). For instance should we revise health care policy toward greater emphasis on catastrophic care, or how about toward public health measures, or maybe cash transfers? (I would say all three.) One might even use this study to revise our views on what should be included in the ACA mandate, yet I haven’t heard a peep on that topic.

There are broader lessons to be learned from what we’re seeing in the world of breast cancer.

Firstly, Americans are bad at statistics. When it comes to breast cancer, they massively overestimate the probability that early diagnosis and treatment will lead to a cure, while they also massively underestimate the probability that an undetected cancer will turn out to be harmless. They’re bad at pathology: they’re easily convinced that something called ductal carcinoma in situ (DCIS) is a form of cancer, for instance, partly because the cancer industry insists on referring to it as “Stage Zero” cancer. They’re bad at biology: they think that it’s physics, basically, and that cancers are discrete, localized growths which start small and get bigger, and that the earlier you find and treat them, in large part by physically cutting them out of the body, the more likely you are to be cured.