Oh crap. Yet more women's health "guidelines" from our corporate culture aimed at reducing costs.

Now, you should only get a Pap Smear every few years and not start till you’re in your 20s.

Under the headline “Negative Effects of Fewer Pap Smears Unknown,” the article reads:

Dr. Donnica Moore, president of Sapphire Women’s Health Group and an obstetrician-gynecologist by training, worried that the new guidelines might keep women who’ve had a normal Pap smear, or no symptoms, away from the doctor.

I'm having the best time punting around the C list; the writing is so much better, and the subject matter is so much more interesting. Here's a great paragraph from eye of the storm:

speaking of art: it's amazing what's hapnin on general hospital these days. i mean it's very typical for sweeps month to get the whole cast at a party and start a gunfight, a fire, a blizzard, and a series of explosions; it might take weeks before you realize that only a minor character they introduced two months ago is actually dead, after the miracle surgeries etc. but now claudia - a paradigmatic super-bitch only much much worse only actually just terribly terribly misunderstood only multiply continuously homicidal and deeply crazy although really just sad and so lonely only sexually obsessed with her brother etc, played by the very-fine and notably buff sarah brown - is heading to the bold and the beautiful or something. so she's being written out in an elaborate way that embroils the whole cast in total disaster. it's a mafia/physician/pregnantwomen conflagration: gh apocalypse. every member of the ensemble has multiple motives to kill claudia, while she has multiple motives to kill everybody, that lovely psychotic bitch! can't get that shit at the met.

No indeed.

The forced-birthers are out in force in the blogosphere, looking for federal funding of abortions in the bill, so I thought I'd help them out.

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The public plan and the exchange[s]

The public plan might or might not pay for abortions that don't fall under the Hyde amendment. The Secretary of HHS cannot require private insurance plans offered through the exchange[s] to cover abortions of any kind. Fortunately Sec HHS can't prevent private insurance from paying for abortions either. Abortion cannot be listed as part of the essential benefits package.

If you want to know why people might NOT want to choose the public plan, here's one reason that some women will "choose" to stay with private insurance.

Oh well, at least it doesn't prohibit abortion coverage outright.

Via ThinkProgress, both the Baucus Bill and the plan put forward by Pelosi will enroll some more people but most will not be in the Public Option and it will not cover everyone:

CBO: Public Option To Attract Only 6 Million Enrollees & Doesn’t Offer Lower Premiums

The public option would attract about 6 million enrollees by 2019 and charge premiums that are “somewhat higher than the average premiums for the private plans in the exchanges.” This is because the public option would “engage in less management of utilization” by its enrollees and “attract a less healthy pool of enrollees,” the office concludes. Moreover, since the House bill expands Medicaid up to 150% of the federal poverty line, it’s possible that the enrollees that would have enrolled in the public option went into Medicaid instead.

Below is a comparison of the relevant provisions in the House and Senate Finance Committee legislation:

	CBO Score Of House Bill	CBO Score Of Baucus Bill
Costs	Reduce deficits: $104B/10yrs Cost: $894B/10yrs Spends on subsidies: $605B/10yrs On Medicaid/CHIP: $425B/10yrs On Small Employer Credit: $25B/10yrs	Reduce deficits: $81B/10yrs Cost: $829B/10yrs Spends on subsidies: $461B/10yrs On Medicaid/CHIP: $345B/10yrs On Small Employer Credit: $23B/10yrs
Insured	Uninsured reduced by: 36M Uninsured in 2019: 18M In Exchanges: 30M | Public Plan: 6M In Medicaid: 15M	Uninsured reduced by: 29M Uninsured in 2019: 25M In Exchanges: 23M In Medicaid: 14M
Revenue	Mandate penalty: $33B/10yrs Pay-Play penalty: $135B/10yrs New taxes: $572B/10yrs	Mandate penalty: $4B/10yrs Free rider penalty: $23B/10yrs New taxes: $196B/10yrs
Medicare and Medicaid	Total savings: 426B/10yrs Medicare Advantage: $170B/10yrs	Total savings: 404B/10yrs Medicare Advantage: $117B/10yrs

With a Single Payer solution it would be everybody in and nobody out - AND it would save a heck of a lot more money for everyone.

The difference is not just everyone being covered but HUNDREDS of BILLIONS of DOLLARS saved every year:   Read more…

[I won't quote a private email discussion, but I'll summarize it by saying that the poster made a suicide request by stating that "any stick to beat a dog"-style argumentation is justified. That's a rule 5 violation, for which the penalty is banning. -- lambert]

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A new fall guy is emerging from the health care reform ruins. Circus progressives, better know as pseudo progressives, such as BTD at Talk Left and Digby have started to blame president Emmanuel for caving in to industry without Republican buy in or aiding, the enemy, Snowe in her attempts to water down reform.

Don't remember voting for Emmanuel for president, consult your physician it may indicate for early Alzheimer.

Never let it be said that the scientists who publish in dry, staid medical journals lack a sense of humor. That resurrecting dead patients line is the title of an article that appeared in JAMA [Journal of the American Medical Association] a few years ago, and beyond the fact that it provided me with a snappy headline, gives me the chance to post one of my favorite lolcats [again], and is cited in another article in another journal, it has no further bearing on this post.

The another article in another journal, Looking Forward, Looking Back: Assessing Variations in Hospital Resource Use and Outcomes for Elderly Patients With Heart Failure, is monumentally less gripping than, oh, the last installment of Harry Potter, or even the labels on cat food cans, but it's nonetheless an important data point in the present health care deform reform debate.

To back up for just a moment, the Dartmouth Atlas Project is a massive gathering of data gleaned from Medicare spending records over many years. Mapping the data has produced the realization that Medicare spending varies widely throughout the country. Peter Orszag, President Obama, and Tom Harkin, to name just a few personages, are all quite taken with it, and with the Dartmouth researchers' assertions that the patients in higher-spending regions fare no better than those in lower-spending regions.

If only those spendthrifts in Miami and McAllen could be made to behave more like those prudent paragons living in Minnesota, we could save hundreds of billions of $$$$$ in health care spending every year.

Not so fast, corpus breath. The Dartmouth Atlas only catalogs dead people. The researchers looked back over the patients' lives for the 6 months [and for some purposes, 2 years] before they died. Concluding that since they all died anyway [duh!], the ones who got more care [and therefore cost more money], didn't really need all that extra care [and therefore we don't need to be spending that extra money on them].

It's an attractive notion, but one of the things the Dartmouth researchers didn't do so much of was looking forward.

Every health deform care wonk will tell you that unless we remake the US into one giant network of Mayo Clinics, we'll never get health care spending down to a reasonable level.

Meanwhile, although the original Mayo Clinic in Rochester MN and the satellite Mayo in Jacksonville FL haven't said anything, at least one Mayo in Arizona is opting out.

Health care reform panel set for Thursday night

Participants in the panel discussion include Washington, D.C. resident Donna Smith of the National Nurses Organizing Committee; Rob Stone, a Bloomington, Ind.-based emergency room physician and Indiana coordinator for Physicians for a National Health Program; and William Connolly, a professor of philosophy and religion at the University of Evansville and a member of the steering committee of Hoosiers for a Commonsense Health Plan.

This great quote at Shakesville made me go look for the answer to that question, which I'd been wondering about, and at Our Bodies, Ourselves, I found this:

Our Bodies Ourselves supports the single-payer model as the most effective approach for solving the United States' health and medical care crisis.

Long, and very wonkish, answer here. It's a nice primer, quite readable, and well worth your time.

The longer answer is more complex than just yes-or-no, because modern health care, even in the best of worlds, is complex. While I think that Medicare's labyrinthine payment system has just added to this problem, that's a subject for another day.

Meanwhile, the last two sections of the post make a nice summary:

And Another Thing...

One other consideration deserves attention.
Hospitals base their cost calculations on spreading the costs of various operating expenses evenly over all patients. However, there is at least one important area where Medicare patients actually cost hospitals considerably less than private insurance patients: the cost of billing for services.

Study after study shows that it costs hospitals 50% to 75% less to bill Medicare than to bill private insurers. In fact, for the mythical “average” hospital, the loss from Medicare of 3% to 7% may actually be cancelled out by the lower costs of billing. This is an area of hospital management where costs are actually being shifted from private insurance to Medicare, rather than the classic opposite.