Obama's Preventive Care Pitch

Last night, President Obama made a pitch for preventive care in his address to a joint session of Congress on health care:

"And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives."

As a doctor who has held the hands of patients dying from totally preventable illnesses, I couldn't agree more. The largest number of deaths in the United States are caused by two preventable causes - tobacco smoking and high blood pressure - killing an estimated 467,000 and 395,000 people respectively in 2005. The list goes on and on, including obesity, physical inactivity, and poor diet.

When I was working in the emergency room as a medical resident, it was heartbreaking to see a patient with poor routine medical care roll into the emergency room with a devastating stroke that could have easily been averted with regular office visits and blood pressure medication - both relatively inexpensive compared to the cost of caring for the stricken patient.

We're not preventing enough deaths by the types of cancer screening tests mentioned by President Obama. One reason is the technology is still not good enough. We need to develop better screening tests that pick up problems early but don't lead to an unacceptable number of unnecessary biopsies, procedures, and further tests. And not enough patients are screened. Only about about 60 percent of women get mammograms and about 50 percent of men and women get routine colonoscopies.

Lack of insurance coverage is certainly a big reason why some patients don't undergo screening. Another reason is patient fear and misunderstanding. In order to educate the public about the risks of colon cancer and the benefits of screening exams, Katie Couric underwent a colonoscopy on national television in March, 2000. Three years later, researchers at the University of Michigan found that colonoscopy rates jumped by 20 percent across the country following Katie's procedure, calling the rise the "Katie Couric Effect."

It's almost 10 years later and we're still not screening enough patients. Although the death rate from colon cancer has - likely mostly because of screening efforts - colorectal cancer still strikes almost 150,000 Americans every year and kills about 50,000.

As a gastroenterologist, I have seen patients' lives saved by the removal of polyps and early cancers found by colonoscopy. I have also taken care of patients whose colon cancers were found too late to save them. Over the years, I must have heard every excuse for ducking a colonoscopy. The top four (and my answers):

I have no symptoms (most colon cancers start small and have no symptoms until they grow larger.)

I have no family history of colon cancer (that's true in about 70 percent of patients with colon cancer.)

I'm afraid it will hurt (that's why we use sedation and, if needed, anesthesia.)

I can't do the prep (we'll figure out a way to clean out your colon that you can tolerate. And even if you have a tough night, it sure beats chemotherapy.)

For this week's CBS Doc Dot Com, I follow Katie's lead and undergo a colonoscopy with cameras rolling in an attempt to remind people that a screening colonoscopy can save your life. I had the benefit of a house call the night before by my office nurse, Debbie Fitzpatrick, who held the video camera and offered advice and encouragement as I had a taste of my own medicine: the colon cleanout solution. The colonoscopy was performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. For more information about the Jay Monahan Center,


For more information about screening for colon cancer, click here.

To watch my colonoscopy, click below:


Watch CBSNews Videos Online

[babooph]

From the last election results ,Obama clearly cured many republicans from delusional thoughts-I will have to go with him on this one ....

[publiccitizen1953]

It is a sad day in the USA that we can say of instead of We the people, we should say We the corporate interest. Don't beleive it look at your elected officals, and the hundred of thousands they get paid in campaign contrabutions. Also look at there votes on matter of Dugs, and Heath Care we get here in the U.S.A. wITH 45,000 people a year due to lack of insuance, tens of millions without insurance, and millions that have to filing bankruptcy due to inadequate coverage. Seems to me that this would be a no brainer. We have the best heathcare in the U.S. trhat your congress well allow, brought and paid for by drug, and insurance compaines!

[chasrodz]

Wonder why President Obama refuses to consider the (National Medical Coverage Support Plan) as a support to his Health Reform, even though this supplemental Health Care alternative would save the government billions of dollars yearly.
A plan proposal, called the? National Medical Coverage Support Plan? (NMCSP) has been sent to the president over the last few months. This plan is a collaborative effort to enhance the Nation?s public health systems, enabling them to provide quality health care to America?s poor and uninsured. It would provide free or very low cost sliding scale pay according to ability ($1.00 to $10.00 per visit), to over 90 million of America?s poor and uninsured population; enhance the quality of health to this population; and greatly improve the performance and capacity of our public health system. The plan would accomplish these objectives by:
1. Greatly increasing the medical personnel of public health systems, at a very low cost.
2. Providing free or low cost medical attention to poor and uninsured citizens, at the public health community
centers.
in English. (Translators would not represent a cash outlay for the government).
4. Reducing governmental medical personnel cost, (to less than 20% of the cost of actual medical personnel),
thus allowing more money to be channeled more vital areas.
5. Eliminating over-billing, and over-utilization of unnecessary medical treatments and procedures.
6. Reducing medication cost. 3. Providing free translators to assist medical personnel in minority areas whose population is relatively non-fluent

7. Eliminating unnecessary hospitalization cost and stays.
8. The program will provide access to free medical coverage for more than 90 million Americans.
9. It will improve general health and lower morbidity among these citizens.
10. It will lower incapacitating and chronic illnesses for this population.
11. It will decrease mortality due to un-diagnosed or un-attended silent diseases such as diabetes or ypertension.
12. It will increase man-hour performance in the workforce.
13. The program will increase the effectiveness and work capacity of thousands of Public Health Centers.
14. It will decrease government expenditure for unemployment compensation, due to illness.
15. It will provide low cost governmental outlay for this new additional medical workforce.
16. It will increase pride, self esteem, and community sensitivity for those serving in the program.
17. It will provide better care with a translator system in place.
18. It will provide a larger and healthier workforce in America.
19. It will create jobs for tens of thousands of Americans, e.g.(service providers for this new workforce)
20. The program will deal directly with the present and future medical doctor shortage.
21. The program will deal directly with the present and future nursing shortage.
22. The program will act directly to incorporate international medical graduates more justly into the American
medical workforce.
23. The program will produce more patient-sensitive medical and nursing practitioners.
24. The program will produce a greater orientation toward preventive medicine in the medical and nursing
personnel.
25. A healthier population reflects in better family and community relations, which in turn mitigate the negative
psycho-social effects of an unhealthy population, thus lowering the crime rate.
26. The translation service will increase rapport and trust in doctors, thus increasing patient compliance with
treatment, and consequently increasing treatment effectiveness.
P.S. Whole plan can be reviewed at http://meetooo.bravehost.com/index.htm

[sjc_1]

I can remember JFK's President's Council on Physical Fitness and the "vigor" health can bring. I can remember how HMOs were suppose to bring about prevention, they prevented people from getting care and increased their profits. Everyone knows good health is a great thing, but so many people are worried about losing their jobs and not being able to pay their bills, it is not high on the list right now.

[Stevenapoli7]

Not so fast Obama. Depends on the test and the disease. 81% of the time if you tested everyone, it would cost the system more. In my opinion the cost is worth it because you catch a lot of things early. But it's a lie to say it will save money; it will cost much more money.

For example, treating a full blown case of disease X costs $50,000. If you can test for it early with a $500 test, after 100 tests you would reach the $50K. With this pretend disease, the "system" is only saving money if the disease affects 1 in 100 people. If it affects 1 in 10,000 people, you are spending $5 million dollars to save $50,000.

A study published recently in the New England Journal
of Medicine called the idea that prevention saves health care
resources ?misleading.? While the study conceded that some 19
percent of preventative health measures do save money, it found
that ?the vast majority reviewed?do not.?

My bottom line, worth doing the tests, but people will have to pony up some of the dough themselves, if it's important to them.