BREAST CANCER HEADLINES: Breast Cancer & Politics

Your first assignment for the new year: learn more about the Department of Health and Human Services (HHS).

HHS is the United States government’s “principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.”

That’s a pretty broad mandate. To get it done, they have a bunch of different agencies:

• Administration for Children and Families (ACF)
• Administration on Aging (AoA)
• Agency for Healthcare Research and Quality (AHRQ)
• Agency for Toxic Substances and Disease Registry (ATSDR)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Service (IHS)
• National Institutes of Health (NIH)
• Substance Abuse and Mental Health Services Administration (SAMHSA)

Many of these agencies deal with breast cancer treatment and/or research, so it’s worth knowing who they are. The following are especially important for us:

Centers for Medicaid and Medicare Services (CMS) is the nation’s largest health insurer, handling more than 1 billion claims per year. Medicare provides health insurance for elderly and disabled Americans. Medicaid is health insurance for low-income people. Together they provide health care insurance for one in four Americans.

National Institutes of Health (NIH) is the nation’s medical research organization. It includes 27 separate health institutes and centers, including the National Cancer Institute (NCI), which is charged with leading a national effort to eliminate the suffering and death due to cancer.

The Food and Drug Administration (FDA) assures the safety of foods and cosmetics, and the safety and efficacy of pharmaceuticals, biological products, and medical devices — products which represent almost 25 cents out of every dollar in U.S. consumer spending.

Agency for Healthcare Research and Quality (AHRQ) supports research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It also provides evidence-based information on health care outcomes and quality of care.

As you can see, HHS is the lead agency for a lot of policies and programs affecting breast cancer. The Director of HHS could be a very powerful force for change in American health care. Or not.

(Next up: Meet Tom Daschle, our next Director of HHS.)

Filed under: Health Care Access, Health Care Quality, Health Care Research | 1 Comment »

The National Breast Cancer Coalition welcomes you to a new year of breast cancer advocacy.

Nothing– not wars or hurricanes or recessions or elections– nothing will distract us from our mission to eradicate breast cancer. In these turbulent and very troubled times, we remain steadfast in our commitment to:

• Increase the effectiveness of breast cancer research and the resources available to it
• Ensure that everyone has guaranteed access to quality health care
• Increase the involvement and influence of those impacted by breast cancer

With a new Administration and an economy screaming out for reform, there is sure to be a lot of policy-making in the coming year. No doubt many of these policies will impact breast cancer. It’s a year full of opportunity. And risk.

We’ll be blogging here about the issues we at the National Breast Cancer Coalition think are most important. Please join the conversation! We want to hear your thoughts, concerns and questions. We won’t accept any hostile comments, but welcome all perspectives.

For newcomers, you might ask, who is the National Breast Cancer Coalition?

We are a community of committed breast cancer advocates. We choose our battles carefully. We look beyond our own breast cancer to the larger issue of breast cancer itself. We always ask what is fair, what is effective, and what will make a real difference. We’re not afraid to tell the truth, even when it’s complicated.

In honor of your loved ones, please make a New Year’s Resolution to join us, in whatever way you can, to eradicate this insidious disease.  And please invite your friends and family to join us here, as we face 2009, together.

Happy New Year!

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Well, it certainly has been a newsworthy and blogworthy Fall. Thanks for joining us here at the Breast Cancer Caucus. We launched this blog in order to highlight breast cancer issues during this incredible presidential election. Of course our work is not done; it is just beginning. Our job now is to provide a specific vision for how to improve the research process, and for how to provide quality breast cancer care. It’s easy to complain about the status quo. Crafting effective solutions… that’s much harder.

The National Breast Cancer Coalition is ready. We have both the vision and the determination to get it done.

We all know that Obama is now busy preparing for 2009 so he can hit the ground running, and that’s exactly what the National Breast Cancer Coalition is doing. We’re ramping up: adding staff, expanding programs, developing new programs. We’re collaborating with the Dr. Susan Love Research Foundation to create an Army of Women– one million healthy women of every age and ethnicity to directly participate in the research that will actually end this disease. We’re also analyzing the existing research process to find innovative ways to dramatically improve the outcomes.

We’ll be transforming this blog into a more general conversation about breast cancer public policy. What’s happening? What should happen? How can we make a real difference? We’ll also be redesigning the blog a bit to make your visit here even more informative and interactive.

So stay tuned as we gear up. And remember, regardless of economic good times or bad, wars, natural disasters, elections or impeachments, the National Breast Cancer Coalition will stay true to its mission: eradicating breast cancer once and for all.

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Have we Americans been sold on the idea that “early detection” is always best?  

Check out Maggie Mahar’s recent post on Nortin Hadler’s interesting new book, ”Worried Sick.”

As Hadler puts it:  “the public-awareness program for cancer has been far more successful in promoting enthusiasm than reason.” Research shows that “Americans are willing to undergo screening without regard to the efficacy of the tests or the likelihood that they will lead to unnecessary treatment.” 

Unless they had a mammogram. Then they would probably find out and be treated—whether or not they need treatment. It  turns out that two-thirds of women over 55 who have breast cancer will die of something else.  Here are the numbers: In order to prevent one cancer death among women over 55,  250 women have to be screened annually, beginning at age 55.  But mammograms will also detect two other women with breast cancer who would not have died of the cancer  and would never have known that they had breast cancer. “In other words” Hadler points out, “the screening will lead to the treatment of three women, for two of whom the treatment is unnecessary.” In some cases, “treatment” means that they lose a breast.

Why can’t even one aspect of breast cancer be simple?

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So, what do breast cancer advocates need to know about Tom Daschle, our next Secretary of Health and Human Services?

The National Breast Cancer Coalition (NBCC) has been tracking the work of our elected officials for many years now, and Tom Daschle’s record is clear: he has been a great ally to breast cancer advocates.  When he was in the Senate:

• He was a consistent supporter of the Department of Defense Peer-Reviewed Breast Cancer Research Program (DOD).

• He not only signed on to the Breast Cancer and Environmental Research Act, but also sent a letter to fellow colleagues in the Democrat party urging them to cosponsor this critical legislation.

• During the 2001-02 Congressional Session, Daschle was the lead Senate sponsor of S. 318, the Genetic Non-discrimination in Health Insurance and Employment Act.  

And then, of course, there’s NBCC’s number one priority: guaranteed access to quality health care for all.  Mr. Daschle’s recent book about health policy ­“Critical: What We Can Do About the Health-Care Crisis” offers a clear and compelling plan for meaningful health care reform. 

Daschle proposes creating a Federal Health Board, similar to the Federal Reserve System, and merging employers’ plans, Medicaid and Medicare to create an expanded federal employee health benefits program that would provide universal coverage.  Many aspects of this plan are consistent with NBCC’s Principles for Guaranteed Access:

• Health care is a basic human right.
• Health care is fundamental to maintaining a productive society.
• Health care coverage must be guaranteed for everyone.
• The health care system must provide the same comprehensive benefits to everyone and must meet the public’s expectations.
• The health care system must be redesigned so that treatment and coverage decisions are based on evidence and best practices.
• All individuals must financially contribute to the system, based on ability to pay.
• The new health care system must be easy to use for patients and providers, and easy to administer.
• Any system of coverage must include these core values:
  • Access. Individuals must be able to get all the care they need when they need it. This must include meaningful access to evidence-based interventions.
  • Information. Individuals must receive information that is evidence-based, objective, complete and correct.
  • Choice. Individuals must have some choice of doctors and care.
  • Respect. Our health care system must treat the whole person, not just a person’s disease.
  • Accountability. Standards regarding care must be clear, uniform, and enforceable. Patients must have a right to sue if their basic human right to health care is violated.
  • Improvement. The health care system must have methods for measuring what is and is not working so that the quality of care can continuously be improved.  Individuals must have access to well designed and efficiently run clinical trials, and must have coverage of all routine care costs associated with participation in such trials.  

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The Institute for Healthcare Improvement (IHI) is an unusually innovative and effective organization promoting health care improvement.  In a recent interview with David Harlow from Health Blawg, IHI leader Don Berwick talks about his work and describes what he hopes to see in the next administration.  If you want to hear some commonsense, take a listen.

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When you read about health care, have you noticed the word “consensus” keeps cropping up? As in,

Unfortunately, there is no consensus on how to reform the health care.

OK, we understand that there are many competing and conflicting approaches to addressing this complex problem. We understand that bi-partisan efforts are essential to getting anything actually done. And there’s never been a better time to bring a wide range of ideas and perspectives together.

But consensus? This country has never had a consensus on any issue. (American Idol doesn’t count.) We don’t have a consensus on foreign policy, environmental policy, or labor policy. We don’t have a consensus on economic policy– not even close. So why do we need a consensus for health care reform? Any reform worth its weight will be extremely disappointing to quite a few stakeholders.

[Translation for people who live outside DC: a stakeholder is most definitely not a "steak holder," or at least very rarely. Where you live, you may simply hold your steaks with forks, but here, things are much more complicated. We even have multi-stakeholders.]

Frankly, if anything remotely like a consensus were possible, health care reform would have been done by now. Maybe we can all agree about that.

Filed under: Health Care Access, Health Care Quality, Obama | 1 Comment »

The National Breast Cancer Coalition has a very focused and specific mission: to eradicate breast cancer. So you might think that we would keep our “eye on the prize” by focusing only on policies that are specific to breast cancer.

Nope. We see the big picture, and we want to change it. We know that Guaranteeing Access to Quality Health Care for All is essential for anyone who cares about breast cancer. We’ve laid out a specific but comprehensive vision for patient-centered, evidence-based health care. It’s a proposal for sweeping reform because 1) it’s the right thing to do, and 2) anything less will fail. Why? As consumer advocates, we know that most consumers won’t accept evidence-based medicine if it’s really just cost-saving and nothing else. Americans are too individualistic and demanding to accept “less health care” simply because, as a society, we can’t afford it.

Don’t get us wrong. We’re fierce advocates for evidence-based health care, and we’re completely committed to dramatically reducing the truly bizarre sums of money Americans spend on health care.

But it has to be patient-centered to be quality health care. Denying a patient the latest and greatest interventions because there’s no evidence it works could certainly be called evidence-based care. But getting that information in a form letter five weeks after the request, staying on hold an hour to be told that the guidelines used are not available to the public, driving an extra 45 minutes to get to a doctor who is in-plan who then tells you that he really likes the latest and greatest intervention, it “worked for his patients”… really, what can you expect? A thank-you letter from the patient that the health insurance company isn’t burdened with an unnecessary expense?

Patients don’t trust the health care system because the system isn’t trustworthy. And as long as patients don’t trust the system, health care reform will continue to be contentious and irrational.

It is possible to create a trustworthy health care system, but that will take, well… big changes.

Ezekiel Emanuel, Chairman of the department of bioethics at the Clinical Center of the National Institutes of Health, has offered our next president some simple and compelling advice: think big.

In health care, big plans are necessary not only to motivate people but as a matter of sound policy. The health care system is broken. It is not enough to just add more people to a broken system. Health care reform must reorganize the system to deliver higher quality care while keeping costs under control. Incremental change that just covers more people will not be sustainable. Reform must include changing the delivery system and how we pay for care. The health care system needs major surgery, not more Band-aids.

Here at the National Breast Cancer Coalition, we wholeheartedly agree.

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It may not be as easy a read as the back of a cereal box, but Uwe E. Reinhardt of the New York Times has a nice piece on what this chart really means.

Filed under: Financing Health Care Access, Health Care Access | No Comments »

Sheryl Crow has been working with the National Breast Cancer Coalition to pass meaningful legislation that would fund innovative research on breast cancer and the environment.

In a recent interview Crow shares her personal and political perspectives. What a voice!

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