BREAST CANCER AND POLITICS

The National Breast Cancer Coalition is gearing up for its annual advocacy training conference on May 2-4, 2009.  Registration is at a record high, and the entire Coalition is coming together to reinvigorate our grassroots.  We’re marking the occasion with a new logo and a fresh look at our all web resources, including this blog.  Don’t miss it!

We’d love to hear from you.  What do you want to see in this blog that you can’t get anywhere else?  What aspects of breast cancer policy do you want to learn about?  This blog, like everything the National Breast Cancer Coalition does, is for YOU, our grassroots network of committed advocates.

Hope to see you at the conference!

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Gov. Kathleen Sebelius has apparently paid her taxes and is ready to take on reforming our broken health care system.

An early supporter of Obama, Gov Sebelius has been working doggedly to expand health care in her home state of Kansas.

A few weeks ago, in her state of the union address, she proudly announced the launch of a Kansas Comprehensive Cancer Center:

Over the past few years, scientists have made tremendous strides in early detection and treatment, so that a cancer diagnosis is no longer an immediate death sentence. We’re fortunate to have a team of researchers at the University of Kansas who are already finding new cures.

We now have an opportunity to create a Comprehensive Cancer Center… The application for National Cancer Institute designation will occur in 2011; and, if successful, has enormous potential as an economic engine, estimated to generate $1.3 billion dollars annually, and create nearly 10,000 new jobs within a decade.

Just as important, Kansans won’t have to travel out of state for cancer care, and our State will contribute to the national goal of finding cures in our lifetime.

The National Cancer Institute designation is another prospect on the horizon, with the potential to impact our state and our citizens for generations to come.

The National Breast Cancer Coalition is looking forward to working with Ms. Sebelius to ensure that all the talk and all the dollars being tossed around actually translate into quality health care– for all.

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Calling all breast cancer advocates who dearly want meaningful health care reform to actually happen… Please,

1) Pay your taxes.

2) Go get elected.

3) Keep paying your taxes.

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To keep up with the health care reform debates, you’ll need to know what a Federal Health Board does– or rather, could do.

It doesn’t exist yet. But if Tom Daschle can explain away that little tax mix-up (Oops! He just forgot about that $128,000 of taxes. Don’t worry about it, Tom, little six figure mishaps happen to all of us) we’ll be hearing about a Federal Health Board very soon.

The idea is to create a Board that can make fair and logical decisions about what health care interventions the federal government should pay for.

It seems pretty obvious: we want to pay for interventions that actually work. The way you know if a particular intervention works is by studying it — medical research. So we want to pay for drugs and procedures that are backed by solid evidence.

Of course it’s not that simple. There’s good quality evidence and bad, preliminary evidence, evidence that just “suggests” something, conflicting evidence, evidence based on biased research, wishful thinking, faulty logical… you get the idea.

That’s why you can’t just make a computer program and be done with it.

Members of a Federal Health Board would be appointed rather than elected, so it would be easier for them to do the right thing, even if the decision is very unpopular.

Not that long ago, our government tried something like this. Dennis Cotter, who has been assessing medical technologies for almost 30 years now, shares a cautionary tale in a Health Affairs blog. Here’s the really short version:

In 1979, the Department of Health and Human Services created a National Center for Health Care Technology (NCHCT). Their job was to figure out how well medical technologies (old and new) actually worked. They started to do just that, found (surprise!) that some of the technologies we were using a lot were a waste of money. This deeply offended (threatened the livelihood) of some in the health industry, who managed to get the NCHCT budget cut to… zero.

NCHCT
1979-82
RIP

The fear was that, by letting the government decide what should be covered (in federal health care programs) we would end up with socialism.

Well, we certainly have avoided socialism. No doubt about that.

Let’s hope this time around, the idea of the government paying for what works and not paying for what doesn’t work is given a little more consideration. After all, we’ve been trying the alternative for a long time now.

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The Kaiser Family Foundation and the Harvard School of Public Health recently presented the results of a recent survey on attitudes about health care reform. Most of it is just what you’d expect: Democrats are a lot more enthusiastic about major health care reform than Independents or Republicans. Big news.

We spend too much time asking people what they want, or what they don’t like, and not enough time discussing what good health care should look like. What would it look like if we did it right? It’s not an easy question, but it’s the right question. When we get specific and practical, we have to really struggle with tension between individual desires and limited resources.

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Live from Washington DC, this is the National Breast Cancer Coalition welcoming Barak Obama to his new post. We wish him the very very best.

If you’ve dealt with breast cancer, you know what the President means about hard times– bracing for the icy currents– and the power of hope.

Now let’s see some real health care reform.

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There’s already a flurry of health care reform packages on the Hill. If you are a policy wonk at heart, you can snuggle up near the hearth with the Commonwealth Fund’s just published (and very thorough) comparison of current health care proposals.

But before placing any bets on any of the current proposals, let’s not forget this important question: What does Tom Daschle, the soon-to-be head of the Department of Health and Human Services, want?

It wasn’t long ago that he wrote down exactly what he wants. His Book “Critical: What We Can Do About The Health Care Crisis” was published less than a year ago. At the risk of over-simplifying, here are the basic components of Tom Daschle’s vision for health care reform:

• Keep the employer-based system that we have.

• Strengthen Medicaid, Medicare and The State Children’s Health Insurance Programs.

• Open the Federal Employee Health Benefits Program to anyone without job-based insurance.

• Subsidize people who can’t afford it.

• Create a Federal Health Board, kind of like the Federal Reserve Board.

• Have Board members confirmed by the Senate and serve for very long terms (10 years).

• Give the Board the difficult work of determining what interventions/services should and should not be covered– what is “cost-effective.”

• Task the Board with other important roles as well, such as promoting quality and transparency.

• Any insurer/provider getting any federal funds would have to abide by the Board’s decisions, so it would in many ways become the “Supreme Court” of health care policy.

What’s not to like? A recent Wall Street Journal opinion piece by conservative Tom Bond answers that in some detail. If you’re opposed to a national health system, a “National Health Board” like the one Daschle has proposed sounds like a nightmare.

But as the status quo is getting more untenable, the naysayers are getting quieter. 2009 will be the year that Americans take a really close look at health care. Whether we want to or not.

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OK, a quick quiz on the last blog: what are the agencies that make up the Department of Health and Human Services (HSS)?

You don’t recall?

Well, Tom Daschle will know that list well, because he is going to lead them all. He is also going to be chief of a new White House Office of Health Reform. So if you care about breast cancer, it’s time to get to know Tom Daschle.

Tom Daschle is the former Democratic Senator of South Dakota (1994-2004). He is the third longest serving Senate leader in party history. (Wow!) He is also the first Senate leader in half a century to be voted out of office. (Not so wow.)

He has supported the National Breast Cancer Coalition’s agenda.

For a thorough discussion of what we might expect from “Health Czar Daschle,” check out Jeff Goldsmith’s interesting article on Health Affairs Blog.

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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.)

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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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