So, it is good to know that Barack Obama checked out o.k. on his first yearly physical as President of the United States. Other than his continued smoking, and apparently a need to ‘moderate’ his drinking, all is well. (I will let you read into that what you will).
But I thought the most interesting thing that came out of the exam is what they did…and what it means for the rest of us.
Obama underwent a virtual colonoscopy. For those that don’t know, a virtual colonoscopy (otherwise known as a CT colonoscopy, or VC for short) is an option patients can choose instead of a traditional colonscopy, which is more invasive because it uses the passage of a camera through the colon. In VC, a CT examination is performed using specific techniques that allows relatively good views of the colon, and can be relatively good in ruling out colon cancer.
Now, first, understand something. I am, by profession, a radiologist. And so I am, by nature, biased. I read a fair amount of VCs, so of course I think it is beneficial. So take this as a slightly biased opinion; as if most of my opinions are not biased.
But here is where we get to the interesting part, as far as public policy is concerned. Last spring, the Centers for Medicare and Medicaid Services conveniently stopped paying for virtual colonscopy.
The Centers for Medicare and Medicaid Services (CMS) said, “We have determined that there is insufficient evidence on the test characteristics and performance of screening CT colonography in Medicare-aged individuals, and that the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average-risk Medicare beneficiaries.”
Dr. Sean Tunis, a former chief medical officer for Medicare, said that there had been cases where a tentative coverage determination had been changed but that this one seemed to be “pretty carefully and fully considered. I personally would be a little surprised if the final decision were different,” Dr. Tunis said.
Now, Mr. Obama is not a Medicare beneficiary, to be sure. But assuming his health report is accurate, he is asymptomatic, and of average risk.
So what are we to conclude from this?
Your first guess, if you are a layman, would be that VC is too expensive. But VC costs from $400-$800, give or take. The average traditional colonoscopy? About $2,500. So that is not the reason.
One rationale is that if one were to find polyps during a VC, then a traditional colonscopy would have to be performed anyway. In the general population, this would decrease the overall savings from performing the cheaper procedure. However, this still belies the point that VC is cheaper, and most of the studies show that it is relatively good at finding colon cancer. So until there is proof that it is truly more expensive in the long run (and no such proof exists in the medical literature as of this date), wouldn’t you defer to the cheaper procedure?
Not if you are the United States government, obviously.
This is a microcosm of everything wrong with government health care. Here is a procedure, virtual colonscopy, that is cheaper and less invasive than the alternative, and has been shown to be relatively effective in detecting cancer. Yet, some expert somewhere in the government bureaucracy decided that it wasn’t good enough…and millions of people on Medicare don’t have it as an alternative. In fact, many private insurers, after the CMS decision, decided not to pay for the procedure as well.
This is exactly what we face with Obamacare. Obama specifically has a provision where experts will decide what should and should not be covered…in fact, the provision was carried over from…you guessed it…CMS.
If the media has any brains (and they don’t), they would demand to know what the reasoning was for Obama to get a VC instead of a traditional colonscopy. Not to mention…did he pay out of pocket? His own department, CMS, has determined it is neither cost effective nor a good enough detection tool for them to pay for their recipients. If that is the case…why use it on the most important man in America?
P.S. – One interesting note from a friend…if you are on Medicare Advantage, many of the programs do pay for virtual colonoscopy. So the one program Obama wants to kill…is the one that provides equal benefits to the President. That speaks volumes.