A government task force is recommending that men should stop receiving a routine blood test to check for prostate cancer because the test does more harm than good. At best, the prostate specific antigen (PSA) blood test will save one life out of 1,000 men tested, but another man will develop a dangerous blood clot, two will have heart attacks, and 40 will become incontinent or impotent because of unnecessary treatment.

The U.S. Preventive Services Task Force made this proposal to drop routine screenings last fall, and it’s sticking by the final guideline despite outrage from the medical community.

Not every form of prostate cancer needs to be treated because most of the cancers found through the PSA blood test are slow-growing and unlikely to cause harm, so a member of the task force said better ways to detect prostate cancer will help:

The controversy will end only with development of better tests — to finally tell which men’s tumors really will threaten their lives, and who will die with prostate cancer rather than from it, said Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force.

“We have been told for decades to be terrified of cancer and that the only hope is early detection and treatment,” she said. The reality: “You don’t need to detect all cancers.”

“We don’t want this to be the answer,” Moyer added. “We want to screen for the ones that are going to be aggressive, manage those early — and leave everyone else alone.”

Even with the new guidelines, it is unclear how many men will skip testing. The task force already recommends that men over 75 skip the blood test, but research shows that about half still have it. And for those who test positive and learn they have have prostate cancer, low-risk patients often choose aggressive treatments with few benefits, according to a 2010 study.

Overall, unnecessary health costs add $158 billion to the nation’s health care tab each year, and the Affordable Care Act invests in comparative effectiveness research to help determine the most cost-effective course of treatment to cut down on those unnecessary health costs. And to cut down on overtreatment, the task force’s guidelines to cut out PSA blood tests that do more harm than good — and lead to sometimes unnecessary treatment — are a good place to start.

As Americans used less medical services overall, health care spending rose at double the rate of inflation in 2010 because hospitals, outpatient centers, and other providers charged higher prices, according to a report by the Health Care Cost Institute.

Health costs jumped by 3.3 percent during the economic downturn even though people were using less care, so people with job-based insurance “are paying more and getting less,” said Chapin White, a senior researcher at the Center for Studying Health System Change. Hospitals and other medical providers “just seem to be able to raise prices faster than general inflation,” he said.

Health care costs grew the fastest for children under 18, and the prices for outpatient visits and inpatient admissions increased faster than other health services:

The analysis studied 3 billion claims paid by insurance companies Aetna, Humana, and UnitedHealthcare for 33 million people who have job-based insurance nationwide, but it does not include spending for people on Medicare, Medicaid, or who buy their own policies.

Along with the growing costs, average health care costs for a family of four have topped $20,000. The report by the Commonwealth Fund found that people in the U.S. spend more on health care per person than any other developed nation, but do not receive the best quality of care.

Insurers argue they simply pass on the rising cost of care to consumers, but because of the rapid increases, these two reports about rising health care costs highlight why the U.S. needs the Affordable Care Act. President Obama’s health care reform law will help reduce costs and improve quality, which is key to making health insurance more affordable.

One major goal of the Affordable Care Act is to slow the growth in health care spending without compromising on the quality of care. So far, it seems to have done that, bringing projected Medicare costs down by nearly $70 billion, according to the Congressional Budget Office. Now, spurred on by Gov. Deval Patrick (D-MA), the state that created the blueprint for Obamacare is following its lead.

Last night, the Massachusetts Senate passed a bill projected to trim $150 billion off state medical costs over 15 years. As the Boston Herald reported, health care spending currently consumes about 40 percent of the state budget and is expected to double by 2020. This legislation, passed by an overwhelming 35-2 vote, aims to reduce that burden by changing the way medical professionals care for patients and taking steps to keep Massachusetts residents healthier:

The bill, which was debated over two days in the Senate and required the consideration of 265 amendments, would seek to limit health care cost growth to a level at or slightly above overall state economic growth.

It aims to achieve that goal by encouraging hospitals and doctors to adopt new care delivery and payment models focused on patient outcomes rather than quantity of care provided, and would transition state-funded health care programs away from fee-for-service to alternative payment systems by 2014.

The Senate has also proposed to invest $100 million over the next five years in a transition to electronic medical records, and another $100 million in wellness and prevention programs paid for with an assessment on insurers.

Celebrating the vote, Senate President Therese Murray said Massachusetts “[o]nce again” leads the U.S. on health care. Moving medical records to an electronic format is expected to reduce administrative expenses, while prevention initiatives could cut health care costs by potentially billions of dollars, reducing the burden on taxpayers without negatively impacting care. A study released last year, meanwhile, found that doctors will improve the quality of care if their performance is tracked.

Leaders in the Massachusetts House have their own version of this bill that differs from the Senate version, including a luxury tax on some high-cost hospitals featured in the House version, which Murray said she would not support. An architect of the bill, Sen. Richard Moore (D), said he hoped “the bulk” of the bill would ultimately become law.

-Zachary Bernstein

One of the goals of the Affordable Care Act is to keep health care costs from ballooning. So far, it has done some good; the law has already helped push Medicare costs lower, required insurers to keep administrative spending low or pay customers rebates, and created prevention programs to fight chronic diseases like heart disease or diabetes.

Now, a new report from Fidelity Investments shows that the law is already lowering future costs for retirees. Health care costs have increased for years, but in 2011, the firm projected a decrease as a result of the changes included in the health law. Seniors will now pay $20,000 less for their medical bills through retirement:

Fidelity has calculated an annual estimate of medical expenses for retirees for more than a decade. For many Americans, health care is likely to be among their largest expenses in retirement. The estimate, which is calculated by Fidelity’s Benefits Consulting business, does not include any costs associated with nursing-home care and applies to retirees with traditional Medicare insurance coverage.

The estimate has increased an average of 6 percent annually since Fidelity’s initial calculation of $160,000 in 2002, with the exception of 2011 when the estimate declined $20,000. That one and only decrease in the history of the estimate was due to a one-time adjustment driven by Medicare changes that reduced out-of-pocket expenses for prescription drugs for many seniors.

Those Medicare changes included alterations to the so-called “donut hole,” the coverage gap for prescription drugs for older Americans. Under the law, generic medications in the “donut hole” will be discounted until 2020, when the gap will be eliminated. So far this year, that provision has saved Medicare recipients $3.4 billion, more than for all of 2010 and 2011 combined. Millions more have cut costs by taking advantage of free preventive health services.

This estimate can still change, however. According to the Associated Press, if the Supreme Court strikes down the health care law this summer, Fidelity analysts say they will “update” the number. In all likelihood, that revision would be considerably higher.

– Zachary Bernstein

A new study shows that roughly 42 percent of all Americans are expected to be obese by 2030 if the nation’s obesity rate continues to rise at the same rate. But if the rate stays where it is instead of increasing by 33 percent, the U.S. would save $550 billion in health care costs over the next 20 years. Even a 1 percent decrease in the obesity rate would save $85 billion, according to the analysis released today at the Weight of the Nation conference. The Centers for Disesase Control and Prevention sponsored the conference and helped with the research that highlights the financial consequences of the obesity epidemic, according to NPR:

That rapidly growing group of severely obese people, who have the most medical problems and incur the highest health care costs, will rise from about 5 percent of the population now to 11 percent by 2030, researchers suggest.

The findings are meant to be a call to action, as experts gathered at the CDC conference consider how best to to combat obesity, a public health problem that affects about 78 million adults and 12.5 million children and adolescents.

Obesity already accounts for 21 percent of health care spending, and experts warn that the next generation may have a shorter life span because of how many Americans are considered obese. But this research proves that a small dent in the rising obesity rate could impact rising health care costs. Now if only House Republicans would stop trying to cut prevention initiatives to help improve people’s health.

A new report out today from the Commonwealth Fund examined health care spending among 13 developed nations, including the United States. According to the report’s findings, the United States spent far more on health care than any other developed nation – “nearly $8,000 per person in 2009.” But the researchers found that the higher level of spending did not correspond to a higher quality of care:

High U.S. spending on health care does not seem to be explained by either greater supply or higher utilization of health care services. There were 2.4 physicians per 100,000 population in the U.S. in 2009, fewer than in all the countries in the study except Japan. The U.S. also had the fewest doctor consultations (3.9 per capita) of any country except Sweden. Relative to the other countries in the study, the U.S also had few hospital beds, short lengths of stay for acute care, and few hospital discharges per 1,000 population. On the other hand, U.S. hospital stays were far more expensive than those in other countries—more than $18,000 per discharge. By comparison, the cost per discharge in Canada was about $13,000, while in Sweden, Australia, New Zealand, France, and Germany it was less than $10,000.

“It is a common assumption that Americans get more health care services than people in other countries, but in fact we do not go to the doctor or the hospital as often,” said Squires. “The higher prices we pay for health care and perhaps our greater use of expensive technology are the more likely explanations for high health spending in the U.S. Unfortunately, we do not seem to get better quality for this higher spending.”

Prescription drugs were also found to be far more expensive in the United States than several other countries, and Americans used expensive technology like CT or MRI scans more frequently. According to the researchers, meanwhile, while the U.S. had the best survival rates for breast and colorectal cancer, the survival rate for cervical cancer was below average. The rate of asthma-related deaths among people aged 5 to 39 was also high, as were amputations for people with diabetes.

This chart details how much the United States spends on health care per capita compared to other developed nations:

This one compares survival rates for three types of cancer:

Previous studies have cast doubt on the effectiveness of more expensive treatments. Meanwhile, the health care reform law encourages physicians to focus on quality rather than quantity of care in an effort to bring down health care costs.

-Zachary Bernstein

Our guest blogger is Christopher Lillis, a full time private practice Internist in Fredericksburg, Virginia. He has been a member of Doctors for America since its founding in 2008.

This weekend, Speaker of the House John Boehner (R-OH) defended a GOP bill that offsets the costs of extending lower interest rates on federal student loans by eliminating the Prevention and Public Health Fund, a provision of the Affordable Care Act that seeks to bolster public and preventive health. Other opponents of the Prevention fund have maligned it as a “slush fund.”

As a practicing physician, I see investments in prevention and public health quite differently. Engaging in preventive care in my primary care practice allows for the early detection of disease, which eases the treatment of so many illnesses. Obtaining a mammogram, considered preventive care, allows for the early detection of breast cancers. Catching a breast cancer at its earliest stage allows for a cure, whereas detecting breast cancer at a late stage often means engaging in chemotherapy and radiation in an effort to extend survival without hope for a cure.

But we are not just talking about funding prevention at the individual level. We need to shift the focus of our health care system from one that only treats disease, to a more sensible system that prevents disease and encourages wellness.

Diabetes is a disease that is exploding in our nation. Two million new cases a year are being diagnosed in America. Twenty five million already have diabetes, and another 79 million have the precursor of diabetes: an elevated blood sugar. This one disease alone may cost America $200 Billion dollars annually. However, diabetes is distinctly preventable, even more so than most other conditions. By eating a healthier diet, getting daily exercise, and avoiding sugary beverages, many can avert diabetes completely. To attack the American diabetes epidemic, we need to focus on preventive health and public health. Better walking trails, nutrition education and coordinated care – all provided for in the Affordable Care Act – will be needed to stem the tide of new diabetes diagnoses.

In the United States, we spend a paltry 3 percent of all of our health care dollars on public health. For this, we trail the industrialized world in infant mortality rates and life expectancy. We can do better as a nation. We can do better as a health care system. My prescription: invest more in public health and preventive health – it will lead to a healthier country that can be more productive and significantly reduce our exploding health care costs.

In my home state of Virginia, $6 million has been allocated to bolster public health projects including tobacco cessation programs. In Colorado, funds went to improving the nutrition in public schools. In Ohio, funds were used to ensure that 4,000 additional students could safely walk to school. This is not a slush fund. This is investing in America’s health and wellness. To see how the prevention fund is being used in your state, check here.

Unnecessary health costs add some $158 billion to the nation’s health care tab, and requiring women to undergo pelvic exams before receiving a prescription for birth control pills only adds to this total. As Mother Jones’ Stephanie Mencimer explains, despite any evidence showing that the annual exam improves health outcomes, one-third of doctors always require women to undergo a Pap smear before they prescribe hormonal contraception, and 44 percent regularly do so:

For instance, there’s no evidence that doctors can diagnose ovarian cancer with a pelvic exam in women showing no symptoms. A clinical trial found that doctors were unable to identify any cancers in test subjects by pelvic exams alone, and the National Cancer Institute no longer recommends the tests for postmenopausal women. [...]

The scientific basis for much of the traditional well-woman ob-gyn annual check-up is so slim that “the routine pelvic examination may be an example of more service leading to worse outcomes,” Dr. Carolyn Westhoff, an ob-gyn at Columbia University, wrote in the Journal of Women’s Health last year.

So why are doctors so adamant about the additional testing? Drug and medical device companies fund most continuing medical education, which is primarily how doctors learn about new science, and these industries are not interested in limiting care, Shannon Brownlee, a health policy expert at the New America Foundation, explains to Menicmer. Under the existing fee-for-service health reimbursement system, doctors are also paid for every additional procedure — regardless of whether it actually improves patient care.

Delinking pelvic exams from women’s birth control prescriptions underscores the importance of health research in guiding health care decisions. The Affordable Care Act invests in comparative effectiveness research to help determine the most cost-effective course of treatment, and it also begins to recalibrate the system so we stop paying doctors for unnecessary care and instead reimburse them for treatments that only bolster patient outcomes.