Your Thoughts Please: Nebraska Colorectal Screening Bill

[Holly]

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[Edward]

Hi Holly,

As you know, I have been working on a getting a screening bill passed in PA. One of the things I think you have to your advantage is I believe Nebraska is a unicameral assembly. Legislation only has to pass one body.

You can check out my blog on this at:

www.coalregionvoice.blogspot.com

One of the uphill battles we have in Pennsylvania is that our General Assembly (both houses) can tap dance around rhetoric without really going on the record. Also legislation has to be voted on and brought out by the committee where the bill originates. Last session, basically one man decided if the bill was going to make it out of committee.

The PA government sometimes makes the feds look like neophytes. Google " Pennsylvania Legislative payraise" "Vincent Fumo" and " PA legislative staff bonuses". If you think our current federal admin keeps the public in the dark, they have nothing on the way the PA General Assembly had operated for the past 25 years. Once elected, it is hard to loose if your an incumbent. You loose based on personal scandle not on legislative performance.

I could best describe it as a hockey game and you have to "Grind". Dig the pucks from the corner, check and cover the blue line.

This session thought, our new banking and insurance chairman is on the record supporting the same bill in the last session. Also, there is story about Northeastern Blue Cross using a 175 million dollars.....get this.....to fund a medical school. We have had rhetoric in PA for years about employers not being able to afford premiums and dropping coverage or closing down all together. Then they blame the unions.

In President Bush's State of the Union, he offered some suggestions in code. The idea is to crack to code. From my guess, he want's to get big business out of providing health insurance to employees in the long run. Leave it up to the individual through a tax incentive. Goldman Sach's paid out 16 billion in bonuses this past December, PA's state bugdet is 27 billion. Will big business use this new found wealth to grow the wage or will it stay at the top? Is every individual able to read the fine print of their indvidual or family plan? Will more people roll the dice? A good read on insurance reform is RJ Eskow's the Sentinel blog about universal coverage and insurance reform.

Once again check out my blog above and draw your own conclusions.

[missjv]

HI GUYS,
WHAT ABOUT THE AGE FOR COLON CANCER SCREENING? WILL INSURANCE PAY FOR PEOPLE YOUNGER THEN 50? I THINK THE GOVERNMENT NEEDS TO CHANGE THE SCREENING AGE ANYWAYS BECAUSE THERE ARE SO MANY OF US DIAGNOSED UNDER THE AGE OF 40 AND AS I LOOK IN THE WAITING ROOM AT MY ONCO'S OFFICE WHO ONLY DEALS WITH COLON CANCER PATIENTS SO MANY OF THEM ARE UNDER 50. ALSO SO MANY YOUNG PEOPLE ARE DIAGNOSED WITH ADVANCED CANCER BECAUSE WHEN THEY PRESENT THEIR SYMPTOMS TO DOCS THE COLON CANCER THEORY IS BLOWN OFF BECAUSE OF THEIR AGE AND THEIR DISEASE SPREADS AND THEY DON'T KNOW THEY HAVE IT UNTIL THEY ARE VERY SICK. SO MANY PEOPLE HAVE THE MAGIC AGE 50 IN THEIR HEADS FOR THIS TYPE OF CANCER AND IT IS A SHAME. EVEN WHEN YOU GO TO SITES LIKE WEB MD AND PLACES LIKE THAT ON THE WEB THEY MENTION AGE 50 AND SOME SITES GO SO FAR AS TO SAY IF YOUR UNDER 50 THOSE SYMPTOMS COULD BE IBS OR HEMROIDS AND THAT IS WRONG CAUSE YOUNG PEOPLE WILL TAKE THAT AS WHAT THEY HAVE AND NOT GO GET CHECKED.

MISSJV

[Edward]

In the study done in PA says 90% of new diagnosis occurs in 50 and older.
The way the bill in written in PA includes family history that copies ACS guidelines.

I was diagnosed in 2002 at age 36 without a family history. I guess it was the way my primary doctory wrote up the order for the insurance company. Maybe I was lucky? I hate to see people lose a medical fight due to an insurance question.

[Magnolia]

My first thought is that a watered down bill is not good enough. Compromise is not a bad thing, but if you aren't getting what you need from the bill, don't support it. If it's essentiall what you want, with a few little concessions, go for it.

As for the age thing, that's a tough issue. Colonoscopy is an expensive and invasive test. Screening everyone, regardless of age or risk, would not be feasible. However we do seem to be seeing more people under 50 without the classic risk factors being diagnosed. It probably still doesn't warrent screening all asymptomatic young people. The yield would be just too low. The vast majority of young people have perfectly healthy colons. I do think the index of suspicion should be higher. That means that colonoscopy should be ordered, and paid for, at the first sign of symptoms that don't respond readily to conservative treatment. Age should not be a factor here. Unfortunately, even for over-50's, it's hard to get colonoscopies paid for. A scope done for symptoms is not a screening colonoscopy. It's referred to as diagnostic and more likely to be covered. It's a good idea to keep track of any symptoms you have and tell the best story you can so your doctor can document everything for the insurance company, even if you're SURE that bleeding is just a hemmorrhoid.

As the world becomes more aware of us and our disease, maybe eyes will open the way they've done with breast cancer. We need to make more noise. Colonoscopy saves lives. Spread....the word.

[Holly]

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[nodo]

Holly,

Do you have a link to this bill? I would be interested to read it. In my former life, I was an attorney/lobbyist and dealt in the health care arena mainly. I promise, I did not work for insurance companies! Anyway, please let me know as I would love to read it. Thanks.

[Holly]

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[nodo]

Holly, Thank you. Even if you could send me the bill number, I could try and find it myself. Hopefully, your dad has been able to offer some thoughts on your testimony. You are correct about insurance - it is very important. I have been lucky to have wonderful coverage and have never had anything questioned. They even covered all my genetic testing without even a question. I am so thankful for that. I understand that it would be wonderful to have a bill that was comprehensive and had everything that you wanted in it with respect to coverage for colon cancer screenings and treatments. However, that's not always the reality with legislation, especially when dealing with a powerful lobby such as the insurance companies. So, sometimes it takes baby steps. If this bill is a step in the right direction, maybe it's okay to take a little piece and work for more later. Thanks for all you do for those on this site.

[Magnolia]

Holly, I have a love/hate relationship with insurance companies. I appreciate the importance of coverage, and have worked hard to make sure my family has had at least some coverage no matter what our employment status was at any given time, although I may have had my "happy 50th birthday" scope at 50 instead of 51 if I had had better coverage at the time. It may have made a difference in staging. No sense in wondering now. I didn't qualify for anything like good affordable coverage because of other factors at the time. I had something, but not adequate coverage. My husband and kid had better coverage. Then my husband got group coverage for all of us through his new job. Happy day!

What really bugs me is the way payors, whether private or government get to manage our heathcare. THEY end up deciding who gets what tests and treatments, rather than the doctors and patients themselves. If your payor decides you only need a sigmoidoscopy, you get a sigmoidoscopy. You can forget about the tumor in your ascending colon. Doctors can plead your case, but the payors get the final word. And payors make decisions based on criteria, not on conversations with individual patients.
We spent a very frustrating year trying to get care for a relative after a stroke. It was decided that, since she was disabled before the stroke, sending her to rehab would not be "worth it". Her baseline functionality was too low to begin with, so getting any independence back was just not important to them. Well it was pretty important to her. It never happened. She died in a nursing home.

On the other hand, my current insurance is paying a huge chunk of my cancer care. A lot of it's covered by the clinical trial, and what's not, the insurance is picking up. We've only paid a few hundred out of pocket. Given that cancer care can bankrupt some families, this is a huge blessing.

I guess what I'd like to see is some oversight of medical spending by a disinterested watchdog agency, not the payor and not the medical provider, to miminize confict of interest. As it is, cutting spending at all costs is in the financial interest of the payor, and unmonitored spending may be in the financial interests of the providers, at least in the short run. If the payor is also the watchdog, he's not going to be doling out any more bones than he absolutely has to. If the provider is the watchdog, he's going to be raking them in. If there's a third watchdog, there may be some objectivity.

[Holly]

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[Magnolia]

Holly, I remember many a heated conversation with my cousin's case manager. Didn't like her at all. At times it seemed like her only interest was in seeing to it that her company saved money. (In reality, that is probably what she was hired to do.) Just doing her job? Maybe, but what caring human would take a job like that? I was an oncology nurse for six years. I can't imagine ever getting so burned out that I'd end up doing something like that for a living.

My husband changed jobs again shortly after my diagnosis and we changed insurance again. I had a case manager with the first company who was nice and very helpful. I don't have one with the new company. I kind of missed the friendly, nice one checking on me. My cousin's snarky lady was a real piece of work, though.