Health reform and oncology: A question for TIE readers

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Yesterday morning at 6:30, I found myself driving around the labyrinth of Chicago’s McCormick Place trying to find a shortcut from Lake Shore Drive to the parking structure. The tour didn’t go well, but I did get a fascinating look at where the busses let people off and the forklifts operate far from where the general public is supposed to be.

Fortunately I encountered no homeland security agents, and (more frighteningly) no Chicago traffic personnel bearing thick ticket pads. I parked without incident—unless you count the $21 parking fee.

asco_excitement

I was there for the annual meeting of the American Society of Clinical Oncology. It’s an amazing affair with something like 25,000 attendees. I spoke on a panel at the invitation of my colleague William Dale. My assignment was to discuss the implications of the Affordable Care Act for geriatric oncology. Twenty minutes before our session was scheduled to begin, you can see that the excitement in the hall was palpable.

We actually had a nice turnout and a nice session, which touched on some key issues:

  • Importance of universal coverage for cancer patients
  • Elimination of preexisting condition clauses and lifetime caps
  • The role of comparative effectiveness research and PCORI
  • Efforts to redress an unbalanced system that reimburses highly cost-ineffective proton beam therapies while leaving more valuable and basic services uncovered, particularly for older patients with comorbidities and patient needs.
  • The need to modify the strange economy and incentives in cancer care exemplified by the “chemotherapy concession.
  • Overuse of costly support therapies such as Epogen.
  • The complex political economy influenced by ill-understood measures such as the 340(b) program.

ASCO2I didn’t talk about some other issues that bear discussion, including the fundamentally flawed and under-funded Preexisting Condition Insurance Plans or the need for appropriate public and private insurer coverage of participation in clinical trials (h/t @donaldhtaylorjr on that last one).

I still found it a humbling experience. Oncology is a $125+ billion business. Health reform will have a significant impact on cancer care.  Covering health reform and participating in the 2008 and 2012 campaigns, I met more than a few cancer patients who desperately needed basic health one sought to provide.

Yet as I prepared to speak, I was struck by how little I knew about the huge, but insulated world. I’ve seen one instant classic essay by Smith and Hillner on bending the cost curve in cancer care.  I’ve otherwise seen surprisingly little about the specific implications of ACA for cancer care.

Hence my question to the TIE community: What should I be reading in this area?

@haroldpollack

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