Reflex: October 31, 2011

State Medicaid spending is skyrocketing, reports Phil Galewitz. “The end of federal stimulus spending is going to mean nothing but pain for state Medicaid programs in fiscal 2012. State Medicaid spending is projected to grow by an average of 29 percent in the budget year that began July 1, the biggest increase in the history of the federal-state health insurance program for the poor and disabled.” Aaron’s comment: Make no mistake about it, much of the increase is because the economy is so bad and more and more people are falling into the safety net. This is going to be a problem, though, until the economy recovers, and with states in budget binds, they will have to reduce benefits or payments.

Herman Cain will discuss his health policy vision this week in Washington, writes Julian Pecquet. His campaign has not focused on health policy beyond the obligatory “repeal Obamacare on day one” rhetoric. Don’s comment: The Republican primary health policy discussion/debates have been reminiscent of a post-modern literary criticism conference: all deconstruction, and no construction. Woefully short on the replace part. This article outlines a few ideas that are mostly talking points and not serious, comprehensive solutions. However, that puts Mr. Cain firmly in the mainstream of those running for the Republican nomination. Maybe he will surprise me on Wednesday.

In a break from the past, expert groups are now proposing less screening for breast, prostate, and cervical cancer, reports Gina Kolata (NYT). “What changed? The answer, for the most part, is that more information became available. New clinical trials were completed, as were analyses of other sorts of medical data. Researchers studied the risks and costs of screening more rigorously than ever before.” Austin’s comment: This may be the start of a movement away from the historical bias toward testing early and testing often in the U.S. This resonates with Aaron’s post today on MRIs. It’s not that testing, imaging, and other technology isn’t of value, it’s just that we use it far too readily and in circumstances where it may do more harm than good, and at high cost. Organizing our thinking about the value and use of health technology is a first step, one taken by Amitabh Chandra and Jon Skinner.

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