Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion — Center on Budget and Policy Priorities

Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion — Center on Budget and Policy Priorities

Claims that states will bear a significant share of the costs of the Affordable Care Act’s (ACA) Medicaid expansion — and that this will place a heavy financial burden on states — do not hold up under scrutiny. Congressional Budget Office (CBO) analysis indicates that between 2014 and 2022, the ACA’s Medicaid expansion will add just 2.8 percent to what states spend on Medicaid, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will produce savings in state and local government costs for uncompensated care, which will offset at least some of the added state Medicaid costs.

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Pa. Director Of Doctors For America Discusses Health Care « CBS Pittsburgh

Pa. Director Of Doctors For America Discusses Health Care « CBS Pittsburgh

I will immodestly say I did really well on this show. Mike is a very fair host and always nice to me.

I also did WESA's Essential Pittsburgh yesterday, June 28:

http://www.essentialpublicradio.org/story/2012-06-28/affordable-care-act-decision-doctors-perspectives-11596

Cheers,

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Obama Health Law Seen Valid, Scholars Expect Rejection - Bloomberg

Obama Health Law Seen Valid, Scholars Expect Rejection - Bloomberg

The U.S. Supreme Court should uphold a law requiring most Americans to have health insurance if the justices follow legal precedent, according to 19 of 21 constitutional law professors who ventured an opinion on the most-anticipated ruling in years. Only eight of them predicted the court would do so.

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The Ryan proposal compels Americans to buy insurance—just like Obamacare does. - Slate Magazine

The Ryan proposal compels Americans to buy insurance—just like Obamacare does. - Slate Magazine

Ryan's roadmap would reshape Americans' access to health insurance mainly through two provisions, both of which pressure people to purchase private health insurance to an extent and through mechanisms that are materially indistinguishable from the supposedly toxic Obamacare mandate. One of these Ryan proposals—as yet little noticed by pundits or politicians—is almost an exact copy of a provision in the Affordable Care Act. * It would repeal the current exclusion from employees' income of employer contributions to their health insurance premiums, thus terminating the subsidized employer-sponsored group health regime that covers nearly 60 percent of all Americans. In its place, the Republican plan would substitute a refundable tax credit, to be provided to individuals who purchase health insurance (or to employers who purchase health insurance for their employees). When this new arrangement takes effect in 2022, the tax credit would be set at $2,300 per adult and $1,700 per child, not to exceed $5,700 per family.

Like this Ryancare tax incentive, the "individual mandate" section of the ACA, which the White House calls the "individual responsibility" provision, constitutes a pay-or-play option. Beginning Jan. 1, 2014, when the ACA provision takes effect, individuals who do not qualify for exemption on hardship or other specified grounds, must either carry health insurance or pay a tax penalty as part of their annual income tax filing. The ACA caps individuals' penalty liability at 2.5 percent of household income above the filing threshold, or a flat dollar amount ranging from $695 to $2,085, depending on family size.

Under both provisions, the result is the same: People who choose to carry health insurance have a lower tax bill than they would if they chose not to. In terms of their respective potential impact on individuals' bank accounts and tax liability, the manner in which they affect individuals' financial incentives, and hence the constraining effect on individuals' financial choices to either buy or forgo health insurance, the two "mandate" provisions are identical. (Indeed, in most cases, the financial difference for the individual taxpayer made by the Republican tax credit would be greater—i.e., more "coercive"—than the ACA tax penalty.)

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Eleven Alternatives to Obamacare's Individual Mandate - Businessweek

Eleven Alternatives to Obamacare's Individual Mandate - Businessweek

The short version:

1. Relabel the mandate to escape the high court’s scrutiny. Give people a tax credit if they do carry insurance, which is functionally the same as penalizing them if they don’t. Sound like a sly evasion? It’s essentially the approach advocated by House Budget Committee Chairman Paul Ryan.

2. Increase subsidies, such as the law’s existing set of tax credits for low-income Americans, to induce more people to sign up voluntarily. This would be along the lines of the enticements in Medicare Parts B (doctors’ and outpatient services) and D (prescription drugs).

3. Use government funds to compensate insurers for the cost of “adverse selection,” in which only sick people sign onto their plans.

4. Have the government and/or employers enroll people into health plans automatically, but with an option to drop insurance. Count on inertia and procrastination to keep them in the system.

5. Require people who go without insurance to sign a form acknowledging that they won’t be able to get back in for five years, even if they have an accident or contract a costly disease and want to get covered right away.

6. Leave it to the 50 states to enact their own mandates under state law, which would not be subject to Supreme Court review.

7. Penalize people who delay enrolling. Charge them more or strip them of the right to buy insurance at a standard rate regardless of preexisting conditions. There’s a precedent in Medicare: People who enroll in Medicare Part B after age 65 pay a 10 percent penalty on their Part B premium unless they have employer-provided health insurance.

There are more, but these are the more reasonable ones...

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Money or Your Life - NYTimes.com

Money or Your Life - NYTimes.com

Critics of the Affordable Care Act argue that many Americans neither want nor need health insurance, and that it forces them to pay for coverage against their will. But just as the government collects taxes to pay police officers and firefighters, the individual mandate compels Americans to pay for a service they may not immediately want but could at any time desperately require.

Much of the debate has focused on the role of government in everyday life. I don’t discount the value of that question, but my focus is on real needs. I treat patients with $20,000 chemotherapy injections or monthly doses of IV immunotherapy that cost $10,000 a bag. If they don’t receive these drugs my patients will die, so to me, the most pressing issue here is compassion. Without change, the patients will resemble the man with leukemia, human beings without insurance terrified that their lives aren’t worth what it will cost to save them, all because of a broken but fixable system.

Crowds at conservative rallies have, astoundingly, cheered the idea that uninsured people should, if they become ill or badly hurt, be left for dead. It’s easy to imagine such a thing in the heat of a rhetorical moment. But the reality is, I hope, harder to embrace. Because reality means a real person — you, me, someone we know — condemned to a possibly preventable death because, for whatever reason, they don’t have insurance.

My patient with leukemia is dead. He got the best care money could buy, but his disease only briefly went into remission and he went home on hospice care. Should he, because he did not buy insurance, have been denied this chance for a cure?

The Affordable Care Act is not the health care solution everyone wants, but when patients wish for death panels as a response to leukemia, something needs to be done, and soon. This plan would help any patient facing a tough diagnosis not view treatment as a choice between his money or his life.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.”

I have had similar discussions with those who are not in healthcare as their profession.  They cannot seem to see the distinction between cutting people off who did not buy insurance, for whatever reason, and actually carrying out this virtual death sentence. We, as medical professionals, just cannot do this. Therefore, we need to figure out how to have universal access to care and universal insurance coverage. ObamaCare is a very good start.

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Sorry, The CBO Did Not Say Health Reform Kills 800,000 Jobs | The New Republic

Sorry, The CBO Did Not Say Health Reform Kills 800,000 Jobs | The New Republic

From Jonathon Chait on the "job killing" myth:

Other provisions in the legislation are also likely to diminish people’s incentives to work. Changes to the insurance market, including provisions that prohibit insurers from denying coverage to people because of preexisting conditions and that restrict how much prices can vary with an individual’s age or health status, will increase the appeal of health insurance plans offered outside the workplace for older workers. As a result, some older workers will choose to retire earlier than they otherwise would. (CBO)

In other words, people who are only working because they desperately need employer-sponsored health insurance will no longer do so. They're not going on the public dole -- they're just people who have the means not to work full-time and will be free to make employment decisions that aren't premised upon an individual health insurance market that shuts them out. Some workers will choose to retire early because they now have the ability to buy their own health insurance. This is what Republicans call "destroying jobs."

Now, CBO does show a very minor effect of higher taxes discouraging the work incentive. But this is a very small portion of what is a fairly small effect to begin with. Basically the analysis shows the effect of giving workers with preexisting conditions access to a health care system that doesn't lock them into the employer-provided system. Apparently, in the conservative view, being chained to your desk at some big company until you're 65 and unable to retire or start your own business because the individual market is rife with adverse selection is defined as "freedom."

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New study: Tort reform has not reduced health care costs in Texas

New study: Tort reform has not reduced health care costs in Texas

Medicare spending up

The researchers assumed that doctors who faced a higher risk of being sued — those in counties that had larger numbers of malpractice cases — would perform more tests and procedures than necessary to protect themselves from lawsuits. With tort reform, which limited damage awards against doctors, the need to practice such "defensive medicine" would decline, the argument goes.

But in comparing Texas counties in which doctors faced a higher risk of lawsuits with counties where the risk was lower, the researchers found no difference in Medicare spending after tort reform and indications that doctors in higher-
risk counties did slightly more procedures.

"If tort reform reduces spending, it would have the biggest effect on high-risk counties," Silver said. He noted that those tend to be large and urban.

"This is not a result we expected," said Bernard Black, a co-author and a professor at Northwestern University's Law School and Kellogg School of Management.

Health care spending has increased annually everywhere, the researchers said, including in the states with caps on malpractice payouts — now at 30, counting Texas, said David Hyman, a co-author and professor of law and medicine at the University of Illinois.

But, said Hyman, who worked on health policy for President George W. Bush at the Federal Trade Commission, "we found no evidence that Texas spending went up slower in comparison to all other states and may have had an increase."

The researchers said their study suggests that Medicare payments to doctors in Texas rose 1 to 2 percent faster than the rest of the country, Black said.

Since tort reform, some Texas residents have complained that they cannot find a lawyer to pursue a malpractice case because of the $750,000 cap on payouts for pain, suffering, disfigurement and mental anguish. The limit often makes litigation cost prohibitive, patients and lawyers said. That concern was not raised in the paper, although the researchers said claims of huge malpractice payouts and rampant "frivolous" lawsuits before tort reform are greatly exaggerated by its advocates.

Silver said he was "very pessimistic" that policymakers will heed the study. "The rhetoric on both sides tends to be very extreme," he said.

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Professionalism, the Invisible Hand, and a Necessary Reconfi... : Academic Medicine

Professionalism, the Invisible Hand, and a Necessary Reconfi... : Academic Medicine

Our third duty in the Charter on Medical Professionalism is to be good stewards of resources. This brief article makes the case for explicit and detailed education for medical students on this critical aspect of health care.

The first two months of medical school (with preexisting courses taxed to create this curricular space) will be devoted to the economics of care. This block will involve multiple pedagogical approaches from traditional didactics and problem-based learning to simulation and social networking. Instructors will range from topic experts to patients and members of the public whose lives are being bludgeoned by health costs. Preceptorships will be community based and will focus on student experiences in educating the public on the cost of both schooling and health care. Once this competency is mastered, students will begin to meet with patients upon discharge (clinic or hospital) to explain all charges. There will be no traditional “patient care” contact until students are fully able to decode and explain the highly cryptic billing statements that encumber patients. As students enter the biomedical side of their training, patient meetings will begin to add explanations of diagnoses and treatment options to those of cost. No student will be admitted to the care side of the educational continuum until he or she is fully able to explain to patients what has been done to them and why. As students move into residency training, they periodically will be shifted from their clinical responsibilities into the discharge process to recheck on their decoding and explaining competencies. National boards will reflect this new mandate. So, too, will CME requirements, which will include mandatory credits in cost competency. Cost will be defined as a major burden of treatment, with “burden of treatment” a major reframing of how we conceptualize and approach health care.³

We seek to provide a system of training that will produce true patient-centered practitioners, a bona fide revolution in what it means to practice medicine, a physician workforce prepared to lead, and a true profession willing and able to regulate itself on behalf of the public.

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Commentary: Affordable Care Act a life-saver for ‘Susan.’ | www.palmbeachpost.com

Commentary: Affordable Care Act a life-saver for ‘Susan.’ | www.palmbeachpost.com

DFA's Dawn Harris Sherling, M.D, illustrates the very real consequences of life with and without health care access...

As the court debates forcing people to buy broccoli and other theoretical legal nonsense, I worry about my very real patients. Unlike the supermarket, very few of us willingly enter the health care marketplace. One day, when we least expect it, we will be flung into it by cancer, heart disease, infection or an accident. We may have led lives to encourage it. We may have done nothing except to have very bad luck. And we can only hope that, unlike Susan, when we are at our lowest the last thing we will have to worry about will be our health insurance.

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Small Business Majority | Small Business Owners’ Views on Implementing the Affordable Care Act

Small Business Majority | Small Business Owners’ Views on Implementing the Affordable Care Act

Key findings:

• Only a third of small business owners want the Supreme Court to overturn the Affordable Care Act; a plurality of 50% would like it upheld, with minor or no changes. This support grows after learning more details about the law’s key provisions:
  Only 34% of small businesses want to see the healthcare law overturned, while 50% want it to remain intact with, at most, minor changes. After learning more about its specifics, only 28% want to see it repealed and a 56% majority want it to be kept, as is or with minor changes. A 55% majority say they want it upheld because we need to make sure everyone has health coverage.
  
  Figure 1: After learning about the law, support for the Affordable Care Act grows
  

  There has been a lot of talk about the nation's health care reform law, the Patient Protection and Affordable Care Act. Which one of the following statements comes closest to your point of view when it comes to this law.

  
  
  
  

  After everything you read, which one of the following statements comes closest to your point of view when it comes to the nation's healthcare reform law, the Patient Protection and Affordable Care Act.

  
  
  
• By an 8:1 margin, entrepreneurs say they’d consider using a state health insurance exchange, and they favorably view many possible features of the exchange:
  A 66% majority of small business owners say they would use their state exchange or at least consider using it, compared to 8% who say they would not consider using it when they provide benefits. By wide margins, entrepreneurs find a host of possible features of the exchange very appealing. By a 2:1 ratio, small business owners support their state applying for federal funds to set one up.
  

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Navigating the Labyrinth of Medical Costs - Your Money - NYTimes.com

Navigating the Labyrinth of Medical Costs - Your Money - NYTimes.com

Hospital care tends to be the most confounding, and experts say the charges you see on your bill are usually completely unrelated to the cost of providing the services (at hospitals, these list prices are called the “charge master file”). “The charges have no rhyme or reason at all,” Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. “Why is 30 minutes in the operating room $2,000 and not $1,500? There is absolutely no basis for setting that charge. It is not based upon the cost, and it’s not based upon the market forces, other than the whim of the C.F.O. of the hospital.”

And those charges don’t really have any connection to what a hospital or medical provider will accept for payment, either. “If you line up five patients in their beds and they all have gall bladders removed and they get the same exact medication and services, if they have insurance or if they don’t have insurance, the hospital will get five different reimbursements, and none of it is based on cost,” said Holly Wallack, a medical billing advocate in Miami Beach. “The insurers negotiate a different rate, and if you are uninsured, underinsured or out of network, you are asked to pay full fare.”

With the exception of Medicare and Medicaid, experts say, the amount paid for services — or the price your insurers pay — is based on the market power of the insurance company on the one side and the hospitals and providers on the other, and the reimbursement agreements they ultimately reach. So large insurers that command a lot of market power may be able to negotiate lower rates than smaller companies with less influence. Or, insurers can place hospitals or providers on a preferred list, which may help bolster their business, in exchange for a lower reimbursement rate. On the other hand, well-regarded hospitals may command higher prices from insurers.

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George Lakoff: The Wisconsin Blues

George Lakoff: The Wisconsin Blues

Scott Walker was just carrying out general conservative moral policies, taking the next step along a well-worn path.
What progressives need to do is clear. To people who have mixed values -- partly progressive, partly conservative -- talk progressive values in progressive language, thus strengthening progressive moral views in their brains. Never move to the right thinking you'll get more cooperation that way.
Start telling deep truths out loud all day every day: Democracy is about citizens caring about each other. The Public is necessary for The Private. Pensions are delayed earnings for work already done; eliminating them is theft. Unions protect workers from corporate exploitation -- low salaries, no job security, managerial threats, and inhumane working conditions. Public schools are essential to opportunity, and not just financially: they provide the opportunity to make the most of students' skills and interests. They are also essential to democracy, since democracy requires an educated citizenry at large, as well as trained professionals in every community. Without education of the public, there can be no freedom.
At issue is the future of progressive morality, democracy, freedom, and every aspect of the Public -- and hence the viability of private life and private enterprise in America on a mass scale. The conservative goal is to impose rule by conservative morality on the entire country, and beyond. Eliminating unions and public education are just steps along the way. Only progressive moral force can stop them.
The Little Blue Book is a guide to how to express your moral views and how to reveal hidden truths that undermine conservative claims. And it explains why this has to be done constantly, not just during election campaigns. It is the cumulative effect that matters, as conservatives well know.

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The Cost of For Profit Health Care - Doctors for America

The Cost of For Profit Health Care - Doctors for America

One of the most frustrating parts of being a Primary Care Physician in the U.S. is not being able to get necessary care for your patients because they cannot afford it. Last week I had to watch a 55-year-old woman with uncontrolled blood pressure and rapidly progressing kidney disease walk out of my office with only half of the medications she needed to control the blood pressure and stabilize her renal function. The medications were too expensive, she couldn’t afford adequate insurance coverage, and 22 months after being laid off from her job as a middle school teacher, was still looking for work. Later that morning I sighed helplessly as a 45-year-old diabetic patient told me he had to choose between buying his insulin and paying his rent. I knew if I were in his position, I’d be forced into the same decision.

The thing is, these patients both had health insurance. Such scenarios are unfortunately not unusual. A 2007 survey by the Commonwealth Fund found that even among Americans who were insured all year, 16 percent reported being unable to pay their medical bills, 15 percent had been called by a collection agency about medical bills, 10 percent changed their way of life to pay medical bills and 10 percent were paying off medical bills over time. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. And yet sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.

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Be wary of ad claims about health care law and brace for a wave of more: PolitiFact Ohio | cleveland.com

Be wary of ad claims about health care law and brace for a wave of more: PolitiFact Ohio | cleveland.com

An independent payment advisory board created by the health care reform law "can ration care and deny certain Medicare treatments."
Pat Boone makes this claim as the front man for an ad from the 60 Plus Association that aired this spring and targets five Democratic senators, including Ohio's Sherrod Brown. The law creates a 15-member Independent Payment Advisory Board to suggest ways to limit Medicare's spending growth, but the board may be overruled by Congress, and it makes no decisions about individual care. It is specifically forbidden from making any recommendations that would ration care, reduce benefits, raise premiums or cost-sharing or alter eligibility for Medicare. The 60 Plus Association was spending $720,000 on a campaign in Ohio aimed at Brown when PolitiFact Ohio ran the claim through the Truth-O-Meter and called it Pants On Fire.
The national health care reform is "a government takeover of health care."
We've heard it before -- so often that PolitiFact national named it the 2010 Lie of the Year -- and we'll surely hear it again. It has come recently from third-party advocacy ads. While the law gives the federal government a larger role in the health insurance industry, it relies overwhelmingly on the private market. In fact, the reform is projected to increase the number of citizens with private health insurance. PolitiFact has noted that the claim has been proven wrong over and over again. The rating: Pants On Fire.
The Affordable Care Act contains "a series of slush funds, set up to stay on the books automatically, with little or no oversight."
So said House Speaker John Boehner in a news release and video, and again during debate on college student loan rates. PolitiFact Ohio found that the health care bill provides several pools of money that the secretary of health and human services can disburse for purposes designated by the legislation. But slush funds? Merriam-Webster defines a "slush fund" as "an unregulated fund often used for illicit purposes." The money in question is designated for programs specifically defined by the law. Congress also has the power to oversee the bill's implementation. The rating: Pants On Fire.
The health care law "slapped Ohio small businesses with a $500 billion tax increase."
This statement came from the National Republican Senatorial Committee. PolitiFact Ohio found that the $500 billion figure was a fair number for total revenue raised nationally by the 2010 health care law, as estimated by the Congressional Budget Office at the time of the December 2009 vote on it. But the number for just taxes is lower, probably between $400 billion and $465 billion. The rest was for various other fees and revenue enhancements, and for all new revenue nationwide -- not just for the share to be paid in taxes by small businesses in Ohio. To pick a national number and apply it to one segment of one state is not accurate, simply ridiculous and gets a rating of Pants on Fire.
"Preventive care . . . saves money for families, for businesses, for government, for everybody." Ad claims in support of the health care law have been exponentially fewer than attacks, but this sweeping claim came from President Obama. Is preventive care a good idea? It can often save lives and keep patients healthier, and certain preventive measures may save money as well. But the findings of the Congressional Budget Office and physicians who have studied the medical literature say otherwise, including a Feb. 14, 2008, article in the New England Journal of Medicine that noted that "the vast majority" of preventive health measures that were "reviewed in the health economics literature do not" save money. The rating: False.
"Obamacare . . . will kill jobs across America."
The U.S. Chamber of Commerce made this claim in ads that targeted Brown and other Democrats, and "job-killing" is the standard epithet applied to the health care law by opponents. PolitiFact looked at the best projections available when the claim was raised, based on how the law is actually written, and found that they do not suggest that the law will "kill" jobs. PolitiFact also looked at evidence provided by the Chamber to support its claim, including a brief from the Heritage Foundation, a conservative think tank that has been critical of the law. When the authors were asked whether their brief supported the claim, they responded that "our paper does not provide evidence that the [health care law] would cause job loss." The rating: False.
The health care law "will cut $500 billion from Medicare."
This claim from candidates and advocacy groups has been examined numerous times by PolitiFact national, PolitiFact Ohio and other PolitiFact state operations. The important point there is that $500 billion is not taken out of the current Medicare budget and that nowhere in the bill are benefits eliminated. The $500 billion represents the projected saving by slowing the projected growth in Medicare spending over 10 years. Medicare spending will still increase. The rating: Mostly False.

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Reproductive Health - NYTimes.com

Reproductive Health - NYTimes.com

Re “The Campaign Against Women” (editorial, May 20):

The onslaught of laws focusing on denying reproductive health care rights is a concerted campaign against women. These laws are not grounded in science or evidence-based medicine.

The American Congress of Obstetricians and Gynecologists believes that access to family-planning counseling and to the full array of contraceptives is a basic and essential component of preventive health care for women.

Efforts to defund Planned Parenthood, which provides cervical cancer and mammography screening, contraception and other preventive care to millions of women, are egregious and disproportionately hurt poor women.

As physicians for women’s health care, ob-gyns see firsthand the havoc that punitive ideology-based laws have on the health of women and their families. These ill-conceived laws are based on the pretext of protecting health, but they do anything but that.

Mandating that women be legally forced to undergo transvaginal ultrasound or any other medical procedure against their will and against their physician’s judgment is an outrageous violation of patient autonomy and the confidential doctor-patient relationship. Decreasing access to family planning and contraception will only increase unintended pregnancies and negatively affect family and societal health.

Politicians were not elected to, nor should they, legislate the practice of medicine or dictate the parameters of the doctor-patient relationship. Our message to politicians is unequivocal: Get out of our exam rooms.

JAMES T. BREEDEN
President, American Congress
of Obstetricians and Gynecologists
Washington, May 22, 2012

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Prostate Cancer Screening: What We Know, Don't Know, and Believe

Prostate Cancer Screening: What We Know, Don't Know, and Believe

Overdiagnosis makes screening seem to save lives when it truly does not (6). Cases of overdiagnosed cancer fulfill histologic criteria for cancer, but are not destined to progress and kill within the patient's natural lifetime. Yet, when detected through screening, these tumors are commonly treated, exposing patients to the harms of treatment without any true associated benefit. The man with such a cancer often believes that screening and treatment saved his life, but he would have been just fine had the cancer never been detected and treated. Overdiagnosis also increases the proportion of patients surviving 5 and 10 years. Lead-time bias increases apparent survival rates. Because screening diagnoses some patients earlier, they live longer after cancer diagnosis, even though they do not live longer than counterparts with similar cases of cancer that were not screen-detected. Overdiagnosis was known to be an issue in prostate cancer well before screening became popular. In the 1980s, the respected prostate cancer expert, Dr. Willet Whitmore, said that the quandary in prostate cancer is, “If cure is necessary, is it possible, and if cure is possible, is it necessary (7)?”

The screening literature stresses a difference between mass screening, in which large numbers of men are tested at an event, and screening within the physician–patient relationship. Much of my own concern about prostate cancer screening has been with mass screenings that mislead men to believe that screening can only help them. Over the past 20 years, celebrities, athletes, politicians, and prostate cancer survivor groups have endorsed screening. Mass screening is commonly conducted in shopping malls, churches, and community centers; at conventions and state fairs; and even in vans parked in grocery store parking lots. Hospitals, medical practices, fraternities, politicians, radio stations, television channels, and even an adult diaper manufacturer have sponsored mass prostate cancer screenings. Promotions for these events frequently discuss the high proportion of men with screen-detected tumors surviving 5 years and sometimes claim that screening saves lives. They never mention the potential harms of screening. Many well-meaning persons have supported screening activities and chose not to listen or believe those who have urged caution about screening. Mass screening is also a lucrative business. As Upton Sinclair once said, “It is difficult to get a man to understand something, when his salary depends on his not understanding it (8).”

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