Health care ACA style

One of the more disturbing aspects of health insurance has always been the reliance on averages. Instead of treating patients, as individuals as most doctors would like to do, the insurance says we will pay for certain procedures, based on some statistical analysis of similar situations. This concept will be greatly enhanced under Obamacare. There will be a group of experts who will set the guidelines for treatment and doctors must follow those in order to have insurance coverage. If you are self-insured you can still get all the treatment the doctor recommends since you will be paying. The less flattering phrase for this is rationing. While people may not like this idea it is absolutely necessary in order to control cost. We live in a world of limited resources and cannot provide every individual with every service. Here is one example of what this panel of experts will be evaluating. It has to do with one type of cancer. As Dr. Conroy explains the process, first, doctors must determine the “Stage” or extent of the disease. The most common system for determining classification of malignant tumors and the extent of a person’s cancer is called the TNM system. “T” measures the size of the tumor and if it’s invaded nearby tissue. “N” determines regional lymph nodes that are involved. “M” measures the distance the cancer has spread from one part of the body to another. These measurements are critical in determining how sick the patient may be. In fact, there are four stages, classified under the TNM system, with multiple possible results determined by a large variable of TNM data. With an adenocarcinoma cell type under the microscope, there are about 40 pathological (histology) types which could lead to as many as 36,000 possible variable combinations of the cancer. The grade or aggressiveness of the cancer is 10 grades. So, 10×36,000 = 360,000 possibilities. Next, hormone sensitive status = 8 possibilities. So, 360,000 x 8 = 2,880,000 and menopausal status = 5,760,000 possible computer input combinations. These are the possible combinations on just one page of data in staging. So the computer system has to evaluate these combinations. Like the old adage says, “don’t worry, I’m from the government and I am here to help”.