Richard J. Ablin is the University of Arizona research professor who discovered the prostate-specific antigen (PSA) test in 1970. Today, in a New York Times op-ed, he decried the misuse of that test by health care monopolies to drive up profits with promises of catching prostate cancer early. First of all, the test can't detect cancer. Screening most men over age 50 costs over $3 billion a year, but has been proven in two recent studies to have little or no effect on life expectancy. Only 16% of men will ever be diagnosed with prostate cancer and only 3% will ever die of it. A European study concluded 47 men suffer grievous treatments that result in loss of sexual activity and incontinence for each life saved. Professional associations are beginning to recommend against PSA tests, but not those captive of the drug companies. Ablin concluded, "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening.

"Reconciliation" is getting a lot of attention in Washington lately. Most understand a reconciliation bill can pass the Senate by majority vote after 20 hours of debate, but that's often where the understanding stops. Reconciliation originated in the Congressional Budget and Impoundment Control Act of 1974 as an optional means of changing (mostly) entitlement spending, but not Social Security, and taxes to achieve the deficit target set forth in the budget resolution. Because a reconciliation bill has a high likelihood of becoming law, it quickly became a magnet for extraneous amendments, which Senator Robert C. Byrd (D-WV) deterred in 1985 with the Byrd Rule, now Section 313 of the Budget Act, which lays out six criteria for determining what is extraneous. Implementing these rules in the Senate has become so complicated that no one can be entirely sure of what will emerge until the Senate Parliamentarian has ruled.

Today, as promised, President Obama released his new health reform proposal three days in advance of Thursday's Blair House summit. Senate Minority Leader Mitch McConnell (R-KY) said he will attend, so at least some Republicans will be there. It's anybody's guess whether we get health reform this year. To me, it looks like we'll either get a watered down bill or nothing but more political posturing. I'll bet every Congress for the next 10 years passes another health reform bill too. I just hope we don't end up with the aimless policymaking like we've had with energy legislation since the 1973 energy crisis.

Friday, the Chief Actuary of the Centers for Medicare & Medicaid Services issued a report estimating that the Senate health reform bill, H.R.3590, would increase federal costs $365.8 b. FY10-FY19.  Today, the President's Council of Economic Advisers estimated that the Senate bill would reduce federal spending on Medicare and Medicaid by 0.7% annually FY16-FY19.  CEA chose that period to get beyond the initial increases these programs would experience as roughly 30 m. Americans gain insurance coverage.  How can the two studies comes to opposite conclusions? 

Senator Byron Dorgan's (D-ND) drug importation amendment would seem to have plenty of votes to spare beyond the magic 60 required, so why was it held in limbo today?  Senator Tom Carper (D-DE) just admitted he has placed a "hold" on the amendment because of his concerns over ensuring the safety of those imported drugs.  Some senators are also concerned about violating the President's pledge to the drug industry not to impose any more costs on them if they support reform, which this would violate.  President Obama co-sponsored a drug importation bill in 2007.  Drug importation was enacted on October 28, 2000 by President Clinton, but neither his HHS Secretary nor President Bush’s a year later would certify the drug import safety as required, effectively killing the effort.  So there the matter sits with no vote.  The Senate is also waiting for Congressional Budget Office scores on several proposals designed to take the place of a public option, which doesn't have 60 votes, including allowing those age 55-64 to buy into Medicare and establishing a national insurance plan provided by private insurers with rates negotiated

The former Congressional Budget Office Director and McCain for President Policy Director spoke to the National Economists Club at 12:30 p.m. last Thursday in Washington, D.C. He made a strong case that Congress is on the wrong track with its health reform bills. His podcast is well worth listening to.

This morning at a closed House Democratic caucus, a proposal to impose a windfall profits tax on health insurers to help pay for health reform gained support.  No details were presented, but the politics were right as numerous members emerged to endorse the idea.  Some members said as much as $100 b. could be raised over ten years.  It's doubtful the Senate could pass it, but this is definitely a shot across the bow of health insurers.

The last windfall profits tax on oil, actually an excise tax, was enacted on April 2, 1980 as price controls were phased out.  It was repealed on August 23, 1988.  It was projected to raise $393 b. based upon oil price assumptions that proved so incorrect that it only actually raised $80 b.  On a net basis, after taking into account income tax deductions and lower receipts from the sale of oil from federal properties, the windfall profits tax only raised $38 b.  To say the windfall profits tax failed to achieve its objectives is an understatement.  This Congressional Research Service report provides the evidence.

Anyone who has tuned in Senate floor "debate" on C-SPAN2 knows how deadly dreary it can be and how little is debated.  Today, the Senate Finance Committee actually DEBATED and defeated Senator Rockefeller's (8-15) and Senator Schumer's (10-13) amendments to add a public insurance option to the committee's health reform bill.  After spending many hours in committee and on the Senate floor, I'm hard to impress.  Today's DEBATE was the best I've seen in a very long time.  It was like watching the 1971 Ali - Frazier heavyweight fight top all the advance publicity.  Senator after senator made well informed and hard hitting statements pro and con.  They were respectful of each other and kept interruptions to a minimum.  They actually listened to each other.  If Congress puts on more debates like this, its abysmal ratings might improve.  Today's votes were never in doubt, but these amendments will come back when the full Senate considers the bill later this year.  I hope to see more informed debated as we