It is a scenario that regularly plays out in statehouses during times of fiscal austerity: funding for Medicaid dental services goes on the chopping block. A shortage of Medicaid dental providers already is a major problem in many communities and dentists often blame low reimbursement rates and budget cuts for making the problem worse.
Mike McGraw’s recent investigation into “big beef” at The Kansas City Star begins with an interesting assumption: Regardless of their safety record, massive slaughterhouses and meatpacking plants introduce unacceptable systemic risk based on their size alone. Or, as he summarizes the argument, “When processing speed and volumes rise, so do the chances for contamination to be introduced and spread widely from its source to other meat inside the plant and at other plants that process it further.”
In particular McGraw focuses on mechanical tenderizing, a relatively new process in which tougher pieces of beef are penetrated with sharp metal blades to break up their fibers. The blades can also pick up E. coli from the meat’s exterior and ram it deep inside, where it’s less likely to be killed when the future steak is seared and served. Statistics are hard to come by, but because the practice is so widespread in the nation’s meat supply, the risk it introduces enjoys similar reach.
USDA data analyzed by The Star show that large plants until recently had higher rates of positive E. coli tests than smaller plants. Federal meat safety officials said the latest data show big plants are improving.
But the volume of meat a plant produces is a key issue. A USDA study published in March showed that from 2007 through 2011, E. coli positives at very small plants resulted, The Star found, in only 465,000 pounds of contaminated beef. A slightly lower rate of positive tests at large plants, however, produced more than 51 million pounds of contaminated beef.
Regardless, experts agree that most E. coli generally originates at larger slaughter plants, where pathogen-laden manure is a bigger problem because that’s where cattle are coming in from the feedlots.
The Kansas Health Institute’s Dave Ranney attempts to illuminate and explain the fears that research into the comparative effectiveness of health care will lead to a “rationing” system that forces patients toward the cheapest options. Ranney interviewed prominent Kansas sources on all sides of the debate.
U.S. Sen. Pat Roberts, R-Kan., expressed his reservations about the possible consequences of seemingly-innocuous research into comparative effectiveness.
Roberts warned that there’s little to stop the federal government from using the research to figure out which medications or treatments achieve similar results for less cost. When that happens, he said, it won’t be long before Medicare starts cutting costs by steering doctors toward the cheaper alternatives and rationed or cookie-cutter treatments heedless of individual results.
And where Medicare goes, the nation’s health insurers will soon follow.
“This is very dangerous territory,” Roberts said.
In response to Sen. Roberts, Ranney quoted a health policy expert who said such theories are “fear mongering, it’s raising the specter of socialism, it’s telling people they’re going to have some fuzzy-headed bureaucrat telling them what to do, denying them choice.”
Ranney includes the answers that Kansas governor and HHS nominee Kathleen Sebelius gave to similar questions posed by the Senate Finance Committee.