An interesting discovery of USPSTF guidelines and Kaiser Permanente. The nutshell version.
The USPSTF was originally an advisory committee to congress and primary care. But the reins of decision making were passed from congress to the USPSTF to make recommendations that would be covered by Medicare - A & B recommendations were covered and most C, D & I recommendations are not.
Bring in the Affordable Care Act/ Obamacare that said that A & B recommendations must be covered by private healthcare too.
In 2012 the USPSTF made a detrimental knee-jerk reaction: D - do not use PSA testing for screening of prostate cancer. This is when we had national outrage by many urology groups who are the true experts in the disease. They expressed their concerns in the flaws of the studies used by the USPSTF and the fallout of such a reckless decision. The urology groups had made huge progress on who and how to treat after 20 years.
Then in 2018 the USPSTF barely raised the bar to C for 55 - 69 and still a D for age 70+. Their big reveal = shared decision making, family history and high risk ethnicities. In reality, there was nothing new.
But who is the outlier in the mix? Dr. David Grossman with Kaiser Permanente who was part of the reckless 2012 decision when he was with KP/ Group Health and stayed on an extra 12 - 18 months at the USPSTF to lead the 2018 recommendation. The USPSTF has 4 year terms but Grossman was there about 9 years. Grossman stepped down after the USPSTF had finalized the recommendation in early 2018 and the draft was published 4 - 6 months later.
Why is this worth the mention? Because Grossman just shaped their company guidelines by his position at the USPSTF. He saved Kaiser Permanente billions in preventive care measures by his leading the 2018 recommendation by making sure it did not get an A or B recommendation. And if you look at the way Kaiser Permanente runs their prostate cancer care and treatment they provided the Permanente Medical Group the protection of defaulting to the "recommendation of the experts at the USPSTF". They can wait for men to show up with symptoms. They don't have to protect those under 55 who would benefit from early detection, etc.
This is the conflict of interest that we have in our healthcare policy in the US. These policies allow the burden to be absorbed by the patient physically and financially and obviously the emotional toll it takes. We need change to better allow the urologists to make recommendations about the disease as they work with patients daily.