She and her colleagues were expecting to see differences in survival based on treatment, "but there really didn't seem to be any difference at all. Which sort of argues for doing the bare minimum versus doing the most you can do." Republicans in Congress and on the campaign trail call for an Obamacare repeal all the time. Plans to replace it are rarer, though. Obamacare is a fantastically complicated policy, and overhauling the health care system would likewise be a complicated business, affecting not only government spending and the economy, but people's very lives on an intensely personal level.
This week, presidential candidate and former Florida Gov. Jeb Bush released his own detailed proposal for repealing and replacing the Affordable Care Act. In a speech and an op-ed in the New Hampshire Union Leader, Bush announced his plan is aimed at cutting health care costs. Here's what his plan would do.
Problems after surgery can be significant, she notes, and include long-term pain, disfigurement and lymphedema if lymph nodes are removed..
"The troubling trend in my point of view is that more women are getting bilateral mastectomies," Hwang says. "That's because there's a limited understanding on how good the treatment is for DCIS. I'm not saying that women don't die from breast cancer; they do. But the cures have never been better, and your likelihood of surviving is greater than 90 percent."
Far better, Hwang says, would be to have a test that can tell which types of DCIS will become dangerous cancer, and which will never cause any harm at all. Other researchers are trying to create those tests, and Hwang is hoping to run a big clinical trial that will compare surgery to taking hormone-suppressing medication instead.
"Wouldn't it be wonderful if we take a disease that women are feeling compelled to have a bilateral mastectomy for, and it can be eradicated by taking a pill once a day?" Hwang asks.
For Democrats worried about Hillary Clinton's uneven performance on the campaign trail, a strong debate showing last night should do much to assuage those concerns. She was well-prepared, pointed with her responses to her scandals and needled her rivals when necessary. And when she could, she pivoted away from Democratic divides to draw distinctions with Republicans.
Perhaps most harmful for Biden, she pointed to ways she would continue Obama's legacy and emphasized how he trusted her experience on foreign policy even after their bitter 2008 fight. If Biden was going to run clinging to the president, Clinton just hugged him a little tighter on Tuesday, leaving less and less room for the vice president.
Her campaign issued a warning shot after the debate too, with campaign chairman John Podesta telegraphing that it was time for Biden to either jump in or move on. Would it lower health care costs?
Bush's plan would make it cheaper to buy your own insurance, says one expert, but there would be trade-offs — lower costs could mean fewer benefits.
"I have no doubt that premiums in the individual market would be lower under Bush's plan, mainly because there would be less regulation of the benefits those plans have to offer," said Larry Leavitt, co-executive director of the Kaiser Family Foundation's Program for the Study of Health Reform and Private Insurance.
Bush's plan gets rid of the requirement that plans cover certain things (Obamacare's "essential health benefits"), like maternal care and mental health. Rather, it encourages so-called "catastrophic" health insurance plans — bare-bones plans that protect people in expensive emergency situations. Those plans tend to not only have lower premiums but also higher deductibles.
"Bush emphasizes high-deductible plans and [health savings accounts] and wants to encourage those plans. High deductibles do discourage people from using services and lead to lower health spending overall," Leavitt said.
The plan also would relax Obamacare's guaranteed coverage for preexisting conditions. Instead, it would only guarantee it for people with "continuous coverage." Defenders say this would stop people from getting coverage only when they are sick, but detractors say this makes it too easy to not be covered, as financial hardship or employment changes can easily interrupt coverage. That provision could likewise lower costs by lowering the number of chronically ill people in risk pools.
Altogether, the plan looks like it could easily lower health care spending.
"Do I believe that his plan will cost less than the current status quo under the Affordable Care Act? I believe the answer is yes," said Mark Fendrick, a professor at University of Michigan's medical school and public health school.
But there are a lot of "buts" to tack on here. For one, there's still a lot we don't know — for example, how much the plan might cut spending on low-income Americans' health care, as well as how much those new tax credits would cost compared to what's in place right now.
Another thing to consider is where that cost-cutting comes from — is lower-cost health insurance always better, or is it at some point detrimental to customers?
Bush's policies would curb cost growth to an extent, said Sabrina Corlette, senior research fellow at Georgetown's Health Policy Institute, but she added a caveat: "I would note that they do so on the backs of consumers, rather than tackling some of the more thorny issues such as how we pay providers and suppliers."
Moreover, Fendrick said, focusing too intently on costs might be wrongheaded.