From Reuters: CHICAGO – Cancer experts fear new U.S. breast imaging guidelines that recommend against routine screening mammograms for women in their 40s may have their roots in the current drive in Washington to reform healthcare…
The decision of the U.S. Preventative Services Task Force, an influential group that crafts guidelines for doctors, insurance companies and policymakers, to backtrack on decades of medical advice urging women to begin getting regular mammograms at the age of 40 has stirred debate and anger. The most alarming aspect of the report, however, is that the new standards being put forth may reflect U.S. health care cost management considerations rather than proper concern for the health of U.S. women. The report sites the “modest” benefits of earlier breast screening for cancer; read: cost-benefit analysis. Similarly, the report points to unnecessary medical treatment resulting from false positives; read: cheaper to miss a few genuine cancer diagnoses than to waste money treating false ones.
Mary Ellen Eagan wrote, “First, let’s look at what the report means by “modest.” According to the data USPSTF collected, screening reduces the breast cancer death rate by 15%. In other words, one cancer death is prevented for every 1,904 women aged 40 to 49 who are screened for 10 years. This might not sound like much on paper, but what if you’re that one woman whose life is spared? What if that one woman is your wife, your mother or your daughter?”
Well, of course. Logically and practically speaking, however, one life can’t be allocated unlimited resources either. Discussing the new standards yesterday, a Fox News reporter opined, “I don’t think cost should be a factor when we’re talking about saving lives.” That is nonsense. Cost and allocation of scarce resources always have to be a factor. The issue is at the core of the health care debate. The legitimate question is, who or what is the best and fairest and most trustworthy entity to balance cost and lives? The woman and her family? The doctors and hospitals? Cancer prevention groups? The insurers? Or the government?
All of these have orientations and agendas that color and influence their analysis. The American Cancer Society, for example, opposes the new standards. Its agenda is to prevent as much breast cancer as possible. Insurance companies can be counted on to leap at the opportunities created by the task force’s recommendations, though they aren’t binding. Insurance companies want to pay for as little as possible, and now they have the ammunition to argue that those under-50 screenings are “unnecessary.” Families? They care more about costs if they don’t have money, and if they do have money, there is no reason to take any risks. If insurance companies start refusing to cover early screenings, then wealthier women, one in 1,904, will live, while one out of every group of 1,904 poorer won’t.
So what is the government’s angle? Our government “by the People, for the People” is supposed to care first and foremost about the health, safety and welfare of the citizens it represents. But once the government becomes responsible for health care costs, and makes keeping them under control a top priority, it has a conflict of interest. We will no longer be able to trust the government to be making its health recommendations based on what is best for our physical health, instead of what is best for the Treasury’s financial health.
Blog after blog, commentator after commentator, is expressing dark suspicions that the battle of U.S. women against breast cancer is being short-circuited in the interests of Obamacare budgeting and health care rationing. The Administration and spokespersons for the Task Force deny it, and perhaps they are telling the truth—or perhaps they are not. That’s the problem with conflicts of interest: when someone has split loyalties and conflicting objectives, it is impossible to know which interest is driving the decision.
It isn’t just health care. When the government is running General Motors, is it going to want to make safer cars at the expense of profitability? Is it going to want to make energy-efficient cars that are less safe? How will we know which competing interest and obligation takes priority?
Typically we won’t, just as we can’t be sure whether the new breast cancer screening standards arise out of a fair assessment of women’s health concerns, or are a conscious effort to sacrifice an “acceptable” number of young women’s lives to save on “unnecessary” expenses.
I am not taking sides here. But supporters and opponents of health care reform involving more government management must accept facts: the more the government is responsible for cost control, the more conflicted it is in setting health care standards. The more conflicted an entity is, the less it can or should be trusted.
Thus, a government panel’s conclusion that women don’t need regular mammograms until a full decade after they had been told that preventive screening was essential is raising suspicions of hidden motives.
Get used to it.