mammograms and govt vs. private-sector rationing

Mammograms are the second, visible example of the new rationing battle.

(The first is Medicare-- and the claim that the govt will root out waste while cutting spending. Left unanswered and usually even unasked is why we would trust the govt to run more health care if they've been so busy wasting money up to now!)

Under the current arrangement-- heavily subsidized and regulated insurance-- the frequency of covered mammograms is determined through a calculus determined by insurance companies and consumers through employers. This may not be the ideal (since the govt intervenes so heavily here), but given the importance of the test, the disease, etc., it's probably close to optimal despite the govt intervention.

Under the proposal for an even-heavier hand for govt in health care and health insurance, some combination of higher costs and more rationing must follow. When the govt starts making decisions, we can hope for a wise and disinterested cost/benefit analysis. But interest groups would be expected to have more pull. And in any case, more rationing is inescapable under the current efforts to extend the highly-flawed status quo coverage to more people.

In the course of one day, I came across five essays in my daily reading: a story by Laura Ungar and Darla Carter in the C-J, an interview by Ungar with Megan Schanie (whose battle with breast cancer was captured in a long C-J series), an op-ed by Eugene Robinson-- a syndicated columnist in the C-J, a WSJ editorial, and an essay from a friend.

My friend's essay starts with the provocative question: "Why do you want my wife to die?" Toward the end of his essay, he provides these details:

...the United States Preventive Services Task Force changed their recommendation for mammogram screening for 40 – 49 year old women changing it to a “C” on the scale of tests to be complete and breast self-exam teaching to a “D” on their scale. In the current Healthcare Reform legislation passed by the House of Representatives (HR3962), the only tests that will be covered are “A” and “B” tests as recommended by, you guessed it, the United States Preventive Services Task Force. Mammograms do not gain the “A” or “B” rating until women are 50 years old and then only every two years.

Ideally, these decisions would come through the market-- here, between health insurance companies and consumers. Insurance companies might want more testing to catch disease earlier. Or perhaps they'd be indifferent, given the cost/benefit. Or perhaps some consumers would want more testing-- and would willing to pay for it. The market can handle such things AND would provide flexibility from both the perspective of insurance providers and consumers. When the govt rations, there is little if any such flexibility.

The WSJ takes "liberals" to task for trying to hide the rationing components of ObamaCare:

The flap over breast cancer screening has provided a fascinating insight into the political future of ObamaCare. Specifically, the political left supports such medical rationing even as it disavows that any such thing is happening....

Even more revealing was Princeton's Uwe Reinhardt, a leading liberal health-care economist, writing on the New York Times Economix blog. Mr. Reinhardt sees the task force's handiwork as an exemplar of "rational decision-making" that had nothing to do with cost analysis, even as he claimed that rationing based on cost is inevitable....

The House bill gives the HHS task force the mandate to review "the benefits, effectiveness, appropriateness, and costs of clinical preventive services" in making its de facto insurance coverage rulings....

What's really going on here is that the left knows its designs will require political rationing of care, but it doesn't want the public to figure this out until ObamaCare passes....

Then, there's this from Mr. Robinson-- on the inherent politics of the rationing games:

The uproar over the on-again, off-again guidelines on when women should have mammograms is proof of the blindingly obvious: Health care reform that actually controls costs — rather than just pretending to do so — would be virtually impossible to achieve.

I say “would be” because none of the voluminous reform bills being shuttled around the Capitol on hand trucks even tries to address a central factor that sends costs spiraling out of control, which is that each of us wants the best shot at a long, healthy life that medical science can offer. Just as all politics is local, all health care is personal. Skimping on somebody else's tests and procedures may be worth debating, but don't mess with mine.

Intellectually, it's simple to understand why it might make sense for women — those who have no special risk factors for breast cancer — to wait until they're 50, rather than 40, to start getting mammograms. The analysis by the U.S. Preventive Services Task Force, which made the recommendation, looks sound. According to the panel, a whopping 10 percent of mammograms result in false-positive readings that lead to unjustified worry and unneeded procedures, such as biopsies. In a small number of cases, women are subjected to cancer treatment or even a mastectomy they didn't need.

This harm, the task force reasoned, outweighs the benefits of discovering a relatively few cases of fast-growing, life-threatening breast cancer in women in their 40s through annual mammography. It is also true that waiting to begin regular mammograms until a woman reaches 50 — and reducing the frequency to once every two years, as the task force recommended — would save a portion of the more than $5 billion spent on mammography in the United States each year.

The problem lies in those relatively few instances when a mammogram does find that a woman in her 40s has a life-threatening tumor, and when early detection saves her life. This scenario may be fairly rare, but it happens. Given the option, many women would rather be safe than sorry — and safe costs money....