Article

2009-11-24 Home Front: Politix

Liberals and Mammography Rationing? What rationing?

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.

No sooner had the Health and Human Services Department's U.S. Preventative Services Task Force recommended against mammography for women under 50 than Secretary Kathleen Sebelius rushed to say don't worry. The decision had "caused a great deal of confusion and worry among women," she said, promising that no policies would change. New Jersey's Frank Pallone vowed to hold hearings, and Senator Dick Durbin leveled the gravest charge Democrats can make: The task force was "appointed by President Bush."

The political duck-and-cover was also on display in that vanguard of ObamaCare known as the New York Times, which ran at least four much-ado-about-nothing items even as it endorsed the reduced screening. On the same day as an editorial and op-ed, a front-page "news analysis" lectured that what the public really needs is "a transformational shift in thinking" about the "evidence-based" medical future that the mammogram decision portends. Yes, and no doubt the Times will tell us what "evidence" to follow.

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.

You have to admire Mr. Reinhardt's partisan dexterity. He knows that no government task force is ever going to justify a treatment denial with an overt claim to costs. Instead, the task force found a sneaky way to use clinical data to take costs into account without admitting it. It cites all sorts of harm associated with the problem of "overdiagnosis"i.e., too many costly procedures. This is a reference to mammograms that lead to further tests and treatments that in hindsight are unnecessary.

The HHS task force concludes that this harm outweighs the benefits of saving lives through early detection, yet this makes little sense unless financial costs are a priority. For instance, the panel cites patient anxiety from false positives, yet the literature also shows overwhelmingly that women would rather risk a scare than allow a cancer to progressespecially considering that about 75% of all breast cancers develop in women who do not have special risk factors.

In any event, the distinction between cost effectiveness and clinical effectiveness will be moot if ObamaCare passes. 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. As Mr. Reinhardt notes, "at some point soon the rising cost of American health care actually will force Americans to bring monetary costs into the analysis as well."

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 it will begin the campaign to instruct the rest of us that we must follow the guidance of Princeton professors about what medical care we can receive. Americans will simply have to accept that the price of government-run health care in the name of redistributive justice is that patients and their doctors must bow to the superior wisdom of HHS task forces.

Just don't admit it until after the White House signing ceremony.

Posted by GolfBravoUSMC 2009-11-24 13:20|| || Front Page|| [10 views ] Top

#1 Dick Durbin leveled the gravest charge Democrats can make: The task force was "appointed by President Bush."

Keep BLAMING the last administration "DICK"... It makes you look BRILLIANT!!! What a piss ant

Posted by armyguy 2009-11-24 13:47|| 2009-11-24 13:47|| Front Page Top

#2 This calls for congressional hearings with female Hollywood starlets, with low, low scoop necked dresses, breast implants on parade, leaning over to testify about the horrors of breast cancer. The old boys in congress will rise to the occasion for those hearings. They always have.

Posted by whatadeal 2009-11-24 14:56|| 2009-11-24 14:56|| Front Page Top

#3 Thing is, the recommendations have a sound scientific basis. While we're all concerned about breast cancer, the screening in the 40 - 50 year old group (absent a high risk factor such as a family history) tends to create as many problems as it solves. The rationale for limiting mammograms is a reasonable one, and in an ideal world the argument would be over the science and medicine.

Of course, we don't live in an ideal world, and anything that has to do with ta-ta's is immediately politicized and objectified (criminy I can't believe I'm writing that, I sound like a wimmins studies major).

Posted by Steve White 2009-11-24 16:00|| 2009-11-24 16:00|| Front Page Top

#4 "ta-tas", Dr. Steve, really? ;-)

Posted by trailing wife 2009-11-24 16:28|| 2009-11-24 16:28|| Front Page Top

#5 Thing is, the recommendations have a sound scientific basis. While we're all concerned about breast cancer, the screening in the 40 - 50 year old group (absent a high risk factor such as a family history) tends to create as many problems as it solves. The rationale for limiting mammograms is a reasonable one, and in an ideal world the argument would be over the science and medicine.

Let me guess, Steve, you believe global warming also?

Posted by DoDo 2009-11-24 16:43|| 2009-11-24 16:43|| Front Page Top

#6 DoDo, Dr. White is professionally qualified to comment on the subject.

Posted by trailing wife 2009-11-24 16:47|| 2009-11-24 16:47|| Front Page Top

#7 I believe to truly access the risk, first one must rank order the boobies by size and firmness. I have the grant application and order for a box of latex gloves ready to go.

Posted by ed 2009-11-24 17:14|| 2009-11-24 17:14|| Front Page Top

#8 Thing is, the recommendations have a sound scientific basis.

For which insurance companies who use such reasoning are pilloried daily by the posturing likes of Pelosi et al and labeled as Evil. Poster child after poster child is put before the public without regard to case or exception to make policy upon for decades. One set of rules for me, another set of rules for thee.

Posted by Procopius2k 2009-11-24 17:23|| 2009-11-24 17:23|| Front Page Top

#9 DoDo, Dr. White is professionally qualified to comment on the subject.

No doubt.

My wife got breast cancer before turning 50. Fortunately that was under the old rules.

Posted by DoDo 2009-11-24 18:34|| 2009-11-24 18:34|| Front Page Top

#10 My friend got Breast cancer at 32. No family history.

Posted by Bright Pebbles 2009-11-24 19:53|| 2009-11-24 19:53|| Front Page Top

#11 Laura Ingraham - breast cancer at age 41

Ingraham once was engaged to conservative author and fellow Dartmouth alumnus Dinesh D'Souza and has dated former New Jersey Democratic Senator Robert Torricelli, as well as briefly dating MSNBC host Keith Olbermann. (WTF?)

In April 2005, she announced that she was engaged to businessman James V. Reyes, with a wedding planned in May or June 2005. On April 26, 2005, she announced that she had undergone breast cancer surgery. On May 11, 2005, Ingraham told listeners that her engagement to Reyes was canceled, citing issues regarding her diagnosis with breast cancer. Despite the breakup, she maintained that the two remain good friends and had told listeners, in 2006, that she was in good health

Posted by GolfBravoUSMC 2009-11-24 20:23|| 2009-11-24 20:23|| Front Page Top

#12 There is a point that no one is addressing, however. Why is it that here in the bad ol' USA, where we supposedly have incredibly awful health care, your survival rate for cancer is so much better than in enlightened Europe? For breast cancer, there's a 15% greater survival rate (75% to 90%) and for prostate cancer it's even better (50% to almost 95%).

If it is not due to more screening tests, done at at a younger age, then why are we barbarians doing so much better than....well, our betters?

Also, is it not true in the case of breast cancer that the younger you are when you get it, the more aggressive it tends to be? Wouldn't that argue for earlier testing?

Posted by Cornsilk Blondie 2009-11-24 20:28|| 2009-11-24 20:28|| Front Page Top

#13 In other news......Obama administraction, JAMA, ACORN, and AARP make joint announcement that there is no scientific connection between cigarette smoking and lung cancer.

Posted by Besoeker 2009-11-24 20:33|| 2009-11-24 20:33|| Front Page Top

#14 Americans will simply have to accept that the price of government-run health care in the name of redistributive justice

The problem will be not enough rationing of healthcare under a government run system.

Or more precisely too many things that should be rationed or limited for medical reasons won't be, and too much that should be more freely available won't be.

This is because governments always pander to emotional poll driven special interests, rather than act on rational evidence.

Posted by phil_b 2009-11-24 21:12|| 2009-11-24 21:12|| Front Page Top

#15 pretty obviously the rationing has begun. Perhaps our good friend IG Gerald Walpin can explain how depoliticized opinions work under this most transparent, scientific admin *spit*

Posted by Frank G">Frank G 2009-11-24 21:23|| 2009-11-24 21:23|| Front Page Top

#16 "government-run health care in the name of redistributive justice"

Pardon my phrench, Fred et al., but FUCK THAT!

You leftist clowns want to redistribute something, redistribute your own goddam money - and leave other people's money alone. >:-(

Morons.

Posted by Barbara Skolaut">Barbara Skolaut 2009-11-24 21:37|| 2009-11-24 21:37|| Front Page Top

#17 DoDo -- the plural of anecdote is not 'data'.

Some very good people looked at this issue. When looking at populations of people, we docs are still charged to do no harm. I understand the emotional overlay that comes with breast cancer, but the data are equivocal, at best, on the use of routine screening mammography for women under age 50.

We also overuse PSA tests to screen for prostate cancer. We've finally put a stake into the heart of routine chest x-rays to screen for lung cancer -- that took about four decades. And don't get me started on the lack of value of an annual physical exam for people under 50.

There are a number of screening tests that were sold to the public. On closer inspection, they cost as much as they save, and they expose a fair number of people to risks that they shouldn't be exposed to.

That's the argument. If only we could get past the ta-tas.

Posted by Steve White 2009-11-24 21:44|| 2009-11-24 21:44|| Front Page Top

#18 Steve, I think most people would probably go with whatever the prevailing view is of the medical community at large.

My hope is that mamography or an equivalent detection process will be improved over time allowing for earlier detection ... that will be adopted by the medical community ... without the bureaucratic gate-keepers who don't have the expertise to evaluate the validity of medical studies.

Posted by Super Hose 2009-11-24 23:09|| 2009-11-24 23:09|| Front Page Top

21:03 Ululating Platypus
20:38 Frank G
20:34 Injun+Sheger1721
20:10 Super Hose
20:07 Super Hose
20:07 SteveS
19:24 James
19:13 Besoeker
19:10 Besoeker
18:59 swksvolFF
18:56 swksvolFF
18:41 Frank G
18:18 Lord Garth
17:53 SteveS
17:51 M. Murcek
17:47 M. Murcek
17:38 SteveS
17:38 Whiskey Mike
16:47 SteveS
16:35 Procopius2k
16:34 Ebboluck Hupimp6002
16:33 ed in texas
16:33 Procopius2k
16:33 Super Hose