The Coming Malicious Faceless Entity

Below is a message from a subscriber to ReturnToExcellence.net that transmits the lead editorial (red highlights by me) in Thursday's WSJ re the release last week of revised lower breast screening guidelines made by the U.S. Preventative Services Task Force - a federally funded task force meaning that BO paid for it.

 

The group's recommendations were published in the Annals Of Internal Medicine.  They dropped guidelines for women to have a mammogram every year starting @ 40 & replaced them with recommendations for testing done every other year from 50 to 74.

 

For anyone who thinks that rationing is not part of BO's universal healthcare plan please consider these reduced (read rationed) breast care recommendations were coupled with a call later in the week by the American College Of Obstetricians & Gynecologists for reduced cervical cancer screening .  All of a sudden Pap tests are now recommended @ a later age & @ less frequent intervals. 

 

It is obvious that BO plans to partially offset the increased costs of insuring the currently uninsured by reducing both the number & scope of medical procedures of those currently insured.  Finally we have found a topic where BO's administration thinks costs matter.  The reduced number of PAP tests & mammograms being recommended admits that less healthcare treatment & screening results in lower costs.  Now why can't we apply this principle to consumer driven healthcare without all of the trillion dollar reforms that BO & Congress are planning for one sixth of our economy?  But then you know the answer to that.

 

None of the 16 members of the breast screening panel who were interviewed could recall how many members voted for the revised lower guidelines but all could say that there was a consensus - in other words the members of the panel hope the blame will go to the anonymous task force itself & not the individual members as if the members have no culpability.  This is the type of malicious faceless entity that will control our medical procedures under BO's universal healthcare plan.  Now these two panels want us to believe that their so-called independent work the same week revising long standing guidelines for both breast & cervical cancer testing that have saved so many lives is merely a coincidence.  We don't know how dumb BO thinks we are but it is obvious that he certainly plans to find out.  I can hardly wait to find out too.

 

A Breast Cancer Preview

The mammogram decision is a sign of cost control to come.

A government panel's decision to toss out long-time guidelines for breast cancer screening is causing an uproar, and well it should. This episode is an all-too-instructive preview of the coming political decisions about cost-control and medical treatment that are at the heart of ObamaCare.

As recently as 2002, the U.S. Preventative Services Task Force affirmed its recommendation that women 40 and older undergo annual mammograms to check for breast cancer. Since regular mammography became standard practice in the early 1990s, mortality from breast cancer—the second leading cause of cancer death among American women—has dropped by about 30%, after remaining constant for the prior half-century. But this week the 16-member task force ruled that patients under 50 or over 75 without special risk factors no longer need screening.

So what changed? Nothing substantial in the clinical evidence. But the panel—which includes no oncologists and radiologists, who best know the medical literature—did decide to re-analyze the data with health-care spending as a core concern.

The task force concedes that the benefits of early detection are the same for all women. But according to its review, because there are fewer cases of breast cancer in younger women, it takes 1,904 screenings of women in their 40s to save one life and only 1,339 screenings to do the same among women in their 50s. It therefore concludes that the tests for the first group aren't valuable, while also noting that screening younger women results in more false positives that lead to unnecessary (but only in retrospect) follow-up tests or biopsies.

Of course, this calculation doesn't consider that at least 40% of the patient years of life saved by screening are among women under 50. That's a lot of women, even by the terms of the panel's own statistical abstractions. To put it another way, 655 additional mammograms are more expensive in the aggregate. But at the individual level they are immeasurably valuable, especially if you happen to be the woman whose life is saved.

The recommendation to cut off all screening in women over 75 is equally as myopic. The committee notes that the benefits of screening "occur only several years after the actual screening test, whereas the percentage of women who survive long enough to benefit decreases with age." It adds that "women of this age are at much greater risk for dying of other conditions that would not be affected by breast cancer screening." In other words, grandma is probably going to die anyway, so why waste the money to reduce the chances that she dies of a leading cause of death among elderly women?

The effects of this new breast cancer cost-consciousness are likely to be large. Medicare generally adopts the panel's recommendations when it makes coverage decisions for seniors, and its judgments also play a large role in the private insurance markets. Yes, people could pay for mammography out of pocket. This is fine with us, but it is also emphatically not the world of first-dollar insurance coverage we live in, in which reimbursement decisions deeply influence the practice of medicine.

More important for the future, every Democratic version of ObamaCare makes this task force an arbiter of the benefits that private insurers will be required to cover as they are converted into government contractors. What are now merely recommendations will become de facto rules, and under national health care these kinds of cost analyses will inevitably become more common as government decides where finite tax dollars are allowed to go.

In a rational system, the responsibility for health care ought to reside with patients and their doctors. James Thrall, a Harvard medical professor and chairman of the American College of Radiology, tells us that the breast cancer decision shows the dangers of medicine being reduced to "accounting exercises subject to interpretations and underlying assumptions," and based on costs and large group averages, not individuals.

"I fear that we are entering an era of deliberate decisions where we choose to trade people's lives for money," Dr. Thrall continued. He's not overstating the case, as the 12% of women who will develop breast cancer during their lifetimes may now better appreciate.

More spending on "prevention" has long been the cry of health reformers, and President Obama has been especially forceful. In his health speech to Congress in September, the President made a point of emphasizing "routine checkups and preventative care, like mammograms and colonoscopies—because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse."

It turns out that there is, in fact, a reason: Screening for breast cancer will cost the government too much money, even if it saves lives.