2009-11-28 / Editorials & Letters

A sneak preview of health care rationing

The truth about the effects of government controlled health care is starting to surface. Last week we got a preview of what will become a regular event if government takes over our health care.

The U.S. Preventive Services Task Force, part of the Agency for Healthcare Research and Quality, threw out a longstanding recommendation for breast cancer detection. Specifically, that guideline said women aged 40 and over should have annual mammograms to check for breast cancer. The task force reaffirmed that recommendation in 2002.

Now, just seven years later, the group recommends against routine screening mammograms for women aged 40 to 49 years. Screening every two years is recommended for women aged 50 to 74 years. Mammogram screening for women 75 years and older is not recommended.

The task force notes that breast cancer is the second most frequently diagnosed cancer, after skin cancer, in women and is second to lung cancer as a cause of cancer deaths. It cites data that in 2008 an estimated 250,230 cases of breast cancer were diagnosed and 40,480 deaths from breast cancer occurred. The lifetime risk to develop breast cancer is estimated at 12 percent according to the National Cancer Institute and risk increases with age. The new recommendation also notes that mortality from breast cancer has been declining since 1990 by 2.3 percent per year overall and by 3.3 percent for women aged 40 - 50. Credit for this decrease is “largely attributed to the combination of mammography screening with improved treatment.”

It certainly appears that the longtime recommendation for annual mammograms is effective, particularly for women aged 40 to 50 years. So why the abrupt change? Well, the elephant in the room is cost. The task force states it takes 1,904 screenings to prevent one breast cancer death in women aged 39 to 49 years, compared to 1,339 for women aged 50 to 59. Since cost isn’t mentioned, what’s harmful about those extra screenings needed to prevent a cancer death in women 39 - 49 years old? Here’s what the task force wrote: “False-positive results are common with mammography and can cause anxiety and lead to additional imaging studies and invasive procedures (such as biopsy or fine-needle aspiration)...Anxiety, distress, and other psychosocial effects can exist with abnormal mammography results but fortunately are usually transient, and some research suggests that these effects are not a barrier to screening.”

Unbelievable! In a couple of sentences, this government task force turns the mantra for cancer detection and prevention upside down. Let’s reduce screening for this widespread, deadly cancer because it can cause “anxiety, distress and other psychosocial effects.” The task force also recommends against teaching breast self-examination. Apparently ignorance is now bliss.

The explanation for cutting off screening at 75 years of age is also instructive. These women are “likely to die from another cause before the breast cancer would be clinically detected.” So it’s not worth it to check grandma for breast cancer since she is likely to die from other causes before breast cancer can kill her. This is starting to sound a little like, dare we say it, death panels in practice.

A decision analysis performed for the task force makes this not so encouraging projection. The new recommendation for biennial screening for women 50 to 75 produces “70% to 99% of the benefit of annual screening.” That benefit is detection of breast cancer. Ninety nine percent looks good, but 70 percent is typically considered very average or a ”C.” It looks particularly poor if you are one of the 30 percent whose breast cancer isn’t detected.

What’s the effect of this new recommendation? Right now, it will likely be adopted by Medicare so mammograms for any women 75 or older won’t be a covered expense. You can expect some other health plans to follow. The impact becomes huge if any of the ObamaCare versions become law. This task force and others will set the standards for care for the initial government contractors (insurance companies) and the eventual single-payer government system when the public option ceases being an option.

Don’t forget this is about breast cancer, probably the most politically conscious disease. It has the pink ribbons, an awareness month and major campaigns with corporate sponsors to fight it. So when screening and detection for this highly publicized and deadly disease comes under attack from government rationers, can you imagine what happens to the hundreds of less prominent diseases.

Once again, we’ll find that FREE government health care really means we’re free to wait weeks or months to see specialists and for surgical procedures. We’ll be free to wait in vain for new therapies, drugs and medical devices to improve and extend our lives. And we’ll be particularly free to die if our age and/or condition fall outside coverage/treatment parameters set by government bureaucrats. It’s not speculation – IT’S FACT as this breast cancer screening recommendation makes perfectly clear. We’ve been given a glimpse of the future. It’s time to act. Tell your representative or senator you don’t want government controlled health care.

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