Who Decides If Breast Tests Are Best?

Patients should make their own choices about mammograms, not bureaucrats.


"The USPSTF [United States Preventive Services Task Force] recommends against routine screening mammography in women aged 40 to 49 years." This simple statement, published on the website of the U.S. Department of Health and Human Services last week by the Agency for Healthcare Research and Quality, ignited a firestorm of protest.

"This recent recommendation by the USPSTF is dangerous because it suggests that women lay down their best weapon in the fight against breast cancer, which is early detection," declared Janelle Hall, founder of the National Breast Cancer Foundation. Bernadine Healy, the first woman to head up the National Institutes of Health, advised, "I'm saying very powerfully ignore [the new recommendation], because unequivocally this will increase the number of women dying of breast cancer."

The American Cancer Society immediately rejected the federal panel's recommendations: "The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40." The ACS also pointedly noted, "With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them." A new USA Today poll finds that 76 percent of women say they disagree or strongly disagree with the panel's recommendation.

In the face of the public anger, a rattled Health and Human Services Secretary (HHS) Kathleen Sebelius immediately disavowed the federal panel's recommendation, declaring that the USPSTF does "not set federal policy and they don't determine what services are covered by the federal government."

Thank goodness that someone stepped in to stop federally-appointed experts and bureaucrats from making health care policy and deciding which patients will get what treatments, right? Actually, no. A federal bureaucrat, namely Sebelius, did decide which patients will get what treatments. The HHS secretary simply rejected USPSTF's clinical cost-benefit analysis for mammography in favor of her own political version of cost-benefit analysis.

The fury and confusion among competing bureaucrats over the new mammogram recommendations is a timely reminder that the proper person to make medical treatment cost-benefit decisions is the patient. Currently, 49 states mandate that health insurers cover routine mammograms between ages 40 and 49. But instead of mandates or potential federal regulations limiting access to mammography, why not let women choose for themselves? If a woman is comfortable with the new recommendations, she should be able to buy a less expensive health insurance policy that does not cover annual mammograms. If she believes that routine mammograms will give her greater peace of mind, she should have the choice to purchase a policy with more extensive and expensive coverage. 

And the patient choice principle extends beyond a resolution for the mammogram controversy: One way to encourage consumers to more carefully balance health care risks and benefits would be by allowing them to choose less expensive high-deductible health insurance policies combined with health savings accounts. In such a situation, patients, not politicians, could decide for themselves how much screening tests like mammograms are really worth to them. (By the way, the USPSTF also has concluded that "the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75." Nevertheless, I choose to get a prostate-specific antigen test every year.) For the record, a quick check with the New Choice Health consumer website finds that mammograms in the Washington, DC, area cost between $140 and $340.

Sebelius' ruling is an example of how politics will overtake decisions about what constitutes appropriate medical treatment as the federal government assumes ever greater responsibility in paying for health care. As health care reform legislation moves through Congress, this controversy should encourage the public do some cost-benefit analysis of its own about increased government interference with health care.

Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is available from Prometheus Books.

NEXT: Sarah Palin, and The Weekly Standard's Decadal Audition for Ideological Ventriloquist in Chief

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. It's really hard to tell from that small picture but I'm calling it now.

    Nice sideboob.

    1. Allright...all women with at least one breast (post pubescent and above the age of consent) line up by height (shortest to tallest) to the left and I will personally conduct direct manual breast examinations...it's a dirty job, but someone has to do it

  2. Ron Bailey on Who Can Best Protect Women's Breasts

    I can! With my hands, and possibly my mouth!

    OK, raunch time over.

    1. Runch time 11:30 AM - 3:00 PM.

      1. Try my shitty chicken!

        1. Rokay. Finarry! Oh no. It's those god-damn Mongorians again! Stop! Stop right there, Mongorians! God-damnit, stop! Stop breaking down my shitty wrall, you stupid Mongorians!

  3. Cost-Benefit Analysis

    You pay the costs; I get the benefits.

    See how simple that is?

  4. My aunt got breast cancer in her early forties, but she noticed the lump on her own, not via mammogram. This was in Canada, where apparently the age to begin mammograms is already 50 (and only every two years).

    1. Well now we know where the enlightened progressives in this Administration's Alphabet Soup of agencies got this little bright idea. Follow the joyous single payer players to the North! Onward and Upward, or some such bullshit.

  5. But instead of mandates or potential federal regulations limiting access to mammography, why not let women choose for themselves?

    That's an outrageous proposal! Who knows where it might lead?!

    * sputters, shakes head, mutters *

  6. Where's Chody to whine that people are ignoring the science?

    1. Probably searching for testicular lumps.

      1. I hear that goes quick with an empty scrotum.

  7. The fury and confusion among competing bureaucrats over the new mammogram recommendations is a timely reminder that the proper person to make medical treatment cost-benefit decisions is the patient.

    That cannot be true, it must not be true, otherwise what would be the reason for Americans to support such a large body of bureaucrats?

    I mean, the reason cannot simply be pusillanimous acquiescence, would it be?

  8. A federal advisory panel recommended last week that women between the ages of 40 and 49 no longer receive routine mammograms to screen for breast cancer. American women angrily rejected the panel's conclusion and a rattled Secretary of Health and Human Services Kathleen Sebelius quickly disavowed the recommendation....

    They just like getting their tits squeezed.

  9. They just like getting their tits squeezed.


    1. I have not yet had the pleasure, but it sure as hell doesn't sound comfy.

      But y'all secretly enjoy the turn-your-head-and-cough, don't you?

      1. Getting your breasts slammed flat between two plates of cold glass sounds horrible.

        It contrast, it's almost pleasant that someone pays attention to the balls for a change.

        1. Gasp. Getting your balls slammed flat between two plates of cold glass sounds worse.

          1. Hernia check... yr doin' it wrong.

        2. Personally I like it when my paramour does an impromptu prostate check.

    2. Nope. Not nearly as much fun as it sounds like it should be, I'm afraid.

    3. It's not bad, really. And the waiting room had snacks and coffee. Colonoscopies are far worse.

    4. Demetri Martin reference?

  10. Pay your own way and you can make your own decisions.

  11. Without the severe distortions of the heavily regulated insurance industry, mammograms would be cheap and could be had by any woman at any age based on her own analysis of the risks involved.

    But that's just crazy talk. Let's argue over what and how to ration, not whether we should ration at all.

  12. I'm not pro single payer but insurance companies will use the same shit for the same reasons. The health market is distorted because employers are customers vs. the real end consumers in most cases.

    Untie health insurance from employer and when more people buy direct the plans will align with true market needs (not some HR department). My work doesn't buy my car insurance or home insurance but somehow they need to be involved in my health insurance choice.

    1. AGreed. That's my theory. Having mostly employer-purchased insurance causes all sorts of perverse incentives. Employers have no incentive to buy care that covers the individual after they leave the company (and will be a competitive disadvantage if they do). Insurers, consequently, have no incentive to offer extended care for existing conditions after the employee changes jobs and leaves the insurance company. And will be at a competitive disadvante to those that don't. Whne the employer is purchasing for the insurer, the most efficient solution is for insurance companies to try to dump patients once they are too sick to work.

      And THIS is the real heart of most people's major complaint about the health care system right now - not anything about the number of uninsured.

  13. But y'all secretly enjoy the turn-your-head-and-cough, don't you?

    Let me tell you, there's nothing like the first time a cold, latex-powdery hand wraps your junk. Especially when you don't know yet that you're allergic to latex.

    1. That does not sound pleasant. But at least you found out before you tried a latex condom.

      1. I was told I had "excellent scrotal structure." Have had much success using that as a pick up line, though.

        1. Sug, you should put that on a t-shirt. I can't tell you how many times I would have given out my number if only --if only I had some inkling as to the gentleman's scrotal situation.

          1. And here I am already married. Dammit!

            What are you doing on your lonely American Thanksgiving? Do you at least have someone that will give you a plate of turkey and stuffing?

            1. Having failed to score an invite to one of your sumptuous American dinners, I will be slinking up to Canada in defeat. At least being around family gives me a good reason to start drinking early in the day.

              I hope all of you magnificent bastards enjoy your turkey.

              1. Fuck that. Come to Kentucky. I have enough turkey for you and 10 Canadians besides. And a vast array of rare bourbons.

                Srsly, I'm smoking three turkeys for 6 people. I have enough turkey.

                1. Dude, that's a lot of turkey. Bourbon, smoked turkey, lots of weed... Kentucky sounds pretty awesome.

                  1. I's making bacon wrapped dates with a goat cheese filling as an appetizer, if that sways your decision.

                    Flash-fried haricort vert, caramelized corn with fried sage, two kinds of sweet potatoes, mashers, sage and sausage stuffing, habanero-pineapple compote, two kinds of cranberry salad... and my wife is surprisingly cool about young women I meet over the Internet.

                    If not though, have a safe trip to Canada.

                    1. Whoa, that all sounds incredible. I will confess to a weakness for all things bacon-wrapped.

                      I wasn't able to make it to the dinner, but some friends of mine made a bacon-wrapped turkey for Canadian Thanksgiving. They dubbed it the Baconator.

                    2. Better watch out for the Food Police, SugarFree. You're going to be dishing up a lot of unhealthy food, and Tony and his fellow travelers might convince Dear Leader to order a strategic air strike on your compound.

      2. What is this "condom" of which you speak?

      3. i prefer the prostate check

        1. I'll volunteer for that.

      4. I actually used a latex condom for years before I found out I had latex allergies. All that time I assumed it was the cat.

        1. and not the pussy?

  14. I think I heard that for exams for women aged 40-50, for every positive result there are 100 false positives.

    This is just a recommendation based on the latest science. I don't believe anyone was talking about forcing people to do anything.

    The worst aspect of this controversy is the politicization of science. Objectivity-loving Reason would never do that, would it?

    1. This is just a recommendation based on the latest science. I don't believe anyone was talking about forcing people to do anything.

      It's just a recommendation for now. That's phase one. Phase two will be a strong suggestion. Only after the frog has been sufficiently boiled a while will we finally get to phase three: "sorry dear, no mammogram for you".

      Unless of course you're one of those evil rich people who can afford to pay the exorbitant costs out of pocket that you socialists are almost foaming at the mouth against.

      1. What the eff are you talking about?

        People with enough money will always have the option to pay out the ass for whatever treatment they want. If we have some sort of publicly-funded service I expect them to work according to the latest objective recommendations and efficiencies. Wouldn't you? Or would you prefer the system pay for anything anyone wants regardless if it's helpful? That's what private money should be for, isn't it?

        1. I'd prefer that people have the opportunity to choose between different insurance companies, some of which might cover mammograms every 6 months beginning at age 25 and others that only pay for them every 2 years starting at age 50. To get that, though, you'd have to decouple health insurance from employment. And any amount you spend on health insurance premiums or health care (not just any amount above 7.5% of AGI, as at present) would be tax deductible.

        2. People with enough money will always have the option to pay out the ass...

          Which is exactly what they will have to do once this plan makes prices go through the roof. Your socialism gets in the way of my free enterprise.

    2. The issue is the timing - why NOW? Why not 5 years ago?

      This is not like the Food Pyramid change.

      This is just a recommendation based on the latest science. I don't believe anyone was talking about forcing people to do anything.

      The problem with these "recommendations" is that they can quickly become the new reference for public and/or private organizations.

      1. But that would be a voluntary choice on the part of those organizations, would it not?

        1. Re: G Mc,

          But that would be a voluntary choice on the part of those organizations, would it not?

          It would, but the problem is the moral hazard created by these so-called "recommendations". Once they become the standard, rationality and common sense go out the window.

          1. Ah... so the true argument to be made really isn't against the change in the recommendation's message, but against the very existence of the recommendation itself?

    3. Tony, taxes are paid voluntarily too...the IRS says so. Obama is going to "ask" us to pay a little more to fund his noble wars as well.

    4. Tony - politicization of science is precisely the point of the column - that's what Sebelius did. Now do you get it?

      1. I agree with you about Sebelius--her decision was a political one.

        Where you lose me is the fanciful idea that science-based recommendations from trusted sources can be replaced by "free choice" of individuals, as if women are both equipped with the proper medical training and information to make such decisions thoughtfully AND are able to shop around insurance policies to find the perfect fit. This is just one procedure. Are enough options going to ever be available for people to get the right fit a la carte style?

        1. The point is that once the government has to start making rationing decisions, then the science will be politicized to either save the government money, or to appease key constituencies.

          The implication in the reactions is that this government appointed task force is claiming they are not necessary because it saves the government money not to pay for it. And how can you trust the government to be honest about the science if they are the ones shelling out for the treatment.

          We've been telling to repeatedly that all rationing decisions in any government system will be politicized. The abortion amendment is an example. This is another. Even if the recommendation is accurate (and it probably is), it's obvious that the politicians care more about what wins votes than what is actually medically necessary.

          1. The point is that once the government has to start making rationing decisions, then the science will be politicized to either save the government money, or to appease key constituencies.

            Which is so much worse than insurance companies? Getting our healthcare via the appeal to one key constituency--shareholders--is better than the people? Or is this more tired, vaguely racist bullshit about how certain "key constituencies" (the ones with no money and spotty voting habits) are all-powerful and command everything Democrats do by way of... asking for handouts?

            And how can you trust the government to be honest about the science if they are the ones shelling out for the treatment.

            I dunno, because there is no profit motive?

            The abortion amendment is an example.

            I agree. The abortion language is an example of government bureaucrats getting between people and their doctors.

            politicians care more about what wins votes than what is actually medically necessary.

            And the health insurance industry cares about finding ways not to pay for what is medically necessary.

            1. Boy Tony, you're really getting unhinged. Race was the furthest thing from my mind. I was actually thinking AARP. Which is a vociferous backer of all things for the elderly, including medical care. I was also kind of thinking Florida, which is a swing state, with lots of AARP members. Crying racism is such an easy intellectual dodge though. I can understand hwo the weak-minded would make it a habit.

              Which is so much worse than insurance companies? Getting our healthcare via the appeal to one key constituency--shareholders--is better than the people?

              In a free market you get a vote in what sort of insurance policy you get - with your dollars. Assuming you're buying it and not your boss.

              I dunno, because there is no profit motive?

              And you can't think of any OTHER motive? Campaign contributions? Elections in key states?

              And the health insurance industry cares about finding ways not to pay for what is medically necessary.

              Only in a market where patients don't actually get to decide who to purchase their insurance from. Get rid of the employer based system, and these practices will be punished by consumers.

      2. But politicization of science is good. (sarcasm)

        Tony, seriously, you need to take a break from your thoughts some day. Wasting time excitedly debating yourself over whether there will be enough options, like some child anticipating what will be in their Christmas stocking, is beyond a little silly. If people like yourself don't start getting a clue there won't be options, period.

  15. It's a recommendation, not a mandate. What's all the fuss about?

    1. Because the very same group that made this recommendation is called out by name as setting policy on what will get paid for by Obamacare. Policy that can only be overriden by a vote from Congress.

      That's what the fuss is about.

      1. You mean insurance coverage in some sort of public option?

        1. In Medicare, Medicaid, and the public option. Which set the standard for private insurance (what's left of it) outside the public option.

  16. Tony, shut the fuck up. We're trying to have an adult conversation about boobies.

  17. Not exactly breast-related, but Jezebel responded to Cathy Young's article on men's rights by crying "rape culture."

    1. sangmo 03:16 PM
      Equality [for men] to be in touch with their emotions, to cry, to cook for their loved ones, to be in touch with their nurturing side, taking care of domestic chores...

      Crying at the stove sounds awesome. You know, if men hold all the power, we could cry or not cry at the stove if we wanted to. The vast majority just fucking don't want to. This is not a problem to be fixed.

      1. Next time you try the crying at the stove thing, put on a frilly apron and be smoking a cigarette. You'll feel totally Betty Draper, promise.

        1. Don? Don?

  18. I love how the news coverage has ignored the real argument for not getting mammograms before age 50: that they actually cause more harm (including deaths) than they save. It's not that they don't save enough lives or are too expensive, but that they cause actual harm.

    The problem with them is the number of false positives that, at the very least, result in biopsies, but that in many cases result in unnecessary mastectomies or other surgical interventions that cary substantial risk in their own right. A study done about ten years ago (no link handy, sorry) found that mammograms were especially good at finding very slow-growing tumors that actually posed no risk over a woman's expected lifetime, but once found, almost always resulted in surgical intervention. (It's sort of like most prostate cancer actually has little risk to the man because it's so slow growing that he'll be in the ground for some other reason before the cancer would cause a problem.) In other cases mammograms weren't particularly useful because they found fast-growing tumors that were not detectable in one year but that were already palpable by the next year, so the mammogram did little to find them unless a woman happened to get one in the narrow window when it was not yet detectable by self examination.

    According to this study, the irony is that the very women most harmed by mammograms were the ones most likely to credit them with saving their lives.

    So the stupid way this has been portrayed in every media outlet ("they don't want to pay to save our lives?") not only totally misstates the basis for the recommendation but it also perpetuates certain ideas that are actively harmful to women...

        1. +3?...just saying

    1. It sounds like the real problem isn't the mammograms themselves, but the unnecessary surgeries that are carried out in response to the information disclosed by the mammograms. You seem to be arguing that less information is better, because doctors and patients are powerless to refrain from taking inappropriate action in response to the information they receive.

    2. As a woman who was diagnosed with an aggressive type of breast cancer at the ripe old age of 36 -- that was caught early, at stage 0 -- thanks to having had baseline mammos at 30 and 36, please allow me to direct you to an unscientific but enlightening poll of women, all of whom were diagnosed under the age of 40. That window may not be nearly as narrow as you seem to think.

      1. The argument isn't that it catches some cancers that are legit, but rather that it does more harm than good on the whole. The problem with anecdotal evidence is that it doesn't see the whole picture. So while you may have been saved by it, many others were harmed. The basis for a medical decision about routine screening can't be made on the basis of just those who have positives that are good and save them but also has to take into account false positives and the harm caused by them. That's why you wouldn't find many researchers giving your poll much credence: it's self selecting and doesn't see everything. Unfortunately, given the current state of medicine, the best that we could do would result in some people being harmed by not screening versus many more being harmed because of screening. The answer that is needed is better evaluation techniques (however, not more sensitive ones, since sensitive ones also produce more false positives) that reduce false positives.

        So while I don't doubt the sincerity of the folks on the link that you posted, or the fact that some (but not all) of them were saved by early diagnosis (I say some, because one of the problems with mammograms is the number of women who are misdiagnosed and have radical treatment thinking it will save their lives when mammography indicated treatments that actually weren't warranted), it is a self-selecting sample that is pretty much useless for determining optimal public policy. I hate to put it that way, but that is part of the problem, and your conviction, while good for you, is actually not good for the population as a whole.

        It may sound like impersonal and brutal calculus, but unfortunately that is what is needed.

        1. but unfortunately that is what is needed

          why is it needed? so when we are all on government health care they can save money?

          You are missing the point.

          If we all paid for health care ourselves it would not be "needed" at all except for advice on the statistical likelyhood of catching something. it would be up the patient and doctor, not up to a beancounter whether he works for the government or for an insurance company.

          Go ahea and publish stats, but is only needed by the people paying. I'm all for people pay

          1. No, I'm not missing the point. I'm just not talking about the payment issue, but rather the point that if you get advice that is supposed to be reliable, *regardless of who pays for it*, that advice can't be based on anecdote, or it will be unreliable. That is entirely separate from the issue of who pays for what. Now, you should have every right to ignore that advice and do what you want (there you will get no argument from me), but if groups are going to publicly pronounce recommendations, those recommendations should be based on some reasonable science, not political motivations about group representation and feminist ideology.

      2. I should add that at least some research (although I haven't followed it in a while) indicates that over the population, mammograms perform statistically no better than routine self examination at preventing death from breast cancer. There may be more recent studies (the one I recall was discussed in 1996 in a Scientific American article), but at least then the data seemed to indicate that mammograms were not actually helpful overall in the population at preventing deaths.

      3. All those mammos done between ages 40-50 are the baselines for ages 50-60. No mention of the role of baselines in later diagnoses in all this.

        Of my 3 benign biopsies, not one surgeon could tell me beforehand which type of cancer, if any, he would find. In other words, he had to biopsy it to know what it was.

        Those stats re: aggressive, treatable and slow-growing cancers are very interesting, but I assume they are based on biopsies.

        Seems to me like a biopsy is needed to know what exactly is growing in there. How else would we know whether it is the treatable cancer?

  19. There was a pretty good write up of this over a Slate last week.

    Short version, women between 40 and 50 have a low incidence of breast cancer. Mamograms have a modest rate of detecting cancers early. Survival rates of cancers not caught by mamograms are actually fairly high. The hazard from the radiation from mamograms is not insignificant.

    So should women between 40 and 50 get mamograms? Not clear. The recommendation -- let doctor's consult with patient to determine the INDIVIDUAL risks for each patient to determine if that patient should or should not get a mamogram.

  20. But at least you found out before you tried a latex condom.

    I'm old-school. It's sheepgut or nothing.

  21. I was told I had "excellent scrotal structure." Have had much success using that as a pick up line, though.

    I bet that looks good on a resume, though.

  22. Fuck yeah. I list it right after "strong leadership skills."

  23. I'm old-school. It's sheepgut or nothing.

    You're crying at the stove, X.

    I use the whole sheep.

  24. Unter - the question who gets to decide about getting a mammogram once they have been informed about risks like false positives.

    1. Indeed Ron. False positives rarely kill. Cancer often does.

      1. I'm not arguing your point at all Ron, but as long as we invest bodies with the power to make even recommendations, we should at least try to understand the basis for those recommendations and ensure that they are ones that maximize benefit and minimize harm.

        I would rather have the recommendation that recognizes the big picture, rather than the one driven by the agenda of breast cancer survivors (many of whom weren't actually survivors but victims of false positives according to the best research on the subject).

        For Joette, amputation of a breast for no reason (which was often the case with false positives) counts as a harm in my book. As does the not insignificant risks associated with unnecessary surgeries and the costs incurred.

        1. Unter - While I don't have numbers to back it up, I would assume that the majority of false positives don't currently result in mastectomy. Biopsies are routinely performed via either fine needle aspiration or core needle biopsy (a punch biopsy) to confirm the preliminary findings of cancer. It seems to me that if a woman with a possible cancer who chose to have a mastectomy without that confirmation, in the case of a false positive, hasn't made a rational and educated decision. The fault for that doesn't lie in the screening.

          And that doesn't address the true positives. The cases like me, the very small grade 3 (aggressive) cancers that are very treatable, often without expensive chemo. Absent an equally cost effective and more efficient screening technology, I find it difficult to justify throwing out the most cost effective and accurate screening technology we currently have, which is what the guidelines are doing. They've even suggested that physicians not teach or recommend SBE and if you were to look at the poll I linked to up-thread, SBE and mammograms accounted for 45% of the diagnoses for the women who took that poll, most of which are under 40.

          I am not arguing that mammograms are the most accurate screening tool. I recognize their limitations quite well. But the fact is, we don't have a cost effective substitute and until we do, I find the guidelines the task force has recommended to be horribly misguided.

  25. And you are perfectly free to make whatever choice you want with your own money. Go ahead and pay for a test that will return far more false positives than real ones, resulting in you getting even more worthless tests and procedures.

    1. And you are perfectly free to make whatever choice you want with however much of your own money you have left after paying for mandatory health insurance, the fine for not having mandatory health insurance, and/or the higher taxes needed to pay for all this.

      Interesting how the Chonys of the world have no problem with coverage denials, and can see clear as day that not being covered isn't the same as not getting care, when its the government, but throw fits when its private insurers.

      1. If your are poor, your health insurance will be free or close to it, so you will have just as much "left over" as ever.

        If you are middle class or rich, I guess you have to choose between one more peice of Chinese crap and a worthless medical test. So be it.

        1. How about choosing between someone else's worthless medical test, and 9say) a not-covered-because-it's-not-politically-expedient, abortion.

        2. Hey, Chad, question:

          Why isn't "means-testing" part of liberal health-care reform?

          Seriously... rich people (by liberal definition, anyone making over $99,999 a year - not fooling us with the quarter-million figure) should be excluded (by liberal bean-counters) from this government-run health care pogrom. No?

          I mean, rich people suck, and nobody should be making a hundred large a year, and if they make THAT much money, why give it to them? Make 'em pay out of pocket AND be taxed for the privilege. No?

      2. People rant against insurance companies denying coverage yet rush to give the government the right to deny them. They must think it will be so much more humane when they are denied mammos based on an expert panel's recommendations (as long as the panel members are not appointed by a Republican president).

        Crazy. I guess they don't like being denied by their enemies (ex., big for-profit companies or republicans).

    2. Except, I'm not allowed to NOT pay for other people's unnecessary mammograms.
      Apparantly, you have a positive right to have unneded medical procedures performed on you at other people's expense.

      1. Just as a side note, it is possible to think that both the "screening guidelines" and Obamacare, single payer or just government run healthcare, are wrong.

        1. Well, yeah. The two are linked.

          If the government is going to be funding health care, it is automaticaaly going to be under intense political pressure to skew the findings of it's own internal panels, to please key constituencies.

          In this case, it's nearly impossible to tell if (a) the task force's findings were skewed to reduce costs to government programs by recommending against mammograms, or (b) the task force's findings were correct but disregarded because it was not percieved to be politically advantageous to support them.

  26. Tony, you've said in the past that "political" decisions mean "what the people want".

    Well, what if "the people" demand unnecessary mammograms? The government is (obviously) capable of overriding the recommendations of their own experts.

    Does the right to health care now include the right to demand unnecessary medical procedures to be paid for by others?

    Should I beforced to cough up cash so that women in their 40s can go get mammograms that may well be more harmful than beneficial, merely because popular and powerful political constituencies are able to sway the government to include these things in the list of procedures covered by the state?

    You really think that a system where everyone votes on what kind of healthcare the state provides is going to produce some kind of fair, equitable, just, results?

    If you do, you are much more of a fool than you seem.

    1. If the people knew they were unnecessary, and caused more harm than good, which is what the recommendation says, they wouldn't demand it. Unfortunately the people are being confused, deliberately, by anti-reform interests who are politicizing the issue.

      Since this country's healthcare system is so embarrassingly inefficient and cruel compared to the rest of the industrialized world, we have a lot of examples to model reform on.

      Maybe your faith in the incompetence of government will be vindicated and the system will be unfair, inequitable, and unjust, but it couldn't possibly be more so than what we have now.

      1. It's not possible to know for certain whether any of these tests are necessary or not. Medical judgement changes. And it's certainly not appropriate to force everyone to come to the same judgement about it.
        You want to put the government in the position of saying "no this isn't necessary", and then realizing 20 years later that it IS? or vice-versa?

        You may consider it "cruel" for people to have to weigh their own personal finances in the decision of what healthcare to pay for. But I don't see that as any less cruel than putting their healthcare up to a secret ballot vote before the general public. I'd rather not price my life at the whims of "the people".

      2. One of the harmful effects of these tests was "stress". I'll take the stress if it results in knowing whether or not I have cancer and which kind.

  27. Of course the recomendation also said that Women should consult with their physician and do what's best based on their indvidual condition, but somehow people ignore that.

    1. Assuming that the patient and the physician are actually the ones who get to decide what to pay for.

      In the health care bills right now, there are these government-appointed expert panels who are supposed to cut costs by elimintating "unnecessary" and "ineffective" treatments.

      The person who holds the purse strings ultimately gets to decide. Not the patient and the physician.

    2. somehow people ignore that

      They HAVE to ignore that. Otherwise the shockwaves from cognitive dissonance would tear their skull apart.

      Healthcare, Informed Decisions, Personal Choice?


  28. Hey, I'm pretty good at this sort of thing...

  29. If people want a breast exam not supported by evidence they can pay for it.
    How much do others have to pay for the greed of others (whether its doctors, insurance companies or patients).

  30. These people never change. First they deny (denial = confirmation) they intend to swing, then they always telegraph their punches even further by spacing off (thanks for your example Sebelius) and behaving as if they scored a KO before they've finished throwing the punch. Unbelievably, enough of the public falls for it every time to provide enough successes to give strong incentive for continued sucker punching.

    Not difficult to see where this is going. No more unfair advantage going to people with common sense. Punch drunkenness will level that playing field.

    Judging by their actions the belief that one improves their own situation by pulling others down to drown with them, is widely accepted to be great wisdom.

    Does anyone really believe they want to drown? Shouldn't it have been our responsibility to protect the learning disabled from themselves and those who intend to ruthlessly use them while we still had an option to do so?

    Few options remaining, better hope we make better choices performing damage control than we've made getting into this mess.

  31. My mother died of breast cancer at the age of 55. Her mother, before her, also died of breast cancer. For me, therefore, mammograms are more than an abstract, hypothetical issue.

    Nevertheless, although I live in Canada and am eligible for state-funded mammograms on an annual basis due to my family history and the fact that I am in my mid-40s, I choose not to avail myself of this service.

    To me, the data suggests strongly that the benefits are minimal, while the stress associated with false positives is very real. Irrational fear and political pandering to the female half of the population does not lead to smart decision making.

    I agree with Ronald Bailey - these decisions should be left to individual women. But organizations like the Cancer Society (whose main function is public education) should strive to base their views on firm data. Otherwise they'll soon be perceived as just another highly suspect advocacy group.

  32. My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp. I'm not concerned that Mr. Crumb will go to hell or anything crazy like that! It's just that he, like many types of religionists, seems to take it literally, take it straight...the Bible's books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on.

  33. so true. we do not need the puppets of american beauracacy telling us what we can and can't do about our god give right to health

Please to post comments

Comments are closed.