Health care reform

Boobs in Congress

What the recent mammogram controversy reveals about health care "reform"


One of the ostensible reasons for reforming our health insurance system is the need to halt the growth of spending on medical treatment. So it may be a surprise to learn that in its first major vote on the health care overhaul, the U.S. Senate took a clear and simple position: Cost is no object.

In November, the United States Preventive Services Task Force, a federally sponsored panel of medical experts, announced that it was recommending against routine mammography among women younger than 50. The proposal, coming amid the health care debate, was taken as a gruesome attempt to sacrifice lives to save pennies.

In fact, cash was not a consideration. The task force's rationale was that the benefits of routine breast cancer screening to women in that age group are insufficient to justify the harms it causes them. Yes, it can be expected to save one life for every 1,904 women aged 40 to 49 who get mammographies, but it also yields false positives, which require additional procedures.

Even when the positives are not false, they often lead to unnecessary treatment—surgery, radiation, and chemotherapy—for tumors that pose little risk. The panel noted that mammograms often serve only to detect "a slower-growing cancer that would have eventually become clinically apparent but would never have caused death."

There are precedents for medical authorities to conclude that tests are not always worthwhile. Last year, the same agency declined to recommend screening for prostate cancer among men under 75 because "the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined." Few protests were heard.

Nor is it usually considered utterly insane to take costs into account. We could save lives by testing everyone over 55 for diabetes, for example. At more than half a million dollars for every healthy year of life that would be saved, however, we have the good sense not to.

But the mammography recommendation goes against the central premise of both American medicine and the welfare state: more is always better. Many American women, who have been told for years that they need to get regular mammograms starting at 40, are not ready to break with that practice, and our political leaders wouldn't dare suggest they reconsider.

Quite the contrary. The Senate voted to force health insurance companies to offer free mammograms—no deductibles, no co-payments. The lawmakers also ordered the federal government to completely disregard the task force proposal.

Republicans as well as Democrats ridiculed the notion that Americans should be denied any test they want at someone else's expense. Said Sen. John Barrasso (R-Wyo.), "I don't want a government bureaucrat making a decision for the women of America, if they should be allowed to have screening mammograms."

Actually, no one has proposed making it a crime for people to undergo screening. Those patients who think a screening exam is essential, but whose policies don't cover it, may find facilities that offer it free. They would also have the option, however unfamiliar, of paying for it themselves, at an average cost (according to the American Cancer Society) of about $100.

The Senate measure is not about the right to obtain preventive care. It's about the right to make someone else pick up the tab.

By demanding mammogram coverage in private and government plans, the amendment would raise the cost of health insurance for everyone. Which, as you may recall, is exactly the opposite of what "reform" was advertised to do.

Those who think we cannot afford unlimited budgets for health care may take heart from another Senate vote. It repulsed an effort by Sen. John McCain (R-Ariz.), to delete more than $400 billion in promised Medicare savings in the coming decade.

Alas, the Senate, by a 100-0 vote, also promised that no Medicare benefit currently provided will ever be canceled. Even the alleged savings (from—get this—eliminating waste and inefficiency) are unlikely to be achieved. They are in the bill to create the impression that someone, someday, will be willing to control costs.

Fat chance. Many opponents of the administration's effort warn that it will lead to federally imposed rationing of medical care, cruelly denying Americans the treatments they need. The more plausible outcome is that the government will insist on providing anything and everything until the day we run out of money.

Our leaders know they can't do this forever. So they'll settle for doing it as long as they can.


NEXT: Winning Hearts and Minds

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  1. I always laugh at the “government takeover of health care” line, because you really have to not understand where we already are to say that.

    1. Opponents of socialized medicine should precede “government takeover” with “ongoing and relentless” if they truly oppose it. But they don’t. Republicans and Democrats are essentially in agreement. They are only bickering over the scope and details of the takeover.

  2. So the lesson for Congress is to remove advisory panels like the United States Preventive Services Task Force for their supposed isolation chambers and into the political arena, so that there is no repeat of the (again supposed) public misconceptions over recommendation changes.

  3. No benefit to prostate screening below age 75? What a crock. I personally know 2 men in thier mid 40’s that had cancer that was found by prostate screening (PSA).

    Do you really want to trust the US Government with your health (and your life)? No thank you.

  4. Before I was born, God whispered to me that I’d have to work or pay for everything I received in the life I was about to live, except for medical care. He told me that he would intervene to alter the laws of economics in this one particular case. He said that he felt bad once he realized how badly he had screwed up the whole “disease thing” (his words), and he wanted to make up for it by giving me free health care.

    So, doctors and nurses and “the rich”: pony up. It’s our God given right.

    1. It won’t be only the “doctors and nurses and the rich” who have to pony up – but also the young, the strong, and the healthy. Although they may avoid or resist many of life’s illnesses and deseases, they apparently won’t be able to avoid the parasiticism they live amongst.

      1. parasitism

      2. Agreed. I think a lot of young people who voted for Obama and support the idea of a government health care plan think they won’t have to pay for any of this. When they realize that “community rating” and a requirement to insure all comers combine to raise their insurance rates dramatically, I think there will be a backlash.

        1. I’m a 20 something and I completely agree. I don’t buy health insurance, simply because it isn’t cost effective from my point of view. I’ve been to a doctor once in 6 years and I live a low impact lifestyle (pothead), so paying a couple of hundred dollars a month for health care doesn’t make sense. Now I’ll be required to pay for something that I don’t want. I’m the person most hurt by this new legislation, as I’m already barely getting by as it is.

  5. The hypocrisy surrounding McCain’s amendment is rather irritating. The bill started off with that amendment since it was known that if the pay to doctors was cut, Medicare and Medicaid would lose doctors. But they decided to remove that provision with the understanding it would be passed as a stand-alone measure.

  6. Don’t worry, when the Chinese get tired of buying our debt so we can live our high fat low activity lives, the shit will hit the fan.

    I predict mantory PT at 5:00 AM, and no more fast food, or donuts.

    1. Except for the cops, of course.

    2. Even if you eliminated all obese and overweight people tomorrow, healthcare expenses would only change marginally. For some reason, this healthcare debate is just becoming about blaming others for the decisions they make. The western world cannot let go of the concept of sin. (See climate change, healthcare reform, etc.)

      1. What’s wrong with the concept of sin? It’s the government’s attempt to force us to pay for sins that’s the bad thing.

        The payment for sin is between me, God, and those I may have hurt. Except possibly for arbitrating between lawsuits, government should have nothing to do with sin!

  7. Chapman is the best writer on health care I have read anywhere. He has no partisan agenda. He’s very cynical, but that’s a good thing. You mean, resources aren’t unlimited? No, that can’t be right.

  8. Or here’s an easy solution. Make everyone that wants the goverment to pay for their healthcare to be a fit non smoker.

    If you don’t want someone else telling you how to live your life, then maybe you should pay for your own healthcare.

    1. Also, they should be limited to one child families. Extra children and pregnancies cost society money.

  9. What’s the real cause of expensive healthcare? I mean, if you eliminated obesity and smoking, required everyone to buy insurance to eliminate the “uninsured” problem, eliminated profits in the medical industry,and eliminated malpractice lawsuits, healthcare costs would only go down about 30 percent, maybe. So obviously, there has to be something else making healthcare expensive. But nobody is talking about it.

  10. What’s the real cause of expensive healthcare? I mean, if you eliminated obesity and smoking, required everyone to buy insurance to eliminate the “uninsured” problem, eliminated profits in the medical industry,and eliminated malpractice lawsuits, healthcare costs would only go down about 30 percent, maybe. So obviously, there has to be something else making healthcare expensive. But nobody is talking about it.

    1. That’s easy to answer. Health care costs so much because in the U.S. there are so many procedures and medications that help so many people. All these meds and procedures keep people alive for longer periods of time so they develop yet more medical problems over time. Naturally everyone wants all the care that can possibly benefit them. And no one wants to tell any interest group “no” because there will be hell to pay come election time.

      1. Lol, true. That and all carteling that occurs in the government and industry.

      2. Pablo, “keep people alive for longer periods” Try again.…..expectancy

    2. It’s also all the requirements that Government places on health care. For example, if I had cancer once before, no health care company in their right mind would want to insure me for cancer: it would be too expensive!

      But could I purchase a plan that didn’t have cancer coverage? No, that would be illegal. Thus, health insurance companies cannot cover me.

      It doesn’t matter if I have virtually no family history for cancer, or if I’m willing to “stick it out” and die from cancer, if it means that my health insurance will be cheaper. Politicians know better than I do what kinds of insurance I need!

    3. The real cause of expensive health care is the third-party payment system. When someone other than the patient is being effectively forced to pay up, be it the state or an insurance company, then neither the patient, nor the doctor, has any incentive to economize. I.e. If someone else is paying for it, why NOT order a whole bunch of extra tests, if it reduces risk even a tiny bit?

  11. the other reason health insurance is so expensive is that it isnt insurance. car insurance doesnt pay for oil changes, homeowners insurance doesnt pay for your gardener, etc. why is health insurance different?

  12. 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…the Bible’s books were written by people with very different mindsets

  13. Sometimes I sound like I’m arguing, when I’m actually not. I just have a way of putting my posts stronger than intended.It’s easier to keep out of the conversation and not take the chance of being misunderstood.

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