Tuesday, November 17, 2009

Obamacare: cutting costs by cutting tests so you can...die!

It truly is Deathcare. Is it coincidence that the new guidelines are issued under this administration, during the big push to socialize American medicine?
Stop Annual Mammograms, Govt. Panel Tells Women Under 50

For the first time in 20 years, a government panel is telling women in their 40s to stop getting routine mammograms and recommending that a host of other breast cancer screenings slow down.

The United States Preventive Service Task Force announced Monday that it recommends against annual mammograms for women age 40 to 49 because, they say, the "harms" and risks of testing do not outweigh the benefits.

USPSTF still recommends doctors start screening all women over age 50, but with a mammogram once every two years instead of annually.

The task force also recommends against teaching breast self-exams for all women and said evidence was insufficient to recommend mammograms for women older than 74.
I tell you bluntly: this is deliberately a first effort to reduce health care costs. It's not about making things more "efficient," no matter how much Obama blabbers that. Gone is his rhetoric about "preventitive medicine" -- reducing costs will first come via reducing the number of tests. Then it won't be long until rationing like Canada or the UK's NHS: "with most [doctors] saying the health service cannot afford to provide free care to everyone."
"These new recommendations are long overdue. Most countries do not support mammography screening under 50 and do it every other year after 50 in their government-sponsored screening programs," said Dr. Susan Love, founder of the Dr. Susan Love Research Foundation.
And outside the U.S., cancer survival rates -- especially breast cancer -- are much lower. Could it possibly be, gee, because Americans get the tests more frequently than Canadians and Europeans, giving more Americans a chance to catch cancer early?
"Their justification: these new guidelines capture 81 percent of mammography's benefits, save a lot of resources, with only a 3 percent drop in survivorship from the most common cancer to affect women," said Dr. Marisa Weiss, president and founder of BreastCancer.org. "But what really is the cost? And who is paying that price? It could be you, your mom, daughter, sister, aunt or grandmother, or all of us."
This doctor's criticism is absolutely correct. How can anyone talk about saving resources when it's directly trading lives, even a mere three percent?

The problem on the other side: some proponents of frequent cancer screenings aren't arguing that it's a woman's right to get screenings as often as she wants, but that the government should mandate, even fund the screenings. This soundbite, in and of itself, is correct, but we don't know what the doctor is intimating. It's also immoral to force insurers to cover screenings periodically, even for the good purpose of mammograms. The solution, as always, is the free market: women can pay for screenings out of pocket, or they can get policies that will cover screenings as often as they want. The latter is general practice with Western insurance, which doesn't make it less silly. Who gets an auto insurance policy that covers oil changes?
However, Dr. Diana Petitti, vice chair of USPSTF, said the task force never looked at costs in their research or their recommendations.

"The task force doesn't deal with insurance and coverage," Petitti said. "Cost was not a part of what the task force looked at."
I don't believe this for a second. The new recommendations state:
The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman's lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman's life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.
The bolded part is my emphasis, proving that monetary costs were very much taken into account. If they were not, then why is the task force worrying about anything being unnecessary? If there's no concern over the monetary cost (equipment and labor), then there's no basis to consider the tests "unnecessary."

But the truth is that the task force doesn't want women to be frightened enough to make sure that it isn't cancer, to spend a little money and endure negligible radiation to make sure it isn't something that can kill them, and to spend a little time. The most damnable part, though, is "would not have shortened a woman's life." That translates to, "How do you know she wouldn't have died earlier from something else?"

In other words, they're telling women not to get screened for that little lump, because maybe they'll die in a car accident next week.

Who among you would want a woman you love to take a chance? Damn the worry of "false positives," and damn "inconvenience." When someone's life could be at stake, why shouldn't she feel free to spend a few dollars for tests?

The AP article mentions a few things that ABC's did not:
Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.

Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated.

In most women, tumors are slow-growing, and that likelihood increases with age. So there is little risk by extending the time between mammograms, some researchers say. Even for the minority of women with aggressive, fast-growing tumors, annual screening will make little difference in survival odds.

The new guidelines balance these risks and benefits, scientists say.

The probability of dying of breast cancer after age 40 is 3 percent, they calculate. Getting a mammogram every other year from ages 50 to 69 lowers that risk by about 16 percent.

"It's an average of five lives saved per thousand women screened," said Georgetown University researcher Dr. Jeanne Mandelblatt.

Starting at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.
It's so easy to talk about reducing costs when the people are reduced to statistics. I don't know how this "researcher" meant the data, but are four lives out of 1000 that easily dismissed? This isn't balancing risks and benefits: it's balancing costs and lives. Again, I'm putting aside the forcing of others to pay for the tests. I'm just pointing out that when the government issues new guidelines, patients and insurers are too quick to swallow the new rules.

Do the math: a mammogram from 50 through 69 will save five lives per 1000 women, but earlier screenings from 40 to 50 and continued screenings for the elderly will save four more lives. That's nearly double.

But don't mind me; I'm just the son of a cancer survivor, who beat it almost 20 years ago. Under ObamaDeathCare, the one test that revealed her cancer would be considered "inefficient" and "unnecessary," because her original medical problem in fact had relation to her cancer. The doctor was puzzled enough, though, and ordered a very extensive assortment of tests.

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