November 17 2009
Carrie L. Lukas
Many have speculated about how a government commission charged with determining what should be considered necessary medical care would operate. As the Washington Post reports today, newly offered recommendations about breast exams from the U.S. Preventive Services Task Force gives us a window into what this future might look like:
Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests.
In its first reevaluation of breast cancer screening since 2002, the independent government-appointed panel recommended the changes, citing evidence that the potential harm to women having annual exams beginning at age 40 outweighs the benefit.
The article quotes experts on both side of the equation: Some welcome these recommendations, while others call them "crazy" and warn that they potentially undermine the progress that has been made in reducing the number of deaths associated with this type of cancer.
Who's right? The article details some of the factors the panel considered: They weighed the number of false positives and unnecessary procedures against the number of lives saved from early dectection and treatment. But who makes the final calculation? Who decides that it is better to increase your odds of missing a diagnosis by a little bit than running the risk of a false-positive?
It seems clear that individuals are the only people who can make that determination for themselves. Certainly, there are some who would rather avoid uncomfortable, and even painful, procedures even if that slightly increased their risks of dying from the disease. And individuals should be aware of the real problems and dangers associated with preventative measures so they can make an informed decision about what's best for them.
And of course there is the matter of cost. While the panel claims that cost wasn't a factor in their recommendation, if it wasn't this time with this particular panel, it certainly would be once government was the nation's primary insurer. And costs have to be taken into consideration: We can't all get daily body scans just to make sure that nothing unwanted is growing. But again, who should determine how much you are willing to spend on preventative care? Clearly, it should be an individual decision: We should make decisions as we shop for insurance policies that offer a variety of coverage options.
Of course, there will be some who cannot afford health insurance on their own and, if there is going to be a federal role in providing insurance, it should be targeted at these truly needy individuals. Ideally, the government should still try to give those in need as much freedom to choose as possible (better to provide them with vouchers or payment support so they can purchase insurance on their own than forcing them into a one-size-fits-all government plan). Yes, this means that some will get more care than others. Some will be able to afford more generous insurance plans than the rest of us. But that will be the case in any system we adopt: The wealthy will always be able to use their money to escape the system and to receive better service and care.
I hope that this panel's recommendation receives a lot of media attention. This is really the central issue in this health-care debate. It's not about coverage, and it's not about costs. It's about control. Who should make these determinations, the individual or the state? I think I know which way the American people would vote.