The New Breast Cancer Guidelines, Obamacare, and Rationing

I am a radiologist by profession, and read mammograms. So I have an inherent interest in mammography.

I don't want to get too deep into the science. Let me say this: the determination by a government panel that mammograms are not necessary in younger patients without serious risk factors has a lot of legitimate science behind it. I am not saying I agree or disagree; in fact, if it is my wife or my mother, I would still suggest them getting earlier mammograms. But that said, I am simply saying that there is a true, honest scientific argument for it.

That said...this also has huge political connotations.

Breast cancer, more than any other disease (other than perhaps HIV/AIDS) has been used for decades as a political football. It has been used to fearmonger, and raise billions of dollars in both the private and public sectors for research. And God forbid if you are against breast cancer research.

The argument these scientists boils down to this: in the 40-49 year old age group, only 1 out of every 1,900 patients are found to have breast cancer. Depending on what you want to price a mammogram at (for this argument, lets arbitrarily say it is $50 per study), that means it costs $95,000 to detect that single case of breast cancer. Economists and government bureaucrats will argue that is not cost effective. And they are right.

But this is the heart of rationing.

I am not against rationing. But if you are against rationing, then you damn well be against Obamacare. This is not the first screening test to bite the dust because of cost concerns. Virtual colonoscopy, a study to screen the colon, was cut by most insurers earlier this year for lack of sufficient data.

While I am not against rationing, this is also the problem with rationing. When someone arbitrarily (with scientific evidence or not) makes a decision that alters the health care landscape, people become upset. They have a thought process built in their minds, and that does not change instantly, regardless of the science.

This has been my argument from the beginning. Government insurance (in whatever method you are going to provide) should be very basic and cover only the things that make scientific sense. But that said, that is exactly why we should not have a comprehensive, mandatory insurance system. We should have a system that is built largely on catastrophic and basic preventative care, with all other care to be decided by patients themselves.

The public rations itself everyday. They decide not to buy that Cadillac. They decide not to buy a $5,000 TV. But when it comes to health care, the most personal of all decisions, you are unable to make those decisions? That is what the Democrats believe.

That is why, as early as last year, I proposed a system in which catastrophic coverage (anything that is unexpected, such as accidents, heart attacks, strokes, cancer, etc.) is mandatory for all individuals. However, after that, we should have personal spending accounts. Preventative and elective care could be paid out of those accounts. And then, for preventative care items that have been shown to save lives (such as mammography), we would set guidelines after which fees will automatically be deducted from your account. Thus, if you are over 50, the cost of a mammogram would be deducted from your account every year or two, whether OR NOT you have a mammogram. That would give people a financial incentive to take care of preventative care issues, such as heart disease, diabetes, etc.

Of course, that kind of common sense is sorely lacking in Washington. And instead, Democrats are preparing to pass a health care reform package that will do none of those things. They will aggravate the cost problems that already exist in the system, and will ultimately lead to real rationing. That is what he have to look forward to with Obamacare, whether Democrats want to admit it or not.

It comes to a simple decision: in the future, would you rather committees like the mammography group to make decisions of what you can and can't do, or would you like to make that decision after discussing the options with your own personal physician?