In God We Trust


Rationing's First Step

Health Care: A government task force has decided that women need fewer mammograms and later in life. Shouldn't that be between patient and physician? We have seen the future of health care, and it doesn't work.

We have warned repeatedly that the net results of health care bills before Congress will be higher demand, fewer doctors, more cost control, all leading to rationing. New recommendations issued by the U.S. Preventive Services Task Force (USPSTF) regarding breast cancer and the necessity for early and frequent mammograms do not convince us otherwise.

Just six months ago, the panel, which works under the Health and Human Services Department as a "best practices" study group, was shouting its concern about a Centers for Disease Control and Prevention study showing a 1% drop in the number of women regularly undergoing such screening and prevention.

The task force was saying that women older than 40 should get a mammogram every one to two years. It found that frequent screening lowered death rates from breast cancer mostly for women ages 50 to 69. But that was then, and this is now.

"We're not saying women shouldn't get screened. Screening does save lives," Diana Petiti, task force vice chairman, said of the recommendations published Tuesday in Annals of Internal Medicine. "But we are recommending against routine screening."

Now the panel recommends that women in their 40s stop having routine annual mammograms and that older women should cut back to every two years. The concern allegedly is that too frequent testing can result in increased anxiety, false positives, unneeded follow-up tests and possibly disfiguring biopsies. Preventing breast cancer and saving lives almost get lost in the new analysis.

"I have a particular concern in this case about who was involved in this task force," says Rep. Charles Boustany, R-La., who was a heart surgeon in private life. "There are no surgeons or oncologists who deal directly with breast cancer or even radiologists. ... I've seen far too many young women develop late-stage breast cancer because they didn't have adequate screening."

Little, if anything, has happened medically in the last six months to cause such a shift. A lot, however, has happened politically as a health care overhaul has limped forward on life support. The Congressional Budget Office has been busy pricing these various bills, a process that includes screening and prevention.

As we have warned, the growing emphasis seems to be on cost containment rather than quality of care. About 39 million women undergo mammograms each year in America, costing the health care system more than $5 billion.

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40," says Otis Brawley, its chief medical officer. "Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."

Daniel Kopans, a radiology professor at Harvard Medical School, says: "Tens of thousands of lives are being saved by mammography screening, and those idiots want to do away with it. It's crazy — unethical, really."

This, sadly, appears to be the future of medicine under government-run health care. Aside from taxes on insurers, providers and device manufacturers, we'll be up to our eyeballs in cost-effectiveness boards that will decide who gets what tests and treatments, when and if. These are only recommendations for now, but they are the shape of things to come.
 

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