When I started this blog, I wanted to keep politics out of it. Mostly because talking about politics always leads to arguments, and as much as I can enjoy a good debate, I usually end up feeling stressed out and frustrated. The people who argue about politics feel very strongly about their convictions and typically seek out information that confirms their opinion while dismissing anything that supports the contrary view. It's called confirmation bias. Because of this phenomenon, I know that I will not be able to convince anyone on the opposing side to change their minds any more than they could convince me to change mine. So I usually prefer to not talk about politics unless provoked. But I am so struck by some recent developments in public opinion on a couple of health care issues that I feel the need to break my own rule. I might not sway people on the other side, but maybe I can help push some people who are on the fence closer toward the right side: my side. Okay, just kidding about that.. sort of.
If you haven't heard about the new recommendations about mammography screenings that have been released by a panel of experts to advise the Department of Health and Human Services, you must be living under a rock. In a nutshell: a review of evidence has led the panel to conclude that routine mammography screenings are not necessary for women under 50.
This recommendation has not surprisingly been met with downright furor from the American public, and especially women. Young breast cancer survivors are standing up saying, "A mammogram saved my life" and critics are calling it a step towards "rationed health care." I can understand these points of view.. to a point. Being a believer in evidence-based life (as the title of my blog suggests), I support the new recommendations, and I'll tell you why in a minute.
First, I have a question for those who think the panel is wrong. It occurred to me after reading a letter to the editor in my local newspaper this morning. In it, the writer says "Shame on this panel. We want to save lives no matter what the cost." My question for this writer and others like her is: Do you also support saving the lives of Americans who are currently uninsured, no matter what the cost? Or is it only the lives of people like you (the "us" in the world) that you want to save, while the rest ("them")are left to get sick and die?
At this time in this country, I am hearing two arguments that, to me, seem contradictory. On one hand, it is morally imperative that we perform 19,000 unnecessary mammograms in order to save one woman's life (NY Times) "no matter what the cost"; and on the other hand, health care reform designed to expand access to health insurance is simply too expensive. I would hope that these arguments are coming from two discrete groups of people, but I suspect there is some overlap; some people who are making both arguments at the same time. This doesn't make sense to me. The only explanation I can think of is that some people will justify any expense to save the lives of the people they can relate to: middle-class or wealthy Americans who already have health insurance, but are simply unwilling to pay to save the lives of those who are below them on the socio-economic totem pole: the poor and uninsured. Now that, to me, is morally reprehensible.
I could go on about that, but I have other things to do with my day so I will leave it at that. Now, to explain why I agree with the mammography recommendation:
1. Although there is the rare virulent cancer that is detected by early mammography screening, there are also other, slowly-growing and innocuous cancers that are detected and treated unnecessarily by risky procedures like surgery, chemotherapy, etc.
2. The recommendation only advises against routine screening, not screening in general. So, for women who are at high risk and would receive the most benefit from early screening, that will always be an option. Even if insurers were to use this recommendation to change their reimbursement policies (which they are NOT doing anyway, so relax), it would only mean that a mammogram would have to be prescribed by a physician after assessing an individual patient's risk, similar to the way that blood tests are ordered and covered by insurers now. My insurance company doesn't cover "routine" blood tests (i.e. blood tests for no good reason), but as long as my physician signs off on it because she feels it is necessary for diagnosis, it is all paid for. Women are not being told not to get screened, they are only being told to make the decision with their physicians on an individual basis rather than automatically being screened every year. I don't see what is so horrible about this.
3. If routine screening for women in their 40's is worth the cost because it saves a handful of lives, then why wouldn't we expand the screening to women in their 30's? Or 20's even? There are women who develop breast cancer and die from it in those age groups as well, so if we are unable to accept any level of risk, shouldn't all women who could possibly develop breast cancer be screened? And for that matter, although it is rare, breast cancer can occur in men, so should all men be receiving regular mammograms, too?
This "save every life at any cost" mentality, though understandable, could lead to a slippery slope of more and more unnecessary screenings for more people, and subsequently higher health care costs. Furthermore, it may backfire by leading to excess disease and deaths in other segments of the population. The uniquely American unwillingness to look at disease from a public health perspective rather than an individual perspective is one of the reasons that the United States spends so much more on health care than other countries, without receiving the dividends of better health outcomes. Although it is difficult, sometimes it is necessary to think with our heads rather than our hearts. The cost of excessive procedures will be paid not only in dollars and cents, but in lives as well. It might save the lives of a few, but those savings will ultimately be paid by those for whom the resulting higher costs of health care become prohibitive. If the cost of health care is increased, access will be decreased, which will lead to greater morbidity and mortality for those who don't have it.
And just think about this: there are already women who can't afford to get mammograms at any age and regardless of their risk because they don't have health insurance. Maybe our first concern should be to get them covered. But then the question is, are they worth saving "at any cost"?
No comments:
Post a Comment