Sometimes, healthcare “rationing” makes sense
Here is a concept that’s difficult for many Americans to grasp: More healthcare doesn’t necessarily add up to better healthcare, especially if the “more” comes in the form of procedures and tests. No, I’m not contradicting myself.
It’s important for those without any health insurance to have access to doctors, but those of us with health insurance sometimes overuse procedures. And that can do real harm. This is one of those issues without an easy right or wrong. There is a lot of gray area here. It’s complicated, and there is disagreement even among the scientists.
After years in which the medical establishment urged all women over 40 to get regular mammograms, the U.S. Preventive Services Task Force has issued new guidelines saying that women between 40 and 50 don’t need yearly screenings. They may, in fact, do more harm than good.
The risk that a 40-year-old woman will die of breast cancer in the next 10 years is very small — just 0.19%, according to data from the National Cancer Institute. (Over her entire lifetime, the risk is 2.86%.) And the risk that a woman of 40 will be diagnosed with invasive breast cancer before her 50th birthday is 1.44%. Most women vastly overestimate these risks, research shows.
Meanwhile, the chance of “false positive” results (which appear to signal cancer but turn out to be incorrect) is 60% higher in women in their 40s than in women in their 50s, in part because younger women’s breasts are denser and harder to evaluate. Rates of over-diagnosis — the detection of lesions that would never become cancerous — can run as high as 10%, the analysis said.
The argument is similar to the one recently surrounding men’s screening for prostate cancer. Several studies have suggested that complications from false positives and biopsies in PSA (prostate-specific antigen) screening outweigh the potential benefits of the procedure. The government panel has not produced general guidelines for prostate testing. The cancer society and institute simply recommend that men consult with their doctors about the potential value of the test. That, in effect, is also what the panel is suggesting for mammograms.
It is critical that we rely on research to determine which procedures should be most often used and how often they are used. With disagreement among scientists over mammograms, it will probably be a few more years before research offers clearer answers. But those answers will come.
However, critics of health care reform have succeeded in substantially reducing the benefits that could come from studying which medicine works best and which procedures should be dropped. With their cries of “rationing,” the GOP has introduced amendments to stop Medicare from using the results of scientific analysis to determine which procedures are best.
As a result, the nation could end up paying for medicine that does more harm than good.
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47 comments Add your comment
Vinny
November 17th, 2009
12:22 pm
Wow. Where to begin. There is so much liberal claptrap contained in this piece, Cynthia has managed to even outdo herself.
Having known several women in their 30’s that have died from breast cancer, I wouldn’t put much weight in anything that the goverment comes out with.
All they are trying to do is prepare us for the rationing that is sure to come under Obama-care
Disgusted
November 17th, 2009
12:25 pm
Tell all this to the obstetrician who’s so worried about getting sued for malpractice that he’ll order every medical test known to humanity. That 1.44% can translate to billions of dollars in court awards.
The American people
November 17th, 2009
12:29 pm
Bow down to another foreign leader Obammy, turn those clocks back. Why has this guy paid his lawyers over a million dollars trying to protect his birth certificate? Does he have something to hide? It’s going to come out next year, good or bad if he likes it or not. There is a court case in January to get things rolling. Mr. President if you have nothing to hide how about you release this thing and end this madness. Unless you do have something to hide. “I promise to give each existing buisness in 2009 and 2010 a $3,000 tax credit for each additional full-time employee hired.” – Barack Obama. “You Lie” – Joe Wilson.
Joan
November 17th, 2009
12:37 pm
Well, I believe my testing should be a matter between me and my doctor, so I will be cautious and do what is necessary to stay alive. Why should I risk my life because of a few percentage points? Is this just a precursor to what to expect under rationing? The cutting off of benefits for tests “the government’ believes are unnecessary?
Betsy
November 17th, 2009
12:38 pm
It’s easy to take one small piece of (governmental) information and generalize profusely in order to make a point. And once again, something liberals seem not to understand, nobody said we don’t need health reform. Us logical people just don’t want the Democrats’ form of “reform” rammed down our throats like we were Hitler or Castro minions. The country is, after all, a republic, not a dictatorship or tyranny, and I would appreciate Mr. President not acting like a dictator or tyrant who is going to do what he darn well wants to whether it is truly in the best interest of the citizens (half of whom elected him to this elevated throne) or not. I am truly afraid for the country. We are sinking fast into a cesspool of governmental intrusion, interference, and mandates, where the people have no say.
booger
November 17th, 2009
12:40 pm
If you want to cut out useless procedures, introduce tort reform. Dems. will not hear of this however, and have even built penalities in the house reform bill to prevent states from doing so. Page 1432 states federal funds may be withheld from any state which enacts measures which limit legal fees, or awards in a medical malpractice claim.
I think we can get a glimpse of the future in the H1N1 fiasco:
-this summer…120,000,000 doses by Nov. 1
-Two months ago…40,000,000 doses by mid November.
-today…..30,000,000 doses by early December.
Now this is rationing you can believe in. This admins. credibility is on a steep downward curve.
mom to four
November 17th, 2009
12:43 pm
I heard this on the news last night and my first thought was the government is trying to prepare us for rationing. The fact that Cynthia Tucker is justifying this is no surprise, but appalling! Sure, the risks of getting breast cancer before 50 may seem low, and all those exams and mammograms may be inconvenient, until you or a loved one are actually diagnosed with cancer before the age of 50. Then those exams are a life- saver. One question, Cynthia does not answer is what is the harm in having the mammograms at 40? Is it just a matter of a false positive? As a woman who had a false positive before the age of 40, I can say that I would rather have a false positive and go through the inconvenience of the tests and biopsy than be one of the women in the .19% who is not detected in time. The irresponsibility of this article and blog are incredible. I wonder how approving Tucker would be if one of her loved ones was in that 0.19% that developed cancer before 40 but was not detected in time because the government would not approve a mammogram. Besides, it is not as if Tucker will actually pay for her healthcare under the government system. Remember, the rich are going to pay for it. If people think this is a two-class healthcare system now (those who have insurance and those who do not), just wait until this bill is passed. The poor and middle class will be subject to government sanctions, while the rest of us pay our own way, including mammograms at 40 if we need them.
ATLshirt.com
November 17th, 2009
1:15 pm
here comes the Death Panels that Palin warned us about !!!
Common Sense
November 17th, 2009
1:49 pm
Ms. Tucker :
That is unless it involves you or one of your loved ones and then you not only want to go to the head of the line but you want the “best” and you want it right now!
It’s the same reason Congress has “their” own plan and the same reason the President sent his kids to private schools in D.C.
It’s the “good for others but not me” syndrome ……….
Jane
November 17th, 2009
1:58 pm
I think we’ve been sold a bill of goods.
From http://www.preventcancer.com/patients/mammography/ijhs_mammography.htm
‘Radiation from routine mammography poses significant cumulative risks of initiating and promoting breast cancer … Contrary to conventional assurances that radiation exposure from mammography is trivial- and similar to that from a chest X-ray … about 1/ 1,000 of a rad (radiation-absorbed dose)- the routine practice of taking four films for each breast results in some 1,000-fold greater exposure, 1 rad, focused on each breast rather than the entire chest … Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening … As early as 1928, physicians were warned to handle “cancerous breasts with care – for fear of accidentally disseminating cells” and spreading cancer … Nevertheless, mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, as yet undetected breast cancers …’
I have no intention of subjecting myself to this before reaching menopause. Finally some sanity is being restore to this debate instead of the blantant brainwashing we’ve all been subjected to for years. 10 years ago, HRT was supposed to be good for women. Now it is known to increase the risk for cancer. 10 years from now, the same will be true for mammography.
jt
November 17th, 2009
2:24 pm
“the U.S. Preventive Services Task Force has issued new guidelines saying that women between 40 and 50 don’t need yearly screenings. ”
As of now, regardless of what a typical disfunctional government agency “recommends”, you may get a mammogram anytime you want.
Wait until the government completely takes over our Medical system.
PublicEnemy
November 17th, 2009
2:47 pm
Watch the WWII series on the History Channel this week. The simularities are scary. To borrow a phrase from my brother Chuck D. Don’t Believe the Hype.
Cassie
November 17th, 2009
2:52 pm
One quarter of all women diagnosed with breast cancer diagnoses are under 50.
What will happen to them?
JOEL PARTAIN
November 17th, 2009
3:03 pm
Cynthia, you’re right ,of course.Sure riled up the wingnuts, tho. I have seen ER docs cave in to moms who want their toddlers to have CT scans that were totally inappropriate.That scan was not available for some other patient who needed it more, for sure. Rationing is rational.Defensive medicine is a definite contributor (or excuse) so tort reform is an idea. Or national malpractice insurance.
Turd Feguson
November 17th, 2009
3:16 pm
Hmmm…so its better for big brother to decide when you are sick, what time for appointments, type treatments and who is entitled to this illustrious OboboCare.
Hogwash.
“It’s important for those without any health insurance to have access to doctors, but those of us with health insurance sometimes overuse procedures.
Uh no. Its more important for those without to get a job or 2 if needed and assimialate rather that rely on us who work/produce something. Personally, I dont care about them so please stop making them my issue. They already get plenty of govt entitlements and need no more.
Uh no. If we pay for coverage we are entitled, by payment of premiums, to have the services for which we have paid.
Ms Tucker, perhaps you might dig into your personal piggy-bank and adopt a person without HCare. Find them a job, dwelling etc the lettuce know how that worked for ya.
Chris Broe
November 17th, 2009
3:16 pm
Sure, absorb some radiation biannually but dont count on being diagnosed correctly. Doctors are not adequately trained to read radar images of breast cancer. With over 300 types of breast cancer, and thus over 300 therapies, the odds that your doctor is competent to ID the exact disease is slim. The therapeutic path is usually a lucky guess and often wrong. Sometimes a hunch pays off, and sometimes it doesn’t.
As far as malpractice goes, the law is that you have only two years to file a lawsuit for a misdiagnosis. Isn’t that asking a patient to heal himself, and know when a diagnosis is incorrect? A patient would have to have a medical degree to rediagnose himself so quickly. The outside limit is five years, but finding a lawyer willing to grapple with the nest of umbrella corporations shielding the hospitals and doctors is daunting. Every examining room at Northside Hospital has a sign on the wall which reads, “The doctor is an independent contractor unaffiliated with Northside Hospital”.
The hospital is pre-emptively disavowing any responsibility for the care of any doctor practicing under it’s roof. You may as well just let mother nature take it’s course and avoid the side effects of chemo.
The privately run, market system of healthcare has failed. Maybe the Government can do better. If it’s your time, then it don’t matter anyway, right?
Turd Feguson
November 17th, 2009
3:16 pm
JOEL PARTAIN
November 17th, 2009
3:03 pm
You have seen no such thing.
StJ
November 17th, 2009
3:58 pm
Tort reform would do more to alleviate “overuse” of testing procedures than rationing. But of course, that makes too much sense and won’t make it into the so-called “health care reform” bill.
pat
November 17th, 2009
4:09 pm
Who in the ruddy hell are you or the government to tell me what tests, procedures or medicines I need. It is not yours or the governement business whether I am getting to much or not enough health care.
At least you admit there will be rationing. But worse it’s behavior control and I will not have it.
not a CT fan
November 17th, 2009
4:36 pm
I personally know 5 women who had BC. Three of them were in their 40’s. One was in her 20′a and one was in her 50’s. All but one of them has survived. Can anyone tell me how old Olivia Newton John, Shirley Temple Black, Jill Ireland and Happy Rockerfeller were when they were diagnosed?
I wonder why CT is so adamant abour us getting screened for colon cancer, but trivializes the need for BC screening.
jconservative
November 17th, 2009
4:45 pm
“…rationing that is sure to come…”
“…Is this just a precursor to what to expect under rationing…”
Rationing has existed since the 1950’s when we committed ourselves to
free market health care insurance. Read your insurance policies, they are all a long list of things the company will pay for & things the company will not pay for. And if a question arises, the insurance company has staff on hand to tell the doctor what they will or will not pay for. They get the final vote, not you, not your doctor.
My wife & I have both been subject to the rationing by both Blue & Aetna. Top notch, expensive policies in both cases. I have spent over $10,000. out of my pocket for care for her the insurance company will not cover.
Look I am opposed to every health care bill now before congress. But to sit here & complain about rationing that may or may not happen & be ignorant of the rationing that does happen is only an insult to yourself.
America
November 17th, 2009
4:50 pm
Please, please can we get rid of Obama. Georgia will do it’s part, who else is with us?
Road Scholar
November 17th, 2009
4:50 pm
Joan : This is the first time I have agreed with you! See, we can agree on something! My wife had to have extensive tests and a biopsy recently and it wasn’t fun for her. They determined that it wasn’t a problem and she based her decisions on what proceedures to do on what the doctor said and reccomended and her research. There is nothing in the bill or common sense that would require omission of prudent actions.
Betsy: You know we had an election and the non-conservatives won! Now you feel how many liberals felt during the Bush years. It is no different that the elected party implement their agenda. As for your quote “We are sinking fast into a cesspool of governmental intrusion, interference, and mandates…” I think not, if we pay attention. That includes Enron, Wall Street, Banks, Insurance companies…IE the Greedy Ba$tards.. who have sold this country down the tubes because of their greed. Checks and balances based on well thought out regulation is needed, not the carte blanche , turn your back approach that has persisted in recent years. The freemarket needs some scruples at times, and if the operators aren’t going to have scruples, then regulation is a must. These business made their decisions and now they are goind to have to live with it.
Spartann
November 17th, 2009
5:36 pm
Ms Tucker……. Under Obamacare,will this kind of rationing be the norm? Will the Government be likely to say , “no…you gotta wait till you’re old enough” ????
Malika P.
November 17th, 2009
6:04 pm
Anyone who supports Obamacare has not sought help at a government run hospital or clinic. It’s the pits. For a taste of what it will be like once Democrats get control of our health care choices visit Grady Hospital. You wait excessively long for service, 8 hours or more, and once you get service you wait excessively long to get a prescription filled. The staff has plenty of attitude and treat you like you are getting government help.
The present health care bill is about Democrats controlling folks lives.
booger
November 17th, 2009
6:12 pm
Sometimes rationing makes sense. Who are you proposing do this rationing. These studies are all made available to doctors for them to mke decisions based on this and other information about a patient. Sounds like you would prefer a one size fits all rationed solution to a doctor/patient solution.
Spartann
November 17th, 2009
6:43 pm
Hey “booger”
You’re absolutely correct about it becoming a one/size fits all governmental bureaucracy …. Her brand of Robinhood politics seeks to fundamentally change healthcare in to a single payer system and to hell with all the rest……..
Rush Limpballs
November 17th, 2009
6:57 pm
mmm mmm mmm
I love me some oxycontin !
Dumb southerners
November 17th, 2009
6:59 pm
I see the comments from you hillbillies and I am embarrassed to be white. White trash….plain and simple
Constitution
November 17th, 2009
7:01 pm
Under the constitution we are all entitled to “life, liberty, and the pursuit of happiness”
You can’t have any of the three without good health, which requires healthcare for all. How we get there is debatable. But get there WE WILL !
Rush Limpballs
November 17th, 2009
7:03 pm
All this talk of rationing’s got me scared. How will I stockpile my oxycontin if it’s rationed?
Adolf Hitler
November 17th, 2009
7:04 pm
I like southerners. They’re my kind of people.
Tony
November 17th, 2009
7:13 pm
Hardball quote: “…dog whistle to her base.”
Love it!
Just because
November 17th, 2009
7:53 pm
FYI, Cynthia, insurance companies scrutinize procedures. Prior approvals are often required and certain criteria has to be met before procedures can be authorize. Any “new” procedure also has to be approved by the FDA and meet certain clinical trial criteria as well.
So . . . there is more to health insurance that I would say folks like you truly know anything about . . . and that includes members of Congress as well. I will bet you if a study were done of the members of Congress you would find that any procedure they requested would be approved whereas any average person would not be able to get the same kind of coverage.
Kevin
November 17th, 2009
8:27 pm
And so it begins.
As we face the inevitable of rationed care under the guise of “care for all”, the left begins its propaganda campaign to sell us on the idea.
Absolutely stunning.
Get ready for it people. This is what 53% of you voted for. I hope you enjoy it.
Sunshine and Thunder
November 17th, 2009
10:40 pm
Seriously, Cynthia, you wrote this:
“It’s important for those without any health insurance to have access to doctors, but those of us with health insurance sometimes overuse procedures.”
I guess making health care free won’t cause anyone to overuse it. Naaaaahhh.
TnGelding
November 18th, 2009
12:11 am
Our system is both underused and overused. Aren’t we clever? You’re right, there is no easy answer, but we have to become more informed consumers of health care. After all, it’s our life they’re gambling with.
TnGelding
November 18th, 2009
12:12 am
Sunshine and Thunder
November 17th, 2009
10:40 pm
Nothing in life is free. I’m sure you’re more aware of that than most.
Madison
November 18th, 2009
1:44 am
Adolf Hitler, I bet you are like him in a lot of ways!
Caveman
November 18th, 2009
6:47 am
How many doctors order tests because they either have their own lab/profit center or get a kickback from the lab? Every one of them that went in to medicine to get rich.
eddy
November 18th, 2009
7:34 am
For all who strongly object to mammo’s and other tests, don’t get them……fairly simple. Your health; your choice!! However, if cancer or some other very serious disease causes symptoms and you visit the ER or your doctor’s office only to discover that you are Stage IV, etc, please do not whine or complain about your plight in life. Just accept your fate and go quietly into the dark! Boy, you showed them that these tests were not necessary.
Most of you just have opinions, know someone who has or had cancer….so your experience is from afar. Wait until your are the patient….wonder if your opinion might change? I am a cancer patient since 2001 and scans and tests have enabled me to live this far. I am thankful that my doctor orders scans regularly. So Cynthia, if and when (and I hope not for your sake) some symptoms occur and cancer is detected and it has spread and you are Stage IV….wonder if these useless tests could have made a difference?
Jimmy62
November 18th, 2009
7:36 am
Cindy, don’;t you understand that the government is likely to force us to do things that seem good now, but later on turn out to be bad? I don’t doubt their good intentions (mostly, I think some understand the score, and want healthcare reform for more power, which it will definitely get them), I doubt their ability to make medical decisions for the rest of us. Heck, it wasn’t too long ago that trained doctors were telling us that smoking was good. And you want us to give congressmen the power to set what services we can and cannot get?
Spartann
November 18th, 2009
9:01 am
Hey “Dumb southerners”….
If you’re soooooo embarassed to be white than get you’re turn-coat arse over to a tanning salon ….They’ll have you lookin “yellow” from head to toe in no time.
Carol Knight
November 18th, 2009
9:19 am
Has anyone looked at that panel of ’specialists’ on this US task force ? 7 women and 8 men….1 of the woman specialty is ‘new approaches to Early Detection in Breast Cancer’ and another ‘cost-effectiveness analysis to assist clinical and public health policy formulation’……so, the one for early detection ? she must have decided that there is no such thing as ‘early detection’, and the other ? looks like she’s in charge of getting rid of UNECESSARY spending ? such as breast cancer screening equipment/procedures?
DEATH PANEL !! Everyone needs to write to their senators and stop this nonsence!!!
RB
November 18th, 2009
12:45 pm
Finally, a study not funded by friends of the American College of Radiology and the groups that make their money off of mammography machines and procedures. False positives, increased radiation, and the possibility of the acceleration of cancer cell creation from the procedure itself are the issues that need further discussion. Self-screening is more useful than mammograms. Millions of lives (and dollars) would be saved if we educated women how to self-screen and get to know their bodies rather than always subjecting them to unnecessary testing.
Patricia Shannon
November 19th, 2009
10:03 pm
Another consideration is that the radiation from mammograms causes a certain number of cancers, leading to death. That has to be balanced against the deaths it prevents. I would like to see the statistics on that for various ages.
Another comment suggested self-screening, but that has not found to work well in practice.
Such studies are quite useful. If a procedure kills more people than it saves, at a certain age, why would people defend it?
Ken
November 21st, 2009
4:19 am
Gee Cynthia, you must be confused. The “insane” liberal inside you says that rationing healthcare is good yet the “irresponsible, sue someone” liberal in you will ALWAYS want to sue the doctors for not testing and doing enough. You can’t have it both ways, so what’s in gonna be? Limit healthcare or limit the trial lawyers? No wait, this is Cynthia Tucker right? You will limit healthcare and then sue. In your liberal world, this is only right!!