Just like the 1930s: Welcome to the age of rationing

Back to the Future II:

There have been a lot of recent references to the Great Depression (the state of the Economy) and to the Vietnam War (the War in Iraq).

Recent Screening for Breast Cancer recommendations raise issues of balancing what amount of the population needs to be screened (or treated) for every one person found to have breast cancer.

The U.S. Preventive Services Task Force (USPSTF) recommendations (http://www.ahrq.gov/clinic/3rduspstf/Breastcancer/) have raised an outcry from patient groups, nonprofits, medical groups etc.

Rationing is not new to the American public -- the Great Depression, World War II etc., but now we are learning that we are not only going to ration commodities, but health itself. This is separate than the idea of health insurance, this is truly about health care. Too often, these topics are discussed interchangeably; For example, may people discuss the right to health care, but then they extrapolate from this a right to health insurance. Currently everyone already has a right to health care -- you are not allowed to be turned away from an Emergency Department, regardless of your insurance situation, and nobody is allowed to impinge on your health -- but this is not the same as saying that someone has a right for their hospital costs to be paid for by others -- just as there is no right to have others pay for your Pursuit of Happiness.

These new Breast Cancer guidelines are just the tip of the iceberg in terms of what we will be facing shortly. Panels will revisit older guidelines and recommendations in order to determine the best way of saving money and resources for the entire population by limiting access to specialized (expensive testing). The goal of the Health Care resolutions in Congress are to expand access -- so more people will have access to less care.

The committee's recommendations take into account the large amount of false-positive results from mammograms and the subsequent testing (such as needle aspiration biopsies) that some women need to be exposed to, but this does not take into account the emotional relief many women face after having a negative mammogram. Which is worse: Having a false positive result or being frightened for 10 years that you may have breat cancer that has not been screened for by a routine mammogram?

The Task Force argues that the recommendations wil not necessarily translate into insurance plans denying routine mammograms for women in their 40s; this is difficult to believe, as Susan Pisano, spokeswoman for American Health Insurance Plans stated that "[m]ost of our member companies look at [the task force's guidelines] as the standard." She continued, "[b]ut if you are in your 40s and have a discussion about risk and benefits and your doctor gives you a referral slip, then that generally is going to be covered." I think that most doctors and patients will find this hard to believe when so many of us already face denials for medically indicated imaging studies (that are not even for screening but for crucial diagnosis and treatment).

Welcome to a Brave New World.

- Dr. Daniel Kantor, MD BSE
Medical Director
Neurologique

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