Critical Condition

NRO’s health-care blog.

What the Mammogram Debate Was About


I always enjoy reading Cathy Young. Her thoughtful piece today on the implications of the recent health-care debate, and her dissection of why the debate was and will remain so acrimonious, was no exception. I did think, however, that in an effort to show that she was being even-handed, she unfairly dismissed the “Right’s” argument about mammogram recommendations.

She wrote:

The misleading claims, too, have been rampant on both sides. Last year, when a government expert panel recommended scaling down mammogram screening programs for women 40 to 50, many on the right saw this as an ObamaCare-related ploy to cut costs at women’s expense — even though the debate on the benefits of routine breast cancer screening in that age group has been going on for more than a decade.

It’s certainly true that the debate about when mammogram screenings make sense from the perspective of a cost-benefit analysis has been ongoing (as it should be). Yet the point those of us who wrote about this topic were trying to make wasn’t that there was anything inherently wrong with experts changing guidance about the use of any procedure, but what this would mean if those recommendations had the force of law. While Young (and many others) are correct that there are no explicit “death panels” contained in this health-care bill, the nature of government-run medicine is that government officials will be in the position of deciding what procedures are considered necessary and what’s off limits and for whom. The kind of guidance offered on mammograms by that health-care board could ultimately have the force of law.

Breast-cancer screening provided a useful example because so many of us know someone who has been affected by the disease — some who have been saved by early diagnosis, some who have been lost without or in spite of it, and some who have gone through the high-anxiety experience of a false-positive test. Imagining the government not just providing advice, but actually determining health treatments from a one-size-fits-all and green-eye shades vantage point, should make all of us nervous. The outcome of the debate — with the Senate rushing to pass an amendment saying that screening must be included for everyone — should provide no comfort, but instead shows just how political a government-run health-care system will be. Well-organized disease groups, like breast cancer, will be able to push legislators to create special carve outs for their victims, while less well-known afflictions will see their treatment regimes determined solely by the vast, impenetrable bureaucracy.

I also wrote about an example from England:

A recent report from the United Kingdom provides a window into what we can expect from such a process. The UK’s National Institute of Health and Clinical Excellence (NICE) is seeking to limit the use of steroid injections to treat chronic lower back pain, and will instead encourage suffers to try alternative treatments, such as acupuncture.

It’s not surprising, really — that’s the way that government’s “control” health-care costs. But what’s noteworthy is that some specialists feel politics was behind the decision. As the British newspaper, the Telegraph, reports: “Specialists are furious that while the group included practitioners of alternative therapies, there was no one with expertise in conventional pain relief medicine to argue against a decision to significantly restrict its use.” In other words, because acupuncture reps were on the panel making the decision, they decided to slash the availability of traditional treatment and encourage more people to try “alternative” treatments.

Yes, I know that the bill that just became law won’t turn the U.S. health-care system into the U.K.’s, but I don’t think it’s out of bounds to point out the ways in which we are moving in that direction and the potentially very high costs of doing so.


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