A Window into the Future of Health Care

For those looking for a preview of what US health care will look like under Obamacare, look no further than to the recent changes to cancer screening guidelines. A couple of weeks after changing the recommendations for PSA (prostate) screenings, the US Preventive Task Force (a government agency) "updated" their recommendations for breast cancer screening. Why the sudden shift, after years of encouraging early screening?

For years, women have been told to have annual mammograms and do breast self-exams starting at 40 and, in some cases, earlier. The logic was that the earlier the cancer could be found, the higher the likelihood of cure. Moreover, 40 was when the risk was supposed to increase. Now, the Task Force is recommending 50 as the starting point, saying that earlier screening doesn't save many more lives and only increases cancer scares. The recommendation also discounts the need for annual exams and calls for an end to breast self-exams. The Task Force utilized the same data set that led to its 2002 recommendation of the current screening practices. What changed, then, in the last 7 years? ObamaCare.

A look at the population data will tell why. There are approximately 153 million women in the US, 54% of which are 35 and over (approximately 83 million) and 47% (approximately 72 million). The average cost of a mammogram nationally is $125. If you annually screen every woman 35 and up, it would cost $10.375 billion, while annual screening for women 40 and over would cost approximately $9 billion. However, if you limit it to 50 and over, the number of women decreases to just over 49 million, bringing the tab to just over $6 billion. Combine that with the change on annual exams, and the cost drops even further. There is a cost savings of $3-6 billion on annual exams alone, more when you factor in the shift to an exam every 2-3 years.

So, what does this have to do with ObamaCare? One of the major problems that Obama and Congress have been having with their sweeping health care legislation is the cost. The Congressional Budget Office has not been kind to the various bills that the House and Senate have sent them, with the cost of most proposals costing over $1 trillion. Both chambers have been desperately looking for ways to lower the price tags on their plans, and that is where the Task Force comes in. If you reduce the number of screenings covered, you can reduce the overall cost. This guideline change (for the record, the American Cancer Society, as well as a number of their patient advocacy groups as well as physician groups have not changed their treatment guidelines) allows Congress and the President to reduce the cost of their bills, since you're now cutting both the cost of the exams as well as any attendant treatment resulting from the exam, while also professing to be following best practices/standards of care. This will also insulate them from any legal repercussions (i.e. malpractice accusations), as they can claim to be following established standards of care- standards that the government set. Imagine if the Bush administration had one of its agencies call for a reduction in the frequency of mammograms, as well as delayed the age of initial exam? Can you hear the accusations by women's groups about the anti-women bias? Or the calls from liberals calling him uncaring? Or that he was politicizing science? Or that he was trying to save money at the cost of our mothers, grandmothers, sisters, wives, and daughters?

This is reminiscent of the ALLHAT trial done several years ago. Conducted at VA centers, it was a comparative trial of various anti-hypertensive therapies. The trial authors claimed that the best treatment for hypertensive patients was a diuretic- not coincidentally, the least expensive (see a pattern?). When the trial was more closely examined, it turned out that the recommendation was only good for the uncomplicated, mild-to-moderate hypertensive- someone without any co-morbidities, family history of cardiovascular disease, etc. A diabetic with high blood pressure should not be treated with a diuretic. However, the government used this as its basis to treat all government-covered hypertensives with diuretics first, irrespective of other factors. It is a study that still can raise the blood pressure of cardiologists and internists, given its "findings". we now have another example where the federal government places dollars before patients- consider the outcry by these same people if an insurer were to apply the same practices and rationales.

This will be the future of American health care- one size fits all care, lowest possible cost. A government unwilling to cover routine exams, uninterested in considering other factors. It doesn't matter that Obama has made preventive care one of the main rationales for his plan. The guidelines for such care will be remade to fit into the budget. The Wall Street Journal (link here: http://online.wsj.com/article/SB10001424052748703792304574504020025055040.html) shows how this is already happening in Washington state. The battle over health care isn't about the best way insure all Americans, or how to care for all citizens. It's about the government taking control of American society. The next time some liberal tells you it's a matter of compassion, or of caring for/covering everyone, ask them how they plan to continue delivering high quality care without skyrocketing costs. You can care for everyone, if you're willing to drive taxes and fees up. Or you can do it by cutting costs and rationing care. You can't have both. We now see how Obama and the Democrats plan to accomplish this.