U.S. breast cancer screening advice

[Mr. Big Dog 10,747]

Might be true if there actually was competition. The fact is most people get only one choice from their employer.

Bingo. The whole idea that people actually have choices is laughable. In fact, way too many people not only do not have choices but actually lack any viable option to obtain any health insurance at all. Those that have coverage are stuck to accept what their employer offers. The choice there is to either sign up for or decline the benefit. Some choice and competition.

[SMR 368]

I listened to a doctor talk about this on NPR. He explained that a recent study showed that the existing guidelines that recommended early mammography and self-breast exams did not reduce mortality related to breast cancer. He was explaining that if a woman does find a lump, let your doctor know about it immediately but that women were getting more biopsies due to self-breast exams and unless at an unusually high risk (such as a genetic tie to this cancer), women were being exposed to radiation from mammography earlier than necessary (putting them at potential higher risk than necessary).

I really don't think these guidelines are based on money after listening to this doctor.

This is the NPR story I'm referring to:

Doctor Backs New Breast Cancer Guidelines

I've heard from many other doctor's and non-profit cancer associations that this is total BS. Also the beginning of groundword for rationed care.

That's a BS argument. Care is always rationed. Check your insurance policy and see what it will and won't cover. If there was no rationing in breast cancer screening today, women of all ages could have screenings on a daily basis. Good luck getting re-imbursed for that under your current policy.

Of course it's always rationed. The point is, we don't want or trust the government to do this rationing. And no, I don't want the insurance company to do it either. Just because I'm opposed to Obamacare doesn't mean I like insurance companies. It means I don't think Obama would be better.

Meaningful healthcare reform means that people have choices. As many have pointed out and some liberals have admitted, Obamacare is designed to push us towards a single-payer system. Single payer is not choices. The government will decide what it will pay for and your only option is do the procedure or not.

First of all, single payer is not on the table. Any claim to the contrary earns you a tin foil hat and not much more. That said, the only way for you to avoid rationing of any kind is to pay out-of-pocket for whatever care you want. Otherwise, you'll be faced with rationing whether that rationing is based on maximizing profit or based on comparative effectiveness analysis. Personally, I'd take the latter over the former any day of the week and twice on Sundays. Why? Because the latter is focused on the most effective care (i.e. on me and my health) while the former is focused on the bottom line of the insurance carrier with my health just being an inconvenient cost component.

I realize that single payer is not presently on the table or in the bill. But a government option with associated tax incentives is designed to force private health insurance companies out of business and lead to de-facto single payer system. Obama is on the record stating that he supports single payer. Other liberals are on the record stating that a government system will lead to single payer and follow that up with a "what's so bad about that?" There was a thread on VJ a while back citing a Democrat in congress who admitted this. While bringing tin foil hats into this discussion may sound witty to you, it doesn't make your argument any more or less true.

Rationing based on maximizing profit is not as evil as you seem to think, particularly in a truly free-market (Over regulation currently leads to monopolies in health care). It's called competition. If health insurance companies were really ripping people, other companies could compete and offer better deals.

Might be true if there actually was competition. The fact is most people get only one choice from their employer. Ending employer sponsored health insurance would be too disruptive to have any chance of actually passing.

Why? I thought you wanted real change. Do you really think it will make any difference whether your health care choices are made by bureaucrats in HR and a health insurance company or bureaucrats in Washington?

Employer sponsored health care would end as soon as Washington eliminated tax incentives that support it. Once your employer doesn't have tax reasons to keep some of the money and pay for your healthcare instead of just giving you a bigger check, they will start offering a bigger check. The next obvious step would simply be forcing you to take the bigger check. There would be other reforms necessary in regulation, but this could lead to a system where you buy health insurance like you buy car insurance. You can find dozens of companies online and chose what types of expenses you want to cover.

[justashooter 430]

my mother was diagnosed with advanced breast cancer at the age of 36 in 1976 when i was 12. she died sometime thereafter. with 7 sentinel lymph nodes responding positively, there was little that could be done but greive. sometimes i still do.

[SMR 368]

Might be true if there actually was competition. The fact is most people get only one choice from their employer.

Bingo. The whole idea that people actually have choices is laughable. In fact, way too many people not only do not have choices but actually lack any viable option to obtain any health insurance at all. Those that have coverage are stuck to accept what their employer offers. The choice there is to either sign up for or decline the benefit. Some choice and competition.

I'm not saying that people have choices right now or that there is competition. We need reform that creates competition, not reform that leads to a single payer system.

[HAL 9000 96]

But the Canadian Cancer Society says U.S. recommendations have now been brought in line with what experts in Canada have been telling women to do for some time.

The U.S. Preventive Services Task Force, a panel of independent experts, released revamped recommendations this week, including advice that women in their 40s should not have routine mammograms because there is no evidence they improve survival in that age group.

"It's very encouraging to see that their recent review of the evidence is in line with what we've been recommending to Canadian women," said Heather Chappell, director of cancer control policy at the Canadian Cancer Society.

"Certainly we think that all women in their 40s should talk to their doctors about their breast cancer risk and find out if screening is right for them and have a discussion with their doctor about the benefit and harms of screening in this age group," Chappell said Tuesday.

"And we certainly do recommend that women 50 to 69 have mammograms every two years because we know that there is benefit in that age group."

So, the recommendation is to align the screening with widely accepted international standards which Canada, for example, has been following for years. Looking at the outcome, it would appear that the aggressive testing done in the US to date has little, if any, actual benefit.

Breast Cancer Mortality Rate Canada: 20.9

Breast Cancer Mortality Rate USA: 20.7

But yeah, let's call it rationing of health care. Let's be good scaremongers. At the end of the day, the excessive tests and procedure based system, which the fee-for-service remuneration system encourages, is not sustainable. If evidence shows that little, if any, benefit is to be had from excessive tests and screenings, then it would seem rational and prudent to adjust the screening guidelines to adopt a more efficient approach.

Of course those with an abhorrent understanding of medicine and medical statistics and worse... a political vendetta... will have major issues with these NON-binding recommendations.

[Mr. Big Dog 10,747]

Might be true if there actually was competition. The fact is most people get only one choice from their employer.

Bingo. The whole idea that people actually have choices is laughable. In fact, way too many people not only do not have choices but actually lack any viable option to obtain any health insurance at all. Those that have coverage are stuck to accept what their employer offers. The choice there is to either sign up for or decline the benefit. Some choice and competition.

I'm not saying that people have choices right now or that there is competition. We need reform that creates competition, not reform that leads to a single payer system.

Like federally regulated exchanges to ensure that you can pick any plan from any participating company and that those participating companies meet certain universal minimum standards to ensure that consumers don't get screwed? Fine. Throw a premium funded public option into the mix for added competition and I'll sign up for the reform.