Last fall, new recommendations for breast cancer prevention set off a firestorm—a storm intensified by the debate about the pending health care legislation. Now, a year later with breast cancer awareness month beginning and the new health care law being implemented, the Federal Drug Administration's (FDA) expected decision about a breast cancer treatment is causing controversy, and reminding us about the problems with government-run medicine.
It was the U.S. Preventive Services Task Force- a government panel charged with reviewing evidence and making recommendations for preventive services- that caused the uproar last year. Rather than encouraging all women over age 40 obtain a yearly mammogram, the Task Force recommended that screening begin at age 50, and then on a more limited basis.
The Task Force reached this conclusion by weighing the number of false positives and unnecessary procedures against the number of lives saved from early detection. They found that when screening began at age 40, about 500 women would have a false positive (often leading to additional unnecessary treatment) for every one life saved. This panel decided that the costs associated with the unnecessary treatments outweighed the benefits of saving one women.
Americans recoiled from this logic. The problem wasn't with the math or the concept of cost-benefit analysis. Adults understand resources are finite. We all can't have weekly full body scans to check for traces of cancer.
What Americans didn't like was the idea of a group of government bureaucrats making such recommendations that would effectively dictate the health care options for millions of Americans.
The health reform legislation under consideration at the time (and that now, after countless amendments, is law) would have required that all insurance companies provide the Task Force's recommended preventative treatments at no cost. Their revised protocol would have affected the services available to millions of women.
Lawmakers heard from angry Americans and activists, and quickly worked to carve out exemptions for breast cancer. Yet this process provided little comfort to Americans concerned about growing government's power over the health care system. Sure, Congress may exempt breast cancer and other well-known ailments from restrictions, but what about less well-organized disease groups? Americans fears were being confirmed: politics—not policy analysis about best-practices—would rule many decisions.
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