Elite Mammograms

Many libertarians and our sibling conservatives often express concern that elite nags and busybodies are constantly attempting to use government power to remake the nation’s social-economic-cultural structure in their own image. The left-wingers nearly as often answer that it is only logical and reasonable to want competent, learned, and accomplished individuals to make policy and to "run" the country.
Well, yes, persons in positions of authority need to know what they are doing. We need the best men and women to implement the policies established by the democratic-republic form of legislative system that has been in place for 220 years. Public policy, in other words, must be made by consensus. This does not mean a bare 51% in all cases, but often must require a super-majority, and in some cases, where certain rights are fundamental and unalienable, even more. No segment of the populace, no matter how intelligent, learned, or prescient should be in a position to dictate how individuals should run their lives, so long as they are not infringing on others fundamental rights. I, of course, would argue that fundamental rights include only one’s life, liberty, and freedom to pursue happiness, and their corollaries.
That these self-evident traits, bestowed on human beings by nature or nature’s God are threatened in a fundamental manner has been made abundantly clear by the latest pronouncement of U.S. Preventive Services Task Force in Washington. This cabal of elite policy makers has decreed that routine mammograms are not necessary for women of average cancer risk under the age of 50, and that women between the ages of 50 and 74 do not need to undergo mammograms more often than every other year. (WSJ 11/17/09, p. A1 & 4; DMN 11/17/09, both citing the Ann Intern Med, November 17, 2009 151:716-726). The Task Force guidelines are based upon a new analysis of statistical data. They were formed by weighing benefits of screening compared with the harms of false positive, such as anxiety and unnecessary additional tests and biopsies which are expensive and time consuming.
This is yet another example of liars figuring. Statistical analysis seems to be arcane that so many of us defer to the so-called experts without question. Thus most of us pedestrians tend to swallow what these studies seem to show and shrug and go on about our business. But this advice, and the concurrent opinion of the Task Force that breast self-examination is essentially worthless, does not impress the the American Cancer Society. The society’s chief medical officer, Dr. Otis Brawley, challenged the new guidelines saying that they are "essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them." Phil Evans, a professor or radiology at the University of Texas Southwestern Medical School here in Dallas and president the Society for Breast Imaging related that there is a "ton of scientific data in this country and others on screening that shows a significant benefit for women between 40 and 49 to be screened. Dr. Evans said he was "shocked" by the changes. "Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Dr. Daniel B. Kopans, a radiology professor at Harvard Medical School. "It's crazy – unethical, really."
More to the point, the Task Force’s "balancing test" disclosed the elitist bias of the panel. Anxiety caused by false positive? Why is that a consideration at all? Anxiety is caused by many of life’s stresses. Anyway, shouldn’t that be for the women concerned to decide? The unnecessary additional tests are not discovered to be such until they are completed. Time consuming and expensive? Whose time? The expense is discussed below. But the bottom line is that the Task Force seems to believe the anxiety, expense, and time are worth more in women over 50 than in those between 40 and 49. The one inescapable fact is that some women – even some who are at statistical low-risk – get breast cancer in their 40s. This, of course is collectivism gone wild.
As for the expense, yes, medical care can be expensive. Mammograms are probably more expensive than they otherwise would be because they are paid for by third parties, and, anyway, like the sticker prices on new cars, it is a rare instance when the third party "insurance" carrier pays full freight. Many carriers are pleased to pay for screening because discovering a condition early reduces the expense of treating it later. I broke my arm falling off my bike a year ago and my carrier sent me a letter suggesting I get a bone density test – on them with no deductible or co-pay. Anyway, if mammograms were not covered by third-party payers, and were advertised like Lasik and breast-enlargement surgery, the price would go down, as would nearly all medical care short of catastrophic trauma or diseases, which is what medical insurance was originally for and would be now except for our crazy tax code, and the mind-boggling levels of bureaucracy necessary to administer the third-party claims resulting from doctor visits for minor aliments.
The most worrisome aspect of the new Task Force guidelines is that it is a harbinger of what we can expect from the government taking over health care delivery in this country with the outrageous bill passed just over a week ago by the House of Representatives. Most of you who have read this far are intelligent to understand that the bill was 1900+ pages for the simple reason that it took that much to include provisions to buy off the special interests with earmarks and other favors. The average person reading the bill would not be able to spot the hidden boodle because of the arcane nature. Regardless of anything else, those who are responsible for designing medical care plans and doleing out the money will be under pressure to keep costs down. Politicians always vote for something that is inherently expensive and the scream at the implementing agencies, boards, commissions, et cetera, to be frugal. The Task Force guidelines are precisely the kind of standard the bureaucrats will use to cut costs. When the left-wing dream comes true, we’ll have to accept what the various panels are willing to pay for. Welcome to rationed health care, everybody. Everybody but the elitists. Most of them will have the means, mostly inherited or otherwise unearned, to pay for whatever medical procedure they want, and the limousine to take them to their doctor.