ObamaCare and "Expert" Medical Panels: A Threat

In the confusion surrounding the health care reform debate, there came a flare in the night, so to speak, a signal or omen, ominous in nature, that shed a bright light on the matter of government monopolized medicine, that small incendiary being the upending of protocol regarding screening mammograms for breast cancer.  Suddenly, it seemed, the contours of some future version of Obamacare appeared in bold relief, and, for a moment, the headlines were ablaze with this portent of things to come, the anticipated waiting lists and rationing, of remote government panels making medical decisions from afar, inserting themselves between patient and physician. 

Obamacare opponents have long raised this eventuality, understanding fully that single payer must inevitably ration once unlimited demand confronts limited resources in an already distended federal budget.  Healthcare reformists, on the other hand, vigorously refute this, denying that which has occurred in every government-run system in the world.  How else to control costs with so vast an entitlement? 

It has been a staple of preventive care that women perform periodic breast self-exams, and for those over 40, to undergo annual or biennial mammograms for early breast cancer detection, a disease that takes the lives of 40,000 individuals every year.  New guidelines, however, from the US Preventive Services Task Force Health (USPSTF), under the Health and Human Services Department, overturning its own 2002 directives, now advise that women of average cancer risk in their 40s no longer require mammograms, and that woman between the ages of 50-74 undergo mammograms only every other year.  It also advises that physicians stop teaching breast self-exam (because of a lack of evidence that it helps) and that woman 75 and over no longer undergo routine mammograms.  The 2002 guidelines, on the other hand, advised mammograms every 1-2 years for all women older than 40 and were agnostic on the matter of breast-self exam.

Breast Cancer is the second leading cancer killer of women.  Since mammograms became routine in the nineties, the mortality rate for breast cancer has dropped by 30% based in part on early detection.  And, so, a pronouncement that women under 50 and over 75 without certain risk factors no longer require screening came as a bombshell.

The outcry, of course, was immediate.  Chief among the concerns was the possibility that private insurers, and even Medicare and Medicaid, embracing the new guidelines, would no longer cover mammograms for women in their forties. 

We learn further that the task force included no oncologists or radiologists (those most familiar with the medical literature pertaining to breast cancer screening), and performed its analysis with spending as its primary focus.  As the Wall Street Journal reports, 1904 screenings were required to save a single life for women in their 40s and only 1,339 for women in their 50s; an additional 665 mammograms were, therefore, needed to save the same single life of women in their 40s.  Based on that comparison, the panel decided that it was not worth performing the screenings for that age group, even though 40% of patient years of life saved are in women in their 40s.  And, of course, for that one individual, it makes all the difference in the world.  This all falls under the rubric of cost containment or, more accurately, "rationing," which describes accurately the inevitable outcome of nationalizing health-care. 

Rationing comes in many forms: it may be revised "guidelines" issued by "expert" panels, long delays and waiting lists, price and use controls, bureaucratic inefficiency, and various compulsory "edicts" delivered by "health councils" or "czars" with an eye to the bottom line.  Such decisions, however, have historically been made between the patient and physician, not a panel of "experts" in Washington.  One wonders what other guidelines will be discarded or modified by government bureaucracies based not on patient safety but cost, aggregate spending, and group averages when limited tax dollars crashes up against fiscal realities?

In a speech last September, Obama spoke of a panel of experts he sought to create, the Independent Medicare Advisory Council or IMAC, who would be "charged with identifying more waste in the year's ahead."  Even Democrats are getting nervous about looming debts, and, in particular, Medicare, with its $37 trillion unfunded shortfall over the next 75 years.  Their answer is an unelected commission that will make medical decisions based in large measure on the basis of cost, in an era of limited resources and exploding demand. 

But heaven forbid, Obama and the Democrats would consider a market based solution, such as providing vouchers for seniors to pay for their own insurance, increasing the single-buyer market, incentivizing seniors to seek out the best value for their money within a limited budget and forcing companies to compete for their business.  No, Obama would prefer his "panel of experts" to decide what is best for you instead. 

As we have seen with the recent changes in breast cancer screening guidelines, it is an unelected panel emphasizing cost containment, issuing guidelines and making medical decisions.  They are, however, simply recommendations and not compulsory.  But, should a health care plan pass bearing any resemblance to current House or Senate bills, look out for a government panel with coercive power coming your way: bureaucrats making life and death decisions - not you or your doctor.