Smells Like Rationing

Smells Like Rationing

Smells Like Rationing

The XX Factor
What Women Really Think
Nov. 17 2009 12:39 PM

Smells Like Rationing

We keep hearing from proponents of health care reform that government rationing of health care is a " canard ." We don’t have health care reform yet, but with the new recommendations from the U.S. Preventive Services Task Force that women shouldn’t get mammograms until the age of 50, and then only every two years, it feels like we’re getting the rationing.

The Los Angeles Times writes that "[i]nsurance companies and Medicare administrators … said they they would continue to pay for the procedure -- although it is not clear how long they can resist the panel's influence." The LAT adds that the panel’s recommendations are "generally followed" by insurers and Medicare. (The NYT does say that Congress requires Medicare to pay for annual mammograms, which provides some measure of comfort.) The panel is made up of "health care experts" but no oncologists , and not surprisingly, oncologists and organizations like the American Cancer Society are unhappy about the new guidelines.

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There are legitimate concerns to be addressed regarding mammograms. Mammograms expose women to radiation, and a false positive on a mammogram can lead to an unnecessary biopsy. But in my eyes, those concerns pale in comparison to the fact that breast cancer in younger women can be more aggressive and more resistant to treatment. What boggles my mind is that the panel worries about "anxiety" resulting from false positives and complications from a minor procedure like a biopsy, but describes as "modest" the 15 percent reduction in the death rate that has resulted from mammograms. I doubt any women who have survived breast cancer because of early detection would consider that to be a "modest" benefit.

The panel’s recommendations aren’t that different from the NHS guidelines in Great Britain, where women over age 50 are "invited" to have a mammogram every three years . That should raise a red flag: Women in the United States are more likely than their British counterparts to be diagnosed with breast cancer, but they are also more likely to survive . If the cancer is caught early, the survival rate in the United States is 97 percent, compared with 78 percent in Britain. That sounds like an argument for maintaining our current standards, not reducing them.

Rachael Larimore is the online managing editor of the Weekly Standard and a former Slate senior editor.