Jewish World Review Nov. 26, 2009 / 9 Kislev 5770
The true cost of freedom from anxiety
By Michael Smerconish
Give me anxiety or give me death. If
You can move aside the battle over single-payer systems, covering illegal immigrants or even abortions. After months of consternation over the direction of health-care reform, something called the
Seven years ago, the task force recommended that women ages 40 to 49 get regular mammograms, and that women from 50 and 74 schedule them annually.
The consternation is understandable. The new recommendations seem like a legitimate motion to ration health care.
Consider the reasoning behind the changes. Proponents said they would reduce the unnecessary dangers — expenses, pain, or anxiety caused by false positives or more frequent testing and follow-up — to younger women who get regular mammograms. Women in their 40s are more likely to experience those harms, but they're significantly less likely to actually be diagnosed with breast cancer.
Though the panel said it didn't take costs into account, there's also an undeniable financial effect of the shift as well. Approximately 37 million mammograms are administered every year. Each one costs about
"We know that it saves lives. I just can't imagine that they're willing to look at numbers and evaluate death vs. cost of treatment. That's basically what they're doing," Savard said in an interview. "They put on one side death, and they weighed on the other side cost of treatment. And they didn't feel it was justified."
That doesn't make this the health-care cabal that President Obama's conservative critics have been predicting for months. The guidelines of an expert panel don't equate to concrete changes in federal policy. Last week, Health and Human Services Secretary
But the new guidelines could potentially cause insurers to change how they cover annual mammograms. Managed-care organizations might decide to stop rating doctors based on whether they performed mammograms on women under 50. And it's possible that
It has happened before. The same task force concluded last year that virtual colonoscopies, which use CAT scans, were an insufficient means of screening men for colon cancer. In part because of that recommendation,
"They're looking at statistics and they're looking at numbers when, as physicians and health-care providers, we're looking at patients and we're looking at faces. And those women have names and families and it's a very different issue,"
That's true, and it's a calculation that affects men as well. Six years ago, I had a full-body scan at a newly opened private facility because it had recently become a radio advertiser of mine and wanted to showcase its services. I had the test despite lacking any symptoms.
The scan revealed "an approximately 2 mm nodule see in the lingular segment of the lung peripherally." The report came just as a friend, a fellow cigar smoker, was dying of lung cancer. The finding, if that is what it was, was frightening and necessitated additional intervention.
My primary care physician referred me to a pulmonologist, who in turn ordered a CAT scan of my chest (which was then to be repeated annually for two years). Where my insurance company hadn't covered the initial full-body scan, it was now on the hook for the cost of this subsequent care.
I knew that at the end of the monitoring I would either thank the radio sales manager who arranged the body scan for having saved my life, or curse him for causing me concern (and costing my insurance company thousands of dollars).
Thankfully it was the latter. Still, I'd take the anxiety that comes with a false alarm over a missed opportunity for intervention anytime. Just like the women who've grown accustomed to having mammograms starting at age 40.
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