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Comments

dr. charles

Wow - that is a compelling post. I tend to see the overabundance of unnecessary biopsies from falsely positive mammograms, but until there is a better screening methodology your points are well taken.

Roxanne

>>Our only hope, in the United States, is to push for more freedom in health care choices. More information. More education.<<

I am all for freedom in health care choices. Heaven knows, I don't want anyone making my decisions for me. But I am assuming that your statement above was made in context to the NHS in the UK, which is a government run service. The problem in the US is that "freedom" of healthcare choices means no healthcare because they can't afford insurance, and it is unavailable to many. Too rich for Medicaid, too young for Medicare, and not enough money for insurance premiums.

So how do we reconcile freedom in healthcare, minimal government interference, with our skyrocketing healthcare costs and the inability of many to afford it? There are many women in the US who can't afford a mammogram or a biopsy should they need one. And medical savings accounts aren't a viable solution for those who live paycheck to paycheck and are barely able to cover their basic necessities. Any ideas?

CodeBlueBlogMD

Your error is to toss together everything you perceive of health care (insurance, cost, delivery, efficacy) into one pot of experience, then throw up your hands in frustration claiming "neither can we do it nor afford it."

First decide that you are smart enough to make your own health care decisions (with the aid of experts, of course, as in any other complex life situation); then decide that INSURANCE DOES NOT EQUAL HEALTH CARE.

If we have insurance problems (creation and delivery) these are separate social and economical problems from health care. If car insurance is difficult to afford WE DON'T MAKE CHEAPER CARS...NOR DO WE ASK THE GOVERNMENT TO TAKE OVER THE CAR INDUSTRY.

I don't agree with your contention that many women cannot afford mammography. Percentagewise I think you are wrong. If you are above Medicaid level you can afford the $115 a year, and if you truly cannot -- I know of many programs that offer FREE mammograms.

Essentially, I believe that our system has developed in a way that makes insurance difficult to obtain because it is too comprehensive and it has traditionally been provided by employers and third parties thus removing the consumer from the loop. Without consumer input providers do a worse job and consumers become dumb. These effects are magnified as we move closer to a nationalized system.

There are a lot of smart market-oriented ways that have been proposed to rectify the current situation; however, we only ever hear the mantra of the left which is to push for more government control. You should, however, look carefully at what has happened in Britain as a result of this government control. It literally has been a genocide -- a MATRICIDE.

CodeBlueBlogMD

Dr. Charles:

I question what you intend by:

"the overabundance of unnecessary biopsies
from falsely positive mammograms"

Mammograms are screening tools. This means, by definition, that they have relatively high sensitivity, not so good specificity, and are cheap and easy to apply to large populations.

Biopsies generated by screening procedures are what we accept when we consider what we are getting and at what price.

Breast biopsies today are relatively benign with minimally invasive stereotactic digitally directed and ultrasound guided techniques.

If anything, the British experience now shows us that the biopsies we do are a small price in exchange for the lives we are saving -- and the lives they have lost -- with screening mammography.

Richard

Fact is public health care have limited funds, and they must be allocated as efficiently as possibly, although clearly early screening increases breast cancer DETECTION, whether it decreases mortality has been much more contentious. Health dollars must be spent where they can do MOST good, and yes this does mean sacrificing lives because there are not UNLIMITED resources. As evidence changes obviously resource allocation changes.

Breast cancer mortality in the United Kingdom has actually decreased 30% in the last 10 years, much in line with the United States without having as wide-spread screening and screening that starts at a much older age.

Also many people in the UK opt for private health insurace, so it's not like the option isn't there.


Richard

The US has double the per capita capital expenditure of health than nearly every OECD country but still ends up in the second half with respect to life expectancy and infant mortality, against countries who smoke and drink a whole lot more.

Real value for money you're getting there.

Joe P.

I see the "lack of afforability" argument as a myth. For example, it costs about $8500/yr. to own and operate a car. How many who "can't afford" health ins. pay $4-500/month merely to own a car, which they do eternally since they are addicted to newer vehicles.

How much does it cost/yr. to educate one child in the public sphere: $5-12,000. Extending the cost into adult education, I pay $1300/yr. in property tax for so-called Education Service District services, which are a sham.

Back when Jimmy Carter was pushing for National Health Care the per capita health care outlay was about $770/yr., which was exceeded by the cost of "entertainment" + alcohol + tobacco per year. What it is now I don't know. But you get my drift.

I won't go into it any further except to note that socialistic systems must fail at some point, and they are doing so.

It's stunning that people who profess the socialistic panacea are unable to analyze real situations at all. And I do mean "at all".

Realistic solutions to certain problems do exist.

CodeBlueBlogMD

Richard:

Interesting stuff.

First, John Reid disagrees with your declaration concerning detection and mortality:

"We know that detecting cancer early helps save lives," says Health Secretary, John Reid in a statement. "Last year, over 11,000 women had breast cancer detected and treated more quickly than they otherwise would have thanks to the NHS breast screening programme. In fact nearly half of these wouldn't have been detected at all without screening. That is why it is so important that women make sure they take up their invitation for breast screening," he emphasizes.

Second, your argument about spending health care dollars where they do the most good is fine by me but is totally unworkable on a massive public scale, and is completely unacceptable in the U.S. where the Tort system sets the goals of health care at nothing short of perfection 100% of the time.

Third, it is quite difficult for me to believe that after all these years of health care debate there is yet someone out there who does not unndersdtand the disconnect between longevity/infant mortality statistics and health care quality.

If you are saying with all this that you prefer nationalized health care then I would like you to have it. You and yours can wait until its too late to have mammography (and let's see what you think about the mortality rates then when your wife or mother or daughter shows up with a FIVE CENTIMETER STAGE FOUR TUMOR INSTEAD OF A TWO CENTIMETER STAGE ONE TUMOR which translates to 10% 5 yr survival versus 90% five year survival) and you can get your rationed care while waiting on lines at the post office.

For me, there are better ways.

Richard

In most 'socialist' systems (except perhaps Canada) there is actually a very vibrant private sector. So if I'm willing to get insurance or pay then I am free to, if I don't then it's there for me. To me that's MORE options.

Ok perhaps the life expectancy/infant mortality is a trite example, but quality of health care does not necessarily equal how many tests and how much money is spent on a patient. Even the United States has limited resources.


CodeBlueBlogMD

Your right, Canada does not allow options out; and neither did Great Britain, for a long time. Governments are dangerous in that they frequently do not want you to be able to opt out, in order to consolidate the resources they are wasting.

Because, in the end government systems do worse than matricide. They do worse than limit important technology and resources. In the end they vitiate care, inhibit innovation, and WASTE. They waste money while providing bad service with poor quality.

"For example, it costs about $8500/yr. to own and operate a car. How many who "can't afford" health ins. pay $4-500/month merely to own a car, which they do eternally since they are addicted to newer vehicles."

Actually, many people in the US do not have access to mass transit (often can't afford the higher cost of urban housing) and do not live within walking or biking distance of employers (suburban zoning often not allowing residential so close to commercial or industrial). If they don't own cars, they can't get to work and earn money in the first place. Of course, this is certainly no excuse for constantly buying or leasing a newer vehicle, but it does justify owning and operating a car. Meanwhile, owning and operating even an older car still costs money (fuel, maintenance, and insurance).

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