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Excesses of the Past Are Shaping the Healthcare Debate Today

The NYT has two Opinion pieces that are instructive today.  Not because they are right, but because they are myopic in their treatment of the issues at hand.  Nicholas Kristof writes of the raging opposition to Medicare when it was first proposed and written into law.  He revives headlines from the sixties that claim Medicare was a slippery slope to government control, and that “Never in the history of the world has any measure been brought here so insidiously designed to prevent business recovery, to enslave workers.”

Opposite Kristof is Gail Collins, writing about the recent outrage over screening for breast cancer in women between 40 and 50.  She does not give the situation a full sounding, just more or less relates her own story of having been tested routinely, given a clean bill of health, and then finding a cancerous lump through self examination. 

The reason I link these two is because they (Medicare and extensive screening for cancer) are great examples of programs that continued to grow in what and whom they covered without a check on how expensive the care was.  Kristof’s article is quite sarcastic, presenting the worries of detractors as totally misplaced.  Really?  The program is bankrupt, and expected to be trillions of dollars in the red over the next 20 years.  Is that a success?  Medicare began overrunning its cost estimates in the first year of existence and never looked back.  The pledge of the government at the time was that it would never add a dime to the federal deficit.  Sound familiar?  The fact that it took four decades to teeter on the brink of catastrophic insolvency is a success?  This is the old story of a man jumping off a 100-story building and at the 25th floor someone asks, “How’s it going?” and he replies, “Pretty good so far.”  This was used by Reagan to describe Social Security, although I don’t think he originated it.

As for breast cancer screening, the new report added one element to their previous findings - the cost of screening and treating false positives of all the women who are between 40 and 50 but do not have cancer.  The estimate was that for every 1,900 women screened between 40 and 50, 1 has cancer.  For women over 50, it is 1 in every 1,300 screened (approximately).  So the extra 600 screened and some treated or subjected to biopsies, etc. for what turns out to be not cancer leads to such increased cost as to make it not worth it, in the eyes of the committee.

This is rationing.  Did the committee draw the right conclusion on breast cancer screening?  I don’t know.  Can there be a “right conclusion?” 

We do not have unlimited funds.  Medicare has worked off of the premise that we do, because Congress has failed in its cost containment efforts, self destructing every time (see the Dr.’s Fix that is currently in front of legislators).  Medicare is a failed program not because it did not provide care, but because it cannot be sustained, and never, ever, could, even at inception.

Screening for breast cancer in women 40-50 saves some lives.  Screening for prostate cancer in men does as well.  Are the effective in terms of cost?  Those decisions are the difficult ones that we will have to make.  None of the snarky comments in the NYT, the WSJ, or elsewhere can change the facts.   We do not have unlimited funds.  We are aging as a nation.  Our method of providing healthcare today comes at such a cost as to be unsustainable at every level.