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Mammograms: don’t you bother your pretty little heads about them — 43 Comments

1. One hopes that women do not fall for this government attempt to ration health care at the expense of women s breasts.

2. My tumor was discovered this year. Foolishly I had skipped a previous year or two of mammograms. Thankfully it was not cancerous but it was a rare aggressive Phyllodes tumor, which in some cases can be malignant. Oddly they occur mostly in the left breast. It was surgically removed. Had I waited until age 50 for my first exam I would have had to endure a full mastectomy due to the amount of surrounding tissue that must be removed, which will be the case anyway if it returns. Yes, I wish that I had kept to a regular schedule of yearly exams. As you said above, we are Mommys. Our children cannot afford for us to wait until we are fifty to start mammograms.

3. Wait a second. Hasn’t one of the biggest arguments in favor of universal health insurance been that preventive care saves money? I seem to remember Obama making that argument . So now, they are proposing reducing preventive care to save money. Which is it?

4. The oddest thing to me about these new “recommendations” have to do with self-exams.

   Why discourage something that costs nothing and may uncover a real problem?

   Because a false positive may lead to those expensive tests, I guess. Or “unnecessary anxiety.”

5. As a practicing physician I can speak with conviction that a woman who has had her cancer found on a mammogram before it had be felt is the most grateful patient in the world. The truly “high risk” patients are few in number. Many more learn they are high risk by being diagnosed. Look at the list of physicians who sit on the USPSTF board: none are practicing in the real sense of the word. They are high ranking faculty members who are administrators, not clinicians. Some of them are epidemiologists who never see patients face to face. The push back on this issue is going to be massive. Insurance companies aren’t stupid. They will continue to pay for mammograms out of liability concerns as well as the incredibly bad publicity of refusing.

6. Dear Women of America,

   This is why freedom and the free market (capitalism) are better than government control (socialism).

   Those bumper stickers calling for “Single Payer” and the phrase “public option” are words that limit freedom.

   As a caring dad and partner of a woman, I want the BEST for this country. The best would be a free market health care system.

   We have less and less of a free market system as people have a third party payer which is 50% government these days and the other 50% insurance companies.

   We need to get back to a system where services are paid for by the consumer and catastrophies are paid for by the insurer.

   Let’s work together sweet women of America. Let’s work together to make America better, lower cost and improve access. LET’S TAKE BACK OUR LIVES.

   Love,

   Baklava

7. As a doc, I find this to be “social medicine” at its worst, and social medicine is a stinking, rotten notion now being pushed in our best medical schools (Harvard). Even dullards will quickly realize all screening yields false positives. Unnecessary workup and biopsy is unnecessary ONLY in retrospect. The best screening is that which is most sensitive to abnormalities, whether benign or malign.
   This is the same gov’t that tried to sell prevention and screening as cost-saving measures, another patent fraud.
   Symbolic of the aggrogant elitists at the helm of state today is the panel’s recommendation that the teaching of breast self-examination should not be taught; SHOULD NOT BE TAUGHT.
   “Just leave it to us, you (voting) prols. Your Obama Mama knows best and is watching over you.” The next step, logically, is that one’s body is not one’s own, but belongs to the state.

8. This may be truer in a more perverse way than people realise at first. The grim joke that socialised medicine is great until you get sick is quite true. Universal health care does reduce anxiety. It also reduces general health outcomes, which are an objective, measurable good. But subjectively, people feel safer, more protected. And human beings being what they are, entire countries have chosen to feel better about their health care rather than have better health care.

   Reducing general anxiety among women, at the cost of the death of one in a thousand, may be a positive outcome in the eyes of government health bureaucrats. Not that folks can endure to see such things clearly about themselves – such moral evasions are usually well disguised to the holder. Cowslip’s warren in Watership Down has been uncomfortably prescient about human behavior.

9. Pingback:Amused Cynic » Blog Archive » Obama’s breast cancer death-panel…The lizards are NOT here to help us, people…

10. Yeah, my mom would have been much less worried if she’d died, painfully, at about 49. No worries about my brother joining the Navy, no worries about my sister’s boy’s health troubles, no worries about my little girl nearly a decade later.

    I think maybe “worry” is not so terrible.

11. On a town hall broadcast conference call with my rep, she said that she would insist that any recommendations to health care and insurance (specifically the “public option” ) come from an independent medical board/committee. I’ll bet this is laying that groundwork.

12. Well, well. On Beck today, according to Dr. Bernadine Healey, M.D., former Director of the NIH, former head of the American Heart Association, former head of the American Red Cross, and now USN&WR’s Health Editor, the panel making this recommendation (recommendations already being backed away from today by HHS Secretary Sebelius, who released a statement saying that this is a recommendation that she doesn’t agree with, and that has no effect anyway) is given sole and absolute power–so much for “having no effect” –in the House “Health Care Reform” bill to rank all medical tests and treatments so as to determine which ones people would be eligible for under the Reform regime, and by this recommendation they have downgraded mammograms for women in the 40-50 and 75 and older age groups from the A and B group and into the C group, which means–TA DA!–they won’t be covered under the new Health Care Reform regime, saving the government a shitload of money, but condemning an awful lot of women to premature, preventable illness and death. But, hey, can’t have an omelet without cracking a few eggs, can we

13. Howdy,

    What I’d like to know is…is there an Oncologist on the U.S. Preventive Services Task Force that wants to scotch mammograms for women under 50? If not, why?

    DallasGal

14. Dr. Dan, above:
    The truly “high risk” patients are few in number. Many more learn they are high risk by being diagnosed.

    Count me in among the women who discovered they were “high risk” by being diagnosed with breast cancer. I would fall into the women over 50 who only need a mammogram every other year. My tumor was small and could not be felt when I had my mammogram, about 18 months after my previous one. Who knows how big it would have become in the ensuing 6 months?

    As it happens, I needed two lumpectomies (there were smaller tumors in the margin of the original excision; tumors that did NOT show up on the mammogram), a full course of chemo, and am now in the middle of radiation. I’m hoping to get another 50 years or so from this body, thankyouverymuch! 🙂

15. Oops. Sorry about the bolding. I forgot to close the block quote, which is the first two lines.

16. It’s the public-health fallacy, the confusion (perhaps willful, on the part of socialized-medicine proponents) between population outcomes and individual outcomes. Do you know how expensive that mammogram would be if every woman had one? The implication is that individuals should make decisions based on averages, the greatest good for the greatest number.

    The better question is, who gets to decide. The more free the system, the more that individuals can weigh their own costs and benefits and make their own decisions. The more centralized the system, the more that one size must fit all — someone else makes your decisions for you according to his criteria rather than yours.

    In a free system you can have fewer mammograms and save money or you can have more mammograms and reduce your risk. Choice. In a government system, someone like Kathleen Sebelius will make your decision for you, and probably not with your individual welfare as her main consideration.

17. There is no oncologist on the Task Force. Currently there are 10 members, one of whom is a PhD. The others hold MDs, but tellingly all 10 are academics, including Dr PS Frame, listed as Family Medicine in Cohocton NY, but on the Univ of Rochester faculty and co-author of lots of papers.
    Two hold MPH (public health) degrees, one a MPP (master, public policy), and one an MBA in addition to their MD. Public Health is notorious as a Leftist haven.
    They are well-positioned; as Einhorn said, “When you’r bombing at 35000feet, you don’t see their faces.

18. Kathleen Sebelius also said in a Washington Post op-ed a couple of months ago that health insurance is fundamentally about “peace of mind.” But this is a lie. Health insurance is fundamentally about paying medical bills. Peace of mind is a side effect, to be sure, but the point of the exercise is to cover health-care expenses. This abominable process of cutting health care costs (so as to pay fewer, lower medical bills) will come at the expense of peace of mind. To say nothing of care lost through strict government-imposed prohibition.

    I just watched Harry Reid speak about the Senate bill, following his briefing of the Senate Democrat Caucus, and he had again that look I’ve noticed lately: He casts his eyes down and rather sideways, not looking directly or squarely at anything, as he mumbles ashamedly through his remarks. Maybe it’s just projection on my part, but he seems to have the look of a man who knows he’s lying. Standing with him were some of the Senate Democrat luminaries, and once again I decided that there has never, in the entire history of civilization, been a colder or more cheerless woman than Patty Murray.

    Ugh.

19. Tom,

    In addition to the academic credentials you enumerate, I’m guessing the 10 Task Force members share a political philosophy. Not comforting.

    Why aren’t the Republicans opposing this madness vigorously? Oh, they raise questions and make critiques, but it’s piecemeal, unfocused. They should be making campaign promises to repeal the thing, oppose these guys on every possible front. There is no honorable compromise with this. None.

    Of course, niggling at the corner of my mind is the fear–which sometimes approaches the level of a certainty–that Republicans can’t do anything but talk anyway, that the elections scheduled for 2010 will either be thoroughly corrupted or not happen at all.

20. Obama’s warning us against mounting public debt is rather like the ebola virus warning us against hemorrhage.

    http://www.ft.com/cms/s/0/ee761ae2-d443-11de-990c-00144feabdc0.html

21. There is something that will not be found in the study itself, nor in the open, but its there.

    first point. with a lot of cancers, we are finding they appear, grow, and disappear. that many of them we never know about, and whats happening is that as diagnostics are developed that test for them, we are finding them earlier, but we are finding more of them that do not go anywhere.

    so this part is true… however there is a hidden premise here they are trying to sell. as i said, they get you to think one level, and they are actually working on another level.

    the goal is wrong for the point they are making.

    that is, they are treating it much the same as an actuarial problem, or some efficiency point.

    that there will be a bell curve distribution of some sort… and think what the goal is, and think of what diminishing returns means to the actuary, vs doctor and self paying patient.

    regardless of what they find, they moved the argument over to the point that looking at them en mass… as if they are all equal, they are going to find the efficiency mean… they think that this wont change things.

    as i pointed out to a doctor when we were bantering statistics on amino acid changes in proteins. i pointed out that we could figure out the statistical odds via calculation, but if you think hard about the calculation to do that, it figures out equivalent odds of a perfect distribution… not actual odds that would end up at the same end.

    the efficiency we have now is that we go past the crest where diminishing returns start, and move forward, and we do so in a distribution based somewhat on wealth (but not as much as they would like you to believe, the wealth influnces health lifestyle choices, which then influence outcomes in hospitals later.)

    so when we are looking at the actual numbers and making our sums and odds, we are taking a kind of messy distribution… and we end up calculating equivalents at the final level, but lost the distributions lower down.

    so when they do this kind of study, they are not trying to actually establish best policy for most benificial outcomes. they are instead placing those outcomes over costs, and then where the smooth line breaks attempt to call it quits then.

    in this way, they take a mathematical equivalent, and imagine they can carve the best part out of it, and with such a simple twist, cut off the waste.

    change that bell curve into an S curve by lobing off the right side…

    put in insurane, i can tell you how many people in a 1 km area around your house will die. it can be done suprisingly accurately. however i cant tell you which individuals are the ones.

    same problem here… the stats may tell you that X marks a sweet spot, but using that sweet spot and cut the rest you are carving out things that help define that sweet spot.

    the population and its oucomes is not evenly distributed statistcally across the lines the way they are looking at them. the numbers are really describing an equivalent that is much neater than the actual numbers.

    i hope i said that in a way that registers

22. Wait a second. Hasn’t one of the biggest arguments in favor of universal health insurance been that preventive care saves money? I seem to remember Obama making that argument . So now, they are proposing reducing preventive care to save money. Which is it?

    yup, and they ARE saving money..
    the person that dies early saves money for them.

    the state, unlike a business, can run hospitals that have zero patients… so the pressures that govern their choices are not the same, and not in our interest, and generally opposite of what is needed.

    preventative CARE saves money… that can mean that they get us all out to do jumping jacks like in china, romania, and other countries. that they mandate foods we cant have, and so forth. it doesnt have to mean a single thing towards diagnostics and not be a lie. YOU are the one that assumes the scope is what you think it is and ignore the things that would fit the bill that are not your assumption.

    preventative diagnostics is whats now on the table, not care. and of course, if they can slice the bell curves second half off, then they are going to cook the books on improvements by offing people early.

    stalin was crude and not clever
    these are clever, devious and understand equivalents. dead is dead, but the public things that there are different forms, some acceptable. so the game then is to conflate that, and voila, what is wrong is acceptable, and when they ask, they can say its what you wanted and asked for.

    ther fewere diagnostics performed, the lower that cost..
    the fewer performed, the more will catch the condition
    with access rationed to do something about it..

    many will end up dead not needing the treatment.

    they get to pocket that money since its taken from the public on presumption, not otherwise.

    the game once you cant tell equivalents is to figure out what excuse will get permission. valid, invalid, a mix, a lie, some stats, an emotional plea. whatever. the mind is the machine that moves material, and who cares what the horses think as long as the material moves the way you want.

    i have explained that before, and no one seems to want to try to apply this. once we are not longer people, but masses of classes, we are cattle, and what we think as individuals doesnt matter.

    what the heck is the whole health care debate about? creating a system in which the matter moves and creates for them… but costs them the least in problems and expense.

    think farm, not society

23. Artfldgr,

    Your post is very interesting and informative.

    In my own (synthesized) field of environmental geology, we rely heavily on risk assessment. I have taken to referring to risk assessment as a numbers racket. Risk assessors calculate this and that, they come up for example with the number of cancers, in excess of those otherwise expected, that will appear in a population when carcinogens are present in groundwater, say, at any given concentration, and then determine what amount of remediation is required to lower the risk to some statistically calculated norm. But the fact is that no one in the field is talking about actual cancers. They’re talking about averages across a population. It’s a scam–begun, no doubt, with good intentions, but sucked dry of real significance by the trick of generalizing from any reasonable particular to a ridiculously general population. It becomes meaningless, like trying to say how many out of a population of tires will experience blow-outs, but being unable to pin-point any fated tire. The fact that we just can’t know these things is, as a professional constraint, ignored.

24. The next step, logically, is that one’s body is not one’s own, but belongs to the state.
    

    sorry… that came before this. the feminists changed it… parens patria was expanded so that children could be taken by the state and parents but wards.

    realize that one does not need a warrant to take a child or enter a home if one is a cps person. the power was unconstitutionally delegated as a response to the feminists scooping all that various power that was at odds and basically changing that.

    once that was done, and precident set, they can then use that idea to control what you eat and so forth.

    Parens patriae is Latin for “parent of the nation”. In law, it refers to the public policy power of the state to intervene against an abusive or negligent parent, legal guardian or informal caretaker, and to act as the parent of any child or individual who is in need of protection. For example, some children, incapacitated individuals, and disabled individuals lack parents who are able and willing to render adequate care, requiring state intervention. In U.S. litigation, parens patriae can be invoked by the state to create its standing to sue; the state declares itself to be suing on behalf of its people. For example, the Hart-Scott-Rodino Antitrust Improvement Act of 1976 (15 USC 15(c)), through Section 4C of the Clayton Act, permits state attorneys general to bring parens patriae suits on behalf of those injured by violations of the Sherman Antitrust Act.
    

    the kicker here is that the state is treating us as non compis mentis. we are crazy because we dont do whats best for ourselves.

    we were willing to make an exception to our morals and ideals to go after all men and demonize and marginalize them, and the reason was to establish something that has a bigger application than what we gave permission for.

    same as the explanation above for the preventative care thing. it was to get permission, but not for your assumption.

    lots of people have argued the implications to the changes wrought, but hey, everyone said we just needed to get laid, hate women, were racists… etc.. [i can quote]

    heck, we brought back debtors prisons where people work for quarters an hour and have little choice.

    that is, under these things, we have debtors prisons for dads.. like parens patria that is going to set the precident for jail to work off your debts.

    oh.. and remember those civil forfeiture laws we let slide past the people to get the druggies. how far have they expanded now?

    your point came before but was silenced, now its implication is coming to roost. i would say barn empty, forget the horse, why bother with the gate.

25. The risk-assessment boondoggle reminds me, especially with respect to cancer, of the constant search for cause. We don’t know causes in the particular, so we have settled on something we call risk factors, and speak of “links.” It amounts to hyping the association of a possible cause with a noted effect. For example, we say that smoking is a behavior that carries a high risk for lung cancer. Now I do not advocate smoking, and it is no doubt a causative factor in lung cancer; but it’s important to look at the actual linkage: It’s true that some 85% of people who contract lung cancer have been smokers, but it’s also true (and nearly never mentioned) that only 15% of smokers acquire lung cancer. This fact throws the conventional cause-and-effect relationship into somewhat greater doubt.

    Another example is the relationship between marijuana use and hard-drug addiction. It’s true that some large percentage of hard-drug addicts began with marijuana. But it’s also true that a very small percentage of marijuana users ever become hard-drug addicts–and this fact is hardly ever noted in the general anti-drug hype. What should we make of this? That question is not answered satisfactorily by anti-marijuana warriors.

26. betsybounds says, “I decided that there has never, in the entire history of civilization, been a colder or more cheerless woman than Patty Murray.”

    But, but she’s the senior senator from my state! Okay, she is a cold, cheerless woman. And not particularly competent either. In fact, does anyone know what she has accomplished in her years in the Senate? Not much!

    Don’t blame me, I’ve never voted for her and never will.

27. J.J. formerly Jimmy J.,

    LOL! Well good for you, that’s what I say!

    I recall that she ran, initially, as something she called a “Mom in tennis shoes.”

    A mom? Pity the poor children.

28. Artfldgr:
    Oncologically speaking, your “finding cancers earlier that do not go anywhere, or come and go” (not an exact quote, but your meaning) needs explication.

    Microscopic cancers are obliterated by the normal immune system. That is why immunosuppressed folks (e.g. AIDS, chronic immunosuppression for organ transplant), folks with immune system derangement (e.g. Rheumatoid arthritis) are at higher risk for clinical cancers. Burnet, an immunologist, first speculated microeradication decades ago.

    Very early breast cancer and prostate cancer are detected by high-quality mammograms, and PSA, respectively. But being found early does NOT tell us anything about biologic aggressiveness, e.g. tumor doubling times.
    All cancers have increased metastatic (non-contiguous spread) risk as they get larger. But some, few, small breast and prostate cancers have high metastatic probability. So failure to diagnose and treat early definitely causes some deaths, more deaths with later detection and therapy.

    But, as you point out, one cannot say which person will die. Rational non-gamblers (most of us) therefore want treatment, not watchful waiting.

    The Task Force objects in its report to the “problem” of “overdiagnosis”, i.e., those cancers that may not kill each of the older women who have some risk of dying earlier of other cause than the breast cancer. As a math example, the Task Force is cool leaving old lady breasts alone because 80% will die of stroke, heart disease, and it is not worth the $ and bother to detect all their cancers in order to prevent a 20% cancer death rate.
    I could go on, but….
    The Task Forcers are pigs, Luddites.

29. If Dr. Healey is right about this, I can see people saying to themselves that “they can’t get away with this,” they can’t just tell women in the 40-50 and 75 and older age groups that under the Health Care Reforms they will not be able to get reimbursements for mammograms or, perhaps, not be “authorized” to get them at all. But, let’s just think about this for a minute, this idea that “they can’t get away with it.”

    The Democratic Party ran a candidate for President who hid all of his relevant records, and offered a basically fictitious and highly tailored biography–riddled with blank or obviously patched over sections and holes yet, with the help of the MSM, no real, hard questions were asked and, they got away with this.

    Despite a biological father who was a citizen of Kenya, a mother under age 18 when Obama was born, and a long stay in Indonesia when he was a child, despite no hospital records or doctor or nurse testimony that he was born in Hawaii as he maintained, and contradictory statements by his paternal grandmother and a sister that they were at the Mombassa hospital (which did have birth records) and witnessed his birth in Kenya, Obama has never had to produce his original birth certificate to prove that he is a “natural born citizen” as the Constitution requires and, yet, to this day, by spending millions of dollars and fighting all the way, with at least three law firms being kept busy on various cases brought in courts all over the country and in the U.S. Supreme Court, he has gotten away with it.

    A little digging in Obama’s past and associations has shown that he was surrounded by far Left, Marxist, Revolutionary, Terrorist, Black Nationalist and Muslim ideologues for virtually his entire life yet, no one really called him to account for or to explain this so, he got away with it.

    Though Obama’s biological father and all of his paternal relatives but one in Kenya were Muslims–“strong in Islam” as his grandmother said, although from age 6 through 10 he was living in majority Muslim Indonesia in the Muslim family of his step-father Lolo Soetoro, although Obama, now called Barry Soetoro, was registered as an Indonesian citizen and Muslim, taking mandatory lessons in Islam at school, attending extra classes after school in reciting the Qur’an in Arabic reserved for the most pious Muslims, and attending the Mosque with his step-father Lolo, Obama and his campaign were allowed to say and pretend that Obama had no real connections with Islam, and he got away with it.

    Although according to newspaper accounts—and then only from English newspapers because the U.S. MSM wouldn’t touch this story–the revered mentor of Obama’s teen age years from as early as 10 to age 17 was an active member of the Communist Party, a hard drinking, drug taking, self-admitted hard core pornographer, and by his own admission a pervert, bisexual, voyeur, sado-masochist and a pedophile yet, these startling facts, this key relationship and it’s implications were never brought up or investigated by the MSM, and Obama got away with it.

    Although he sat for 20 years in the pews of the Trinity United Church of Christ under the Rev. Jeremiah Wright–who Obama used to often call his “very close friend,” his “mentor,” and his trusted “spiritual and political advisor”–and heard Wright’s Marxist and profoundly racist, anti-White and anti-Semitic, anti-American, Black Liberation Theology based ravings, Obama was allowed to get away with saying that all of these 20 years of praise, this deep 20 year relationship were no longer “operative” when Wright’s “God Damn America” sermons surfaced, as if this praise and this relationship had just never existed, and Obama was also allowed to say that in those 20 years of listening and perusing the thick Sunday church program, crammed with radical essays by Wright and others, he never heard or was aware of Wright’s racist, profoundly anti-American rants, and again Obama got away with it–case closed. Same thing with Obama’s close and longstanding personal, professional and political relationships with unrepentant urban terrorist Bill Ayers; the profoundly incurious MSM allowed Obama to get away with it.

    Once Obama became President, the Democratic leadership of Congress promised to put all bills about to be voted on up on the Internet for citizens to read before voting took place, and similarly Obama promised that he would put all bills that he was about to sign up on the Internet before he signed them too, yet, they’ve gotten away with not putting them up.

    Congress has crafted in secret and voted into law a massive $786 billion dollar stimulus bill so quickly–in a matter of days–most members couldn’t and some didn’t even try to read it–with some members even seeming to be proud of this fact–or hold anything like adequate hearings and thorough debate yet, they got away with it, and are doing the same thing for the even more important and far reaching Health Care Reform and Cap and Trade bills. You’d think that in the United States, in our Democracy, they couldn’t get away with it, but they have and are.

    You’d think that members of Congress couldn’t get away with ignoring their constituents questions, their concerns and fears, their wishes expressed loud and clear at Town Hall meetings all across the country, get away with ignoring the immense Capitol Hill protest rally on 9/12, ignoring the results of recent gubernatorial elections and avalanches of constituent mail and phone calls telling them not to pass these bills, not to spend this money, and you’d think that–since they presumably all have a very fined tuned sense of political self preservation–they wouldn’t and couldn’t just go barreling ahead and get away with it yet, they are, and are demonizing and belittling, and their allies at SEIU are giving a beatdown to, constituents who dare to protest.

    Obviously “what we have here is a failure to communicate,” and one wonders what measures will have to be taken by citizens, what actions and message will be strong enough to get through, and if they can be crafted and driven home before it is too late for the United States, the Constitution, our Democracy and for us.

30. Great! My friend who had a double mastectomy at age 43 can go get her tits back because the experts say she didn’t have cancer.

31. There is nothing wrong — nothing immoral — with using a cost-benefit analysis as a component of decision-making. And, in fact, it’s generally wrong — immoral — to decline or refuse to do so.

    Would you have a mammogram done every day for every woman, day in and day out? That would certainly save more lives, it might even save all lives potentially lost to brest cancer.

    But no one in his right mind would suggest such a regime. Why? Because the benefit isn’t worth, doesn’t justify, the cost!

32. Can’t you see? The reason the “liberals” are getting so much traction with the so-called “heath-care crisis” (which they fully intend to use as a tool to grow government and shrink liberty) is because nearly everyone, including you yourself, are thinking in “liberal” terms.

    Consider your words:
    “… The attempt to weigh these things in a cost-benefit analysis is exactly what we fear will become more frequent with ObamaPelosiCare. Although this already happens to a certain extent with insurance companies, is there anyone here who thinks the restrictions will become more rational and less Draconian when government is in charge? If you do, there’s a certain bridge in Brooklyn that I might be able to offer you …”

    Can you not see that in regard to insurance companies, your unspoken assumption is that your health-care should cost you (personally) as close to nothing as possible and should have no rational connection to benefit-per-cost? Can you not see that that widespread attitude is the hook by which the “liberals” are reeling in the nation?

    An insurance company is offering you a contract for future medical services … and you are free to purchase or decline that contract. Further, you are free to spend out-of-pocket to purchase more health-care than you had contracted via the insurance policy. And, you are free to take your money (and thus their potential profit) to a different insurance company, one that offers a contract more to your liking.

    To the extent that the above paragraph fails, it is due to government intrusion disguised as do-gooderism.

33. Ilion:

    There is nothing wrong – nothing immoral – with using a cost-benefit analysis as a component of decision-making. And, in fact, it’s generally wrong – immoral – to decline or refuse to do so.

    That’s not the question. The question is who gets to make the cost-benefit analysis for your health expenditures — you or Kathleen Sebelius?

34. Hmm. I have had mammograms since 40. At age 46 a suspicious “area” was found in my left breast, and I underwent a surgical biopsy, complete with general anesthesia. The area removed was benign, and I’ve had no further problems (11 years out).

    With the information I have today, I might then have chosen to do watchful waiting rather than have the biopsy. That said, I do believe that individual women should be able to choose at what age and how often to have mammograms.

    Ilé­on said: “you are free to spend out-of-pocket to purchase more health-care than you had contracted via the insurance policy”. I agree.

    Here in my area a screening mammogram costs around $100. Surely many, if not most, women can pay for that themselves if insurance doesn’t. How many Starbucks visits, cable TV packages, cell phone fees, or manicures does that work out to?

    What concerns me is that my ability to decide any of this could be eliminated under a state-run system (unless I become a member of Congress, a Hollywood star, or a professional sports figure, none of which is going to happen).

35. I think we must always remember that getting better, cheaper, more widely available Health Care, or better managing our Energy supplies and usage to prevent Global Warming and Heal the Planet, or fixing our Financial Systems, or improving Education–the major problem areas Obama identified early in his campaign–without any proof at all to back up his counterintuitive diagnosis–as the sources of all our economic problems–are not and never have been the ultimate objectives of any of these major bills; the ultimate objective is, and always has been, Obama & Co.’s acquisition of power and control over every aspect of our lives. Obama & Co. and their allies in the MSM and Academia merely picked and hyped these “crises” in Health Care, in Energy, in our Financial System, in Education, as the most convenient vehicles–as Rahm Emanuel said, “Never let a crisis go to waste”–to get them to where they wanted to go.

    Where do they want to go? Well, between the various nationalizations that have taken place so far, and Fannie and Freddie and, thus, now the Federal government owning 80% of mortgages in this country, and the immanent government takeover of the 18% of the economy represented by the health care industry, the government will own or control roughly 48% of the economy–48%, and they haven’t even gotten started on the Energy sector!

    They will use their control over health care to regulate and control virtually every aspect of our lives because–they will argue–how we live our lives, our “lifestyles,” the choices we make to have children or not and how many, to exercise or not, eat junk food or not, get overweight or not, drink or not, smoke or not, own a gun or not, all effect our health and thus health care costs, as does our age and stage of life (with our genetic profile soon to come as a major determinant)–age and stage which will henceforward determine our access to care and how much of it we get–and if we want Federal health care coverage–soon to be, designedly, “the only game in town,” we had better conform our lives to the dictates of the government’s regulators.

    They are just getting started dealing with the “Education crisis,” but so far they have cut the many private lenders completely out of the student load business, and, henceforward, all student loans will come directly from the government, which will set their terms. In addition, the federal government has recently unveiled a plan to forgive such loans, if a young person works for the government for 10 years–control and indentured servitude anyone?

    Similarly “Cap and Trade” is not really about saving the planet–which AGW and climate guru Al Gore said in a TV interview the other day, has a core temperature of “millions of degrees” like the Sun (in reality, temperatures at Earth’s core are estimated to be between 5,000 and 10,000 degrees Celsius)–but about controlling our access to Energy and it’s cost. Again, a way to control any aspect of our lives that involves Energy, which is virtually all of them–what kinds of cars we drive and how many, to where, when and how far and fast we drive, what energy supplies we have access to and at what cost, what particular home appliances we have, how we configure and maintain our houses–even if we can sell them or not if they don’t meet government energy standards–and what temperature we set our home thermostat at.

    Like the spider Shelob in the “Lord of The Rings,” Obama & Co. are trying to inject their poison into us to paralyze us, building a spider web to entrap us, to squeeze and constrain us, to dictate our every move, and, ultimately, to suck us dry of our life’s blood, and in Obama we have our very own hypnotic, silver-tongued “Saruman the Wise.”

36. Jonathan: “That’s not the question. The question is who gets to make the cost-benefit analysis for your health expenditures – you or Kathleen Sebelius?”

    And this contradicts anything I said, how?

    It doesn’t, of course; it’s implicit in what I said.

    tnxplant: “What concerns me is that my ability to decide any of this could be eliminated under a state-run system …”

    Exactly … except that there’s no “could” about it; your freedom will be eliminated under a state system.

37. And this contradicts anything I said, how?

    Because you tried to switch the argument to imply that anyone was suggesting having testing every day, when the topic is, basically, not breaking a system that is working better than any other on earth.

    Right now, we can choose when we do our tests. For now.

    Suddenly, now that the gov’t is looking into controling healthcare, it’s becoming acceptable to virtually assure a death rate of over one in two thousand. (I’m sure some small fraction of the women who are diagnosed before 50 will still be found out in time to survive.)

    None of us are talking about cost-benefit being bad— annoyingly, even the folks making this outrageous suggestion, which is outside of their fields, aren’t talking about cash. They’re phrasing it in terms of emotional impact.

    Just makes you sick, don’t it?

38. Tom,
    i work at a research hospital. and since the lectures are free, i sit in for fun…

    i speak to common people, and of course if i did explain it better (As you did), i would be lambasted for assuming people are stupid and my post being too long.

    i tried to be simple in passing, so i can get to the meat of my point which was that how we decide what to do to reshape the graph, is the real argument here, not the fact that they are studying or learning. we are used to now avoiding the conclusions by excising facts, rather than change the outcome.

    on another note.
    i have a MUCH better explanation as to why we have cancer. a top stem cell physician is working with me to put it together. suffice it to say that the blue print model is dead. and htat cancer has a purpose, and so on.

    way way way way way too much to put even a short thing here. just one email between myself adn the phds is mroe than 11 pages typed. and has cross refernces and such.

    just remember.
    the failure of the stuff is not the math or the people who can use the math betsy. the failure is in people using their superior intelligence and other things to play games wiht the math so that people of lesser knowlege cant choose. thats just a special high faluting form of lying and fraud. since end justifies the means now, its as acceptable as lysenkoism was.

    our last vote cut the last chords tying the population to reality.

39. Ilion, thats the point they wont get. that they have been taught to think a certain way, and that way defends the points and has institutionalized the rules to the point that its just a game for the leadership to find the excusze that unlocks permission, and byu doing avoid problems for them selves by shifting the blame to those asking for what they dont realize.

    the state could not do numbers that claimed loss of money or productivity for cigarettes, obesity, etc. unless the state claimed ownership of you and the frutis of your labors!!!!!!!!!!!!

    that they report this and justify this, is just that most have learned to pretend that they are part of the stae, and part owners too. so when they see loses, they no longer realize that they are owned, and the loses can only be determined against a base line of behavior.

    that is, they are upset that some of their cattle deny them X amount of productivity by having their own wishes. like breedinb bulls for docility so as not to hurt the other animals adn reduce what they own and can own, and can achieve.

    the change occured when personel offices became human resources.

    if i smoke and die 20 years early. we as a society lose nothing. absolutely zero. why? because I OWN MYSELF… which is why i can work for someone, i own me, and i can contract my own slavery to someone else. when i die, there is no loss to the state.

    but if the state owns me, and i smoke, then i will be givign back to the state less than i could. since the state paid for my schooling and training, they want their investment back. so, they compare what they are putting in to what they are getting out.

    and guess what?

    people living their own way, do not maximize their productivity, their taxes, and basically ownership that is being expanded by it.

    here is the way to understand it.

    liberals use the fact that we do not want to accept the limitiations of our times to create disatisfaction with now, and the desire to move to the future faster.

    such a thing is impossble..

    the only way that one in state can promise an outcome is by having control of the means of that outcome.

    when they promise things to us, and we accept, we are giving permission to them to take our lives.

    think about it.

    we give permission for them to change the future
    they can only do that by controllign us, or then admit that they cant control the future
    so, ipso facto, we sold ourselves to a slaver for the promise of a future to arrive faster, which can never happen. it is what it is when it happens, faster or slower, its the future. its like trying to get ahead of a treadmill by running faster.

    so, we are now all owned and all slaves, and the rest is the stae consolidating and mking permanent that hold,. and we are again, more than once removed from the real argumetn

    yup they are dummies…
    only dummies can play the geniuses that way.

40. Does anyone know whether the study required a value for a year of life (QALY)? I tried to find the assumption but it appeared to be hidden along with the model details. My question: Is the value placed on a year of life in this study comparable with the values implied by pollution or safety rules?

41. Quality-Adjusted Life Year (QALY) is not measured in $. One can come up with cost per QALY if cost is an input.
    Cost and cost reduction were not evaluated by the Task Force, which implicitly made the reasonable assumption that more mammograms cost more money. But it was not a cost-sensitive report.

42. Tom,
    I asked whether there was a stated assumption for the value ($ value) of a QALY. If they didn’t make their recommendation on a minimum cost basis then what did they base it on, maximum QALY’s? Are mammograms that dangerous?

43. Pingback:Chicago Boyz » Blog Archive » The Public-Health Fallacy

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