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Friday, November 27, 2009

On the Hazards of Cost Reduction

The recent flap over mammograms is a vivid illustration of the difficulties to be faced by anyone who attempts to seriously address the issue of the cost of health care.

Unless you have been hiding under a rock the last few days, you will know that the U.S. Preventive Services Task Force, a federally chartered group responsible for developing recommendations on preventive services like cancer screening, recently issued a statement questioning the value of mammograms for women in their 40’s, of more than one mammogram every two years for women 50 to 74, and of self-examination of breasts. Those conclusions were based on a number of scientific studies conducted since 2002 when the group issued its previous statement on the subject. These studies suggested that the small benefits of more frequent mammograms were more than offset by the harms of false positives, including anxiety and unnecessary tests and biopsies.

Similar guidelines have been issued by the World Health Organization and by some U.S. physician groups such as the American College of Physicians.

Given all the rhetoric by the Obama administration people about the need to curb the rising cost of health care, one might have thought they would have jumped on this chance to promote some actual savings without having to deal with fractious legislators or add to the already overstretched federal budget.

But when the task force announcement was greeted with a chorus of objections from cancer groups, radiologists, mammography machine manufacturers and others who felt threatened by it, the Obama people ran for cover. Within days, HHS Secretary Sebilius announced that the task force announcement did not constitute federal policy and that women should continue to get mammograms as before.

When surveyed, people say they are concerned about the high and rising cost of health care, but it seems that they don’t want to give up anything in order to do something about it, even when the evidence indicates that they might benefit as a result.

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