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Wednesday, July 08, 2009

Steyn on health care reform and preventive screening.

One of President Obama's arguments for "reforming" health care is that "preventive" care - more tests, more screening - will help control costs. Really? A propos cancer, Professor H Gilbert Welch of Dartmouth Medical School notes:

For starters, the majority of folks who are screened receive no benefit. That's because, despite scary statistics, most people will not get cancer. Let's look at breast cancer as an example.

According to government statistics, the absolute risk of a 60-year-old woman dying from breast cancer in the next 10 years is 9 in 1,000. If regular mammograms reduce this risk by one-third-a widely cited but by no means universally accepted claim-her odds fall to 6 in 1,000. Therefore, for every 1,000 women screened, three of them avoid death from breast cancer, six die regardless, and the rest? They can't possibly benefit because they weren't going to die from the disease in the first place.

Apply that across the system: How can testing 997 out of a thousand people for no good reason save money? As David Harsanyi writes:

A government policy that prods people into incessantly visiting medical offices for checkups, screenings, and tests will only raise costs even further. According to studies, preventive medicine thwarts little, though it does mean early diagnoses for relatively harmless ailments—and treatments for them.

One of the points I make in the current NR is that, if health care "systems" are so critical to your health, why is there an entirely negligible difference in outcomes?

Life expectancy in the European Union 78.7 years; life expectancy in the United States 78.06 years; life expectancy in Albania 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia & Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral – margin-of-error territory. Maybe we could get another six months by adopting EU-style socialized health care. Or we could get another six weeks by reducing the Lower 48 to rubble in an orgy of bloodletting, which seems to have done wonders for Bosnian longevity... Even within the United States, even within the Medicare system, there are regions that offer twice as much “health care” per patient – twice as many check-ups, pills, tests, operations – for no discernible variation in outcome.

Indeed, the fate of the late Michael Jackson may yet prove an instructive lesson in the perils of too much medical attention. But that's his choice - under our present system. You want to get tested for something you're statistically unlikely to get? That's up to you. But it's harder to discern the state's interest. A system of universal "preventive" care will create a hugely expensive, inflexible regime geared not to the illnesses you actually get but to the bureaucratic processing of waiting rooms clogged with perfectly healthy people getting annual tests for diseases they'll never get - and none of it will impact on our health, only on our tax returns.

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