I have been asked by Pam, a Facebook buddy, what I think about the timing of the revised attitudes regarding breast exams and pap smears, and does it relate to the health care bill which is taking shape. Naturally, I don’t have any personal knowledge of those procedures, but I think we can use them as a symbol and discuss the broader issue: How is health care going to change?
To begin with, I am not an Obama fan. I occasionally agree with him about what constitutes a problem, but I rarely approve of his solutions. I think he is a caring man, but naïve. Many Americans and National Governments agree with me. He recognizes the plight of the downtrodden, but he seems oblivious to what makes an economy work. Billionaire Rupert Murdoch also agrees. Worse yet, he gets pushed around by the tag-team duo of Pelosi/Reid, who have done more to destroy the once-wonderful Democratic Party than any other democrats I can think of.
I tell you all of this political stuff so that you will not think of me as a homer when I say the new recommendations for the procedures mentioned seem on the right track to me.
My wife’s sister is a very seasoned intellectual-type midwife. Mary Ann has delivered thousands of babies and has been writing for text books and journals plus speaking at seminars for years. One of her studies, and pet peeves, has to do with all of the urine samples and tests that pregnant women undergo. She has been arguing that the information gleaned from such tests is available through the other tests they perform; therefore, gathering all of those urine samples is redundant. Many doctors are following her recommendations and cutting back.
I serve this up as another example of a test-crazed medical industry. It seems to me that doctors tend to fear getting sued, so they deflect responsibility from themselves by recommending, and even pushing, all sorts of tests. “Tis better to error on the safe side.”
I asked Mary Ann what she thinks about the suggestion to cut back on the two tests which Pam mentioned. Mary Ann said there was ample fact-based evidence supporting the suggestion to reduce the number of pap smears, but she was slightly dubious about the mammogram.She said she had not read enough to form an opinion but she did say that women in general do a lot better job of self-examines these days so cutting back on mammograms will probably also be prudent.
We all like to hear that our medical tests came back with positive results, but do we really give sufficient thought to all of the dynamics that went into obtaining the tests in the first place, or the consequences thereof? This, “test the bedickens out of everything” mentality we tend to embrace has to be running up our collective health costs unnecessarily, and I am all for cutting out some of the waste.
On a side topic, I am a devout capitalist, but I have to say that the insurance companies play an unseemly role in all of this. I think they love high prices. Every time there is a new expense they get to add on 10% for themselves. The more doctors who get sued the better; more tests mean more expenses and more expenses mean they can raise their premiums. After all, if you were an insurance company would you rather make a 10% profit on a million dollars or a 10% profit on two-million dollars? So as long as they can pass along the expenses to somebody, anybody, why would they want the medical industry to cut back on tests or anything else?
So all of this brings me to Pam’s question: Does the philosophical shift in the frequency of the tests that she mentioned coincide in any way with Obama’s health care program?
There is plenty of room for cutting back on unnecessary medical overhead, but I am woefully unqualified to know how often a woman should subject herself to the crunching, the exploring or the weekly pee-in-a-cup ritual of pregnancy. On the other hand, Mary Ann knows this stuff inside and out. I think I will take her word for it and conclude that the reports are legitimate, whether the timing is suspicious or not.
In the mean time, we can all “hope” (to use Obama’s term) that this is not the first sign of dangerous health care rationing.
Your ideas are wanted.
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3 comments:
Add to that the following garbage we should all as a society cut out:
1) My son Alex exhibited H1N1 symptoms. There is no cure so my thought was give him tylenol, rest, and fluids. My wife wanted him tested (they can't do anything if the test is positive). They gave him the quick "swab" test, results back in 3 days, and then said the results were 50% accurate. What????? How much did that cost?
2) I've cut my fingers three times in 2008 bad enough to require stitches. I didn't get them. Scrub carefully, use iodine to clean the wound, bandage properly with antibiotic, change the bandage everyday, and keep it dry and clean. All have healed fine in 10 -15 days. How much would stitches cost?
3) Our dog Jasmine just died. The doctor knew 90% that it was terminal cancer by a simple observational exam. But we had to be sure so we got bloodwork and x-rays. $700 to find out we had to kill our dog. Do you think a farmer 50 years ago would do the same?
4) Dental insurance. Why does this even exist? The most expensive procedure around costs in the low thousands, and routine maintenance is around $100. Dentists charge way more than they should because they know you don't look at the bill. My dentist doesn't even PRINT the bill for me, I have to ASK. Then they seemed offended that I tell them they seem expensive. And why do they give you a bag with a toothbrush and toothpaste? You already have that at home . . . how much did that add to the bill?
5) Hospitals. I've been to the hospital twice without insurance . . . OH NO, I WAS ONE OF THE MILLIONS OF AMERICANS WITHOUT INSURANCE!!!! CALL OBAMA, HELP!!! HELP!!! Each time cost me around $3000 for a two-three hour stay. That sounds bad, but if you add up the four years of monthly premiums I saved, I came out ahead. And I PAID. What about the spanish speaking folks in the bed right next to me that got equivalent care and didn't pay . . . is part of my $3000 paying their bill? What about my insurance premiums now? Oh . . . you say they CAN'T pay because they are poor? How about they clean my house for a week for a piece of my $3000? Something . . . Anything . . . you know in the old days if you didn't pay at a restaurant, they made you wash dishes. How about we get families of sick folks that can't pay to sweep the floors or take out the trash?
6) Hospitals part 2: Here's a list of some of our biggest hospitals: St. Anthonys, St. Luke's, St. Joseph's. Who are all those guys? Sounds religious to me. How come when we were delivering Abbie Jesus was staring at me from his spot on a cross on the wall? How come my laptop was barred from accessing "youtube" on the local wireless connection? Where are the separation-of-church-and-state police? The answer is they are hiding because they can't pony up that kind of cash. Next time someone tells you Americans are greedy bastards in it for themselves or that without government the poor and helpless would go hungry and without medicine, take a trip down to see one of your friendly "Saints".
Here's some solutions:
a) everyone gets a catastrophic health insurance policy ($500 per year) that will cover you if you get cancer.
b) You start actually paying the doctor when you go, $120 for services rendered instead of a $10 copay.
c) Don't go to the doctor when you don't need to. You know who you are . . .
This isn't just about healthcare. People will buy whatever someone pitches them as long as it comes with a guarantee for better safety. I was lucky Uncle Dave took time out of his day to show me how to buy tires for my car. If he hadn't, I would have spent around $300 more than I should have on tires that the salesman guaranteed me were "much safer", all because they make you stop slightly faster than another set of tires. Probably not worth the money, but if you claim that it's for safety, people will always buy it. I know I would have, but now I question things more.
The healthcare debate is the same thing. People will test themselves silly only because someone tells them that it'd be unsafe if they didn't. I had three tests done to confirm I had a tumor. The first two were relatively cheap ultrasounds, but the third, admittedly unnecessary by the surgeon, was an MRI. It offered a slightly clearer picture of the tumor, which he already said he didn't REALLY need, but he still insisted I have the MRI. That test cost literally thousands of dollars to confirm that I had a tumor which I could feel with my hands. Waste.
It's not surprising, however, that there is a culture of waste in a society that encourages consumption of shiny new products we don't need and can't afford. I'm all in for researching what tests are unnecessary and cutting them out, along with encouraging consumers to be more responsible about the products they buy and why they buy them.
Matt: I did not ask for him to be tested, it is a routine part of the examination when anyone comes in with flu symptoms. But you're right, what's the point in testing if the results are 50/50?
Dave: My aunt recently died of breast cancer at the age of 52. She had been diagnosed at the age of 40, during her first routine mammogram. She battled the cancer for 12 years before losing her fight. For many of those years, her quality of life was good. Had she not been given the opportunity to have the mammogram that gave her this grave news, she probably would have died much sooner as she would not have known she had breast cancer until it was much too late. Early testing bought her at least 10 years of life. Worth it? Well I don't know, why don't you monetarily quantify a year of your life, multiply it by 10 and you tell me.
I don't know enough about the reduction in pap testing to have an opinion on that right now.
Also, I don't see them reducing the frequency of screening tests for men. Only women. Why?
I agree that the health industry as a whole can definitely benefit from cutting out some waste, but putting off mammograms and reducing the number of cervical cancer screenings women receive is not the solution.
Case in point: My mom works at a small Dr's office. In past years,representatives from major pharmaceutical companies have come in and catered lunch for the office. This is not an occasional event. This was two to three times a WEEK. With the lunch there would be pads of paper, staplers, pens, with the name of a new drug printed on them. How much does all of that cost? And who's paying for it? You want to cut out waste, start with the pharmaceutical companies, not life saving tests for women.
Thankfully, the Dr's at my mom's office said "enough" and no longer accept any gifts from the pharmaceutical companies.
Hopefully more Dr's offices will follow suit.
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