Carrie Lukas is Vice President for Policy and Economics and author of The Politically Incorrect Guide to Women, Sex and Feminism
Proponents of the proposed healthcare reform reassure the public that the government won't be in the business of "rationing" care. It's one of the topics on the White House's "Reality Check" website; the headline insists: "Reform will stop rationing—not increase it."
Yet the public is getting a glimpse into how government rationing might work. This week, the U.S. Preventive Services Task Force (that's a panel charged with reviewing evidence and making recommendations for preventive services) offered its opinion about best practices for screening women for breast cancer. Their recommendations were a significant change from what's common today: They suggest that women in their 40s should not have annual mammograms and older women should reduce the use of this screening devise.
In conducting their analysis, the panel weighed the number of false positives and unnecessary procedures against the number of lives saved from early detection and treatment. They estimated that screening at age 40 (as opposed to at age 50) prevented 0.7 breast cancer deaths for every 1,000 women screened, while 470 women would have a false-positive and another 33 would have unnecessary biopsies.
Is it better to have one women die than have 500 undergo unnecessary medical tests? I suspect most women would say no, but there's no "right" answer. It's a matter of perspective. Not surprisingly, experts disagree about the new recommendations: some welcomed them while others called them "crazy" and worried they would undermine the progress being made reducing breast cancer deaths.
Who's right? Who should decide if it is better to slightly increase your odds of missing a diagnosis than running the risk of a false-positive?
Each individual is the only one who can properly make such determinations. Certainly some would rather avoid uncomfortable, and even painful, procedures, even if that slightly increased their risk of death. Others would make a different calculation.
This panel claimed not to have considered cost. Yet if cost was ignored by this particular panel, certainly cost would be a primary consideration once the government becomes the nation's primary insurer. After all, we can't all get daily body scans to make sure that nothing unwanted is growing. Resources are finite, including the government's.
Yet the public should recoil from having government make these top-down, one-size-fits-all determinations about the right balance between risk and costs. Individuals have different preferences for risk—we express them every day when we decide what cars to purchase, where to live, and what kinds of activities to engage in. We should also weigh those tradeoffs when it comes to our healthcare.
In promoting its version of healthcare reform, the White House emphasizes that people already face rationing—rationing that's imposed by their health insurance company. Yet in a functioning marketplace, individuals would shop for policies that represent our preferences since we would choose based on what's covered and what's not, and at what cost. That's how we buy car insurance—we weigh the costs of the policy versus the potential risk of having to pay the deductible).
Unfortunately, we don't have a functioning health insurance marketplace. Our laws heavily favor employer-provided health insurance, which limits individual choice. Congress should focus on solving this problem: for example, allowing inter-state purchase of health insurance and giving insurance purchased by individuals the same tax advantages as employer-provided insurance would both create a more robust health insurance marketplace. Of course, some cannot afford health insurance and, if there is going to be a federal role in healthcare, it should be targeted to those truly in need.
This market-based approach means that the wealthy will be able to afford more generous insurance plans than the rest of us. But that will be true in any system we adopt: the rich will always be able to use their money to escape the system and receive better care (as they do in socialized health system around the world).