Friday, November 20, 2009

Health care and the Women We Love

The s---storm that erupted in response to new guidelines for mammograms and cervical cancer testing is only a dress rehearsal for the decade-long struggle ahead about how much preventive and recuperative care is effective--and affordable--as a result of health insurance reform.

Several important women in my life have courageously faced the challenges of breast and cervical cancers, and luckily all have survived and thrived. For these Women I Love, it's hard to define what too much care would look like. And for those women we love who are at greater risk for developing these cancers, wouldn't we want to err on the side of too much rather than not enough preventive care?

Of course, ours isn't a satisfactory answer from a public policy perspective---kind of the opposite of the NIMBY (not in my backyard) challenges that often thwart the location of nuclear waste repositiories, incinerators, and Federal prisons in or near local communities. In the case of health care, we WANT as much as we can get, when we want it, and where we want it.

Call the solution by any name you choose. Rationing? Well, that won't do. But maybe some smart marketer at Procter & Gamble can coin the term for the new, improved health care. One thing is for sure: spending on testing, diagnostic procedures, and treatments that do not have proven levels of success over time is not sound public policy and threatens the financial viability of our entire network. There are ways to measure outcomes---digital medical records would be a big boost to these efforts. And to consider cost-benefit analyses as one input among several in the medical decision-making process.

The bottom line is this: under the heading of the Change We Need, we are going to have a debate about exactly the kinds of choices the US Preventive Services Task Force tried to (clumsily) address with respect to cancer: How much health care is good health care, and can we afford to provide ourselves all the health care we want. And who decides?

A thoughtful quote from today's NYT:

“People are being asked to think differently about risk,” said Sheila M. Rothman, a professor of public health at Columbia University. “The public state of mind right now is that they’re frightened that evidence-based medicine is going to be equated with rationing. They don’t see it in a scientific perspective.”

We can have this national conversation without bringing up the death panels again. Perhaps we don't need to have it now, on the eve of the Senate debates and votes on reform. But we'll need to have it soon.

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