One could do some cost/benefit analysis with those numbers, but I don’t know what the costs involved are when a woman gets a positive screening for cancer, to get them to the point where they find out it was a false positive.

As for your second comment, about breast cancer, that’s a tricky one. I understand your point — yeah, you have some false positives that will cost money. But when you catch breast cancer in a 40-year old, as Dr. Healy states, it’s usually pretty aggressive. I don’t know the stats on false positives in 40-50 year old women, how much it costs to treat aggressive cancers, and other important things. To be cynical about it, from a pure cost perspective, it’s better to let these women die so we don’t have higher health costs for them in their lives later. That may sound absurd, but it just points out how things can go horribly wrong when all you look at for health care is cost/benefit analysis in health care itself, and don’t look at the number of lives saved and the value of those lives. I don’t know that these guidelines looked at that at all. (They may have, but I don’t think so — Dr. Healy seems to think it’s just looking strictly at health care costs.)

First, you mention the comparison between the percentage of claims denied by Medicare (6.5%) and the average of insurance companies (3.5%). Is this really a fair comparison? If you took the average of insurance company rejections for the population over 65 and adjusted the population by their income distribution, do you think the medicare denial rate would still be higher? My impression is that the elderly, and especially those in lower socio-economic groups, tend to have a higher rate of over-use of the medical system than, say a 28 year old in good health.

Second, the issue with the breast self-exam is a good one to discuss rationing. I personally don’t think it is unreasonable to suggest that women who are at low-risk of breast cancer (those under 50 without a family history of breast cancer) should not have the same access to scarce quantities of medical diagnostic services as those with higher risks. I don’t think your sentence, “..the government is saying to stop looking for cancer – because, you know, if you find it, you’ll need to be treated for it.” is complete. I think rather that they are saying to stop looking for it if you are low risk because if you find something, it probably isn’t cancer and we are spending a lot of resources on false diagnoses. For the same reason, you wouldn’t want to give a CAT scan to everyone who has a bad headache. It might be brain cancer, but chances are it is not. If there is a family history of cancer, and if you have other symptoms then perhaps the tests are warranted.

I remember discussing the Canadian-U.S. health systems with one of our fellow WashU students back in the day (which was a Wednesday, in case you’re a Dane Cook fan) and he told a story about getting an MRI when he was 10 and fell off a bike. He meant the story to indicate how great the U.S. system was, that he had access to such great diagnostic tools. I, on the other hand, was appalled at this seemingly horrific misuse of resources.

Thanks again for the blog – always enjoyable!
Janice