Ms. Collins, in “The Breast Brouhaha,” says describing the last 10 years as the Terror Era sounds too much like a downer. How about the Decade of Medical Backtracking? Mr. Kristof, in “The Wrong Side of History,” says attempts to discredit the health reform proposals now before Congress resemble the flawed arguments made in the 1960s. Here’s Ms. Collins:
Everyone has been trying to come up with a good nickname for the 10 years we’re concluding next month. Terror Era really sounds like too much of a downer. How about the Decade of Medical Backtracking?
Somewhere between the reports that Pap smears and tests for prostate cancer aren’t all they were cracked up to be and the news that a high fiber diet doesn’t do anything to prevent cancer, the health establishment began looking decidedly nonomniscient. Then this week, a federal task force reported that most women don’t need annual mammograms.
Even more fascinating, they suggested that doctors stop telling their female patients to self-examine their breasts for lumps.
If you happen to be a woman, particularly a somewhat obsessive woman, this is huge news. The to-do list just got one item shorter. Now if dentists would just decide to withdraw the flossing directive, we may have enough additional spare time to learn Spanish.
The task report said that the jury is still out on whether doctors should do the examinations themselves, but my general impression is that the U.S. Preventive Services Task Force feels that younger women should not let anybody near their breasts unless the plan is to have sex.
The report triggered two immediate and inevitable responses. Doctors and patients began an animated discussion. And Republicans declared it was all a Democratic plot.
“I mean, let the rationing begin. This is what happens when bureaucrats make your health care decisions,” said Representative David Camp, the ranking Republican on the House Ways and Means Committee.
Representative Camp is definitely on to something. Whatever happens, we do not want the government conducting any studies on whether current health practices actually do any good. Let this continue and soon you will not be able to get your hands on a good leech when you need one.
There is no possible political advantage in coming out against medical testing, so the Obama administration scurried away from the report. The task force did not consider the matter of cost, but, of course, people like Representative Camp depicted it as the first step toward rationing. The current position of the Republican Party seems to be that it is not possible to spend too much money on medicine. Party on.
(Has anybody noticed that the people who darkly warn about government bureaucrats forcing insurance companies to cut back our coverage appear to be the same ones who just voted to force insurance companies to stop covering abortions? Where’s the sanctity of the marketplace when we really need it?)
Every rational American wants qualified experts to keep re-examining current medical practices. The only thing that bothers me about the mammogram report is all the emphasis on the “anxiety” that might follow a false-positive. We live in a time when we are constantly being reminded that a fellow plane passenger might be trying to smuggle explosives in his sneakers. We can manage anxiety.
I am going out on a limb to say that the real problem with a test that creates a lot of false-positive results is that it leads to a lot of other medical procedures, some involving hospitals. Unless you are genuinely sick, there is no more dangerous place to be hanging around than a hospital.
I had breast cancer back in 2000, and I am trying to come up with a way that I can use that experience to shed some light on these new findings. I have never believed that everything happens for a reason. But I do feel very strongly that everything happens so that it can be turned into a column.
Whatever the moral would be, I don’t think it helps Representative Camp’s argument. I had mammograms every year like clockwork, and I had just gotten a clean bill of health from my latest one when I found a lump on my left breast while watching a rerun of “Buffy the Vampire Slayer,” multitasker that I am.
It turned out to be cancer, of a fairly low-grade variety. My oncologist felt strongly that it never would have developed if I hadn’t taken estrogen replacement therapy — another one of the medical marvels that has now been consigned to the Seemed Like a Good Idea at the Time category.
So, in summary, the cutting-edge of medical thinking of the 1990s may have induced my cancer, and then the universally recommended testing protocol failed to detect it.
Nevertheless, everything seemed to work out fine, except that I had to have radiation while I was covering the Republican National Convention in Philadelphia. In retrospect, it is possible that my attitude toward the Bush-Cheney ticket was colored by the fact that I was thinking a lot about mortal danger at the time.
Here’s Mr. Kristof:
Critics storm that health care reform is “a cruel hoax and a delusion.” Ads in 100 newspapers thunder that reform would mean “the beginning of socialized medicine.”
The Wall Street Journal’s editorial page predicts that the legislation will lead to “deteriorating service.” Business groups warn that Washington bureaucrats will invade “the privacy of the examination room,” that we are on the road to rationed care and that patients will lose the “freedom to choose their own doctor.”
All dire — but also wrong. Those forecasts date not from this year, but from the battle over Medicare in the early 1960s. I pulled them from newspaper archives and other accounts.
Yet this year those same accusations are being recycled in an attempt to discredit the health reform proposals now before Congress. The heirs of those who opposed Medicare are conjuring the same bogymen — only this time they claim to be protecting Medicare.
Indeed, these same arguments we hear today against health reform were used even earlier, to attack President Franklin Roosevelt’s call for Social Security. It was denounced as a socialist program that would compete with private insurers and add to Americans’ tax burden so as to kill jobs.
Daniel Reed, a Republican representative from New York, predicted that with Social Security, Americans would come to feel “the lash of the dictator.” Senator Daniel Hastings, a Delaware Republican, declared that Social Security would “end the progress of a great country.”
John Taber, a Republican representative from New York, went further and said of Social Security: “Never in the history of the world has any measure been brought here so insidiously designed as to prevent business recovery, to enslave workers.”
In hindsight, it seems a bit ridiculous, doesn’t it? Social Security passed, and the republic survived.
Similar, ferocious hyperbole was unleashed on the proposal for Medicare. President John Kennedy and later President Lyndon Johnson pushed for a government health program for the elderly, but conservatives bitterly denounced the proposal as socialism, as a plan for bureaucrats to make medical decisions, as a means to ration health care.
The American Medical Association was vehement, with Dr. Donovan Ward, the head of the A.M.A. in 1965, declaring that “a deterioration in the quality of care is inescapable.” The president of the Association of American Physicians and Surgeons went further and suggested that for doctors to cooperate with Medicare would be “complicity in evil.”
The Wall Street Journal warned darkly in editorials in 1965 that Medicare amounted to “politicking with a nation’s health.” It quoted a British surgeon as saying that in Britain, government health care was “crumbling to utter ruin” and suggested that the United States might be heading in the same direction.
“The basic concerns and arguments were the same” in 1935 against Social Security, in 1965 against Medicare, and today against universal coverage, said Nancy J. Altman, author of “The Battle for Social Security,” a history of the program. (The quotes against Social Security above were taken from that book.)
These days, the critics of Medicare have come around because it manifestly works. Life expectancy for people who have reached the age of 65 has risen significantly. America is no longer shamed by elderly Americans suffering for lack of medical care.
Yet although America’s elderly are now cared for, our children are not. A Johns Hopkins study found that hospitalized children who are uninsured are 60 percent more likely to die than those with insurance, presumably because they are less likely to get preventive care and to be taken to the doctor when sick. The study suggested that every year some 1,000 children may die as a consequence of lacking health insurance.
Why is it broadly accepted that the elderly should have universal health care, while it’s immensely controversial to seek universal coverage for children? What’s the difference — except that health care for children is far cheaper?
Granted, there are problems in the House and Senate bills — in particular, they falter on cost-containment. In the same way, there were many specific flaws in the Social Security and Medicare legislation, but, in retrospect, it’s also clear that they were major advances for our nation.
It’s now broadly apparent that those who opposed Social Security in 1935 and Medicare in 1965 were wrong in their fears and tried to obstruct a historical tide. This year, the fate of health care will come down to a handful of members of Congress, including Senators Joe Lieberman, Blanche Lincoln, Ben Nelson and Mary Landrieu. If they flinch and health reform fails, they’ll be letting down their country at a crucial juncture. They’ll be on the wrong side of history.
