Former NIH director: ObamaCare an attack on patient choice

Dr. Bernardine Healy ran the National Institute of Health has a rather daunting resumé on health care issues.  She became the first woman to run the National Institute of Health in 1991, has served on two Presidential Council of Advisers on Science and Technology, and served as President of the Red Cross.  Healy also survived brain cancer, which gives her a rather complete perspective on the state of American health care, patient choice, and best practices.   Now as senior medical editor of US News, Healy writes that ObamaCare is nothing less than an attack on patient choice and a leap toward government diktats on treatment — and that the epicenter of last week’s recommendations on mammograms is only one of the data points:

The bill takes all sorts of choices out of patients’ and doctors’ hands. Even mammograms and prostate-specific antigen tests would be similarly restricted by the government for millions of people, and they actually serve as better examples of what happens more broadly to personal medical decision making in the new system.

The ground is being laid already, with the announcement by the U.S. Preventive Services Task Force, a government-appointed body, of new guidelines for mammograms just days ago. Such a board of experts, composed mainly of primary care, prevention, public health, and epidemiology experts, would recommend the list of preventive services covered in the post-health-reform insurance plan that all would have no choice but to buy. Until now, the government’s task force has been one voice among several medical groups issuing sometimes conflicting prevention guidelines, leaving room for patient-doctor choice. But in an elevated role under health reform, the federal preventive task force’s declarations would carry greater force and have an economic impact on everyone.

Prostate-specific antigen (PSA) tests help catch prostate cancer early. The American Urological Association wants men screened with the test beginning at age 40 to catch the problem at its earliest stages. The government has other ideas here, too:

But loss of personal choice is not an issue for women only. Look at PSAs. As the pioneering prostate cancer surgeon Patrick Walsh of Johns Hopkins points out, a European randomized trial showed that PSAs saved lives. In the United States, there has been a 40 percent reduction in prostate cancer deaths since testing began in the early 1990s. Yet prostate screening arouses many of the same concerns as does breast cancer screening: too many follow-on studies, too many biopsies, and surgery on slow-growing tumors that may never have harmed the patient. The government task force claims that there’s insufficient evidence to make a recommendation for routine screening of men younger than 75 and is firmly against screening in men older than that. The American Urological Association’s position is the polar opposite: Baseline PSAs should be offered to men at age 40, and the frequency of subsequent testing should be determined by doctor and patient choice.

In other words, the USPSTF decision on mammograms was no fluke. The government board wants to move away from what it sees as excessive testing, claiming that it will reduce unnecessary stress and anxiety in patients. It’s no small coincidence that it will also save the government money — and in the case of PSAs, it will save money directly if Medicare refuses to pay for PSA tests until age 75, rather than retirement age.

Right now, the US leads the world in catching, treating, and curing prostate cancer. Britain, which has a single-payer system that rations care, has one of the lowest ratings in the world. That’s not a coincidence.

He who pays the piper calls the tune. If we want to keep patient choice, then we have to pay for our own care. If we allow the government to absorb our choices in the name of “fairness,” expect the USPSTF and other government panels to ration these tests and reduce our chances of surviving these cancers.

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