Sibelius Recovers The Downed Trial Balloon. Reality Won’t Let The Cost Curve Bend.

We just got a fascinating glimpse of what proponents of nationalized healthcare will do to improve the outcomes of Federal Medical Programs. They won’t know that you are sick, they therefore won’t attempt to cure you. As a result, they will fail far less often and prove that socialized medicine has a much higher likelihood of producing positive healthcare outcomes. Also, what they don’t know about doesn’t cost Jack.

So just how would this X-Files Episode proceed? How does the government deliberately not know something? Wouldn’t deliberately not seeing the obvious look suspicious?

It would be kind of like letting a guy who hated the US Army’s involvement in Iraq, join the US Army, have his medical training paid for by US taxpayers, spend years saying things like “infidels should have their throats cut open and filled with boiling oil”, drive on post with semi-automatic weapons and then gun down fourteen of our soldiers. We all know the US government wouldn’t be stupid enough to allow those sorts of man-made disasters to ever happen again after 9-11.

Thus, they lay the groundwork carefully. Let’s say, just for the sake of argument, that breast cancer detection and treatment really bent the Cost Curve of Orszag in the wrong direction. Let’s say the tests are expensive, the treatments uncertain and the political ramifications of not spending this money generously quite daunting for the professional office-seeking class. How do you go about shunting this money to uses that generate more Quality-adjusted Life Years per dollar expenditure?

It all starts with science. You can do anything with science. Just ask former divinity student and Vice President Al Gore. You need lots of science to deprive people of their healthcare. Especially after Senator Burris assured them it was a constitutional right.

Thus, the US Government has to prove that they can take away the mammograms without endangering the actual mammary. Once they’ve “proven” this statistically unlikely piece of truth, then they can move on to the policy implications. Otis W. Brawley, Chief Medical Officer of The American Cancer Society, describes recent research that argues against routine mammography for women between 40 and 49.

On Monday, the U.S. Preventive Services Task Force took a step backward in the fight against breast cancer. The task force announced that it would no longer recommend routine mammograms for women between the ages of 40 and 49, a group that accounts for about one out of six breast cancers. The recommendation is based on data that find that mammograms do reduce the risk of death in these women, but apparently not enough deaths to recommend that all women 40 to 49 should be screened.

This development has once again raised a heated public discourse on the benefits, risks and harms of breast cancer screening. This rigorous discussion is an important part of reaching clear and understandable public health guidance. But it can be messy and confusing to the public. And, in this case, it could result in fewer women getting screened and a return to the days when we caught cancers only when they were big enough to feel. That’s a step the American Cancer Society does not want to take.

Not taking the mammograms seems to be taking unnecessary risk. Davey Johnson, a former manager for the New York Mets, used fundamental precepts from Operations Research to help him make better baseball decisions during games. He hated it when a player on his team committed unnecessary chance deviations. Even if the official scorer didn’t ring that player up for an error in the box score, Manager Johnson made sure that guy heard it in the clubhouse.

Unnecessary chance deviations involve doing something that lowers your chance of success without any sort of compulsion. Nothing good gets accomplished by one of these and they only make failure more likely to occur. People who speak English rather than Math Nerd call these sorts of things bad decisions.

If cost rationing plays no part in anyone’s thinking, reducing the currently accepted regimen of mammography that most women undergo is a negative chance deviation. It’s only in the Land of Orszag, where the shadows lie, that this type of policy has a positive outcome. Take out ten years of routine mammography from every member of the current female population under forty, and that cost curve starts bending exactly where President Obama promised us it would.

Female GOP Congresswomen wasted no time in beating Democrats soundly with this issue as a shillelagh. Politico describes the immediate connections that were drawn between Orszag’s cost curve bending and the sudden advocacy athwart routine testing for breast cancer. Representative Rodgers of Washington State lead the GOP pushback.

“This is the wrong approach, especially as we’re debating health care reform in America,” Rep. Cathy McMorris Rodgers (R-Wash.) said. “It is concerning to us that these recommendations mirror policies in single-payer nations like England.”

Marsha Blackburn wasted no time supporting her colleague. She issued the following critical statements regarding the report.

“This is how rationing begins. This is the little toe in the edge of the water. And this is where we start getting a bureaucrat between you and your physician. As we have gone through this health care debate over the past several months, this is what we have warned about,” Rep. Marsha Blackburn (R-Tenn.) said.

Thus, with push-back running rampant, it was time for Democrats to prove their party has female members as well. Secretary Sibelius was trotted out to clean up the remains of Barack Obama’s initial experiment in Cost as An Independent Variable analysis outside the domain of defense acquisition. She issued the following statement cum denial regarding the recent study.

“The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government,” the statement said.

So, in much the same way that Great Britain’s National Institute for Health and Clinical Excellence never recommends specific patient treatment regimes, this panel of doctors just issues advice. This just so happens to be mathematically calibrated advice designed to effect a Pareto Optimal outcome that supersedes the particulars of any particular patient.

Republican Candice Miller very effectively pointed out why Pareto Optimal societies are great to live in – unless you happen to be an individual human being.

“What is the driver of many of their decisions?” Rep. Candice Miller asked about the numerous task forces created by the new health care bill. “Will cost be a consideration? If that is the case, for instance, why have all these mammograms because it is very costly, they could test 2,000 women and only one is a positive. I guess it doesn’t matter. If you’re the one, it matters.”

Sibelius can dissemble. She can announce that George W. Bush hired the doctors. She can claim Barack Obama is way too caring an individual to ever take away people’s mammograms. The final hypothetical advice could even be God’s own truth whispered only to Kathleen Sibelius’ privileged ears.

Yet why should we even consider passing a healthcare reform bill that gives Barack Obama the opportunity to be that caring and nice? He’s got seven more years of such swell niceness left in the tank at most – unless he’s taking his advice in Constitutional jurisprudence from Hugo Chavez or Vladimir Putin.

At some point reality intrudes upon the fantasy of universal healthcare as a basic human right. The people peddling these delusions understand this already. The efforts to lop off a huge cost driver by denying the necessity of early detection to better fight breast cancer were laying the groundwork not to have the state-run health insurer pay for them. That would have given the badly strapped Federal Treasury a whole bunch more change to believe in.