Rationing, the Unspeakable, But Honest Solution

By Eugene Robinson
WashPost

WASHINGTON -- The uproar over the on-again, off-again guidelines on when women should have mammograms is proof of the blindingly obvious: Health care reform that actually controls costs -- rather than just pretending to do so -- would be virtually impossible to achieve.

I say "would be" because none of the voluminous reform bills being shuttled around the Capitol on hand trucks even tries to address a central factor that sends costs spiraling out of control, which is that each of us wants the best shot at a long, healthy life that medical science can offer. Just as all politics is local, all health care is personal. Skimping on somebody else's tests and procedures may be worth debating, but don't mess with mine.

Intellectually, it's simple to understand why it might make sense for women -- those who have no special risk factors for breast cancer -- to wait until they're 50, rather than 40, to start getting mammograms. The analysis by the U.S. Preventive Services Task Force, which made the recommendation, looks sound. According to the panel, a whopping 10 percent of mammograms result in false-positive readings that lead to unjustified worry and unneeded procedures, such as biopsies. In a small number of cases, women are subjected to cancer treatment or even a mastectomy they didn't need.

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