Poorly Rationed Reasoning

So my new goal here at Hogs is to play around with some of the big arguments of the day. On Monday I dove into the troubles that erupted around the climate change debate after the computers were hacked at CRU. The most interesting comment for me was Karmavore's distinction between "Climate Change Skeptics" & "Climate Change Disbelievers." The difference is important, and it will affect the way I engage in that discussion in the future.

I hope that kind of thing will happen more often here. I want to look at the divisive issues that are too often cast in black and white and then seek out the gray areas.

The hot button issue for today is health care, more specifically last week's ruckus around the word rationing. The issue came into sharp focus after the results of a study on mammography were released by the Preventive Services Task Force. The study recommends that women do not need to start regular screenings for breast cancer until the age of 50. The previous recommendation had been to start screenings at 40.

Patients can ignore the study and get screened in their 40s anyway. However, the people signing the check for those screenings may object, and since most people do not sign the check for their own health care, there is a conflict. People are nervous that the check signers might listen to the experts and certain tests won't get paid for.

Of course that nervousness spilled over into the health care reform debate.

Last week the WSJ's opinion page suggested a lot of things that might happen if the government tried to reduce health care spending. The piece critiques how the government plans to decide what medical procedures to pay for? The idea is to put experts in place, experts like the ones who put out the study on mammography.

With that study out, suddenly we have a stand-in for "the bureaucrat that will get between you and your doctor." And that bureaucrat is advising us to reduce breast cancer screenings. I understand the uproar. Women have been told that regular screenings can save their lives. Now some acronym is telling them to forget about that. It is a powerful reminder of the fact that personal heath care decisions are not always up to the individual. And with the reform bill ready for debate next week, powerful reminders like that are explosive.

My concern is that such explosive material can be misused. Private insurers are also likely to take note of the mammogram study. No matter the insurance scheme, there is a limited amount of money in a pool, and someone needs to decide how to best spend it.

Peter Singer's July piece in the NYT Magazine asks readers to do the following: think about the spending limits you would put on another person's medical treatment if experts claimed that the treatment was not effective in most cases. Singer asks for a number. It's a tough call.

This is the decision any insurer must make. The pro-reform people have cast the private insurers as heartless for refusing service, but the measures up for debate in Congress will put similar decisions in the hands of government appointees.

And that is the heart of the matter: Who do you want making those decisions about rationing?

I like the government appointed panel of experts, because we can demand transparency. The debate over the mammogram study is an example of how a government panel's findings are open to the public and up for debate.

What do you think?