The recommended cutbacks in mammograms for women under 50 on the part of the US Preventative Task Force has attracted criticism from lefty George Lakoff and libertarian Keith Halderman. The latter thinks it lends credence to the “death panel” charge, whereas the former thinks the true death panels are located in insurance companies. In either case, Lakoff laments the application of cost-benefit analysis, something officially not considered by the USPTF, though Lakoff is suspicious:
”Cost-benefit analysis” has been reframed as “risk-benefit analysis,” as if the Preventive Task Force were not concerned with “cost” to insurance companies and tax-payers, but rather with “risk” to women. But “risk-benefit analysis” is just cost-benefit analysis, which in turn is what corporations use to maximize profit in the short term. Both cost-benefit analysis and the Preventive Task Force were introduced as government institutions by the Reagan administration. They were right-wing moves – part of the strategy to privatize government.
(Is it typical to see the introduction of government institutions, and even a concern with cost-benefit analysis itself, as a “strategy to privatize government”? I hadn’t thought so.)
I don’t see why risk-benefit analysis can’t be conceptually differentiated from cost-benefit analysis. They both involve tradeoffs, but only one monetary concerns.
Halderman supports Lakoff’s contention and asserts that, by a process of deduction, the only motivation spurring the USPTF’s decision must be a concern with cost-benefit:
The members of the team claim that cost did not enter their deliberations but as Lakoff points out the different reasons put forth are spurious. Besides expense what other motive could explain a policy that would result in so many extra fatalities?
But are they spurious? And is the loaded question Halderman asks unfair? Helen Searls at Sp!ked says no and yes, respectively. Lakoff suggests that the downsides to screening, such as false positives, exposure to radiation, and the general unease and anxiety that comes with getting a mammogram, is nothing compared to the lives supposedly saved by the procedure. Referencing an op-ed in the NY times, he writes:
Aronowitz also claims that the figures show that mammograms haven’t helped prevent breast cancer. He observes that the rate of 28 breast cancer deaths per 100,000 people has not changed substantially since the 50′s, despite more mammography and better treatments. But that could mean, and probably does mean, that there has been an increase in breast cancer offset by earlier detection and better treatment, saving tens of thousands of lives, but not affecting the overall rate. But he did not consider the possibility that the occurrence of breast cancer might have increased, while the rate of deaths did not change because of earlier detection due to mammograms.
But according to Searls this is erroneous. Overseas, where screening before 50 is not common, death rates are no higher:
The World Health Organization does not recommend screening mammograms for women in their forties and many developed countries do not offer routine mammograms to younger women. In Britain, for example, women do not undergo regular screening mammograms until they’re in their fifties, and even then they are screened only once every three years.
But perhaps Aronowitz didn’t compare the US system to those in Europe and elsewhere, in which case Lakoff’s point, not privy to international data, stands.
Searls suggests that the USPTF is honest in their claim that cost was not considered, and that the new recommendation is being used by Republicans to bash Obama’s health initiatives, but doesn’t make the bolder case that a cost-benefit analysis might actually make sense.