Tom Firey: Is cancer screening bad for you, and Obamacare?

November 16, 2011|By THOMAS A. FIREY

It’s been a tough autumn for the nation’s new health care law, known as the Patient Protection and Affordable Care Act inside the Beltway and as “Obamacare” everywhere else.

First, a new report on employer-provided health insurance found that family premiums increased 9.5 percent in 2011, while the portion of workers covered by employer-provided insurance declined to 58 percent. Then, the Obama administration announced that it couldn’t find a way to create a sustainable long-term care insurance program, as required by the new law. And then the latest opinion poll on Obamacare found that it has fallen to a new level of public disfavor, with Democrats increasingly opposed to it.

But the worst news came when a federal health care task force recommended that seemingly healthy men not undergo P.S.A. (prostate-specific antigen) screening for prostate cancer. The announcement might seem unrelated to Obamacare, but its implications are profound.

The task force’s recommendation comes after years of scientific evidence suggesting that P.S.A. screening does not benefit men as a group. The problem is not simply that the test gives false results, though that happens. The big problem is that P.S.A. screening and follow-up biopsy can’t tell whether a detected cancer is dangerous.

The idea that cancer can be non-dangerous might seem ridiculous. But cancer can be very slow-growing — so slow that the patient will die of other causes long before it becomes a problem. It can also not grow at all, instead existing neutrally in the body like wisdom teeth. And in some cases, the body’s own defenses can kill off cancer.  

The vast majority of prostate cancer appears to be non-dangerous. Over half of men over age 50 have prostate cancer, as do more than 80 percent of men over 70. Yet just 3 percent of men die from the disease.  

But isn’t it still worthwhile to undergo screening and receive treatment if the screen and biopsy are positive? The problem is that treatment is risky. About half of men who undergo prostate-removal surgery experience sexual dysfunction; a third have urination problems; and between one and two in a thousand die soon after surgery. Men who undergo radiation treatment also risk impotency and urinary problems, and 15 percent suffer radiation damage to the rectum.

For men with dangerous prostate cancer, the benefits of treatment likely outweigh the risks and side effects. And men experiencing possible symptoms of prostate cancer — urination problems, for instance — should see a doctor. But for healthy men with no symptoms, the task force believes the anxiety and risk of unnecessary treatment outweigh the benefits of P.S.A. screening.  

What’s this to do with Obamacare? One of the law’s more important provisions is the strengthening of a federal body known as the Independent Payment Advisory Board. IPAB is to “recommend policies to Congress to help Medicare provide better care at lower costs,” with the hope that private insurers will also follow the recommendations. Eliminating coverage of P.S.A. screening would be a prime candidate for IPAB. But history and politics suggest IPAB will have bad results.

In 2009, the same federal task force announced that it did not recommend breast cancer mammography screening for seemingly healthy women under age 50. It reasoned the benefits to women as a group seem not to outweigh the harms of false alarms and unnecessary treatment.  

How did politicians react to that announcement? Congress considered terminating the task force and the Obama administration mandated that government programs continue to provide screening for women in their 40s. Beginning next year, Obamacare will require insurers to cover screening for women in their 40s, with no deductible. That means government is increasing health care costs with no overall benefit to Americans’ health.

Expect a similar response to the P.S.A. recommendation, except that government policy will increase costs and harm Americans’ health. In fact, legislation already mandates that Medicare ignore the task force and continue covering P.S.A. screening.

In a perfect world, under limited government, people would bear both the costs and benefits of screening and decide whether to have one. In a less perfect world, with a more interventionist government, such decisions are socialized. Government sets policies that generally benefit society rather than increasing individuals’ freedom to pursue their own benefit.  

But it’s a far less perfect world where government receives an expert recommendation on how to benefit society, but then adopts a policy opposite of that recommendation. That’s what’s happened with mammography screening for women under 50. That’s what’s happening with P.S.A. screening.

And that’s very bad news for Obamacare.

• Thomas A. Firey is senior fellow for the Maryland Public Policy Institute and a native of Washington County.

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