Who should get a mammogram? At what age? How frequently? What about Pap smears and prostate cancer tests and colonoscopies? Aren’t these questions experts can decide? Unfortunately, no. Any reader of daily newspapers knows that we are forever getting conflicting advice from well-meaning people. Part of the problem is that people differ in their attitude toward risk and in their willingness to spend money to reduce risk. A danger in a one-size-fits-all approach fashioned in Washington, DC, is that the experts may not share your values. Their attitude toward risk reduction may be different from yours.
The Danger of Cookbook Medicine
Another danger is that, harried by far more requests for services than they can possibly deliver, doctors will take a routine approach to all their patients and ignore what makes you unique as an individual. What if you feel you are at a heightened risk for breast cancer because your mother or grandmother had breast cancer—but you fall outside the guidelines for early breast cancer screening before age forty? Women at higher risk of breast cancer might want to begin them at age twenty-five, as recommended by Susan G. Komen for the Cure. But will you be allowed to do so? If necessary, will you be allowed to pay for the test yourself? The answers to these questions are not clear.
The Dangers of the Politics of Medicine
Both Congress and the Obama administration have already shown that they are unwilling to let experts set the guidelines for preventive care. For example, the Affordable Care Act stipulates that seniors are entitled to an annual physical and that males are entitled to an annual prostate cancer test—even though neither is recommended by the Preventive Services Task Force. Also, HHS Secretary Kathleen Sebelius has chosen to include annual mammograms for women in their 40s, even though the task force recommended against it.
Expect more politics to come. Women’s groups have already successfully pushed for free contraceptives under the guise of prevention. Also, while more free services may sound good, remember that the doctor’s time is limited, as are the number of healthcare dollars. Granting more marginal care to one person may mean less really serious care for another.
Letting Individuals Make Their Own Choices
There is a better way. Instead of giving all of your healthcare dollars to an impersonal, bureaucratic insurance company, you should be allowed to put some of those dollars in a Health Savings Account that you own and control. That way, you could consult the advice of the Preventive Services Task Force on your own. You could also consider the advice of other experts, including your doctor, and take into consideration personal data about you and your family.
Preventive care is not like an investment good that pays a positive rate of return. Instead, it’s like a consumption good. Preventive care leads to better health. But the enjoyment of that result must be compared with the benefit of other goods and services we could have purchased with the same money.
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