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Health care: Be careful what you ask for as you might just get it

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POSTED November 19, 2009 2:04 a.m.
Back in the mid-1960s a government study determined the artificial sweetener known as cyclamates can cause cancer.

It was based on injecting the equivalent of cyclamates found in 350 cans of diet soda directly into a rat’s stomach that lead to bladder cancer in eight out of 240 rats.

The Food and Drug Administration’s review of two petitions to reverse the ban on the use of cyclamates based on the 1960s study led the agency to state that a review of all available evidence does not implicate cyclamate as a carcinogen in rats or mice but it still remains off limits as an artificial sweetener. Meanwhile, 55 countries allow the use of cyclamates including Canada.

All of this begs the question – is Canada killing off its people by allowing cyclamates or is the United States shortchanging its citizens who might be able to lead a healthier life if they can keep weight off because cyclamates works for them?

The government’s handling of the cyclamates issue is something to keep in mind as we digest the government’s latest health pronouncement that mammograms for women should start when they’re 50 and not 40 years old.

You’ll note a lot of people do not agree that the government knows best when it comes to breast cancer detection and mammogram. Right now, women still have a choice unless, of course, insurance companies use the government’s advice as a reason to cut benefits and therefore costs.

The government panel’s decision is rooted in a numbers game based on the results of studies much like the cyclamates question. The only problem, though, is just what level of lives lost through the use of cyclamates or early detection of breast cancer washes out when balanced against other factors that are acceptable whether it is cost or avoidance of other health issues.

It underscores what happens when you have the fox guarding the hen house.

Government oversight is easier to accept in the case of the cyclamates debate because they don’t have a direct need to control costs. Even though a skeptic might argue it would require injecting the cyclamates equivalent to of 35,000 cans of diet soda a day into an average-size human to cause cancer if the results were straight-lined based on weight, you still accept the government’s reading because it doesn’t have a direct stake in the issue.

But what happens when controlling costs is a direct government issue as it would be with government in the driver’s seat with a public option health plan? It costs money to perform mammograms and exploratory surgeries.

All we will be doing in essence is replacing a for-profit insurance firm driven by the need to keep costs down and manage a profit at the same time for a government oversight that is driven to keep costs down but without worrying about competition in terms of quality of service or coverage.

The real bottom-line of the health care debate isn’t universal access – although that is one of the goals. Instead it’s cost containment.

The boards dubbed “death panels” by some to ignite emotion would allocate scarce health resources for expensive treatments. The boards will have to set perimeters on expensive procedures in order to control costs. Is this necessarily a bad thing? No, unless of course you are the one they are telling “no.”

In that aspect the government is no different than a private insurance company with two big differences – they don’t have to worry about competition or solvency.

Yes, private insurance is expensive and you may be limited on what you can afford to pay or are willing to pay but in order to make government-based insurance work they have to have the ability to control costs.

Add the fact the government has the final say on what is OK in terms of medical treatment and you have the ingredients for centralized decision making on your health.

Too young for a mammogram? No problem. Pay for it yourself.

Hold it, wasn’t that one of the arguments in the first place that procedures and other medical care is getting too expensive which is why people can’t afford insurance?

Maybe, just maybe, it has something to do with choices. The choices people in their 20s make not to have insurance. The choices people make to do things they know adversely impact their health. The choice of whether to take extraordinary steps to save extremely preemie babies or those extremely ill and old.

The new advice on mammograms should be a wake-up call. Having the government in control of this country’s health care system is not a cure-all.

We may get affordability and near universal access but it may be at a cost that no one anticipated paying.
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