Then I read some fellow saying the Ken Thorpe is wrong about the problems with the health care system. I don't know if this fellow is right or wrong, I haven't bothered digging lest I discover another conservative ideologue, but he's using breast cancer screening as an example! This month of all months! And it's an irresponsible argument at that! Not to mention that Ken Thorpe didn't make any arguments in his article.
Leave to Health Despairs [sic] to claim that the major reason the US spends more on health care is because we are sicker. Confusing diagnosis (which is a function of being able to see a doctor multiplied by what the doctor can do time what the doctor gets paid for) for prevalence Ken Thorpe et al. claim that at least part of the underlying difference in prevalence is poorer health status. Really? He goes on to estimate that the prevalence of diagnosed cancer was 12.2 percent in the United States but only 5.4 percent in Europe in 2004. A huge difference. Even Thorpe has to write: "Are Americans really more likely to develop malignant tumors, or are they just screened more intensely than Europeans are? Comparisons of breast cancer screening rates and five-year cancer survival rates suggest the latter"Bad idea. It's a little more complicated and this guy doesn't seem to know Thorpe, since anyone who has met the man would be surprised if he ever made a claim that was not supported by the data. I would respectfully suggest the study is an example of how one tests a hypothesis. Once you design the study, you follow the data, wherever it may take you. Authors are permitted to suggest potential explanations for the data, but never state a 'claim', lest their objectivity and intellectual integrity be challenged.
The US is heavily doctored, but access is uneven. The wealthy take care of themselves wherever they may be. The middle class takes the brunt of profit-making, getting access, but not necessarily access to the best. How can you tell if someone is good anyway? How can you tell if you're being encouraged to have an investigation or a procedure just because it is billable?
So the hypothesis that more cancers are being detected earlier is certainly possible, given the data.
But the American health care system is not driven by cost-effectiveness as socialized countries are. There is no point doing a mammogram in a young woman because the test is not sufficiently discriminative until most women get into their 40's. It also detects a lot of abnormalities that are not cancer. PSA's are just not done in low-risk individuals for fear of extra cost for no benefit and sometimes even the potential of harm.
In the US, we have a consumerist society where the patient, now a client, makes the decision themselves. It's a little like picking out a purse at Coach, "I want two preventions and a diagnostic."
So in the middle of breast cancer awareness month, Robert Goldberg is suggesting that the European system rations health care and gives the example of breast cancer and mammography rates. However, in Europe mammography coverage is higher than it is in the US. So they don't need to ration by preventing people from having so-called unnecessary procedures. The procedures have, in fact, become moot. The are sufficient misconceptions about breast cancer, that women don't need someone muddying the waters.
The kicker, I guess, is that the US rations health care more than socialized economies. We ration by money so if the cost is prohibitive the test or procedure simply doesn't get done. Could this have an effect on Dr. Thorpe's data? Why don't we hear about it in the US? Well, the middle class can be vocal, especially when they can't get the handbag -- uh, I mean procedures they want, and still can't afford a better quality of advice... the one that tells them about the tests and procedures they don't need.
The US spends more money on health care because it misplaces its resources. Period.
Ladies, get your mammograms. For this test, there are funds available so that no woman in America should go without. I suspect, when all is said and done, it will be clear that European women who get free mammograms benefit from earlier detection. Thus these countries enjoy a remarkably low cancer rate. In the US, it is not a matter of cost, it is that women don't know they can get free mammograms through their local health departments. Citizenship doesn't matter. And it could save your life.