The stupidest argument against health care reform ever

This is so stupid it deserves to be enshrined in the Stupid Hall of Fame in its own stupid little glass case with a stupid brass plaque explaining its significance in the annals of stupidity:

The big screen   [Mark Steyn]

One of President Obama’s arguments for “reforming” health care is that “preventive” care - more tests, more screening - will help control costs. Really? A propos cancer, Professor H Gilbert Welch of Dartmouth Medical School notes:

For starters, the majority of folks who are screened receive no benefit. That’s because, despite scary statistics, most people will not get cancer. Let’s look at breast cancer as an example.

According to government statistics, the absolute risk of a 60-year-old woman dying from breast cancer in the next 10 years is 9 in 1,000. If regular mammograms reduce this risk by one-third-a widely cited but by no means universally accepted claim-her odds fall to 6 in 1,000. Therefore, for every 1,000 women screened, three of them avoid death from breast cancer, six die regardless, and the rest? They can’t possibly benefit because they weren’t going to die from the disease in the first place.

Think that is stupid? It gets stupider:

Apply that across the system: How can testing 997 out of a thousand people for no good reason save money? As David Harsanyi writes:

A government policy that prods people into incessantly visiting medical offices for checkups, screenings, and tests will only raise costs even further. According to studies, preventive medicine thwarts little, though it does mean early diagnoses for relatively harmless ailments—and treatments for them.

One of the points I make in the current NR is that, if health care “systems” are so critical to your health, why is there an entirely negligible difference in outcomes?

Life expectancy in the European Union 78.7 years; life expectancy in the United States 78.06 years; life expectancy in Albania 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia & Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral – margin-of-error territory. Maybe we could get another six months by adopting EU-style socialized health care. Or we could get another six weeks by reducing the Lower 48 to rubble in an orgy of bloodletting, which seems to have done wonders for Bosnian longevity… Even within the United States, even within the Medicare system, there are regions that offer twice as much “health care” per patient – twice as many check-ups, pills, tests, operations – for no discernible variation in outcome.

Indeed, the fate of the late Michael Jackson may yet prove an instructive lesson in the perils of too much medical attention. But that’s his choice - under our present system. You want to get tested for something you’re statistically unlikely to get? That’s up to you. But it’s harder to discern the state’s interest. A system of universal “preventive” care will create a hugely expensive, inflexible regime geared not to the illnesses you actually get but to the bureaucratic processing of waiting rooms clogged with perfectly healthy people getting annual tests for diseases they’ll never get - and none of it will impact on our health, only on our tax returns.

Oh my fucking god, is he seriously implying we should just chuck medical screening since “the majority of folks who are screened receive no benefit”? Math isn’t my forte, but assuming a US population of approximately 300M—about half of whom are women—and that 3 out of every 1,000 would “avoid death by breast cancer” according to the very study Steyn cites above, wouldn’t 450,000 women live instead of dying over 10 years thanks to early breast cancer detection? Seems like a pretty tangible benefit to me. And that’s just breast cancer outcomes.

Attempting to further dismiss the benefits of preventive screening, Steyn cites some dude from Reason who claims that “According to studies, preventive medicine thwarts little, though it does mean early diagnoses for relatively harmless ailments—and treatments for them.”

That flies in the face of both common sense and the opinion of virtually every medical professional on earth, so I checked out the article Steyn quoted. It turns out that author’s point is that preventive care doesn’t affect outcomes for lifestyle-related illnesses. It’s a dubious claim and one that is poorly supported by the non-medical professional who made it. But it has fuck-all to do with breast cancer screenings anyway.

As for correlations between life expectancy and access to health care, even if you buy the statistics Steyn cites (and I don’t—he writes for NRO, after all), the point is, we’re paying more than twice as much for medical care as any other industrialized country with universal coverage and have more than 40M uninsured.

People without coverage do eventually get treatment—at the emergency room, after untreated bronchitis turns into pneumonia or undetected hypertension triggers a stroke, for example. And naturally, the more severe conditions are more expensive to treat. Shouldn’t a capitalist like Steyn be concerned with the lack of bang for our health care buck, even if he’s unconcerned with the hundreds of thousands of lives that could potentially be saved?

Remember, Steyn is one of the “conservative intellectuals” leading the charge against health care reform. And this sad mess of lies and distortions is all he’s got. No wonder he threw Michael Jackson into the mix at the end, as if health care reform entailed assigning a Doctor Feelgood to every US citizen. Wanker.

[Cross-posted at Betty Cracker]

Posted by Betty Cracker on 07/08/09 at 09:29 AM • Permalink

Categories: PoliticsBedwettersHealth CareNutters

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Shorter Steyn: “If they are going to die, they had best do it and decrease the surplus population.”

Life doesn’t matter. The only thing that is truly sacred to these assholes is the free market. Free, that is, in the sense that it’s rigged to keep the Big Boys on top and the workers frightened to death of losing their health insurance.

I just paid several hundred dollars (I have insurance, but it’s an 80/20 PPO plan) for a biopsy on a lump in my breast. It was benign—but if it hadn’t been, at least I would have been diagnosed at a stage when there was a fighting chance. Choke on a bowl of cocks, Steyn, you fuck.

Sorry, Betty, but Steyn and Welch are right.

The cost-effective approach is only to test (and thereafter treat) those who actually have the diseases in question.

Nah, he’s talking bollocks even in his own terms (indeed, I wonder if he’d be so cavalier in his disregard if the subject was testicular cancer, where early diagnosis has transformed treatments and survival rates).

As you mention, caught early, many cancers, for instance, need less invasive and hence less expensive treatments. That’s not counting the costs in terms of lost production from the sick person and those in their family who have to contribute toward caring for them, and given the demographic affected by breast cancer, take over child care if necessary.

There are issues about cost-benefit analyses and “rationing” of health care in socialized medicine, but breast cancer screening and care is one of the success stories in recent decades.

Wanker.

Quite.

Pap smears, prostate exams, pre-natal care and ultrasounds, mammograms - all part of the gay/liberal/Muslin/Socialist agenda to keep a brother down.  Let’s look at some facts, as they regard taking some form of preemptive action or position:

1 - Most babies are born perfectly healthy.
2 - Most houses never burn down.
3 - Most people aren’t involved in car accidents.
4 - Most people on boats don’t drown.
5 - The USA is rarely attacked by any foreign military force.

So, why do we bother taking any preventative measures at all?

Of course, Steyn fails to realize the most obvious reasoning behind preventative screening, his “statistics” be damned: Even if only 6/1,000 women develop breast cancer, most women have no idea if they’ll be one of those 6 or not.  Fucking moron…

More typical anti-science bullshit from the radical right.  They’re pretty much opposed to anything that the left embraces this day, so this comes as no surprise.  I’d encourage the Dems in congress to introduce a resolution declaring that 2+2=4, just to see which GOP idiots actually oppose it.

I guess it’s not all that surprising that they refuse to apply their (massively flawed) model to insurance companies, who continue to charge rates commensurate with 100% screening of all patients.

This argument also works in favor of getting rid of fire departments, FEMA, etc. GET GOVERNMENT OUT OF OUR LIVES!

Hmmm.  I wonder if Steyn advocates that approach for his mother, wife, sisters, daughter.

May he be fucked sideways with an actuarial table.

May he be fucked sideways with an actuarial table.

Gimme, did you lift that from the uncensored version of Carson’s “Karnak the Magnificent?” ;)

Gimme, did you lift that from the uncensored version of Carson’s “Karnak the Magnificent?” ;)

Heh. Not quite, but it would be a good answer to the question, “What do you wish for when a Republican hack talks out his ass?”.

According to government statistics, the absolute risk of a 60-year-old woman dying from breast cancer in the next 10 years is 9 in 1,000.

Because only women 60 years or older get breast cancer. Really. It’s true. Look it up.* And ... and ... and even if younger women do occasionally sometimes maybe get breast cancer, it would be better to wait until the cancer is advanced enough for anyone to detect from across the room because treating that would be much cheaper than a screening exam every two years.

*Not here, ‘tho. These are the CDC’s rates and you can’t trust the gubbermint!

Here’s an argument that’s right up Steyn’s racist alley:

White women who die young of undiagnosed cancer can’t outbreed the scary scary Muslims! BOO!

“Conservative intellectual”?
That is an oxymoron,please always put quotations around these two words when grouped together…..

Conservative “intellectual” thought consists of this:

given that we want corporations to make more money, what possible path can we take (valid or not) to justify such action?

It took me about 15 seconds to find a website about screening for colorectal cancer that would completely rebut Mark Steyn’s “argument”. 

http://www.ahrq.gov/clinic/colorsum.htm

“Colorectal cancer mortality can be reduced 15 to 33 percent by FOBT and diagnostic evaluation and treatment for positive tests. Annual FOBT screening leads to a greater reduction in colorectal cancer mortality than biennial screening.”

(Dipshit)

See Dean Baker for real data on the economics of screening.  Screening is very expensive because of the patent system and because physicians often get a cut (they claim they have to protect themselves from lawsuits, but this is mostly false).

Note also that the US is not really “on top” of infant mortality and some other things because so many people lack health care; part of the country is more like the third world than other developed countries

He’s talking percentages, which make his argument seem persuasive. While translating to actual numbers - which he doesn’t dare do - the human side of the equation eviscerates his case.

Let us also not overlook the fact that Mr. Steyn is writing this all from the perspective of a man who will never have to worry about paying for his own cancer treatments should he, god forbid, get cancer himself since he’s, you know, Canadian.  He’s likely never had to worry about how any medical treatment will be paid for, and never lived a moment of his life without insurance praying that nothing bad will happen to him.

When he gets sick, is the Canadian government going to search through his past and decided that since he misspelled the name of his street once that his insurance is suddenly null & void right at the precise moment he needs medical treatment?

Doubtful.

There is actually some scientific support for the idea that breast cancer specifically really doesn’t change too much from screening.  And in fact that it can detect cancers that disappear on their own.

The first stimulus bill included funding for comparative effectiveness testing.  That’s where all the real cost cutting will come from. 

Because currently some doctors do too many tests with no real benefit in outcome.  Which is a result of the fact that the system is capitalist.

Don’t ever accept a conservative’s statistics at face value. As simple search at WHOSIS demonstrates, the life expectancy of a person born in the U.S. in 2006 is 78 years, in Bosnia it is 75, in Libya it is 72, and in Albania it is 71 years. Those figures are outside “margin-of-error territory,” and pretty much destroy the foundation of Steyn’s argument.

Comment by The Venerable Ed on 07/10/09 at 06:00 AM

Sorry Betty, but this isn’t stupid at all—it’s 100% correct.  Iona Heath is a physician who declines her own doctor’s recommendation that she have screening mammograms. She writes in BMJ that “for every 2000 women invited to screening for 10 years one death from breast cancer will be avoided but that 10 healthy women will be “overdiagnosed” with cancer. This overdiagnosis is estimated to result in six extra tumorectomies and four extra mastectomies and in 200 women risking significant psychological harm relating to the anxiety triggered by the further investigation of mammographic abnormalities. The percentage of women surviving 10 years if they are not screened is 90.2%; it is 90.25% if they are screened. Is this enough of a difference to risk the possibility of significant harm? For me, it is not.” If more women were given this information—which is entirely accurate, by the way—fewer might choose to be screened.

Even if the outcomes are basically the same (they’re not), all those other places spend significantly less on achieving that outcome. The conservative is arguing that paying more for the same thing is better?

There is actually a nugget of truth in Steyn’s generally poor argument and there should be some caution in reflexively supporting preventive medicine. From the NEJM:

Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.3 For example, screening costs will exceed the savings from avoided treatment in cases in which only a very small fraction of the population would have become ill in the absence of preventive measures. Preventive measures that do not save money may or may not represent cost-effective care (i.e., good value for the resources expended). Whether any preventive measure saves money or is a reasonable investment despite adding to costs depends entirely on the particular intervention and the specific population in question. For example, drugs used to treat high cholesterol yield much greater value for the money if the targeted population is at high risk for coronary heart disease, and the efficiency of cancer screening can depend heavily on both the frequency of the screening and the level of cancer risk in the screened population.4

The focus on prevention as a key source of cost savings in health care also sidesteps the question of whether such measures are generally more promising and efficient than the treatment of existing conditions. Researchers have found that although high-technology treatments for existing conditions can be expensive, such measures may, in certain circumstances, also represent an efficient use of resources.5 It is important to analyze the costs and benefits of specific interventions.

Basically every preventive measure needs to be evaluated for cost effectiveness. Because healthcare is so deeply personal, it can be a hard thing to do. Anecdotal evidence can cloud the issues…

this is conservative “thinking” in a nutshell.  its what gives us disasters like katrina.  lets see, spend a bunch of $$$ to fix levees and do the necessary precautions NOW or do nothing until its too late and spend those $$$ x 1,000 + add in death, suffering, and ruination.

can also be applied to pollution regs and averting global climate change and a 1,000 other things.

You want to know what’s REALLY stupid? Defining “prevention” as “testing”. Disease is not prevented just by testing but by good nutrition and healthy lifestyles. That’s how other countries beat the US on life expectancy and infant mortality. They have not so completely contaminated their environment and food supply, they don’t promote and facilitate exclusively processed, Franken-food diets, and even the poorest people still have access to real, fresh food locally instead of live on fast food because the nearest grocery is 20 miles away. Granted American medical facilities and med-school trained providers by and large cannot undo what we have done to our food, our cities, our schools, and our culture. They cannot undo the corporatist expectation that even people with highly paid jobs work so long and hard for their living that they have NO genuine leisure in the day or the week to spend on health restoration/maintenance in the form of adequate rest, relaxation, and useful exercise.

This controversy about the relative value of testing completely ignores the real and much larger environmental causes of epidemic-level incidence of diabetes, cancer, and neurologically-based illnesses in our children and elderly in this country. Even adopting universal single-payer healthcare tomorrow won’t dramatically alter the path we are on until these cultural and systemic causes are addressed.

For extra stupid points, even if you accept Mark Steyn’s premise (the lives of women do not count - only $$$ is worth measuring), he’s still wrong.  Early detection of breast cancer saves more health care dollars than annual mammograms.  Details in this Sadly, No! comment:
http://www.sadlyno.com/archives/23094.html/comment-page -7#comment-947049

caveat: dialogue at Sadly, No! tends to be immature, profane, offensive and totally hilarious.

Comment by Dragon-King Wangchuck on 07/10/09 at 10:11 AM

Did Steyn just say that since only about 20 women per 1000 have an abortion it isn’t a big enough deal to get all worked up about?

Sorry…but as an American liberal/leftist, and someone who is 100% in favor of radical health care reform (including single payer health insurance), you shouldn’t diss on H. Gilbert Welch.

Welch’s point is simple:  absolute risk matters, not just relative risk.

And anyone who thinks screening is an unalloyed good doesn’t know anything about public health.  Screening can lead to unnecessary procedures, some of them harmful.  Not to mention the psychological harm a false positive can generate.

Dragon-King Wangchuck wrote,

Early detection of breast cancer saves more health care dollars than annual mammograms.  Details in this Sadly, No! comment:

Unfortunately, the referenced comment is very unpersuasive.  For example, in his/her calculation, the commenter assumed “Early detection would reduce these costs significantly – but let’s say that it’s only by a factor of two.”  There’s no evidence produced for this figure.

In fact, H. Gilbert Welch wrote an excellent book showing that survival statistics bandied about in connection to cancer detection are worthless garbage.  Why?  Because it’s always possible that the cancer was detected earlier, and the time from detection to death is greater, but the age of death is the same.

I suggest anyone who is interested in health care buy that book, or read Welch’s argument on the web.

Comment by liberal on 07/10/09 at 10:54 AM

fish wrote,

Basically every preventive measure needs to be evaluated for cost effectiveness. Because healthcare is so deeply personal, it can be a hard thing to do.

Huh?  Proposing that health care measures be evaluated on a rational, scientific basis, instead of just screaming how we need to detect and prevent every possible incident of disease, even if we possibly can’t do so?

How dare you!!

Also, why use the death statistics? Plenty of cancers that aren’t ultimately fatal, but could have been cured far more easily, at vastly less expense, had they been caught earlier.

The kernel of a valid point in there is that you don’t actually want to indiscriminately screen for many low-frequency illnesses, because even for very high-accuracy tests, false positives will swamp genuine hits, and you’ll end up wasting a lot of scarce resources. That’s not really an argument against preventative care, it just means “more screening” isn’t *always* a good idea.

part of the country is more like the third world than other developed countries

And you’d be surprised just where that part is. It’s all around you. We had a petition in support of a strong public option at our Dem booth at the local town fest here in middle class suburban Chicago a few weeks back. We got 800 signatures on it in less than 3 days. A lot of people, well dressed, middleaged Rs, Ds and Independents alike, admitted they have no insurance, they just can’t afford it.

Debating the efficacy of individual screening recommendations is perfectly valid, but that’s not what Steyn is doing. He’s trying to make the larger point that preventive health care in general is worthless and that testing isn’t worthwhile unless an unspecified majority of people benefit. It’s a stupid argument.

Unfortunately, the referenced comment is very unpersuasive

False positives do occur, that’s why mammography is considered a screening test.  Follow-up tests such as bloodwork and biopsies aren’t free… UNLESS YOU’RE COMPARING IT TO THE COST FOR TREATMENTS OF ADVANCED CASES OF CANCER.

Stop obfuscating.  The cost of providing annual mammograms to women 60+ would be significantly smaller than even conservative estimates of the direct health care costs of breast cancer.  That was my point.  Early detection not only protects a woman from having to deal with having a deeply rooted advanced cancer, but it also saves the resources that would have been spent on such.

Reports out today reveal that only an extremely small number of the leads generated by Bush’s warrantless wiretapping program produced any actual evidence of terrorism.

Wonder what Steyn thinks about the utility of that program?

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