Reply To: Health Care Overhaul

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Ben Levi,

Health care for the elderly in the US is almost entirely paid for by a government health insurer and has been for 44 years. This will not change under any plan under consideration. Thus your concern about end of life care is not necessary. And yes, it would be cheaper to replace private health insurance with a government plan, even for congressmen — Medicare is the most efficient health insurer in America and Medicaid is second — but that isn’t going to happen.


Health care is and has been “rationed” ever since the first health insurance plans were created about 70 years ago. The question is, how should it be rationed. Right now, if you don’t have insurance, you have been rationed to almost no care except immediate life threatening emergencies. Private health plans and Medicare deny coverage all the time. (My wife, a family physician, tells me that NY Medicaid has never denied coverage for any treatment she has recommended, so maybe that should be the model for coverage? But NY Medicaid is very costly.) The issue of mammography is about using the best scientific evidence for medical decision making, and unfortunately there has never been any evidence to support mammography screening in the general population for women under the age of 50. The US Preventive Services Task Force should never have recommended it when they did, and they were absolutely correct in changing it to something more sensible. (The best studies don’t even show that mammography screening saves life in women *over* 50; I can post the evidence if there is interest.) The situation for prostate cancer in men is about as disappointing. The situation is very depressing but we can’t allow politics to interfere here as some pro-screening advocates want to do.