Are Seniors Getting Too Many Tests?
Every year like clockwork, Anna Peterson has a mammogram. Peterson, who will turn 80 next year, undergoes screening colonoscopies at three- or five-year intervals as recommended by her doctor, although she has never had cancerous polyps that would warrant such frequent testing. Her 83-year-old husband faithfully gets regular PSA tests to check for prostate cancer. … But increasingly, questions are being raised about the over-testing of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit — and considerable risk — from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.
Sandra G. Boodman in the Washington Post.
If we (1) let seniors control more of their health care dollars and (2) allowed them to decide how many tests they wanted, my guess is that there would be fewer tests.
I read an article a few years ago about Boca Raton, Florida where there is a large population of affluent retirees. Many of them use doctor visits as a social activity, where meeting and talking to people at the doctor is a way to get out and about. A common topic of discussion when meeting friends was which specialists they used and how they liked them.
The less time I spend being tested, the better I feel. But, at the end of the day, it’s all about risk and reward.
Probably… And taking too many pills.
As Brian says, the proper question is whether these people would be getting these tests if they were paying for them. In the private sector, people spending their own money gain from changing screening procedures as they age in cousultation with physician.
The conventional wisdom is that we’re spending too much on health care in America. But I don’t recall people being too worried about how much we spend on transportation, entertainment or food away from home. When we socialize an area of consumption it becomes a priority for policy wonks to minimize consumption all the while consumers’ inclination is to maximize utilization.
The real question is would they be getting these tests if they were properly informed of the risks and benefits of testing at their age. I’d prefer that the utility of the test rather than finances be the main determinant of a patient’s decision.
If and when Medicare goes onto an actual budget — where a fiscally responsbile government spends no more than the taxpayers actually give them —
then Medicare will probably stop paying for tests of any kind over the age of 80.
That is a good long life span by any historical standards.
In a number of European countries, dialysis and chemotherapy are essentially not available to the very old.
Medicare in the US should continue to pay hospitals, to do hip and knee replacements and to ease the terrible pains of death.
But over age 80, people are going to die of something, and it is a luxury to detect and try to prevent every single death.
Unfortunately, there are not going to be enough working people, making high enough salaries, to pay for lifetime testing on what will soon be 65 to 70 million persons on Medicare.
For fiscal reasons, not moral ones, we will have to shed the widely held belief that the purpose of medicine is to prevent death. Don’t let anyone know I said this, but for fiscal reasons we need more deaths.
I think it was Bertrand Russell who said that some people would rather commit suicide than do arithmetic. Right now, we have politicians who equally fail to understand basic demographics.