As part of his recent physical check-up, Obama chose as the screening test for colon cancer a “virtual” colonoscopy, which is essentially a CT scan of the colon, rather than an actual colonoscopy, the standard, recommended test which consists of a direct visualization of the lining of the colon by a doctor using a flexible tube with fiber optics.
Why? Presumably because it’s easier on the patient. The problem: The test is not recommended by the US Preventive Task Force, whose recommendations drive coverage in government programs and greatly influence coverage in private plans. Obama’s test is not covered by Medicare. Furthermore, most plans won’t cover such colon cancer screening tests for normal-risk individuals under age 50; Obama is 48 years old, and there’s no information I have seen to suggest he has a family history of colon cancer that places him at above-average risk.
This episode reinforces what we all know – that government elites know that whatever health care rules come to exist under socialized medicine won’t apply to them. Note the recent story of a Canadian provincial premier who chose to have necessary cardiac surgery in the United States, with his own money, rather than rely on the quality and efficiency of his own country’s system of medical care; Mark Steyn commented (link) on the Premier's statement that "it's my health, it's my choice": "the Canadian state does not accept that proposition, which is why, if a Canadian such as Mr Williams wishes to exercise his choice he is obliged to leave the country."
David Whelan wrote at Forbes Magazine online (link):
President Obama talks a lot about how Americans should hold the line on health costs by following evidence-based medicine and not rushing to embrace every new high-tech medical device. But when it comes to his own body, it turns out that he won't drink his own medicine…. Last year Medicare made the controversial decision to skip paying for these [“virtual colonoscopy” CT] scans, saying the evidence was too thin…. The decision showed how comparative effectiveness research, which the President funded in last year's stimulus bill and continues to champion, might lead to tough decisions to block certain kinds of expensive tests and treatments.Dr. Mark E. Klein commented in the Wall Street Journal (link):
In 2008, the United States Preventive Services Task Force, an independent panel of experts appointed by the Department of Health and Human Services, issued a report that found that there was not enough evidence to determine whether Medicare should cover virtual colonoscopies. Medicare based its decision not to cover the virtual exam on the task force's findings.
I applaud the president. He and his physicians correctly recognized virtual colonoscopy as an excellent alternative to screen for colon cancer. Why undergo a traditional colonoscopy—a procedure that carries a risk of serious complication and requires sedation—when a safer screening method is available?
Of course, the problem is that Americans over the age of 65 do not currently enjoy the same option. They cannot have a virtual colonoscopy unless they are willing to pay out of their own pockets for it. You can imagine their surprise to learn that the president had personally chosen a procedure that his own administration had decided did not warrant Medicare coverage.
This is one reason why Americans fear a government-backed health plan. They have been told that such a plan would not affect the availability of high-tech diagnostic tests and treatment, but their eyes tell them otherwise.
John M Greco
