Strengthening Constitutional Self-Government

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Health Care

Wither the State?

Charles Krauthammer asks what's the big deal about the possibility that the new national health pannel will recommend not paying for mammograms for women under fifty. They might be right on the science, he notes:

And the problem here is a mammogram is extremely inaccurate. One in ten tests which are returned as cancer are not, so you have a 10 percent false positive, which causes not just anxiety and suffering, but new tests, more [diagnostic] radiation, even a [surgical] procedure, and perhaps other harms.

I won't debate science with Dr. Krauthammer.  More interesting to me is his belief that the creation of such a pannel is no big deal:

People are reacting as if we never had a panel or a recommendation before. Years before, we had a recommendation from a panel like this who said start at age 40. Every day the FDA is deciding this new drug is a good one or not -- and if it's not, you don't ever see it.

 So it is not as if these kinds of independent commissions don't exist and determine what we get and what we don't. So the issue here is not panels in general or recommendations in general, it's the recommendation in and of itself.

Perhaps.  I suspect, however, that Krauthammer is only half correct.  On one hand, such independent agencies have become relatively common in the U.S., at all levels of government.  Even so, Americans still find them frustrating and often chafe against them. (I would even suggest that part of the frustration we saw in the elections of 2006 and 2008 was due to frustration at such extra-democratic agencies).  I would also suggest that was still don't have a constitutional theory, other than the vague idea that the constitution "evolves" which justifies such agencies.  Americans still don't like the delegation of legislative power, even if it has, in fact, become part of our government.

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