The young and healthy don’t value primary care

This is the correct attitude for all, not just the young. Until there is an actual health problem, there is not a lot the health care system can do to benefit the well.

Cancer screenings for those without particular risk factors are of minimal value. Query once for history for risk factors when the patient is 30ish and one can then pass on screenings for the next couple decades. For heart disease, again genes and family history count for much. No risk factors and a normal lipid profile in your 30s and send them away with the reminder to eat right (food, not packaged stuff, not too much, mostly plants), and exercise regularly. If they aren’t fat then screening for diabetes, hypertension and other such chronic conditions is of limited value also.

Medicine still cannot vanquish your genes. Not knowning what will kill you is no worse off in most instances than knowing what is going to kill you (and knowning that there’s little to do about it anyway).

Preventative health care does not stand up to outcomes based evidences.

The patient in the article hadn’t seen a doc in 4 years. I havn’t seen as doc myself since I last turned my had and coughed at age 17 (not an exam quickly forgotten by an adolescent male). That’s now been 25 years and counting. My 92 year old grandmother keeps the same attitude regarding preventative health care. Someday when she feels the need she might go see a physician; but even then what could possibly be offered?

As far as I know, mammography, psa, and pap smears are all well established in efficacy at decreasing mortality (has this changed recently???)
1. There is no evidence that PSA decreases mortality from prostate cancer. If you have it, would you care to show it to us?
2. The mortality reduction shown in studies for mammography (not sure about pap smears) is desease-specific mortality. Nobody has ever shown all-cause mortality reduction for screening. Yes, I understand it is difficult to show it given a small fractions deaths from specific condition represent among all deaths, but it is still important to keep the fact in mind.
3. While the relative (desease-specific) mortality reduction is statistically significant, the probability of an individual benefitting is extremely small. This is true for all screening tests.
4. The mortality benefit comes at a price. For every woman whose life is saved by, for example, mammograms, several women may get diagnosed with breast cancer unnecessarily. Overdiagnosis leads to overtreatment and overtreatment may cause problems. A lot more women will have false positives and biopsies.
5. During preventive care visits doctors often order non-recommended tests. Tests lead to false positives, overdiagnosis, and cost money. False positives lead to more invasive tests, those have risks of its own.

There is a case to be made for preventive care; but there is a case against it as well. It is up to an individual to decide.

All the hoopla about universal coverage threatens to force people to pay for something that many dont’ want: comprehensive health care. Even if you pay people to see a doctor regularly, many just don’t want to.

I don’t blame them. It is fine for sick people. But the people who live to remarkable ages didn’t get that way by handing around doctor’s offices. After two negative breast biopsies (and no breast CA in the family) my wife has decided no more mamograms. She would rather forgo the reduction(not elimination) in risk of fatal breast CA than the higher risk of more negative biopsies.

My great grandmother lived to 100 and never saw a doc before the last few years of her life (midwife deliveries).

Health care is a personal option, not the public’s business, and people should be free to seek it or not, pay for it in advance or take their chances. Either way, we all die in the end, insured or not.