Some of the statements coming from politicians and pundits about health reform are so stone ignorant you wonder if they ever in their lives got sick or saw a doctor. The word ‘choice’ gets flung around a lot.

Sometimes it’s claimed that we should all have medical savings accounts. We can save faster by skipping the preventive care. Then when we have a stroke we’ll pull out the phone book and consult the online doctor ratings and shop around for the best deal. That’s empowering.

Another out-of-context concept is ‘more is better’. Kiersten wrote about a classic NYT article by Dr. Atul Gawande contrasting two Texas towns. They were much alike except for the quality of medical care, which was better and cheaper, with fewer tests and healthier people in the town that reformed its system. You’ll hear Dr.Gawande’s study quoted a lot in the debate.

Last month the right wing had hysterics about a task force recommendation that routine mammograms could start at a later age. They missed the word, ‘routine’ and grabbed this as an example of mad scientists forcing us to ration health care, even though the government has not acted on the recommendation.

“Simmer down”, I wanted to say. Studies like this look at populations of tens and hundreds of thousands. We have to have evidence to justify routine screening. Otherwise why not start mammograms at age 16? Someone would make a buck off it, and there are rare cases of breast cancer in very young women. Why shouldn’t they be scared all the time too?

Mammograms are a form of x-ray, and x-ray exposure raises the risk of cancer. X-rays are totally justified if there is a benefit, but old people like me notice that they are used less routinely and with shorter exposures than when we were young.

And any woman who’s been through a scare when an abnormal mammogram requires more tests and waiting knows that it’s not a no-risk proposition. The emotional toll is huge. Hecate, a breast cancer survivor, gives a nuanced and beautifully honest account of her ‘routine follow-up’. She strongly favors screening mammograms and knows what she’s talking about. It’s a very individual decision.

A few years ago private companies were offering a full-body CT Scan for people who wanted to pay cash to be checked out. It was a totally boneheaded idea. Now evidence shows that the radiation in a CT scan is a cancer risk, which is unsurprising. I’ll bet there were a lot of people who went through multiple tests and anxiety when their CT scan showed some spot that turned out to be nothing. There was no evidence that scanning healthy people was beneficial, and no map for what to do with the abnormalities that were bound to show up.

Michael Jackson had all the medical care a millionaire could buy, with doctors on call day and night. He got whatever he wanted from them, but they didn’t make him well. He seems to have lived in a nightmare of pain and anxiety, until his hired doctor gave one too many doses.

Brittany Murphy, it appears, died from too many prescription drugs. Rahul K. Parikh, M.D. in Salon.com has some insight into the fragmentation and lack of information in our current system that allows a troubled person to doctor shop for drugs.

I worry about some of my patients, the ones who have trouble sorting out the chaos of our present system. They can’t always see the same doctor in the office they go to. Test results disappear. They take pills but don’t always know why or what the effects are. I work very hard to teach patients and organize their information. That’s my job.

But it shouldn’t be this hard. Privatization makes competitors of what should be a team. I like computers, but they will not do any good if there are not humans with humane intentions to use them right.

And the key word in the mammogram panic–routine. If you have a reason to get a mammogram at age forty, tell your doctor. That was also in the task force recommendation. Unfortunately there are few of us who can’t name some risk factor. I think doctors will generally err on the side of testing.

But perhaps younger women shouldn’t have a slip handed to them once a year for a routine screen. Time will tell. That’s epidemiology, the study of large groups over time.

Speaking of large groups, it looks like the H1N1 flu will be mild. It’s a relief, but let’s look at it as a test. Our public health system at best got a ‘C’ for response.

Thinking individually fails in health care. We fail to get good care if we randomly demand every test they invent. We’ll fail to stay safe if we don’t make immunization available to all. The consumer model doesn’t work. Consume chocolate, but don’t treat medical care like a product. It’s a science, an art and a relationship and life is precious.

UPDATE: Dr. Parikh really got flamed in the comments section of Salon. I think we are paying too high a price in wasted money and lives for the present system, but privacy concerns are valid. Paranoia strikes deep. Centralized medical records will be the ‘death panel’ talking point of 2010, and a reasonable discussion of how to protect privacy while ensuring that your doctor knows what she needs to know will be hard to find.