Same difference. At least, where long term survivorship is concerned. The particular study I worked on dealt with locally-advanced (non-resectable but non-metastatic) pancreatic cancer. In about 25-30 percent of the cases, the cancer was successfully downstaged and removed. In the majority of those cases, the cancer didn't recur (ie. never returned, hence, didn't metastasize).
Removal before it metastasizes does not mean it wouldn't metastasize, intervention doesn't factor into the behavior of a disease left untreated. The context for the statement was rebuttal to a theory that cancer screenings catch cancers that will never metastasize, thus inflating the US survival rates.
Fuckin' A right it is. Arguing over the specifics of pancreatic cancer treatment outcomes is a really good example of why rationing of care is part of all health care systems. Most combat vets understand this because they know what triage is, although triage is certainly not what it used to be on account of the amazing skills of modern trauma surgeons and nurses.
I see this and think it makes sense that they didn't have a tenth of the surgeons they needed in the past. Top down command and control is never efficient, it's the expected outcome. We're still like that too. You might be thinking, no way our military has the best care in the world, it's technically true. If we had a thousand casualties in a week in Iraq, we'd have been in the exact same situation we were in during the dark ages of medicine back in the civil war. We'd have been chopping legs off, running out of anesthetic, antibiotics, all kinds of horror.
Even in the world outside battlefields, there are limited numbers people with the requisite medical skills, limited equipment, and limited supplies. Private insurance orgs do the same basic things that the British PHS gets slammed for doing in the US press--namely, putting dollar values on abstract peoples' lives and rank-ordering health care needs to help determine who gets what service or meds, and when. Somehow here in the US, it is 'good business' to fully subsidize boner meds but often a real problem to get birth control covered. Is that the free market in action, or is that a reflection of the disproportionate political power of religious conservatives? Looks like the latter to me.
This is why us crazy free marketers get irritated at capitalism being blamed for it. None of that is a product of a free market. The health insurance agencies are heavily regulated. The reason you have poor catastrophic coverage, when you actually need insurance, is because your federal government exempted health insurance companies from the Constitution, allowing states to restrict interstate trade from them. They then stuffed regulation on top of regulation into the insurance market, telling them what they can and can't sell in the respective state. This is why you pay for insurance that covers boner meds in the first place. You could be skipping the idiocy entirely, paying for catastrophic coverage that would actually protect you from the economic problems due to a life altering illness. Instead, selling such insurance is illegal in most states.
Why do we have high administration costs? You pay your insurance company a hundred bucks for a routine checkup and it pays your doctor eighty for the visit. Why do political powers get to decide what kinds of things we have coverage for? Because politicians are mandating that coverage to everyone and forcing people to fund someone elses abortions, boob jobs, whatever. If uncle weren't stepping on your rights, you could get catastrophic coverage anywhere and stop paying the insurance company to pay your bill for you. You could get added coverage for things you think would be worth paying for over time in advance, and only those things.