Although the Senate is poised to hold a key vote to begin debate on its health overhaul bill tomorrow night, bloggers are focused instead on debating the new recommendations from the U.S. Preventative Services Task Force for mammograms and breast self exams. Commentators are hinting that the new recs could lead to rationing, while others think the public has been poorly informed all along.
Economist Austin Frakt thinks the new recommendations could cause some unintended complications for health practitioners: “My experience suggests that two-year intervals are tricky, and I speculate that behavioral factors could lead to actual intervals that are much longer. … Is it possible that annual screenings are preferable just for behavioral reasons? I think it is at least plausible that the answers are “yes” to both of these. This would seem to be a good topic for behavioral economists. (I know a few…stay tuned.)”
Health journalism booster and critic Gary Schwitzer says people should have been more familiar with the USPSTF, adding ”I think journalists have failed badly in explaining this work. … Since they’re an independent group of experts from across the country, they have no PR machine like the American Cancer Society does. So it’s easy for the ACS to rule the airwaves and the columns when they disagree with something the USPSTF states.”
The Washington Post’s Ezra Klein writes, “Suffice to say, you could hardly imagine a better example of why cost control is so hard: This was a recommendation from an institution with no actual power that was based entirely on accepted medical evidence. Cost was not a component in the analysis. This is simply the data on whether mammograms make sense for most women between 40 and 50, not whether they’re “worth” doing as opposed to other expenditures.”
Hot Air’s Allah Pundit isn’t convinced by arguments that the USPSTF is small and its recommendations are optional and not connected at all to cost: ”Beyond that, though, even if the panel’s role is small now, why would anyone trust the feds not to expand it over time as rationing became more urgent to limit costs? Everyone understands that the [health overhaul] program will end up costing vastly more than the early projections indicate; there’s no reason to think that inertia towards growth wouldn’t also apply to agency responsibilities.”
Critical Condition’s Hans Kuttner looks at what the Secretary of Health and Human Services would do with recommendations like this under the House health bill:
The HHS secretary can decide to cover something that is not recommended (e.g., routine mammography for women ages 40 to 49), but she could not decide to take away coverage of something the task force recommended. (Senator Reid’s plan is similar.)
The much more important point is that the HHS secretary would have plenary power to decide what helath insurance must cover. Not just preventive services, but all services. That is the essence of political health insurance and what distinguishes the system of private health insurance we have now from a system of political health insurance.
Heritage’s Edmund Haislmaier agrees, saying that giving more force to these types of recommendations could reshape the system so that the “eventual result will be that the only medical care paid for through private health insurance will be the specific, items and services required by federal regulations promulgated by HHS. At that point, Congress will have effectively nationalized the entire American health insurance system under the supervision of the Secretary of HHS — regardless of whether or not it also sets up yet another government health insurance program in the process.”
Time’s Karen Tumulty reacts to the panels’ recommendation that women not do their own breast self exams, acknowledging her own history with breast cancer scares:
So it would seem I’m the perfect example of a person who shouldn’t have had mammograms, or even examined my own breasts. But am I sorry I’ve had the information I’ve had through mammograms and self-exams? Not for a second.
That’s why I think these scientists are pinheads. Pink ribbons are lovely, but women who want information should have it. And I would remind Swampland readers of the important lesson we all learned from Carly Fiorina. Information is power, ladies, and don’t let some scientific panel tell you it isn’t.
And with new recommendations calling for fewer pap smears out today from the The American College of Obstetricians and Gynecologists, the furor is likely to continue. NPR’s Scott Hensley asks about the timing of the two reports as the Senate readies to take up its health bill:
“It’s just pure coincidence that these guidelines have been released now,” Dr. David Soper, the Chairman of ACOG’s Gynecology Practice Bulletin Committee, told NPR.
They new guideline has been in the works for years and reflects evolving scientific evidence that shows, for instance, the risks of cervical cancer developing in young women is quite low. Indeed, the vast majority of abnormalities found on Pap tests in very young women clear up on their own.