One of the ostensible reasons for reforming our health insurance system is the need to halt the growth of spending on medical treatment. So it may be a surprise to learn that in its first major vote on the health care overhaul, the U.S. Senate took a clear and simple position: Cost is no object.
In November, the United States Preventive Services Task Force, a federally sponsored panel of medical experts, announced that it was recommending against routine mammography among women younger than 50. The proposal, coming amid the health care debate, was taken as a gruesome attempt to sacrifice lives to save pennies.
In fact, cash was not a consideration. The task force's rationale was that the benefits of routine breast cancer screening to women in that age group are insufficient to justify the harms it causes them. Yes, it can be expected to save one life for every 1,904 women aged 40 to 49 who get mammographies, but it also yields false positives, which require additional procedures.
Even when the positives are not false, they often lead to unnecessary treatment—surgery, radiation, and chemotherapy—for tumors that pose little risk. The panel noted that mammograms often serve only to detect "a slower-growing cancer that would have eventually become clinically apparent but would never have caused death."
There are precedents for medical authorities to conclude that tests are not always worthwhile. Last year, the same agency declined to recommend screening for prostate cancer among men under 75 because "the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined." Few protests were heard.
Nor is it usually considered utterly insane to take costs into account. We could save lives by testing everyone over 55 for diabetes, for example. At more than half a million dollars for every healthy year of life that would be saved, however, we have the good sense not to.
But the mammography recommendation goes against the central premise of both American medicine and the welfare state: more is always better. Many American women, who have been told for years that they need to get regular mammograms starting at 40, are not ready to break with that practice, and our political leaders wouldn't dare suggest they reconsider.
Quite the contrary. The Senate voted to force health insurance companies to offer free mammograms—no deductibles, no co-payments. The lawmakers also ordered the federal government to completely disregard the task force proposal.
Republicans as well as Democrats ridiculed the notion that Americans should be denied any test they want at someone else's expense. Said Sen. John Barrasso (R-Wyo.), "I don't want a government bureaucrat making a decision for the women of America, if they should be allowed to have screening mammograms."
Actually, no one has proposed making it a crime for people to undergo screening. Those patients who think a screening exam is essential, but whose policies don't cover it, may find facilities that offer it free. They would also have the option, however unfamiliar, of paying for it themselves, at an average cost (according to the American Cancer Society) of about $100.
The Senate measure is not about the right to obtain preventive care. It's about the right to make someone else pick up the tab.
By demanding mammogram coverage in private and government plans, the amendment would raise the cost of health insurance for everyone. Which, as you may recall, is exactly the opposite of what "reform" was advertised to do.
Those who think we cannot afford unlimited budgets for health care may take heart from another Senate vote. It repulsed an effort by Sen. John McCain (R-Ariz.), to delete more than $400 billion in promised Medicare savings in the coming decade.
Alas, the Senate, by a 100-0 vote, also promised that no Medicare benefit currently provided will ever be canceled. Even the alleged savings (from—get this—eliminating waste and inefficiency) are unlikely to be achieved. They are in the bill to create the impression that someone, someday, will be willing to control costs.
Fat chance. Many opponents of the administration's effort warn that it will lead to federally imposed rationing of medical care, cruelly denying Americans the treatments they need. The more plausible outcome is that the government will insist on providing anything and everything until the day we run out of money.
Our leaders know they can't do this forever. So they'll settle for doing it as long as they can.
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