. . . The recommendation by the U.S. Preventive Services Task Force that mammograms not be given routinely to women under 50 and that the teaching of self-exams be de-emphasized has sparked a spirited debate among doctors, researchers, advocates and ordinary women. Thats a good thing. The questions of when such screenings are most effective and what benefits and risks they provide are too seldom considered in a medical culture that tends to assume more tests are always better. There are thousands of examples of women whose potentially deadly cancers were caught early because of mammograms, and many others in which women suffered unnecessary consequences ranging from anxiety to needless treatment because the tests raised false alarms. Its a debate worth having.
But using that question of medicine and public health policy as a talking point to oppose reforms of the health care system that will result in vastly greater access to medical care for millions of people is nothing but scaremongering. Opponents of President Obamas effort to reform the nations health care system, from conservatives in Congress to the Wall Street Journals editorial page, are ominously pointing to this recommendation by a previously obscure panel as proof positive that health reform will result in the rationing of care and that people will die as government bureaucrats scramble to cut costs.
This line of reasoning ignores the fact that rationing already exists in the American medical system. Millions of low- and middle-income women are rationed out of mammograms because they lack health insurance.
Others find treatment for breast cancer rationed by insurance company bureaucrats who scramble to increase profits by denying coverage, sometimes on the flimsiest of pretexts. And the extent to which private insurance companies now offer coverage for screening tests is often determined by state mandates that they do so.
Those mandates, incidentally, are also something many conservatives oppose; when they talk about allowing the sale of health insurance across state lines, what they mean is that they would like people to be able to purchase lowest-common-denominator policies from states that take a minimalist view on what kinds of tests, procedures and treatments ought to be covered. (According to the New York Times, all states except Utah require mammogram coverage for women in their 40s.)
The fear tactics on mammograms also ignore another feature of a health care system in which the government plays a larger role. The government, ultimately, isnt run by bureaucrats but by politicians. Its no coincidence that Health and Human Services Secretary Kathleen Sebelius disavowed the task forces recommendation after a public outcry, or that the White Houses deputy communications director moved quickly to assure the public that Medicares policy on mammograms wasnt changing. If anything, placing greater responsibility for health care in the hands of government is going to lead to more coverage than necessary, not less.
Whats getting lost is any serious discussion of a set of recommendations that even those making them acknowledge are a difficult call. The task force studied new data from England and Sweden and found that the risks associated with breast cancer screening are much higher for women in their 40s but the chance of detecting cancer is much lower, making for a lopsided risk/reward ratio.
Seven years ago, when the same panel recommended mammograms for women under 50 and that screenings be given annually, as opposed to once every two years, members said that, too, was a tough call. We seem stuck in a place where no data is likely to tip the scales conclusively to one side or another. That suggests we need to put resources into developing new, more accurate screening techniques that offer greater benefits at less risk of harm. That would be the proper response to these findings, not a set of politically motivated attacks.