Last week Dem Sen. Barbara Mikulski of Maryland, reacting to women’s outrage over the National Preventative Services Task Force’s ruling that annual mammograms for women under age 50 weren’t cost-effective, inserted an amendment into the the Senate health bill assuring younger women’s access to the breast-cancer screening procedure.
Trouble was, as physician Marc K. Siegel writes for the New York Post:
Yet her amendment did nothing to change page 17 of the Senate health bill — which focuses on guidelines that insurance, starting with Medicare, will be compelled to cover: “Items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventative Services Task Force.”
That is, insurers wouldn’t have to cover tests graded C or D — and the Senate bill, with its taxes and other penalties for “overly generous” policies — slams many insurance plans that go beyond government recommendations. And, of course, it was this same task force that gave routine mammograms for women age 40 to 50 as a grade of “C.” In fact, some of the most aggressive breast cancers occur in this age range, and the test has a greater than 80 percent chance to detect them.
As Siegel points out, it took GOP Sen. David Vitter to straighten out Mikulski’s amendment by specifically allowing a bypass of the task force’s guidelines where breast exams are concerned. That’s all well and good, Siegel says–but only because breast cancer is is such a hot-button issue that it wasn’t hard to muster the votes to override the task force. What about other medical conditions that the task force may decide it’s not cost-effective to treat?
And the Preventive Services Task Force is just getting started. It’s also studying PAP tests — and might well follow up on the American College of Obstetrics and Gynecology’s finding that these are overused and restrict them. Yet PAP tests have reduced the incidence of invasive cervical cancer in the US by 74 percent since 1955; the problem is now largely restricted to underdeveloped areas where the test isn’t readily available.
Coming up on the task force “research” menu is the effects of falls on the elderly and whether it’s cost effective to intervene. More than 25 percent of the elderly die in the first year after breaking a hip; will the task force realize that such patients’ best chance at a meaningful recovery is hip repair or replacement — or conclude that this would be wasteful, since the patient probably won’t live long anyway?
n my examination room of the near future, I’ll likely have to check an insurance checklist to see whether I can refer my female teen patients to a gynecologist for a yearly pelvic examination and a PAP test. When a woman reaches the age of 40, I may not be able to order a mammogram — or a colonoscopy when she turns 50. My men may have to forgo their Prostate-Specific Antigen test, despite the innumerable cancers it helps uncover. How long before a federal guideline emerges about the age when it is officially no longer “beneficial” to be wearing a hearing aid? If an elderly patient is depressed, it may no longer be “cost effective” to offer an anti-depressant.
Some would call this rationing. Others would say, um, “death panel.” And it’s built into the Senate bill.