The United States Preventive Services Task Force has controversial new guidelines for mammograms in women under 50. They have been universally derided and have the appearance of bad science. George Stephanopoulos has noted that this task force has the force of law. So is this bad science and will the senate bill really deny mammograms to women under 50?
The answer to both questions is no. But you have to look to find the answers. Or follow me after the jump.
The new health care bill will make preventative care free. But to be free, it has to be rated as an A or B. This procedure is rated C for women between 40 and 50. It would not be free. Would it be a covered procedure? Yes. And that's the part of the story no one seems willing to explain in the sound clips and debates and with all the cross talking and over talking that occurs on the television news shows.
But if you look for the answers, you can find them - like this New York Times Opinion piece from November 19th.
These recommendations have shocked many people, but the American College of Physicians made similar recommendations two years ago and the National Breast Cancer Coalition, an advocacy group for patients, has been saying for years that mammography screening has been oversold, has significant limitations and can cause harm. It urges women to make their own decisions based on the best available facts.
In suggesting that women in their 40s not get screened (unless they are at high risk for breast cancer), the panel argued that the harms of mammograms for those women appear to outweigh the benefits.
Screening turns up lots of tiny abnormalities that are either not cancer or are slow-growing cancers that would never progress to the point of killing a woman and might not even become known to her. If a suspicious abnormality is found, women usually get another mammogram or imaging test to better identify it and often a biopsy to determine if it is cancerous. If it is, most women have it treated with surgery, radiation, hormone therapy or chemotherapy, all of which carry risks for the patient.
The scientific argument is that it is not worth taking such risks for the large number of women whose cancers grow too slowly to kill them. But it is difficult, in practice, to apply that kind of scientific analysis to the immediate questions confronting a woman and her doctor when a mammogram turns up an abnormality.
So it isn't bad science. And the National Health Care Bill increases mammograms - that is it increases prevention. For one, more people will be covered. Further, preventative measures are free if rated a A or B. And this procedure is for women 50 and over.
And rating the procedure as "C" for woman under 50 doesn't ration care for them either. If you are under 50, you get the same coverage you always got. It would just not be free under the senate bill. One might have a copay under their insurance plan or might not. Depends on the plan and the state. From the New York Times:
Opponents of the health care reform bills moving through Congress have seized on the new recommendations as evidence that the government is seeking to put bureaucrats between you and your doctor or that it would ration care by denying coverage for some mammograms that are now covered.
There is virtually no chance that any insurers, either public or private, will deny coverage to anyone based on these recommendations. Government and industry officials have said that explicitly and, in fact, every state but Utah requires private insurers to pay for mammograms for women starting in their 40s.
There is nothing in the reform bills that would change the current Medicare laws, which require that annual mammograms be included among the preventive services covered, an important benefit for more than a million women in their 40s who get Medicare coverage because they are disabled or suffering from end-stage kidney disease.
It is in the Medicare law that breast screenings start at 40 - with copays. It is also law in almost every state for insurance companies to pay for one breast screening per year. Nothing has changed other than there are more breast screenings then there used to be because more people are covered and copays get waived.
So... we have good science doing what it is supposed to do. And we have good policy doing what it is supposed to do. We have an expansion of preventive help. We have overall lower patient cost. But we don't have perfection as one can reasonably disagree with the Panel. And in today's environment perfection is indeed the enemy of the good.
With all this rukus, one can't expect mom and pop ploppie to ferret this stuff out. Hell, not even news guys get it completely. Witness the attempt on ABC "This Week" where Steph managed to note that the procedure gets a C and would not be covered but didn't bother to explain what that means. So look for an amendment in the bill. And expect continued breast fetish by Republicans.
Mrick