The controversy surrounding the recent mammography guidelines issued by the U.S. Preventive Services Task Force is a recommendation for swift and decisive defeat of efforts to expand federal oversight of health care. It almost seems as if this was designed as a laboratory experiment to learn exactly what will happen under Obamacare. The results validate some of the most compelling arguments that opponents have made over the past few months.
When opponents claim that Obamacare will lead to rationing of medical services, defenders counter with an irrelevant but true retort that care is already rationed by insurance companies. By this logic, everything is rationed by economics. Housing is rationed by the availability of capital to invest in housing which is a collective market choice. Cars are rationed in that you can’t just walk into a dealer and drive off the lot. So, yes, currently the health care market, mostly in the form of third-party payers (insurers and public programs), rations care in that there are finite resources to pay for treatments and everyone cannot have everything any time they wish.
The reason that argument is irrelevant is that the debate here is about government rationing of care, which represents an entire new level of restrictions on individuals. When the government sets up panels of “experts” to make recommendations of what kind of care is appropriate under what circumstances and those recommendations are implemented in the form of regulations over what care will and will not be paid for by both private and public insurance, it limits the rights of patients to control their care in consultation with their physicians. It also destroys the market for those excluded treatments which then become either prohibitively expensive or entirely unavailable.
Under Obamacare, new cost effectiveness panels will join the advisory panels like the Preventive Services Task Force. Instead of just making clinical recommendations primarily intended to improve the quality of patient care, they will make recommendations intended to also contain the cost of care. So when the cost effectiveness folks decide that mammograms are only indicated every two years and only for women over 50, that will become the reimbursement policy for Medicare and Medicaid, and the mandate for private insurance that must comport with coverage standards. Sure, you could pay higher premiums for more coverage or pay out of pocket if your and your doctor think it wise to have annual mammograms at age 40, but wait, we were told Obamacare would save us money and wouldn’t decrease our coverage.
So we have a federal panel of “experts” setting policies for medical treatment. That will hopefully prevent people from consuming unnecessary care that drives up the total cost of health care. (Never mind that defensive medicine caused by liability concerns are strictly off the table.) But we have just seen the knee jerk reaction of Congress and the White House to what is only a non-binding recommendation, where they instantly caved to public opinion and special interests (in the form of radiologists and the American Cancer Society) and disavowed the recommendations and assured American women that they could go right ahead and keep getting all the mammograms they want.
What will Congress do when the cost effectiveness folks decide that expensive colonoscopies should be denied to all but a limited group of patients? Is it possible that when voters start calling their offices that Congress will step in to protect access to limitless colonoscopies? Every time Congress or future administrations bow to pressure cost containment becomes more and more impossible.
Health and Human Services Secretary Sibelius made the farcical excuse that the Preventive Services Task Force doesn’t make policy or coverage decisions so all the controversy is a political ploy. But that is not the point. The entire purpose of the various new panels created under Obamacare (and already created in the stimulus bill) is precisely to make policy and coverage decisions. In fact, the Preventive Services Task Force will play just such a role in the new world order. So if everyone is reacting this way to a mere recommendation, how will they react to an actual policy dictate that meets opposition from some constituencies? And when they create political pressure and the politicians give in, what happens to cost containment?
Health care professionals who agree with the Task Force recommendations to reduce the use of mammograms recognize this for exactly what it is–politicization of health care. Under Obamacare, the most effective lobbying efforts will have more impact on the care you can get than the opinion of your physician.
The White House has launched its usual ad hominem attacks against those who have pointed to this instance as a taste of things to come. They accuse opponents of lying and being disingenuous. They even try to imply some sinister motive to the Task Force by pointing out that its members were appointed by the Bush administration. Since they have reduced this debate to the level of a playground back-and-forth, the “rubber and glue” principle applies and these charges are beginning to bounce right back on to the administration.