rssDems’ Health Bills Would Adopt New Mammogram Guidelines
Saturday, November 21, 2009 at 6:45 am
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Senate Majority Leader Harry Reid, Speaker of the House Nancy Pelosi (WDCpix)
The Democrats downplaying the gravity of new recommendations for breast cancer screening have left out an inconvenient fact: their health care bills would automatically adopt them.
Both the House and Senate health reform proposals would force insurance plans to follow the new mammogram guidelines for women ages 50 to 74 as part of a minimum swath of services deemed by the legislation to be medically essential. The recommendations were an unexpected wildcard in the middle of an already contentious health reform debate, and they’ve caused Democrats to de-emphasize their significance at the same time that some in the party are calling for a legislative fix to nullify them.
[Congress1]The animated reaction to the recommendations follows several weeks in which women’s reproductive health had been at the forefront of the health reform debate, after the House passed a provision limiting coverage of abortion under private plans. The saga has been a distraction to Democrats as they aim to enact the most sweeping health care reform in generations, and it’s complicated their defense against GOP-fueled charges that their proposals would lead to a rationing of care. House leaders have already passed their version of the bill, but the debate in the Senate is just beginning, with upper-chamber leaders scheduled to vote Saturday on a procedural measure to bring their bill to the floor.
The mammogram episode has also revealed the influence of a previously obscure preventive-medicine panel, raised questions about the effectiveness of the Democrats’ reform proposals to weed out unnecessary medical procedures, and highlighted the potential complications when the entrenched habits of patients and providers are called into question by medical science.
“These new recommendations,” breast cancer specialist David Gorski wrote this week, “are a classic example of what happens when the shades of gray that characterize the messy, difficult world of clinical research meet public health policy, where simple messages are needed in order to motivate public acceptance of a screening test.”
The controversy ignited on Monday, when the U.S. Preventive Services Task Force, a federally appointed panel of independent medical experts, released guidelines suggesting that women should not seek routine mammograms before the age of 50 — 10 years later than current protocols dictate. The task force also concluded that annual mammograms are unnecessary for any age group, suggesting biennial screenings instead.
Critics in Congress and the medical community were quick to pounce, arguing that the recommendations would jeopardize the lives of women, particularly those aged 40 to 49. Democrats moved swiftly to divorce their health reform proposals from the new guidelines, maintaining that they merely represent a non-binding data-bank for lawmakers to consider as they craft coverage policies, both public and private.
“I don’t think there’s any general acceptance of what was proposed,” House Speaker Nancy Pelosi (D-Calif.) told NPR Thursday.
“These individuals do not determine federal policy,” Rep. Rosa DeLauro (D-Conn.) added in a statement. “They have simply made recommendations.”
Yet the health reform language moving through Congress tells a different tale. Both the House and Senate bills create an “essential benefits package” which all insurance plans would have to offer. Neither chamber’s proposal specifies what those services would be, instead, empowering the Department of Health and Human Services to make those decisions at a later date. But the bills do outline broad categories of minimum services, including a mandate to cover those recommendations of the task force rated “A” or “B.” The new biennial-screening guidelines for 50- to 74-year olds are rated “B.”**
The 16 members currently on the panel were all appointed by the Bush administration. None specializes in oncology.
A number of Democrats have blasted the findings. Rep. Debbie Wasserman Schultz (D-Fla.), a breast cancer survivor, said the guidelines are “causing mass confusion” among women accustomed to screening more frequently and earlier in life. Rep. Frank Pallone (D-N.J.), chairman of the Energy and Commerce health subcommittee, has already indicated that he’ll hold a hearing early next month to examine the recommendations. And Rep. Jerrold Nadler (D-N.Y.) is pushing legislation to require insurance companies that cover diagnostic mammograms also to cover routine, annual mammograms to women beginning at age 40.
“Cancers can progress very far in two years,” Nadler said Friday, criticizing the panel’s recommendation for biennial screenings.
The White House has also been wary, quickly indicating that the new recommendations would have no bearing on public policy. In a statement issued Wednesday, HHS Secretary Kathleen Sebelius played down the task force as “an outside independent panel of doctors and scientists who make recommendations.”
“They do not set federal policy,” she added, “and they don’t determine what services are covered by the federal government.”
Yet they certainly can have influence. Indeed, in May, when HHS announced the controversial decision not to pay for virtual colonoscopies under Medicare, the agency leaned heavily on the judgments of the Preventive Services Task Force, which had concluded earlier that the radiation risks outweighed the benefits of the less intrusive cancer-detection procedure.
The HHS declined to comment this week on why the agency was so quick to dismiss the panel’s new mammogram recommendations.
By issuing their report in the middle of a contentious debate over health care reform, the task force didn’t do the Democrats any favors. Republicans are already blasting the reform bills for their funding of comparative effectiveness research, which compares different treatments of the same ailment to discover which work best. The critics fear that the effectiveness data could tempt insurers — both public and private — to deny coverage of certain drugs, devices and other treatments. In the eyes of the GOP, the new mammogram recommendations are just another threat to patients’ access to care.
“This is how rationing starts,” Sen. Jon Kyl (R-Ariz.) said Friday. “Delay of care … then denial of care. At first, it’s guidelines, then the insurance companies … adopt those guidelines with respect to coverage decisions.”
Private insurers, for their part, say they often use the task force recommendations to make coverage determinations. But they deny that the mammogram findings will have any effects — at least not immediately. “Whatever we do today, we’ll continue to do — as far as we can tell,” said Gloria Barone, spokeswoman for Cigna.
Susan Pisano, spokeswoman for America’s Health Insurance Plans, the industry lobby group, pointed out that the task force recommendation against routine screenings for 40-somethings is hardly an outright moratorium, instead leaving the decision to women and their doctors. “I don’t see this as limiting coverage,” Pisano said.
Under Medicaid, states have leeway to set their own coverage rules. Ann Kohler, director of the National Association of State Medicaid Directors, said state officials use the task force guidelines “often.” “However in this case,” she added, “I think they will not change their historical policy.”
Julius Hobson, former lobbyist for the American Medical Association and now a senior policy analyst at the Washington law firm Bryan Cave, suggested that the members of the task force had crunched their numbers without consideration of the broader effects of their recommendations. “They missed the psychological and social impact of what they were saying,” Hobson said.
Their timing, he added, was also a bit suspect. “You’d have to be deaf, dumb, blind and crazy not to know that Congress has spent the whole year working on health reform.”
**Clarification: An early version of this story implied that the recommendations for 40- to 49-year olds would also be adopted by the Democrats bill. That would not be the case. That recommendation is rated “C.”
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Comment posted November 21, 2009 @ 8:36 am
“Overall, they found that starting screening at age 40 instead of age 50 would save relatively few additional lives. To prevent one additional breast cancer death, 1,000 women would have to get mammograms starting at age 40 vs. age 50. But doing this would result in roughly 500 of the 1,000 women getting false positive results at least once, and 33 of them getting unnecessary biopsies, says Jeanne Mandelblatt of Georgetown University, who led one study combining the results of the computer models. “
–http://www.forbes.com/2009/11/16/mammograms-cancer-screening-business-healthcare-mammogram.html
“92% of women overestimated the benefit of mammography screening by at least one order of magnitude or reported that they didn't know”
–http://www.ajho.com/benefits-of-cancer-screening-overestimated-by-the-public/article/156594/
Nobody is rationing anything. There were several scientific studies done to gauge the benefit of early screenings. The aim of the studies was to prevent unnecessary medical procedures, saving time, money, and mental anguish of the women giving false positive results, or worse, unnecessary biopsies. To the woman 's point in the article above that says cancer can progress very far in two years, I don't think the study recommends suspending self examinations. They aren't saying that you should just forget about the health of your breasts in between your mammogram visits. I'm all for preventative care, but you wouldn't change your oil every 1500 miles just because you would be 0.1% less likely to breakdown.
Isn't it just some crazy possibility that we didn't know as much about cancer when the original guidelines were released, and now that we know more, we can make a more informed recommendation? No. It's far more likely Barack Obama is a Kenyan born Islamic terrorists who is trying to bring down the United States from the highest position in its government.
Comment posted November 22, 2009 @ 10:35 am
I swear, these Democrats would screw up a one car funeral.
Why are they legislating what gets covered? How stupid can they be?!
It doesn't matter what the science says. This is no time to be offering the opposition such an unbelievable advantage, something they'll use to “prove” their assertions that “government run health care will kill you.”
Arguing statistics looks like arguing what the meaning of “is” is to those tens of millions of people who play the lottery, thereby demonstrating their total ignorance of the subject.
It's hard enough to maintain a rational discussion without offering up self-inflicted opportunities for the insurance lobby to derail that rationality. They'll be riding this thing like a pony at a birthday party.
Comment posted November 22, 2009 @ 10:50 pm
ABSOLUTELY WRONG MIKE LILLIS…..the reccomendations by USPS Task Force are NOT a “B” catagory, they are a “C” catagory. Had you bothered to actually read the actual reccomendation….it would have been pretty difficult to miss the BOLD RED type that declares this particular reccomendation a “C” catagory. Although you certainly made it easy for the average reader to fact check your article by providing the handy link. Here, see for yourself:
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm
And so by default, the entire premise that you offer is also a COMPLETE FALSEHOOD. You state rather snarkily, that the language of both bills in the House and Senate, how did you put it? Oh yea, “tells a different tale”, than the Democrat Members of Congress that you quote, about the impact of the reccomendations on either pieces of proposed legislation. You did at least get the fact correct, that both bills would make MINIMUM coverage of reccomendatons of the USPS Task force….catagories A, and B, among with other broad catagories from other sources. But then you (accidentally?) falsly conclude for your readers, that since this reccomendation is a “B” catagory, (which as I said, it clearly is NOT), then both bills would outlaw mammograms for women under 50.
I wonder if you will be inclined to correct your mistake? Yea um….I'm guessing NOT. Since it seems nearly every article I have read on this website includes blatent faslehoods that the most minimal fact checking would reveal….and I've yet to ever see a retraction.
Here's a conclusion for you: This publication either has an agenda that it is not afraid to make up or present false information to advance…..or the writers are actually 8th graders, moonlighting from their “journalism” job on the junior high newspaper.
Comment posted November 23, 2009 @ 5:30 am
“You’d have to be deaf, dumb, blind and crazy not to know that Congress has spent the whole year working on health reform.” …. :)
Comment posted November 23, 2009 @ 10:45 am
It is my understanding that the bills mandate that any positive recommendations are adopted, while any negative are not/
Comment posted November 23, 2009 @ 11:12 am
While I have both versions downloaded, I certainly haven't read either completely, have just referenced various sections. I'm sure I'm not qualified to interpret the practical implications of any provision, with any accuracy. That being said, I can't confirm or deny anything about “positive or negative” reccomendations being adopted, or not. But if that is true David, my next question would be how are the terms positive and negative defined. What I do know for sure, is that the reccomendations of USPS Task Force in catagories A & B will be adopted, but purely for the purpose of defining MINIMUM standards of care that must be covered by any plan participating in the exchange…whether that be a government plan or a private insurance company plan participating in the exchange. And by definition, of the word MINIMUM, there is no language outlining any limitations on specific procedures to be covered. With the exception of the Stupak amendment in the House bill of course. And of course, the specific reccomendation regarding mammograms, is a C catagory reccomendation, so it would not apply to this legislation. Which is why discussing it in terms of the proposed legislation is merely a political tactic by various interest groups opposed to the bill, which being used, deliberately in some cases, accidentally in others, but the net result is to mis-inform the public.
Comment posted November 23, 2009 @ 11:53 am
Point taken, luckykentucky, and we've clarified the piece to reflect that the task force recommendations for 40-49 year olds are rated C, as you mention. The equally controversial recommendation for biennial screenings of 50-74 year olds, however, is rated B, and therefore would seem to be incorporated under the legislation as part of the minimum coverage requirements for insurers.
Comment posted November 23, 2009 @ 1:00 pm
Thank you Mike, for the technical correction. Although I notice it seems you worked hard to maintain the negative inferrance, while not pointing out that reccomendations for annual screening mammograms for women between 40-49, would not be impacted at all by these new reccomendations, in either proposed legislation.
Nor do you point out that private insurance plans, outside of the proposed exchange, would be more than free to decline coverage according to these reccomendations. Why bother to mention the rationing of minimum care that the private insurers have and continue to dictate on a regular basis? Not relevant at all I suppose, when you strive so hard to present the notion that the legislation will serve to ration healthcare!
As a 46 year old woman, with a significant family history of breast cancer, my first two mammograms at age 40 and 41, were declined by my employer provided BCBS insurance plan. I had to pay for them out of pocket. At the age of 43 I married and opted for coverage on my husband's plan, which is part of the Federal Employee's Benefits…i.e. the exact same plan that every Member of Congres is offered by their employer, the Federal Government. It was only then, that my annual screening mammograms, were first covered by insurance.
I guess I can assume you aren't familiar with the procedure personally, maybe that explains why you didn't find it particularly relevant to point out that neither of these reccomendations, for either age group, would result in an automatic limitation of coverage by a plan in the exchange. Better to just leave that incorrect suggestion hanging out there like the grim reaper. But it is a fact, that if a woman and her physician determine that more frequent screenings in the case of the 50-74 age group, or a diagnostic mammogram is determined to be prudent…then there is NOTHING in either bill that would serve to limit the coverage of those procedures. Those new reccomendations, would only be referenced to define the minimum coverage, as in, NOT LESS THAN, for regular, screening mammograms, absent any known high risk factors.
I wonder if you even know the difference between a regular screening mammogram, and a diagnostic mammogram? They are quite different procedures, prescribed for quite different reasons. Maybe you would benefit from some research with a provider, or even a recipient of, women's healthcare, before you write with such authority about that which you clearly know very little.
Comment posted November 23, 2009 @ 6:46 pm
You have left out the more controversial 3 years screening for ovarian and cervical cancer: Pap smear.
The guidelines were already implemented by Kaiser Permamente- women will not get yearly Pap smear. They will have to wait three years.
It takes the cancer 5-6 years to kill.
A three years old cancer has very little chance to be cured.
Comment posted November 24, 2009 @ 8:41 pm
Linda – Actually the reccomendation isn't quite that simple for pap tests. For women who have had 3 consecutive annual screenings with no irregular findings, then yes, it has been the reccomendation to perform that test on an every 3 year interval, for several years now. The American Cancer society, and other relevant medical associations offer the same guidelines. So I would be shocked if Kieser or any of the other major insurers haven't been following that for some time. That being said, just like with the reccomendations for mammograms, they are typically covered for women who have family history or other factors that put them at higher risk. The last time I had an abnormal finding on a pap test was more than 20 years ago. My doctored a second one 6 months later and it was back to normal and has been ever since. I do still get annual screenings, but I also have a family history that puts me at higher risk. I have never had a pap test declined by any (many) of my insurance providers, with one exception when the doctor's office coded it incorrectly. So I suspect, just like the mammograms, if the woman is in a higher risk catagory, and if the doctor codes the forms accordingly, they should be covered.
But, as you probably know, there is no guarantee, they can decline any procedure they want. As long as private insurance companies remain completely un-regulated, enjoy exeption from anti-trust laws and are not subject to the competitive market forces that any other business in this country has to operate in….we are all at their mercy. They are not in the business of caring for anyone's health, they are in the business of profit making. Which is fine, but they should have to earn their profit within the same free market structure as any other industry, which they don't currently. And they are leveraging that advantage at the expense of millions of people's lives, and to add insult to injury…they are so profitable because they dump any and all but the healthiest of the population, into the public clinics and hosptials for the state and federal budgets to pick up the tab….which of course means you and me, with our state and federal tax dollars. Bottom line, there always has been, and always will be some measure of rationing of health care for those who cannot afford to pay out of their pocket for uncovered procedures. It's human nature, we all want every possible test available to screen for any possible ailment or disease. We all want access to the most advanced technologies and procedures, if it means it will extend our life or alieviate suffering. Of courses we do. But of course that's not ever going to be possible for every single citizen. Lines have to be drawn, limits established. The ideal is for those lines to be drawn based on reliable science, with the goal of providing the best possible outcomes for as many people as possible. What we have now, is a system where those lines are being drawn by corporations with the single goal of increasing profit and market share. I understand how and why people may be wary of the Federal Government establishing those lines, but the alternative…what we have now, is entirely unsustainable, from both a fiscal perspective as well as a moral one. At least if the government is the one establishing and enforcing the standards of care, there is accountability, there is a recourse available. It's called an election. Right now, the private insurance companies are free to impose whatever standards they choose without impunity. The only recourse you and I have is to pay cash out of pocket for our healthcare, or get whatever care you can at free clinics and hospitals and send the bill to the US taxpayer.
Neither the Senate or the House Bill are perfect in their current form. But there will literally be hundreds, thousands probably, ammendments added, and deleted before a combined bill makes it's way to the President's desk. If you care what the final version ends up looking like, I suggest you read both versions, and call your elected representatives and bring any provision that troubles you to their attention. Personal letters are still the most effective, more than emails, and don't waste your time with lobbyist or association provided form letters. Trust me, they know what the special interest groups perspectives are already. The personal letters from confirmed voting consitutents are what they pay attention to. Special interest groups can write checks, but they can't vote. But you should also temper your expectations that any endeavor this huge, to completely reform a massive system of society, that impacts so many other areas….it's not going to please everybody, and there will be mistakes and poor solutions included in it initially. It will have to mature and evolve, just like our Constitution has. Medicare doesn't look anything like it did when it was first established. Nor does Social Security, or Medicade, or the V.A. That's the beauty of a democracy, the inate ability to remain fluid and dynamic and self correct, while ensuring a set of basic rights and freedoms remain intact.
Bottom line….it's not only going to be OK, it's going to be better. There's plenty I'm not going to like in the final bill I'm sure. But in the end it's the balance that matters. If it means that I may have to pay for 2 pap tests out of my pocket every three years, I can accept that trade off is it means the members of my family who cannont afford ANY health insurance at the moment, will have access to a basic, minimal level of healthcare. I have a cousin who had to sell her car to pay for a medically necessary surgery. It took her 3 years before she could afford to replace it. I'm pretty sure she didn't have ANY pap tests in those 3 years.
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[...] The mammogram episode has also revealed the influence of a previously obscure preventive-medicine panel, raised questions about the effectiveness of the Democrats’ reform proposals to weed out unnecessary medical procedures, and highlighted the potential complications when the entrenched habits of patients and providers are called into question by medical science. [more...] [...]
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Comment posted April 2, 2010 @ 7:21 pm
yep, I agree with you… Point taken, luckykentucky, and we've clarified the piece to reflect that the task force recommendations for 40-49 year olds are rated C, as you mention. The equally controversial recommendation for biennial screenings of 50-74 year olds, however, is rated B, and therefore would seem to be incorporated under the legislation as part of the minimum coverage requirements for insurers.
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Carl Levin (D-Mich.) to instead emphasize the training of Afghan soldiers and police.
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Specter said, adding that he questioned “even staying” in Afghanistan unless the administration demonstrates that continuing the war is “indispensable to our fight against al-Qaeda.” His position, he said, came as a result of extensive consultations with Secretary of State Hillary Rodham Clinton, Secretary of Defense Robert Gates, Adm. Michael Mullen, the chairman of the Joint Chiefs of Staff, and the heads of the intelligence community, as well as antipathy to the government of Hamid Karzai.
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Nobody is rationing anything. There were several scientific studies done to gauge the benefit of early screenings. The aim of the studies was to prevent unnecessary medical procedures, saving time, money, and mental anguish of the women giving false positive results, or worse, unnecessary biopsies. To the woman 's point in the article above that says cancer can progress very far in two years, I don't think the study recommends suspending self examinations. They aren't saying that you should just forget about the health of your breasts in between your mammogram visits. I'm all for preventative care, but you wouldn't change your oil every 1500 miles just because you would be 0.1% less likely to breakdown.
Comment posted August 3, 2010 @ 2:50 pm
Nobody is rationing anything. There were several scientific studies done to gauge the benefit of early screenings. The aim of the studies was to prevent unnecessary medical procedures, saving time, money, and mental anguish of the women giving false positive results, or worse, unnecessary biopsies. To the woman 's point in the article above that says cancer can progress very far in two years, I don't think the study recommends suspending self examinations. They aren't saying that you should just forget about the health of your breasts in between your mammogram visits. I'm all for preventative care, but you wouldn't change your oil every 1500 miles just because you would be 0.1% less likely to breakdown.
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Check out the NCCN Breast Cancer Guidelines for their recommendations http://www.nccn.com
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How can you compare breast cancer to changing the oil in your car! Your car can survive without an oil change for some time. Even if you do break down from neglect, it’s a machine, it's fixable. Breast cancer effect someone’s LIFE, they aren't a machine that you just through to a mechanic to fix. Obviously your life as not been directly or indirectly effected by this. Next time you decide to case points DON’T compare people to objects!
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Nobody is rationing anything. There were several scientific studies done to gauge the benefit of early screenings. The aim of the studies was to prevent unnecessary medical procedures, saving time, money, and mental anguish of the women giving false positive results, or worse, unnecessary biopsies.
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