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 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.

Image by: Matt Mahurin

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 mammogram guidelines are rated “B.”

In reaching its conclusions, the task force reasoned that the benefits associated with routine breast-cancer screenings for women aged 40 to 49 did not outweigh the harms associated with the tests. Those dangers, the panel noted, “include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results.” Such false-positives, the panel added, are most common in women aged 40 to 49.

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, 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.”

Mohammed is the 31st Guantanamo detainee to win his petition for habeas corpus, which challenges the government’s right to continue to hold him without charge. According to David Remes, a lawyer who represents about a dozen Guantanamo detainees and closely tracks these cases, federal courts have ruled that the government can continue to detain eight of the 39 prisoners whose habeas cases have been heard.

I admit I overlooked this case, because it was initially reported as a suicide. But it’s no longer so clear that that’s the case.  now looks like that may not have been the case. Guantanamo spokesman Lt. Cmdr. Brook DeWalt told According to journalist Naomi Wolf, “the status of the investigation into Mr al-Hanashi’s death … is now a Naval criminal investigation – meaning that he is no longer considered a suicide but a victim of a murder or a negligent homicide.”

Guantanamo spokesman Lt. Cmdr Brook DeWalt, however, who I spoke to after initially writing this post, denies that interpretation. According to DeWalt, “any death is investigated by NCIS [Naval Criminal Investigative Service] on navy bases. Whether it be natural causes, whether it be suicide, criminal, across the board.”

Wolf’s “news” has just gotten a little fuzzier. What is clear, though, is that five months after al-Hanashi’s death, we still don’t know what happened to him.

In all the discussion of where the administration is going to try Guantanamo detainees, the news about Hanashi has been buried.  It’s In fact, both the Bush and Obama administrations have been extremely tight-lipped about the deaths of detainees in U.S. custody. Although the government reports when a Guantanamo detainee dies, As I’ve pointed out before, at some point the military stopped reporting the deaths of its prisoners in Iraq and Afghanistan. I’ve repeatedly asked why, and I’ve asked the Pentagon to define its current policy for reporting deaths of detainees in U.S. custody overseas.

I’ve never received any explanation. I’ll keep trying.

This post has been updated for clarification, based on DeWalt’s statement that Wolf misinterpreted his remarks.

Under the Senate legislation as it is currently written, Americans with employer-provided coverage, whose income is below 400 percent of the federal poverty level and whose premiums are between 8 and 9.8 percent of their total income will be exempt from having to purchase health coverage but will not be able to access the exchange to qualify for government assistance to purchase insurance.  The agreed to amendment will make it possible for these individuals to convert their tax-free employer health subsidies into vouchers that they can use to choose a health insurance plan in the new health insurance exchanges.

Critics contend that the proposal will cause a flood of young, healthy workers to flee employer-sponsored plans, hiking rates for the older, sicker folks who remained. But a number of Senate Democrats had recently joined Wyden in urging adoption of the so-called “free-choice” amendment.

The Congressional Budget Office estimates that the change will cover an additional 1 million people, Wyden says.

It’s a ridiculous set of recommendations. It’s causing mass confusion among women, because we have been trained to know that, when we’re 40 years old, we should get a mammogram routinely.

Wasserman Schultz also criticized the suggestion that women between the ages of 40 and 49 should simply talk with their doctors to gauge their breast-cancer risk.

About 75 percent of women who have breast cancer didn’t have any risk, weren’t in a higher-risk category. I was in a higher-risk category, didn’t even know it until I found my lump myself and went to the doctor.

So, these recommendations are really patronizing, because they’re presuming that women can’t handle more information and make a rational decision with their health care provider.

The congresswoman’s office hasn’t returned calls this week about whether Congress needs to enter this fray legislatively.

“The reason I ask you,” said O’Donnell, “is that I think there’s some confusion about Sarah Palin’s policies.”

It wasn’t a man-on-the-street interview with a dopey tourist being asked a surprise question, of the kind John Ziegler conducted with Obama supporters to “prove” that they had no idea what Obama believed. Jackie was a political activist with a political message. And the history of the bailouts has really been mangled by conservative spin since September 2008, when, in a panic, most Republicans (in Congress) supported them. When former Massachusetts Gov. Mitt Romney gave a speech at the Value Voters Summit this year and attacked “bailing out banks,” few people in the crowd remembered that Romney had supported the bailouts.

By and large, I’ve found that Tea Party activists and conservatives do not forgive Republicans who supported the bailouts — there is a lot of anger toward former President George W. Bush, and more toward former Treasury Secretary Hank Paulson. And here is what Palin said about the bailouts in her debate with Joe Biden.

John McCain thankfully has been one representing reform. Two years ago, remember, it was John McCain who pushed so hard with the Fannie Mae and Freddie Mac reform measures. He sounded that warning bell.

People in the Senate with him, his colleagues, didn’t want to listen to him and wouldn’t go towards that reform that was needed then. I think that the alarm has been heard, though, and there will be that greater oversight, again thanks to John McCain’s bipartisan efforts that he was so instrumental in bringing folks together over this past week, even suspending his own campaign to make sure he was putting excessive politics aside and putting the country first.

In September 2008, McCain suspended his campaign to go to Washington to help negotiate a government response to the financial crisis, resulting in a $700 billion bailout bill.

And here is what Palin says in “Going Rogue” about the bailouts, on page 270.

[T]he House of Representatives rejected a Bush-backed economic bailout plan in a vote in which two-thirds of Republicans voted no. The impression this made on the electorate was not helpful to our cause. Millions of Americans were poised to go bankrupt or lose their savings, and the perception was that Republicans had failed to respond.

I don’t think you can avoid the conclusion that Palin supported the bailout package. If a Palin supporter doesn’t know this, it’s perfectly legitimate to find out why. And yet The Weekly Standard, not alone in the conservative media, takes this exchange and makes it all about a brave 17-year-old girl battling back against an “ambush” from MSNBC.

My test on this is easy: Would George C. Marshall have accepted such payments? I doubt it. (Remember, he declined to write a memoir that would have made him wealthy because he thought it would have been improper to get into the failings of some of his comrades.)

“This weekend, I will vote for the motion to proceed to bring that debate onto the Senate floor,” Nelson says. “The Senate should start trying to fix a health care system that costs too much and delivers too little for Nebraskans.”

Nelson has previously indicated that his vote for passage of a final bill is far from certain, but his announcement today removes one potential Democratic roadblock on the path to a final vote. TPM also reports that two other fence-sitting Demoratic senators, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, remain uncommitted on tomorrow’s vote but have hinted they intend to vote in favor of sending the bill to the floor to debate.

Blackburn was joined by GOP Reps. Cathy McMorris Rodgers (Wash.), Sue Myrick (N.C.), Candice Miller (Mich.), Michele Bachmann (Minn.) and Jean Schmidt (Ohio).

Funny, though, that none of the participants has signed on in support of legislation to ensure that all women aged 40 and up have access to routine mammograms. That bill, sponsored by Rep. Jerrold Nadler (D-N.Y.), would require insurance companies that cover diagnostic mammograms also to cover routine, annual breast cancer screenings for all women 40 and older.

Only one Republican, Rep. Ileana Ros-Lehtinen (Fla.), is among the 79 co-sponsors of Nadler’s bill.

The message from the Republicans seems to be: We’re wary of the government recommending fewer tests based on independent research, but it’s OK for private insurance companies, driven by profit motives, to deny access to the same services.