If all goes according to plan, the Senate will vote this evening whether to allow the health care bill to be debated on the Senate floor. The votes that will ultimately decide the bills fate will come from two Democratic Party senators, Mary Landrieu and Blanche Lincoln, who've yet to announce how they intend to vote tonight.
Over the last couple days, Republicans have been using recent recommendations on mammogram and pap smear frequency as examples of the kinds of rationing of health care services should health care reform become law.
First the recommendations -
- Early this week, he United States Preventive Services Task Force, a group of 16 health care experts (half of them women) recommended the frequency of mammograms be changed from yearly beginning at age 40 to every two years beginning after a woman turns 50.
- Midweek, the American College of Obstetricians and Gynecologists recommended pap smears every two years for women over 21 years old, and every three years for women who've had three consecutive negative tests. The prior recommendation had been yearly exams either 3 years after becoming sexually active or 21 years of age, whichever came first.
The timing is, no doubt, unfortunate for the health care bill debate and I wouldn't even begin to argue whether the recommendations are founded or unfounded. I don't believe the recommendations are sexist, as some have claimed; it was just a month ago that men's prostrate cancer screening protocols were updated to reduce the recommended testing frequency.
But these new recommendations on mammograms, pap smears and prostrate cancer screening do raise issues about health care rationing. If we all recognize that U.S. health care costs are too high, doesn't it make sense that we look at how the money is being spent? Money spent on unnecessary testing is wasted money and often cited as a reason U.S. health care costs are through the roof.
Like it or not, health care is already being rationed and the decisions about insurance coverage are mostly about statistics and public relations. No one has any gas about insurance companies denying reimbursement for nose jobs and liposuction. And, likewise, no one would have much gas about insurance companies denying payment for PSA testing preteen boys for prostrate cancer. The previous guidelines for mammograms was a yearly test once a woman reached 40 years of age. What would have happened if a woman insisted, without reason, that she wanted to be tested twice a year beginning at age 25? Of course, the insurance company would refuse payment and everyone would think that kind of rationing is reasonable.
There will likely be tragic circumstances of folks that would have benefited from earlier testing than what's been recommended and fail to get diagnosed because of these kinds of restrictions. But that happens now - there are certainly women under 40 years old who've been diagnosed with breast cancer that an elective, non-reimbursed mammogram would have discovered.
This is where it gets hard and emotional. It doesn't help to have knuckleheads screwing around with the discussion for political purposes, but there are already rationing decisions being made and if we're really serious about preventing out of control health care costs bringing down the U.S. economy, sane people need to have sane discussions about reining in costs.
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