Breast Cancer May Be Above Politics, But It's Not Beyond Policy

Carrie Lukas
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Posted: Dec 02, 2009 4:15 PM
Rep. Debbie Wasserman-Schultz (D-FL) is a breast cancer survivor who is passionate about ensuring that women have health care options. After undergoing treatment in 2008, she worked to promote screening efforts to insure that women are diagnosed early to increase their chance of survival. When the U.S. Preventive Services Task Force (a government panel charged with reviewing evidence and making recommendations for preventive services) recently changed their recommendations about best practices for screening women for breast cancer, Rep. Wasserman-Schultz expressed concern.

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She's a cheerleader for current efforts in Congress to transform the health care system, which she argues will "provide greater access to preventative care." She recoiled when opponents of the health care bills used the new recommendations that scaled back the use of mammograms to highlight the potential for government rationing, and accused Republicans of "playing politics with breast cancer."

Perhaps breast cancer should be "above politics." But it isn't beyond policy. Clearly, access to preventative services will be affected by major changes to the health care system. Indeed, Wasserman-Schultz sells proposed legislation by claiming it will give more women access to screening (therefore using breast cancer to advance her own policy agenda). And while she insists that recommendations made by the panels would just be "recommendations" and wouldn't affect access to services, the legislative text suggests otherwise.

Section 2713 (on page 17) of the Senate bill reads "A group health plan and a health insurance issuer offering group or individual health insurance shall provide coverage for and shall not impose any cost sharing requirement for evidence-based items or services that have in effect a rating of 'A' or 'B' in the current recommendations of the United States Preventative Services Task Force." In other words, services that receive grades of "C" or below (as did mammograms for women under age fifty) would not have to be covered.

ABC's George Stephanopoulos reports that when confronted with this specific legislative language, Rep. Wasserman-Schultz said that the "language needs to come out of the bill" and insisted that the task force recommendation "won't be controlling."

http://blogs.abcnews.com/george/2009/11/breast-cancer-controversy-will-reform-impose-guidelines.html

Yet surely Wasserman-Schultz recognizes that the government, if it becomes the primary insurer of millions of Americans and sets the terms of health insurance contracts more broadly, will have to set limits on the care that's covered and made available to most Americans. The government's resources are finite and costs have to be taken into account. The U.S. Preventive Services Task Force's recommendations were based on a cost-benefit analysis that was not unreasonable from the government's point of view: they weighed the potential for 500 false positives out of every 1000 women screened in their forties against 0.7 additional breast cancer deaths. They decided it was worth about one woman's life to eliminate 500 unnecessary false positives.

Do we want the government to be in the position of making such calculations?

Wasserman-Schultz is likely relieved to see that Senator Mikulski (D-MD) has offered an amendment to the Senate health bill, undoubtedly in reaction to the controversy sparked by the new breast cancer screening guidelines. The amendment would guarantee women access-for free-to comprehensive preventative and screening tests, which she explains "could" include mammograms for women under age 50.

Yet this should be little comfort to those concerned about the potential effects of government-run health care. Breast cancer activists are politically powerful and well-organized. Few politicians will want to take a vote that could seem indifferent to their cause. But what about the scores of other diseases and treatments that government panels will be asked to consider? What this process tells us, from the panels' original pronouncement to the political response of politicians, is that government officials will be in the position to determine what care should be available. The name for that process-no matter how much the bill's proponents insist otherwise-is rationing.

Of course, health care has to be rationed. We can't all afford to consume all of the health care we want without taking costs into consideration. But there is an important distinction between the kind of "rationing" that results from individuals making decisions based on their own resources and preferences and the kind of one-size-fits-all rationing of a government panel. We can address the problems associated with personal "rationing" by helping those who truly can't afford to buy insurance or obtain services-and, certainly we don't need to subject the entire health care sector to government micro-management to do so.

Breast cancer treatment will be profoundly affected by the decisions that our elected officials make about the health care system. Far from being out of bounds, we should have a robust debate about these policies' effects on those afflicted by this disease and others. The American people deserve nothing less.