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.