Congress Joins Mammography Debate

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Efforts are under way to expand the scope of evidence-based medicine as part of an attempt to rein in health care costs. Congress is still meddling in medical decisions, such as the new guidelines on mammograms. Wednesday's discussions by a House panel on routine mammograms got tangled with the issue of health care overhaul.


The debate over when women should get mammograms goes on, and now Congress has joined in. NPR's Joanne Silberner reports that on the Hill, the discussion got all tangled up with another tough issue: health-care overhaul.

JOANNE SILBERNER: The House Energy and Commerce Subcommittee hearing looked like it was going to be about the breast cancer screening recommendations issued last month by an independent government advisory committee. Dr. Diana Petitti was there to defend the recommendations. She's the vice chair of the U.S. Preventive Services Task Force.

She told the committee that her task force's recommendation against routine mammography for women in their 40s got totally overblown. The idea was that the exam shouldn't be automatic. Women should discuss the risks and benefits with their doctors before deciding.

Dr. DIANA PETITTI (Vice Chair, U.S. Preventive Services Task Force): What I thought would happen with these recommendations is that it would move the discussion more towards the notion of individualized decision making and restratification.

SILBERNER: Opponents of health overhaul legislation seized on the recommendation. They said that it meant that women in their 40s wouldn't be able to get mammograms under the House bill. But Michigan Democrat John Dingell told Petitti she was being vilified.

Representative JOHN DINGELL (Democrat, Michigan): From the things I've heard said on the other side of the aisle about you folks at the agency, I was afraid you'd appear with horns, tail, fangs and in a red suit, breathing fire.

SILBERNER: But Republicans were insistent that the task force's recommendations would become law. John Shadegg of Arizona said that in several of the new insurance plans that would be offered under the House bill, women in their 40s would have trouble getting mammograms.

Representative JOHN SHADEGG (Republican, Arizona): Under Section 303 of H.R. 3962, women purchasing insurance under the first three categories - basic, enhanced or premium - would not be allowed to purchase because the insurance company would not be allowed to offer a policy covering mammogram services.

SILBERNER: It would be illegal, he said. But Section 303 does not specifically talk about mammograms. Section 303 refers to required, basic benefits packages. Insurance plans would have to cover tests recommended by the health task force. But as for tests like mammograms for women in their 40s, Democrats insist that the task force's guidelines are just a minimum, and the plans could cover more on their own or be required to cover more. And the Democrats accused Republicans of using scare tactics. Again, John Dingell.

Rep. DINGELL: These recommendations that we're going into this morning are recommendations, nothing more. And to say anything different than that is either to transmit the grossest kind of carelessness or - and I hope this is not the case - or just plain, outright deceit.

SILBERNER: The debate brought an unusual apology to the authors of the guidelines from subcommittee chair Frank Pallone of New Jersey.

Representative FRANK PALLONE (Democrat, New Jersey): This has been totally politicized. I guess that's just the nature of the process around here. So I don't know what we can do about it or make it any different.

SILBERNER: Meanwhile, on the other side of Capitol Hill, the Senate is considering amendments to its health overhaul bill. Early on the agenda: a plan to require insurers to cover - with no co-payments - preventive care for women, including mammograms for women under 50.

Joanne Silberner, NPR News.

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