The GOP has seized on the uproar over the revised recommendations for breast cancer screening, forcing the Obama administration to focus on political damage control.
The new guidelines, issued this week by an independent, government-funded task force, call for later and less frequent mammograms for most women. Republicans are suggesting that the guidelines reinforce their nightmare scenario about health care rationing under President Obama's proposed overhaul.
The political brouhaha comes as the Senate is about to take up its health care overhaul bill — and Democrats don't yet have the votes to pass it.
To make matters worse politically, the guidelines focus on the emotional issue of breast cancer — the No. 1 health care concern for American women, according to polling done by Bob Blendon of the Harvard University School of Public Health.
"The study clearly creates a political problem," Blendon says, "because it raises doubts among many women about what reform would mean in an area they deeply care about and feel that they and their physicians need some discretion."
'I Was So Outraged By It'
For Republican Rep. Dave Camp of Michigan, the mammogram study was the best weapon Republicans could have. "This is the preview of what the movie's going to look like if the Pelosi health care plan or the Obama health care plan passes," Camp says.
The Democrats' health care bills all create a marketplace or exchange where people could go to buy health insurance. The government would rely on independent task forces — including the one that issued the breast cancer screening recommendations — to help determine which prevention benefits insurers in the exchange would have to offer.
To Camp, the task force's recommendations for fewer annual mammograms was a much more effective way to make the argument about rationing than the hyperbolic complaints about death panels heard at town hall meetings last summer, which Camp said were not very helpful..
"Some people discounted the idea that the government would actually put people to death," Camp says. "And this actually is really showing how the insidious encroachment of government between the patient and their doctor plays out. And it's not a pretty sight."
A group of Republican congresswomen, including Rep. Jean Schmidt of Ohio, held a press conference on Capitol Hill Wednesday to warn that access to mammograms could be restricted.
"That's why I was so outraged by it," Schmidt said, adding, "Every year, I'm allowed to have a mammogram, because that's what the recommendations are. My fear is it'll be every two years, and then maybe every three years."
Assurances From The Administration
To counter these arguments, Health and Human Services Secretary Kathleen Sebelius issued a statement saying that women should keep doing what they've been doing for years.
In an interview with NPR Wednesday, she offered this reassurance: "Medicare will continue to pay for mammography services. Medicaid will continue to pay for mammography services."
Addressing the GOP charge that if a health care bill passes, task-force studies like the breast cancer recommendations would be the basis for restricting coverage on the health care exchange, Sebelius pointed out that it is the secretary of health and human services — not the advisory panels — who would be the final arbiter of what is and is not covered.
Asked whether she would be willing to pledge that as long as she remains secretary of health and human services, she will make sure that every plan offered on the exchange will give coverage for annual mammograms for women over 40, Sebelius responded: "Well, yes. I think that is an important service. It's a determination that we've made."
The firestorm over breast cancer screening is just one example of why overhauling the health care system is so difficult. And, says Harvard's Blendon, there will be many more arguments like this one, as Congress struggles with how to provide higher-quality, lower-cost health care for everyone.
"The Congress and the president [have] put hundreds of millions of dollars into studies which will look at the effectiveness of major treatments, preventive approaches that are currently being used today to see if they are both effective, and if there are less costly ways of treating the same problem. And then they're going to have panels that come out with recommendations based on the scientific studies."
And many of those recommendations could involve changing the kind and quantity of health services Americans have come to expect.