The Politicization of Access to Health Care?

A few days ago several women Senators stood in the well of the Senate  and supported an amendment to the Reid Health Care Bill that would “fix” the developing crisis regarding breast cancer screening.  Incredibly, they tried to “spin” the Public that the amendment is necessary because the health of American women is at risk due to unfair practices by insurance companies!  In the words of Senator Mikulski “For many insurance companies, simply being a woman is a pre-existing condition.  Women pay more and get less.”  Thus the Senators tried to gloss over the shortcomings in the Reid Bill that made this amendment necessary.  Rather than admit the bill is basically and deeply flawed, the Senators merely proposed additional layers of complexity to address the specific area of womens’ health.   

This myopic and dogmatic belief in an ever more complex and meddlesome Government-mandated system, with layer upon layer of tweaks to control and correct outcomes, seems to be central to the Democratic Party’s approach to health care.  The truth is that the current Government health care bureaucracy is already way over its head and is essentially incompetent at administering even its current health care responsibilities.   In fact, this very incompetence is the cause of the current breast cancer screening debacle.  Is it possible the Senators think that the Public  has already forgotten that this current crisis was caused by an already existing GOVERNMENT entity called the U.S. Preventive Services Task Force (USPSTF) and NOT BY AN INSURANCE COMPANY!?! 

OK, let’s review.  The USPSTF, a Government-appointed panel advising DHHS on the practice of preventive medicine, recently declared that mammography for women under 50 years of age was rated as a class “C” procedure.   Astoundingly, this decision, which contradicts the recommendations from many other medical groups, was apparently made without a single oncologist on the panel.  Unfortunately, under the Reid Bill, the USPSTF decision, no matter how arbitrary and unfounded, trumps other recommendations because USPSTF decision-making is codified in Section 2713 of the Senate health care bill:

“a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for—(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;”

This means that  under the Reid Bill, insurers, both Public and Private, would not be required to provide coverage for mammograms to women under 50 years of age.  In the super-competitive, low profit  environment being mandated by the new bills, insurers will not be able to afford to offer coverage for such non-required items.   Thus, under the Reid Health Care Bill, The USPSTF decision would effectively deny access to mammography for women in the age range from 40 to 50. In her press release, Senator Mikulski admits  “The pending bill doesn’t cover key preventive care for women, such as annual women’s health screenings for women of all ages.”  What would be the effect of  this lack of coverage?   The USPSTF itself estimates that 19% of cancers currently detected in women in this demographic would not be detected under the new guidelines.  Senator Mikulski goes well beyond this figure and states  “Studies have found mammography screenings decrease breast cancer deaths among women in their 40s by over 40 percent.”   

But Senator Mikulski and her cohorts in the Senate still fail to see the more basic threat revealed by the current breast cancer screening debacle – A decision by the USPSTF, or other Government entity, which  under our current system is merely an arbitrary and ill-informed recommendation which doctors and insurers may choose to regard as just bad advice, has the potential, under the Reid Health Care Bill, to become a death sentence!   And such arbitrary fiats are not limited to breast cancer screening , but could be issued regarding any preventive medicine procedure!  What happens under the new system when there is a similar arbitrary USPSTF decision regarding children, or old people, or people with a rare and unpopular disease?  In short, what happens when rationing is imposed on a group that is not a key interest group and that does not have Senators who are eager to stand up and fight for it?  Will there be a Senator with me in the Doctor’s office when my Doctor consults the Law, the Regs, and the USPSTF guidelines, and then informs me I am not eligible for some early detection diagnostic procedure that might save my life?

The need for the Mikulski amendment reveals the basic immorality inherent in Government-mandated health care.  This Amendment has (temporarily) “fixed” the problem of access to preventive procedures only for a politically important subset of patients -women – but the basic problem remains in the bill.  As a result, the rationing of health care resources which is built into the Reid bill will just be pushed off onto those groups of patients that do not have such strong lobbying factions and active political advocates.   In effect, we may be seeing the beginning of the politicization of access to health care.  If followed to its logical conclusion, this will lead to a new health care order – one which replaces the traditional free-market “cost-based” rationing with “interest group-based” rationing.  As we gain experience with this new model, I suspect that we will look back and marvel at how fairly and humanely the much-maligned free-market system has worked for us all. 

Ultimately, when it comes to health care, we are all just “single person” interest groups – our medical situation is personal and unique.   As I have stated before, our goal as individual patients is simply to obtain quality, life-preserving, health care that suits our personal needs, whereas the goal of a Government-mandated health care system is to conserve scarce resources for the bureaucracy, and for other, more worthy groups of patients than us.  The Mikulski Amendment just brings this brutal fact into sharp focus.

The Skeptic