On July 20, 2011, the American College of Obstetrics and Gynecology (ACOG) joined with the American College of Radiology (ACR) and other groups in recommending annual mammograms for women starting at age 40. I used to deal with ACOG and they are a solid, science-based group that does not jump to conclusions or take marginal positions, so their recommendation is very significant. You can read about it at:
and at the ACOG site:
The new ACOG recommendations stand in stark contrast with those of the United States Preventive Services Task Force (USPSTF). In 2009, amidst the ObamaCare battle, the USPSTF classified mammograms for women between 40 and 50 as a “class C” procedure. “So what,” you might say, “USPSTF has been around for ages, and no one has noticed.” Yes …. but ObamaCare transforms this obscure board into a Frankenstein monster by specifically codifying USPSTF decisions into law.
According to Section 2713 of the Affordable Health Care Act, only procedures classified by USPSTF as “A” or “B” are required to be included in private or public insurance coverage, regardless of the recommendations of other professional organizations. The class “C” rating means that, under ObamaCare, mammograms for women between 40 and 50 would not be covered by insurance.
So what might, anytime during the last 20 years, have been viewed as merely a bad decision by USPSTF, which insurers and doctors could choose to work around, could no longer be ignored, due to the impending passage of ObamaCare. Furthermore, there is no appeal built into the law. That’s right, left to its own devices, the USPSTF, a bureaucratic board with no specific expertise in the area of oncology, could have been responsible for placing the lives of tens of thousands of women at risk – the risk of undetected breast cancer.
In December, 2009, ObamaCare proponent Senator Mikulski was shocked by this ruling. She openly stated that “Studies have found mammography screenings decrease breast cancer deaths among women in their 40s by over 40 percent.” Realizing the public relations nightmare this ruling was for ObamaCare, and genuinely frightened by the prospect that some insurers might decide to conform with the intent of this decision even before ObamaCare became effective, Senator Mikulskui moved quickly to amend other sections of the Law to specifically include coverage for preventive procedures affecting women’s health.
But what about the underlying problem created by Sec 2713 which allowed this situation to arise? What has been done to improve the quality of the future ratings of other preventive procedures by the USPSTF? If you read the amended section, there is no mitigation of USPSTF’s sole purview in determining coverage, no requirement for review or oversight of USPSTF decisions, no requirement for pathology-specific experts to be included on the panel, no requirement for USPSTF to “benchmark” to other recognized standards or recommendations, no feedback loop to monitor negative impacts of USPSTF decisions going forward, and STILL no appeal process.
In short, the Law does not require this bureaucratic Government board to take action to address the root cause of its failure to make a correct, or even supportable, decision about breast cancer screening. Without such corrective action there is nothing to prevent future wrong decisions which could put the Public Health at risk in the same manner. Incredibly, there is no requirement for USPSTF to implement any of the types of safeguards that would, for example, be required of any private sector medical device firm in order to prevent the recurrence of an FDA violation or potential risk to Public Health. All that Congress did in amending Sec 2713 was to exempt decisions made in November 2009, the month that USPSTF made this ridiculous ruling, from having force of law. There is not even a mention that any error was made, or what medical procedures were involved!
This unwillingness to admit to error is typical of Government bureaucracies. In fact, because USPSTF has never rescinded its previous finding, there has been concern in some quarters that the USPSTF could revisit this issue and rerule to uphold its previous position to not cover mammograms for women younger than age 50. Such a new ruling could nullify the amended Section 2713 because that wording is time specific – only denying official status to USPSTF decisions made in November, 2009. Such a ruling might even come into conflict with other provisions of the Mikulski amendment and muddy the waters about who is eligible for what.
That is why the new ACOG decision is so very important. ACOG carries tremendous professional and political clout, and, hopefully, even a system as flawed as ObamaCare would be reluctant to incur the political firestorm that would ensue if USPSTF defied ACOG.
The larger problem, of course, is that the “root cause” of this incredibly harmful USPSTF decision remains unidentified and unaddressed, and there are thousands of other preventive procedures which this board also rates using the same flawed methodology. They are all just time bombs waiting for erroneous ratings by this bureaucratic entity, and they could affect any one of us.
Don’t let anyone tell you there are no “Death Panels” empowered by ObamaCare. In fact, according to the Congressional Research Service, ObamaCare authorizes a literally uncountable number of bureaucracies (see http://www.politico.com/news/stories/0810/40561.html). Many of them may have just as much arbitrary power to deny you access to care as does the USPSTF, and that arbitrary denial of access to care – denial based on bureaucratic considerations rather than grounded in science – is exactly my definition of a death panel!
The Obama-apologist-media love to ridicule popular criticism of ObamaCare by raising the strawman that simple-minded Tea Partiers believe in a “death panel” that sadistically puts thumbs up or down on each individual patient like some modern-day Caligula. Of course, we all understand the bureaucracy doesn’t work that way, but rather makes impersonal decisions on a grand scale that apply to entire demographic groups. But just because these entities don’t consider your individual case won’t make it feel any less personal, or desperate, or outrageous, when it is you or your loved one who is being denied access to life-saving care.
With all the talk about our debt, let’s not forget WE NEED TO REPEAL THIS MONSTROSITY in order to preserve some small modicum of freedom over our own bodies.