In response to a September 25, 2013, Fox story on mammography, Media Matters has published a response and critique. Unfortunately it has a lot half-truths and wishful thinking to support their premise that Obamacare is infallible and benign. The tragedy here is that discussions of this subject which fail to categorically condemn the November 2009, decision by an ObamaCare board, the USPSTF (United States Preventive Services Task Force), can only lead to further confusion about mammograms among patients and doctors.
This confusion has already resulted in 54,000 fewer mammograms per year for women between the ages of 40 and 49 according to a Mayo Clinic study released in 2012. You can read about it at http://consumer.healthday.com/Article.asp?AID=666143″>http://consumer.healthday.com/Article.asp?AID=666143 or at the Mayo Clinic site http://www.advisory.com/Daily-Briefing/2012/07/05/Mammography-rate-dipped-following-USPSTF-guidelines
However, the Fox story is also incorrect. Let’s take on these claims and evaluate whether dumb Fox or evil Media Matters is more correct about mammograms under ObamaCare.
Fox: The USPSTF recommendations would delay the beginning of regular mammograms until age 50.
Inaccurate – that WOULD have happened except that Senator Mikulski and others amended ObamaCare to nullify the task force’s November 2009 recommendation.
Fox: The USPSTF recommendations would end mammograms at age 74.
Inaccurate – The USPSTF held off judgment on this issue for lack of data
Fox: Cancer patients take a greater reduction in services from ObamaCare than other patients.
True, but it’s not just from ObamaCare. Congress has reduced the budget share for cancer treatment compared to other health care areas several times even before ObamaCare was on the scene.
Fox: Hospitals and doctors are disincentivized from providing care to the elderly.
True – The payment schemes in Medicare will now punish doctors and hospitals exceeding a baseline average per patient expenditure deemed appropriate for their institution. Hospital readmissions will also result in penalties.
And now for Media Matters
Media Matters: ObamaCare Contains “Specific Repudiation” Of the Task Force Recommendation
Inaccurate – Although Media Matters faithfully presents the wording in the Act, the assertion that it is specific, or that it repudiates the USPSTF finding is unfounded – you be the judge. Here is the wording:
“…the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography and prevention shall be considered the most current other than those issued in or around November 2009,”
Is that clear to you? This awkward wording was added after the issuance of the recommendations to try and fix up the mess in the Act. I will translate – the “current” recommendation (of November 2009) is not the “most current.” Rather, the previous “current” recommendation of 2002 is now considered the “most current.” This wording, far from being specific, does not even mention any problem with the 2009 recommendation, and does not give any hint of disapproval or sanction.
Actually, the vagueness of the wording fulfills that age-old bureaucratic requirement of not admitting to error, and of not tying your hands for the future. The time-specific wording of the rescission also leaves open the possibility that USPSTF could revisit mammography at some time other than “November 2009” and make a similar recommendation. The USPSTF has never rescinded their recommendation, and, in fact, have defended it, so a future similar recommendation would not be surprising.
Media Matters: The task force’s recommendations are “not binding”
Inaccurate – They are really reaching here – using only media references including a statement from a paid TV Doc (NBC’s Snyderman). But the law is another matter, and it is quite specific at sec 2713 – USPSTF is empowered to rate diagnostic procedures as “A”, “B”, or “C.” When it rates a procedure as “C,” co-pays can be required by the insurer. All I can guess is that Snyderman was thinking it is not binding on doctors, but, when “C” is decided, it’s pretty binding on patients because their insurers are not going to cover any such procedure for free. The result may be that many patients may elect not to pay for a Class C test that they would just as soon avoid in the first place.
But actually it’s worse than that. Media Matters also uses a statement from the NEA Health Network to point out that the recommendations are not binding, but also were only intended to protect women from unnecessary procedures. That rationale is indeed part of the USPSTF finding and one would have to be extremely dense to think that such a finding published by a Government board of supposed “experts” would not impact doctors’ decisions to prescribe the test. In fact, the Mayo Clinic study has shown that the USPSTF “recommendations” resulted in 54,000 fewer mammograms per year among women 40-49.
Media Matters: Task Force Did Not Recommend Blanket Ban On Mammograms For Women Under 50 AND
Task Force Encouraged Policymakers To Include Additional Considerations And “Individualize Decision Making To The Specific Patient Or Situation”
Misleading – These boiler-plate type disclaimers by USPSTF overestimate the power of both doctors and policymakers to act outside the recommended guidelines. Every guidance document I wrote at FDA prominently bore required statements that they constituted non-binding guidance. However, once issued, these documents were slavishly adhered to by industry, who are just looking for a ‘safe harbor’ where they will have reduced exposure to litigation. Doctors are in this same boat trying to avoid exposure to malpractice, and policymakers are just looking for an expert on whose opinion they can base their position – they are not going to go beyond what they are handed.
So who fared worse in this clash of titans? I would say that Fox made the more egregious factual error in failing to recognize that ObamaCare ultimately did include the Mikulski amendment rescinding the November 2009 recommendation. However, Media Matters’ omission of the desperate need for an 11th hour amendment to “fix” the mistake made by a board specifically empowered by ObamaCare, and the assertion there was no problem anyway because the recommendation was non-binding, puts a happy face on a systemic shortcoming that is far from fixed for every other diagnostic procedure, and maybe even for mammography. This board’s power is essentially unchecked and there are insufficient safeguards to make sure that their future errors are not as catastrophic as this one.
To the extent that Media Matters may have lulled their public to sleep and avoided the root issue that still exists at sec 2713, their errors of omission may have the more severe Public Health consequences.