The furor over a federal panel’s recommendation against mammograms for most women in their 40s shows the obstacles the U.S. may face trimming costs in a $2.5 trillion health system, even when research suggests the cuts may be appropriate, said Uwe Reinhardt, a Princeton University economist.
U.S. President Barack Obama speaks at a town hall style meeting with university students in Shanghai, on Nov. 16, 2009.
Photographer: Qilai Shen/Bloomberg
With a health-care overhaul nearing a Senate vote, Republicans said the recommendations by the panel, the U.S. Preventive Services Task Force, for fewer mammograms proved Obama’s agenda will lead to rationed care. Democrats, fearful of antagonizing a key voting group in women, said the U.S. won’t change federal reimbursements to support guidelines that most women shouldn’t get regular mammograms until age 50.
The panel’s suggestions provided “the perfect place to throw a bomb into the health-care debate,” said Representative Lynn Woolsey, a Democrat of California and co-leader of the 82- member Congressional Progressive Caucus, in an interview. “We’re not going to ration anything. We’re going to give people choices based on science.”
‘Worst-Case Scenario’
The new guidelines would reduce annual mammograms by more than half under a “worst-case scenario,” said Junaid Husain, a Boston-based analyst at Soleil Securities, in a note to investors Nov. 17. Senator Sam Brownback, a Republican of Kansas, said the task force’s recommendations represent the start of an Obama administration plan to ration health care to pay for its overhaul.
“There are other ways to reduce costs,” Brownback said in an interview. Data show that 17 percent of breast-cancer deaths occur in women from ages 40 to 50, he said. Those statistics mean the panel “is effectively saying 17 percent wasn’t high enough to warrant spending the money to save lives.”
Democrats active in supporting the health-care overhaul legislation sought to distance themselves from the panel’s advice. Woolsey said resources will have to be used more efficiently, “but we’re not going to start with women.”
Medical economists said the U.S. will have to prepare itself for these kinds of decisions if it wants to cut health- care costs. Health-care legislation calls for comparative effectiveness research, as a way to determine whether treatments and procedures aren’t being overused.
Political Science
The new guidelines for mammograms are based on the same kind of science that told the U.S. Food and Drug Administration that Merck & Co.’s painkiller Vioxx posed more dangers than benefits. The Whitehouse Station, New Jersey, company withdrew Vioxx in 2004 after studies showed it increased the risk of heart attacks and strokes.
“You wouldn’t want to see every drug approved,” Reinhardt said in an interview. “The FDA makes judgments on what is effective. If the science kills it then you shouldn’t have to get into the politics.”
Americans want low costs, access to all procedures and technological advances without regard to income, all of which can’t co-exist, said Reinhardt, one of 23 economists who urged Obama in a letter Nov. 17 to make sure Congress includes “additional funding for research into what tests and treatments work and which ones do not.”
‘Russian Roulette’
“In this case, the doctors are saying the risks are too high of getting mammograms every year, so why should we use taxpayer money to play Russian roulette,” Reinhardt said.
The breast cancer test suggestions were followed today by guidelines released by the American College of Obstetricians and Gynecologists on cervical cancer. That group said women should begin cervical cancer screenings at age 21 rather than an earlier age, and most women younger than 30 can get the exam every two years instead of annually.
The cervical cancer guidelines were not immediately challenged by the American Cancer Society, women’s groups and other doctors, as the mammogram suggestions were.
Kathleen Sebelius, the U.S. health and human services secretary, said Nov. 18 the recommendations of the task force, which operates under the umbrella of her department, “won’t determine what services are covered by the federal government” and she would be “very surprised if any private insurance company” changed its coverage decisions. The recommendations “have caused a great deal of worry and confusion among women,” she said in her statement.
AARP Support
Sebelius’s department also administers Medicare, the government insurance program for the elderly, which pays about $94 for a mammogram. Obama, praising the House-passed version of health-care legislation on Nov. 7, cited the Washington-based AARP, the advocacy group for retirees, as one of the vital supporters to his cause.
Insurers led by UnitedHealth Group Inc., the top company by sales, said they are maintaining present policies, which generally cover annual breast screening for women older than 40 if ordered by a doctor.
WellPoint Inc., of Indianapolis, Indiana, Aetna Inc., of Hartford, Connecticut, and Philadelphia-based Cigna Corp. joined UnitedHealth in saying they rely on more than the task force’s recommendations in deciding coverage.
‘Close Look’
“What’s happening here is exactly what should be happening: a close look at what the evidence supports and a reminder that this is a decision women need to talk about with their doctors,” said Tyler Mason, a spokesman for Minnetonka, Minnesota-based UnitedHealth.
This week’s debate has devolved into “a whole lot of hype” about women losing coverage, Mason said by telephone. “I don’t know of one health plan nationwide that’s doing anything with their guidelines as a result of this.”
Insurers generally follow the lead of the National Comprehensive Cancer Network, a nonprofit alliance of 21 schools that study the disease, Mason said. The Fort Washington, Pennsylvania-based group said in a statement Nov. 16 it would continue to recommend annual mammograms for women starting at age 40.
If insurers are going to cut coverage, they aren’t likely to admit it in the current political environment, as lawmakers consider new restrictions on the industry, said Therese B. Bevers, chairwoman of the network’s panel on breast-screening guidelines and medical director of the Cancer Prevention Center at M.D. Anderson Cancer Center in Houston.
Insurers may find the lower costs of policies without mammograms irresistible, as will small businesses struggling with soaring premiums, Bevers said by telephone. “That’s a huge factor for them,” she said.
Known for Conservatism
The task force is known for its conservatism in recommending procedures, and its statistical analysis may have missed the calculus women make in their own minds, Bevers said.
“If you ask the women in my clinic, most of them would tell you they’d be willing to undergo an unnecessary biopsy so some other woman, not even them, may not die of breast cancer,” she said.
The task force was formed in 1984 to give advice on screening, counseling and preventive medicines based on an impartial assessment of scientific evidence. The panel has been supported by the U.S. Agency for Healthcare Research and Quality since 1998.
Sixteen academic and practicing doctors make up the group, according to the panel’s Web site. They have published guidelines on more than 100 topics and are reviewing 11 more, including cervical cancer screening, preventive medicine for osteoporosis and skin cancer counseling.
2002 Recommendation
The recommendation that 40-year-old women should get mammograms to detect breast cancer was first issued by the task force in 2002 with a grade of ‘B,’ meaning there was “at least fair evidence” that it “improves important health outcomes.”
Health-care policy analyst Henry Aaron said the timing couldn’t be worse.
“This was a scientific recommendation, but at the same time dealing with women’s breasts provokes real sensitivity,” said Aaron, who works at the Brookings Institution, a Washington foundation that does policy research. “I know I heard an earful from my wife at the breakfast table this morning.” [rc]
Alex Nussbaum in New York
E-Mail: anussbaum1@bloomberg.net
Pat Wechsler in New York
E-Mail: pwechsler@bloomberg.net
Nicole Gaouette in Washington
E-Mail: ngaouette@bloomberg.net
Copyright Bloomberg LLC
November 20, 2009
USA: Breast Exam Guidelines Test Obama Cost-Cutting
.
NEW YORK, NY / Bloomberg News / November 20, 2009
By Pat Wechsler, Alex Nussbaum and Nicole Gaouette
A medical debate over breast-cancer screening that has turned political may set the tone for a battle over President Barack Obama’s health-care overhaul that will resonate for years.
The furor over a federal panel’s recommendation against mammograms for most women in their 40s shows the obstacles the U.S. may face trimming costs in a $2.5 trillion health system, even when research suggests the cuts may be appropriate, said Uwe Reinhardt, a Princeton University economist.
U.S. President Barack Obama speaks at a town hall style meeting with university students in Shanghai, on Nov. 16, 2009.
Photographer: Qilai Shen/Bloomberg
With a health-care overhaul nearing a Senate vote, Republicans said the recommendations by the panel, the U.S. Preventive Services Task Force, for fewer mammograms proved Obama’s agenda will lead to rationed care. Democrats, fearful of antagonizing a key voting group in women, said the U.S. won’t change federal reimbursements to support guidelines that most women shouldn’t get regular mammograms until age 50.
The panel’s suggestions provided “the perfect place to throw a bomb into the health-care debate,” said Representative Lynn Woolsey, a Democrat of California and co-leader of the 82- member Congressional Progressive Caucus, in an interview. “We’re not going to ration anything. We’re going to give people choices based on science.”
‘Worst-Case Scenario’
The new guidelines would reduce annual mammograms by more than half under a “worst-case scenario,” said Junaid Husain, a Boston-based analyst at Soleil Securities, in a note to investors Nov. 17. Senator Sam Brownback, a Republican of Kansas, said the task force’s recommendations represent the start of an Obama administration plan to ration health care to pay for its overhaul.
“There are other ways to reduce costs,” Brownback said in an interview. Data show that 17 percent of breast-cancer deaths occur in women from ages 40 to 50, he said. Those statistics mean the panel “is effectively saying 17 percent wasn’t high enough to warrant spending the money to save lives.”
Democrats active in supporting the health-care overhaul legislation sought to distance themselves from the panel’s advice. Woolsey said resources will have to be used more efficiently, “but we’re not going to start with women.”
Medical economists said the U.S. will have to prepare itself for these kinds of decisions if it wants to cut health- care costs. Health-care legislation calls for comparative effectiveness research, as a way to determine whether treatments and procedures aren’t being overused.
Political Science
The new guidelines for mammograms are based on the same kind of science that told the U.S. Food and Drug Administration that Merck & Co.’s painkiller Vioxx posed more dangers than benefits. The Whitehouse Station, New Jersey, company withdrew Vioxx in 2004 after studies showed it increased the risk of heart attacks and strokes.
“You wouldn’t want to see every drug approved,” Reinhardt said in an interview. “The FDA makes judgments on what is effective. If the science kills it then you shouldn’t have to get into the politics.”
Americans want low costs, access to all procedures and technological advances without regard to income, all of which can’t co-exist, said Reinhardt, one of 23 economists who urged Obama in a letter Nov. 17 to make sure Congress includes “additional funding for research into what tests and treatments work and which ones do not.”
‘Russian Roulette’
“In this case, the doctors are saying the risks are too high of getting mammograms every year, so why should we use taxpayer money to play Russian roulette,” Reinhardt said.
The breast cancer test suggestions were followed today by guidelines released by the American College of Obstetricians and Gynecologists on cervical cancer. That group said women should begin cervical cancer screenings at age 21 rather than an earlier age, and most women younger than 30 can get the exam every two years instead of annually.
The cervical cancer guidelines were not immediately challenged by the American Cancer Society, women’s groups and other doctors, as the mammogram suggestions were.
Kathleen Sebelius, the U.S. health and human services secretary, said Nov. 18 the recommendations of the task force, which operates under the umbrella of her department, “won’t determine what services are covered by the federal government” and she would be “very surprised if any private insurance company” changed its coverage decisions. The recommendations “have caused a great deal of worry and confusion among women,” she said in her statement.
AARP Support
Sebelius’s department also administers Medicare, the government insurance program for the elderly, which pays about $94 for a mammogram. Obama, praising the House-passed version of health-care legislation on Nov. 7, cited the Washington-based AARP, the advocacy group for retirees, as one of the vital supporters to his cause.
Insurers led by UnitedHealth Group Inc., the top company by sales, said they are maintaining present policies, which generally cover annual breast screening for women older than 40 if ordered by a doctor.
WellPoint Inc., of Indianapolis, Indiana, Aetna Inc., of Hartford, Connecticut, and Philadelphia-based Cigna Corp. joined UnitedHealth in saying they rely on more than the task force’s recommendations in deciding coverage.
‘Close Look’
“What’s happening here is exactly what should be happening: a close look at what the evidence supports and a reminder that this is a decision women need to talk about with their doctors,” said Tyler Mason, a spokesman for Minnetonka, Minnesota-based UnitedHealth.
This week’s debate has devolved into “a whole lot of hype” about women losing coverage, Mason said by telephone. “I don’t know of one health plan nationwide that’s doing anything with their guidelines as a result of this.”
Insurers generally follow the lead of the National Comprehensive Cancer Network, a nonprofit alliance of 21 schools that study the disease, Mason said. The Fort Washington, Pennsylvania-based group said in a statement Nov. 16 it would continue to recommend annual mammograms for women starting at age 40.
If insurers are going to cut coverage, they aren’t likely to admit it in the current political environment, as lawmakers consider new restrictions on the industry, said Therese B. Bevers, chairwoman of the network’s panel on breast-screening guidelines and medical director of the Cancer Prevention Center at M.D. Anderson Cancer Center in Houston.
Insurers may find the lower costs of policies without mammograms irresistible, as will small businesses struggling with soaring premiums, Bevers said by telephone. “That’s a huge factor for them,” she said.
Known for Conservatism
The task force is known for its conservatism in recommending procedures, and its statistical analysis may have missed the calculus women make in their own minds, Bevers said.
“If you ask the women in my clinic, most of them would tell you they’d be willing to undergo an unnecessary biopsy so some other woman, not even them, may not die of breast cancer,” she said.
The task force was formed in 1984 to give advice on screening, counseling and preventive medicines based on an impartial assessment of scientific evidence. The panel has been supported by the U.S. Agency for Healthcare Research and Quality since 1998.
Sixteen academic and practicing doctors make up the group, according to the panel’s Web site. They have published guidelines on more than 100 topics and are reviewing 11 more, including cervical cancer screening, preventive medicine for osteoporosis and skin cancer counseling.
2002 Recommendation
The recommendation that 40-year-old women should get mammograms to detect breast cancer was first issued by the task force in 2002 with a grade of ‘B,’ meaning there was “at least fair evidence” that it “improves important health outcomes.”
Health-care policy analyst Henry Aaron said the timing couldn’t be worse.
“This was a scientific recommendation, but at the same time dealing with women’s breasts provokes real sensitivity,” said Aaron, who works at the Brookings Institution, a Washington foundation that does policy research. “I know I heard an earful from my wife at the breakfast table this morning.” [rc]
Alex Nussbaum in New York
E-Mail: anussbaum1@bloomberg.net
Pat Wechsler in New York
E-Mail: pwechsler@bloomberg.net
Nicole Gaouette in Washington
E-Mail: ngaouette@bloomberg.net
Copyright Bloomberg LLC
The furor over a federal panel’s recommendation against mammograms for most women in their 40s shows the obstacles the U.S. may face trimming costs in a $2.5 trillion health system, even when research suggests the cuts may be appropriate, said Uwe Reinhardt, a Princeton University economist.
U.S. President Barack Obama speaks at a town hall style meeting with university students in Shanghai, on Nov. 16, 2009.
Photographer: Qilai Shen/Bloomberg
With a health-care overhaul nearing a Senate vote, Republicans said the recommendations by the panel, the U.S. Preventive Services Task Force, for fewer mammograms proved Obama’s agenda will lead to rationed care. Democrats, fearful of antagonizing a key voting group in women, said the U.S. won’t change federal reimbursements to support guidelines that most women shouldn’t get regular mammograms until age 50.
The panel’s suggestions provided “the perfect place to throw a bomb into the health-care debate,” said Representative Lynn Woolsey, a Democrat of California and co-leader of the 82- member Congressional Progressive Caucus, in an interview. “We’re not going to ration anything. We’re going to give people choices based on science.”
‘Worst-Case Scenario’
The new guidelines would reduce annual mammograms by more than half under a “worst-case scenario,” said Junaid Husain, a Boston-based analyst at Soleil Securities, in a note to investors Nov. 17. Senator Sam Brownback, a Republican of Kansas, said the task force’s recommendations represent the start of an Obama administration plan to ration health care to pay for its overhaul.
“There are other ways to reduce costs,” Brownback said in an interview. Data show that 17 percent of breast-cancer deaths occur in women from ages 40 to 50, he said. Those statistics mean the panel “is effectively saying 17 percent wasn’t high enough to warrant spending the money to save lives.”
Democrats active in supporting the health-care overhaul legislation sought to distance themselves from the panel’s advice. Woolsey said resources will have to be used more efficiently, “but we’re not going to start with women.”
Medical economists said the U.S. will have to prepare itself for these kinds of decisions if it wants to cut health- care costs. Health-care legislation calls for comparative effectiveness research, as a way to determine whether treatments and procedures aren’t being overused.
Political Science
The new guidelines for mammograms are based on the same kind of science that told the U.S. Food and Drug Administration that Merck & Co.’s painkiller Vioxx posed more dangers than benefits. The Whitehouse Station, New Jersey, company withdrew Vioxx in 2004 after studies showed it increased the risk of heart attacks and strokes.
“You wouldn’t want to see every drug approved,” Reinhardt said in an interview. “The FDA makes judgments on what is effective. If the science kills it then you shouldn’t have to get into the politics.”
Americans want low costs, access to all procedures and technological advances without regard to income, all of which can’t co-exist, said Reinhardt, one of 23 economists who urged Obama in a letter Nov. 17 to make sure Congress includes “additional funding for research into what tests and treatments work and which ones do not.”
‘Russian Roulette’
“In this case, the doctors are saying the risks are too high of getting mammograms every year, so why should we use taxpayer money to play Russian roulette,” Reinhardt said.
The breast cancer test suggestions were followed today by guidelines released by the American College of Obstetricians and Gynecologists on cervical cancer. That group said women should begin cervical cancer screenings at age 21 rather than an earlier age, and most women younger than 30 can get the exam every two years instead of annually.
The cervical cancer guidelines were not immediately challenged by the American Cancer Society, women’s groups and other doctors, as the mammogram suggestions were.
Kathleen Sebelius, the U.S. health and human services secretary, said Nov. 18 the recommendations of the task force, which operates under the umbrella of her department, “won’t determine what services are covered by the federal government” and she would be “very surprised if any private insurance company” changed its coverage decisions. The recommendations “have caused a great deal of worry and confusion among women,” she said in her statement.
AARP Support
Sebelius’s department also administers Medicare, the government insurance program for the elderly, which pays about $94 for a mammogram. Obama, praising the House-passed version of health-care legislation on Nov. 7, cited the Washington-based AARP, the advocacy group for retirees, as one of the vital supporters to his cause.
Insurers led by UnitedHealth Group Inc., the top company by sales, said they are maintaining present policies, which generally cover annual breast screening for women older than 40 if ordered by a doctor.
WellPoint Inc., of Indianapolis, Indiana, Aetna Inc., of Hartford, Connecticut, and Philadelphia-based Cigna Corp. joined UnitedHealth in saying they rely on more than the task force’s recommendations in deciding coverage.
‘Close Look’
“What’s happening here is exactly what should be happening: a close look at what the evidence supports and a reminder that this is a decision women need to talk about with their doctors,” said Tyler Mason, a spokesman for Minnetonka, Minnesota-based UnitedHealth.
This week’s debate has devolved into “a whole lot of hype” about women losing coverage, Mason said by telephone. “I don’t know of one health plan nationwide that’s doing anything with their guidelines as a result of this.”
Insurers generally follow the lead of the National Comprehensive Cancer Network, a nonprofit alliance of 21 schools that study the disease, Mason said. The Fort Washington, Pennsylvania-based group said in a statement Nov. 16 it would continue to recommend annual mammograms for women starting at age 40.
If insurers are going to cut coverage, they aren’t likely to admit it in the current political environment, as lawmakers consider new restrictions on the industry, said Therese B. Bevers, chairwoman of the network’s panel on breast-screening guidelines and medical director of the Cancer Prevention Center at M.D. Anderson Cancer Center in Houston.
Insurers may find the lower costs of policies without mammograms irresistible, as will small businesses struggling with soaring premiums, Bevers said by telephone. “That’s a huge factor for them,” she said.
Known for Conservatism
The task force is known for its conservatism in recommending procedures, and its statistical analysis may have missed the calculus women make in their own minds, Bevers said.
“If you ask the women in my clinic, most of them would tell you they’d be willing to undergo an unnecessary biopsy so some other woman, not even them, may not die of breast cancer,” she said.
The task force was formed in 1984 to give advice on screening, counseling and preventive medicines based on an impartial assessment of scientific evidence. The panel has been supported by the U.S. Agency for Healthcare Research and Quality since 1998.
Sixteen academic and practicing doctors make up the group, according to the panel’s Web site. They have published guidelines on more than 100 topics and are reviewing 11 more, including cervical cancer screening, preventive medicine for osteoporosis and skin cancer counseling.
2002 Recommendation
The recommendation that 40-year-old women should get mammograms to detect breast cancer was first issued by the task force in 2002 with a grade of ‘B,’ meaning there was “at least fair evidence” that it “improves important health outcomes.”
Health-care policy analyst Henry Aaron said the timing couldn’t be worse.
“This was a scientific recommendation, but at the same time dealing with women’s breasts provokes real sensitivity,” said Aaron, who works at the Brookings Institution, a Washington foundation that does policy research. “I know I heard an earful from my wife at the breakfast table this morning.” [rc]
Alex Nussbaum in New York
E-Mail: anussbaum1@bloomberg.net
Pat Wechsler in New York
E-Mail: pwechsler@bloomberg.net
Nicole Gaouette in Washington
E-Mail: ngaouette@bloomberg.net
Copyright Bloomberg LLC
