Liberals and Mammography

Rationing? What rationing?

The flap over breast cancer screening has provided a fascinating insight into the political future of ObamaCare. Specifically, the political left supports such medical rationing even as it disavows that any such thing is happening.
No sooner had the Health and Human Services Department's U.S. Preventative Services Task Force recommended against mammography for women under 50 than Secretary Kathleen Sebelius rushed to say don't worry. The decision had "caused a great deal of confusion and worry among women," she said, promising that no policies would change. New Jersey's Frank Pallone vowed to hold hearings, and Senator Dick Durbin leveled the gravest charge Democrats can make: The task force was "appointed by President Bush."
The political duck-and-cover was also on display in that vanguard of ObamaCare known as the New York Times, which ran at least four much-ado-about-nothing items even as it endorsed the reduced screening. On the same day as an editorial and op-ed, a front-page "news analysis" lectured that what the public really needs is "a transformational shift in thinking" about the "evidence-based" medical future that the mammogram decision portends. Yes, and no doubt the Times will tell us what "evidence" to follow.
Even more revealing was Princeton's Uwe Reinhardt, a leading liberal health-care economist, writing on the New York Times Economix blog. Mr. Reinhardt sees the task force's handiwork as an exemplar of "rational decision-making" that had nothing to do with cost analysis, even as he claimed that rationing based on cost is inevitable.
You have to admire Mr. Reinhardt's partisan dexterity. He knows that no government task force is ever going to justify a treatment denial with an overt claim to costs. Instead, the task force found a sneaky way to use clinical data to take costs into account without admitting it. It cites all sorts of harm associated with the problem of "overdiagnosis"—i.e., too many costly procedures. This is a reference to mammograms that lead to further tests and treatments that in hindsight are unnecessary.
The HHS task force concludes that this harm outweighs the benefits of saving lives through early detection, yet this makes little sense unless financial costs are a priority. For instance, the panel cites patient anxiety from false positives, yet the literature also shows overwhelmingly that women would rather risk a scare than allow a cancer to progress—especially considering that about 75% of all breast cancers develop in women who do not have special risk factors.
In any event, the distinction between cost effectiveness and clinical effectiveness will be moot if ObamaCare passes. The House bill gives the HHS task force the mandate to review "the benefits, effectiveness, appropriateness, and costs of clinical preventive services" in making its de facto insurance coverage rulings. As Mr. Reinhardt notes, "at some point soon the rising cost of American health care actually will force Americans to bring monetary costs into the analysis as well."
What's really going on here is that the left knows its designs will require political rationing of care, but it doesn't want the public to figure this out until ObamaCare passes. Then it will begin the campaign to instruct the rest of us that we must follow the guidance of Princeton professors about what medical care we can receive. Americans will simply have to accept that the price of government-run health care in the name of redistributive justice is that patients and their doctors must bow to the superior wisdom of HHS task forces.
Just don't admit it until after the White House signing ceremony.