Health care decisions should be the peoples’

By Brian Greenspun (contact)

Sunday, Nov. 22, 2009 | 2 a.m.

How’s this for timing?

Here was Senate Majority Leader Harry Reid, ready to unveil his long-awaited Senate health care bill — a bill that, while it has drawn the usual complaints from the usual suspects, hasn’t been dismissed as unworkable or unreasonable.

And then, unexpected, was an announcement about detection of breast cancer that suddenly overshadowed the entire health care debate.

If it is true that timing is everything, the timing of the U.S. Preventive Services Task Force’s recommendations regarding mammograms was downright ridiculous and clearly harmful to any responsible effort to reform our out-of-control health care system.

One constant refrain in the health care debate has to do with the “public option” plan that, depending upon which side you talk to, is either not a government takeover of health care but merely an option designed to provide competition to the insurance companies, or is Big Brother incarnate trying to gobble up one-sixth of our federal budget, enslave future generations and put the insurance companies out of business.

As is the case with most things controversial in our country, where you come down on this subject has a lot to do with how you see politics, where you watch television or how you discern fact from fiction. In this case, though, the facts are clear, and therein lies the problem.

While the debate rages on about government involvement in health care decisions — complete with purported death panels designed to save money — here comes this recommendation from the U.S. Preventive Services Task Force that says women 40 to 49 years old need not have routine mammograms. That is a departure from the advice of practically every other organization that deals with breast cancer and recommends mammograms as a vital part of the preventive regimen for that disease.

And because the words “United States” describe the health panel that came up with that little gem, to those who oppose comprehensive health care reform, conjuring up federal bureaucrats deciding who lives or dies is a no-brainer.

It is one more major reason why the government needs to stay out of the health care decision-making business. Taken a step further, it is absolute proof that insurance companies and their functionaries have to be kept out of these kinds of decisions because with them it is always about money.

No good reason to delay

The mammogram recommendation is so obviously wrong on practically every level.

Women — they are the people most likely to get breast cancer — know better than to wait an extra 10 years before they start routine screening for what is the most common cancer among women in the United States.

It is counterintuitive for women who are interested in early detection to accept any suggestion that says test later, not earlier. In fact, the incidence of breast cancer in young women — women in their 20s and 30s — is growing at an alarming rate.

A recommendation that takes one of the best tools we have for early detection and puts it out of reach for many women is ludicrous.

Unfortunately, the timing of the report clouds the debate over health care. Simply put, “if the government can’t get this mammogram thing right, then how can it be trusted with my family’s other health care decisions?”

Again, the premise is wrong — doctors and patients must be the only folks involved with personal, health care decision-making — but the argument sounds good enough to distract many Americans from the substance of the debate.

Cancer striking earlier

The good news is that people in positions of responsibility have distanced themselves from the recommendations. Health and Human Services Secretary Kathleen Sebelius said the task force “does not set federal policy and they don’t determine what services are covered by the federal government.”

Experts in the field have also weighed in, from the American Cancer Society to practically every other responsible institution that deals with cancer and, especially, breast cancer. While I am no expert, I have had too much practical experience with the disease of late and I can tell you that breast cancer doesn’t just show up at age 50.

While it may be true that breast tissue in younger women fails to show the kind of contrast that is provided by the tests in older women — and, therefore, positive readings are more challenging — the fact remains that early detection is early detection.

Cancer treatment centers seem to have more young women showing up for treatment than ever before. To suggest that women in their 40s forgo regular testing while breast cancer strikes women at ever younger ages flies in the face of what most of us know instinctively.

A spokesman for the American Cancer Society put it best. “Mammography for women ages 40-49 saves lives. Just not enough of them!” That makes the panel’s decision sound like it’s about money, pure and simple.

Panels don’t set policy

I think one of the first things the Senate should do when it starts to work on the health care bill is make it clear to all of us that panels like the Preventive Services Task Force have no place in setting policy or making decisions for the kind of health care we will receive, regardless of the health plan we have.

If there is one principle that must survive the legislative process, it should be that decisions about our health and our health care must be made by doctors and patients. Period.

Right now the insurance companies have the upper hand. People fear that tomorrow it could be the federal government that will call the shots. It will do no one any good to substitute one set of bureaucrats for another.

If timing is everything, now would be a very good time to make sure every American knows that when it comes to our health care decisions — regardless of who pays and how — we, the people, are in charge.

Brian Greenspun is editor of the Las Vegas Sun.