Don’t Worry About Your Mammogram

The big news this week was the recent report by the non-partisan, government sponsored, expert panel of physicians and scientists “the US preventative Services Task Force” recommending a major change in guidelines for screening mammography.  The report suggested women between 40-49 should not be screened and women 50-59 should be screened once every other year instead of annually.  Ok, so basically everyone agrees this is nuts.  Women are outraged, physicians seem to universally disagree with the findings, and so does HHS Secretary Kathleen Sebelius.  In fact, the main conclusion in the report was you get 81% of the benefit over the current screening guidelines if we make the change (and save lots of money) but what about the 19% of people who would not benefit?

In truth, no needs to worry.  Insurance companies are not going to change the coverage guidelines and stop paying for screening mammography based on this report.  Certainly, the government is not going to change how Medicare reimburses doctors and hospitals (and it has nothing to do with the fact that women in the impacted age category are not eligible for Medicare anyway).  The public simply will not allow this to happen.  However, it is important to note women do not have universal protection today from insurance companies.  Here is the secret – individual states determine whether an insurance company selling insurance in that state have to pay for mammography screening.  Even in high cost, highly regulated states like New York, mammography coverage is not mandatory for large, self insured plans.  But don’t worry about it anyway.  No one wants to touch this topic.

Here’s the catch.  We are talking a great deal about healthcare reform right now.  The Senate is getting ready (hopefully) to start debating their bill next week (stay tuned for my next blog). Part of healthcare reform is not just covering all uninsured Americans and making sure people can no longer be dropped by their insurance company.  It is also about controlling the spiraling costs of the current system.  One of the proposals in the Senate Bill includes an independent commission of experts that would be appointed to do exactly what the expert panel above did which is review current treatments/drugs/outcomes to make sure we are spending our Medicare dollars wisely.  They would have the ability to stop Medicare from paying for certain services, only to be overruled by a majority in Congress — good luck with that one.  Since most insurance plans follow Medicare guidelines, any future recommendations should they occur, would have broad implications.  Can you imagine what would have happened if the mammography screening study was turned into policy?  Even if the results suggested the panel was right, and the costs far outweighed the benefits, are we going to be ready to face this head on?  I think the mammography study is not a good test case because given the findings, I would never expect to see a change in policy.  But get ready.  This is the process.  Expensive drugs, drastic end of life measures, treatment protocols for horrific diseases will all be fair game.  I hope our country is ready to start the process and have the conversation.  We must do this now.  As I said on Fox News this morning, the cost of doing nothing and watching our healthcare costs continue to climb above the 16% of the GDP it is today is far worse than reforming the system – even if we do not like everything written in the current bills.  The price of doing nothing is far worse.  Just be prepared.

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