I don’t think that word means what you think it means

It’s right there in the title of Senator Hutchison’s op-ed, “Task force undermines freedom“:

The health reform law undermines Americans’ control over their health care in multiple ways. One of the most troubling provisions gives unchecked power to the U.S. Preventive Services Task Force.

This task force’s recommendations determine whether an insurance company must cover certain preventive services. If the task force does not favorably endorse a procedure that an individual and his or her doctor decide is important, the patient could be forced to pay for the service out of pocket or choose to forgo it.

Before health reform, a recommendation from the task force would have been just that — a recommendation. A doctor might take it into consideration while deciding when and how often a specific patient should have a preventive service, like a mammogram or colonoscopy. But the physician would also be looking at other key information, such as medical risks and family history — factors that could easily defy a blanket task force recommendation.

There is so much wrong in this piece that I’m not sure where to start.

Senator Hutchinson makes the argument that the task force is denying you things.  That’s just not so.  The task force makes recommendations as to the quality of evidence to support preventive care.  It’s the United States Preventive Services Task Force.  Not the cancer therapy task force, not the drugs and pharmaceuticals task force, not the end-of-life care task force.  So let’s take a deep breath.  In the case of mammograms, which is what upset Senator Hutchinson here, they recently changed the recommendation on universal screening for women starting at age 40:

In its first reevaluation of breast cancer screening since 2002, the independent government-appointed panel recommended the changes, citing evidence that the potential harm to women having annual exams beginning at age 40 outweighs the benefit.

“We’re not saying women shouldn’t get screened. Screening does saves lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

Know why?  There’s not much conclusive evidence that universal screening saves lives.  And, there is some evidence that it might do harm.  So what did this evil group propose? Diana Petitti, Vice Chair, U.S. Preventive Services Task Force said:

“So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values.”

How is that removing freedom?  Does the word mean anything anymore, or is it just a political catchphrase?

Let’s recap some of the key facts.  The USPSTF did not outlaw mammograms.  They said they no longer routinely recommend them for everyone.  You can get one.  It is possible that your insurance may, at some point in the future, stop paying for them, but that’s an insurance company decision.  Likely a private insurance company decision, since most women in their 40’s don’t have Medicare. But, hey, if you want to pay for it – go ahead!  No one is saying you can’t have one.  They are saying that others might not pay for it.

Does Senator Hutchinson have a problem with that?  That’s the whole point of HSA’s after all.  We make people decide to pay for things with thier own money.  They make personal decisions as to what they think they need.  Does she no longer think that’s a good idea.

If, on the other hand, Senator Hutchinson believes we have a right to any care we want, and if she equates coverage with getting care, then she’s way, way, way to the left of the PPACA.

Senator Hutchinson also seems to have a problem with a group of people deciding what should and should not be covered.  Unless, I guess, it’s a private corporation making that decision.  Then it’s OK?  Because that happens every day, when your private insurance company decides what it covers.

And Senator Hutchinson keeps stating that doctors and patients disagree with the decision.  I’m sure some do, but last I checked, she doesn’t speak for everyone.  Moreover, does she really believe that what insurance should and should not cover be left up to a majority vote?  If people want it covered it should be?


I’m baffled by people who, on the one hand, believe that we should be paying for more things out of pocket, should be reducing health care spending, and that health insurance coverage is not the same as health care, and, on the other hand, seem to state exactly the opposite whenever it’s politically convenient.  Is it really too much to ask for a little consistency here?

Or even better, could politicians please stop being treated as health policy experts?  I’ll agree to stop writing op-eds on politics if they do.

P.S.  In my running theme of old news becoming new again, you can read similar thoughts from me here and here and here and here.

UPDATE: Forgot to thank reader BradF for the tip!

SECOND UPDATE: A friend pointed out a typo

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