Cost-Cutting Begins

By Robert Wallace
America’s Right

Until this week I had never heard of the U.S. Preventive Services Task Force, but the government group made headlines when it released updated guidelines recommending that women in their 40s should not get mammograms.

Right off the bat the recommendations didn’t make a lot of sense to me. What’s the harm in doing the tests? According to the task force there is a concern that false positives could lead to women being scared while they wait for the test results. Or that women who don’t get mammograms and then get cancer will feel guilty. Really? Guilt and trepidation are reasons to not screen yourself for a deadly disease?

But the real story came when Health and Human Services Kathleen Sebelius weighed into the controversy:

My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer, and they still are today… There are other groups who have disagreed with this information.

She then added that the task force is “making recommendations, not coverage decisions, not payment decisions.” This is true. For now.

If you don’t feel like watching the video, here is the money quote from former NIH director Bernadine Healy:

She [Sebelius] is absolutely wrong in saying this does not determine the kinds of preventative services covered. It absolutely does. Health reform designates this Preventive Services Task Force as the sole source informant for what preventive services will be covered. It doesn’t go to the doctor groups, it just uses this government group. And this particular government group was just one of a voice of many… suddenly they have been elevated to be the choice of the government for setting standards. Specificaly in the language in the House bill… only A’s and B’s will be covered, which means C’s won’t be. [T]his mammogram report… lowered to C coverage for women in their 40s and over 75 years of age.

Right now we can all safely ignore the recommendations of the Task Force, but if the healthcare reform bill becomes law so will these suggestions.

You might think that this is another example of deliberate deception from the Obama administration. That was my first reaction. I figured that this was a trial balloon to see how strong the backlash to service-cutting would be, but I’ve changed my mind.

First of all there is the simple fact that this Task Force predates the Obama administration and many of the appointees are Bush appointees. So it’s more likely – but not any more comforting – that this is merely an unintended and unforeseen consequence of the Obama administration’s approach to healthcare reform.

And that’s really the hallmark problem with Democratic fiscal policy, isn’t it? Lack of foresight.

The healthcare reform effort is supposed to achieve two goals at the same time: cut costs and cover more people. And the more you can cut costs, the more people you can cover with the same amount of money. So far so good.

The problem is that the strategy they have taken is to create a command economy where the government sets prices rather than the market. We have about a century’s worth of history in modern command economies and the evidence is clear: they don’t work. You can force people to set lower prices for a good or service, but the only result is that there is even less of that good or service to go around.

Americans want to cover more people, but you can’t cover more people with fewer services.

A secondary myth this should explode is the myth that preventive services are some kind of economic silver bullet. No matter how much Obama may try to demonize the insurance industry and doctors as money-grubbing fiends who would rather skip a test now so that they can charge for a surgery later, the fact is that more often then not the preventive services cost more than they save. Not only do you have to pay for the tests themselves, but often the result of finding a disease earlier is more cost, not less. Because if you don’t catch cancer until it’s about to kill you there’s not a lot of time to fight it and there’s not a lot that can be done. If you catch it earlier you will live longer and use more resources. So this kinds of screenings raise costs, they don’t lower them.

As Healy put it:

This group focuses on public health and economics and modeling and health policy. This is very different from groups… who sit down and look specifically at what’s right for the patient.

That’s exactly what is going to result from the healthcare reform. Government bureaucrats are going to determine what tests and treatments you are allowed to get based on balancing their spreadsheets. This is why the Task Force didn’t include a single oncologist, and their recommendation has been criticized by the American Cancer Society. In a few months or years – if the reform passes – those criticisms won’t matter.

Healy also said:

In the area of cancer we lead the world and that includes breast cancer and prostate cancer, and it is in large part because we do vigorous and aggressive screening which other countries don’t do.

So this reform is going to take those areas where the United States is definitively leading the world and cripple them. Yay for fairness, right?

I don’t believe Sebelius or Obama had anything to do with the report this Task Force just offered, but I most certainly believe that they are having an influence now. And the orders they are giving are simple: “shut up”.

There will be plenty of time to ration healthcare later, after the healthcare bill votes. We wouldn’t want the concerns of the American people to weigh on their representatives minds during such an important vote now, would we?

Robert Wallace is classical liberal studying economics in graduate school. He and his wife work as business analysis consultants, and they live as undercover conservatives with their two small children in a socialist bastion of a college town. He has been writing for America’s Right since December 2008.



  1. Dee says:

    I was infuriated when I read this yesterday and even more so today when I read that they feel women don't need early Pap smears and not as frequently. I was in my
    40's when a mammogram showed a suspicious finding. They did a biopsy right there and thankfully it was a cyst. Yes, I did worry until the results came in but all I could think of was my mother, who did not have a mammogram until it was too late and she died in her early 50's. When I thought about it, her cancer started at about the same age I was when the cyst was discovered. We have a good friend who had breast cancer a year after her wedding. She was in her early 30's. That was 15 years ago and she is doing wonderfully. I know it is all about money and this administration is the worst one I have ever experienced. They have no feelings or experience. All I can think of is that "what goes around, comes around". Thank you, Robert, for a great article.

  2. Anonymous says:

    Well put, Robert.

    And, whats_up … because no other administration is looking to ration care. This administration knows what will happen. This administration and all of its people want single-payer, and it doesn't take a rocket scientist to see what happens in terms of rationing in other single-payer systems.

  3. Boston Blackie says:

    Like I said before. I'd rather be scared from a false positve in my 40's than dead in my 50's. Dead is so permanent.

  4. whats_up says:

    The group that is talking about Pap smears is a totally unrelated group. Why do conservatives feel the need to incorporate them all into "this administration"

  5. Robert Wallace says:


    "The group that is talking about Pap smears is a totally unrelated group. Why do conservatives feel the need to incorporate them all into "this administration""

    I actually left the pap-smear recommendations out of the article. But you're not quite correct on why it's irrelevant.

    It isn't a question of whether or not this administration is to blame because what this administration wants is not the issue. Once you unleash a healthcare reform that is empowered to deny coverage for preventive tests based on cost-cutting objectives it no longer matters what the Obama administration or any other adminstration may want. Coverage is going to be cut when it makes economic sense, and that means you will see rationing for (among other things) mammorgrams.

    The reason that the pap smear report is not relevant is that the basis for recommending they be done less was medical, not economic.

    I don't know enough about the medicine to agree/disagree, but I have no problem with the reasoning. Saying "we shouldn't do test X because it's medically bad for the patient" is a whole different ballgame than "we shouldn't do test X because it will cost the government too much money".

    See the difference?

  6. Boston Blackie says:

    Amen, Robert, Amen!

  7. whats_up says:

    To anonymous,

    So because Obama wants to do that, it is okay to lie about who is giving out information? That just doesnt make sense. The group that put out the Pap smear recomendations has no ties to the Obama administration whatsoever.

  8. Boston Blackie says:

    whats_up said…
    Boston Blackie,
    Which govt agency was that?
    November 19, 2009 3:37 PM

    Hey whats_up,
    Yesterday, you questioned where I got my info regarding the delay of mammograms, as if I made it up. Today you complain that Dee mentioned pap smears, do you even have any common sense on how quickly cancer spreads. In case you want to question Dee, here is the article;

    The American Congress of Obstetricians and Gynecologists released new pap smear guidlelines that dramatically decrease the frequency of the exam. The organization now recommends that women wait until they are 21 years of age instead of 18 before receiving their first pap smears. Women younger than 30 may forego annual rescreening and instead opt for biennial pap smears; women older than 30 can stretch it out to three years in between pap smears.
    Just six short years ago, the ACOG offered different pap smears recommendations. The 2003 Pap smear guidelines stated that women 21 years of age or older as well as those younger, who had been sexually active, are candidates for pap smears. As a general rule of thumb, women under the age of 30 were to have annual Pap smear tests, while those over the age of 30 – with three normal pap tests in three consecutive years – could stretch out their rescreening to one test every two to three years.

    (I hope that wasn't too much info for you to absorb)
    These groups are lining up with the administration so not to piss them off and lose funding.
    I hope to God no woman you know get either of these cancers if this disaster of a healthplan goes through.

  9. goddessdivine says:

    Less mammograms and no self-examination? Yeah, tell that to my mom who found a lump, and immediately went to the doctor to find out it was cancerous. She had surgery and chemo right away.

    I hate to think that I won't be so lucky….as the rationing could be in full force when something like that hits me. Do these groups not get that people have a substantially higher chance of survival if cancer is discovered in stages I and II? (Or maybe their goal is to depopulate the earth…..quickly.)

  10. Anonymous says:

    whils still sending out instructions to not get tested they "say" go ahead and do whatever, but what are is going to make a bigger impression – an interview by Sebilius that will not be seen by the majority of america or something that arrives in the mail in ink on paper that one will actually read and quite possibley hold on to?

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