Duncan explained that mammograms are considered a value-based benefit because they are preventative in nature and relatively low cost – about $125 per exam.
He compared mammograms to diabetes drugs. Insurance companies pay for them, and thus increase the "utilization" -- the frequency that people use them – but they do this in the belief that, down the road, it will eventually reduce disease and, therefore, medical costs. Mammograms should reduce the need to pay for expensive cancer treatments later.
But talking about costs instead of clinical practices has taken on a new and ominous tone in light of the push for health care reform.
"I definitely think this is the beginning of rationed care and I am very upset that women are the first to get slammed with this," said Dr. Elizabeth Vliet, a women's health care specialist based in Tucson, Ariz., and an ardent opponent of health care reform. "I think that this change is designed to cut costs, not improve women's health."
But that fear may be unwarranted. Duncan said many private insurers may take the political hornets' nest into consideration and "leave the coverage where it is." Or insurers might propose a compromise: "We will move the official standard to age 50 but we will be fairly liberal in allowing physicians to come in and argue for coverage on behalf of their patients."
In addition, Health and Human Services Secretary Kathleen Sebelius issued a written statement Wednesday that emphasized the members of the panel "…do not set federal policy and…don't determine what services are covered by the federal government."
Sebelius' statement continued: "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. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you."
Still, despite the desire for damage control, many warn that mammograms have already become "the new death panels." And that is disheartening to people like Marmor, who say a discussion of care and cutting costs can take place together.
"People are holding up the standard of medical care that any medical treatment that does any good for anybody cannot be denied," he said. "That is a ridiculous standard."
And a costly one.