Could Mammogram Brouhaha Stymie Health Care Reform?

It is a vehicle, noted Dr. David Orentlicher, co-director of the Hall Center for Law and Health at Indiana University that could serve to polarize those who until this point have been on the fence in the debate.

"Critics of the bills have had some success in mobilizing opposition on the ground that the government should not be making health care decisions," he said. "The revised cancer screening guidelines can easily reinforce the public perception that government will be too quick to compromise patient welfare for budgetary reasons."

Ironically, members of the task force have insisted that cost control had nothing to do with their recommendations -- a point that some outside experts have also cited.

"[They] attempt to balance benefits and harms, not reduce costs [and are] supposed to focus on clinical, not economic value," said Richard Hirth, associate professor of health management at the University of Michigan in Ann Arbor.

"Such evaluations of the risks, costs and benefits of screening... are what medical science and policy analysis does and should do," noted Ted Marmor, professor of public policy and management, at Yale University.

But the notion of cost control has already given rise to worries over health care rationing among some -- a gross misconception, said White.

"The story itself has been badly misunderstood," he said. "The report does not in any sense call for 'rationing' [as some opponents have claimed]...all the report says [is that] physicians should exercise judgment."

But applying cost concerns to the nation's health and wellbeing provokes controversy, Orentlicher says, and "it is very difficult for the public to accept efforts to eliminate the excesses in the U.S. health care system."

Nonetheless, issues of cost cannot be ignored says Dr. Aaron Carroll, director, Center for Health Policy and Professionalism Research at Indiana University:

"We spend about $2.5 trillion a year on health care... and that's simply unsustainable. But if every attempt [to reduce health care spending] is immediately viewed in political terms, then it's hard to imagine how we will ever succeed in containing costs."

Others agree. "In the false world of some politicians, it's okay to trick people into believing that they can have all the health care that any doctor, anywhere, might be willing to provide--and all the care that someone else is willing to pay for," says Alan Sager, director of the health reform program at Boston University.

"Back in the real world, every family knows they have a budget, and wasting money on things we don't need means that we can't afford what we really need."

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