Sunday, November 22, 2009

The Rationing Con

On November 16 the U.S. Preventive Services Task Force issued its controversial guidelines recommending most women wait until age 50 to get a mammogram and then have one only once every two years. It advised additionally that women should not be taught breast self-examination which, it concluded, is of little benefit.

As the mainstream media falls all over itself screaming “government panel, government panel,” there is nary a mention of the nature of the “government panel.” It was first convened by the U.S. Public Health Service in 1984, during the administration of that famous big government socialist, Ronald Wilson Reagan. Since 1998 it has been “sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications.”

The sixteen primary care physicians who currently comprise the task force were appointed during the GW Bush administration, but members nominate themselves or are nominated by professional organizations and colleagues. Though financed by the Department of Health and Human Services, the group is structured to be apolitical.

Unsurprisingly, that hasn't stopped some Republicans. On November 18, a group of GOP congresswomen held a press conference at which one of their number, Marsha Blackburn of Tennessee, claimed

This is how rationing begins. This is the little toe in the edge of the water.

Two days later, Blackburn had this revealing exchange (video below) with MSNBC's Nancy Snyderman:

BLACKBURN: It is troubling also that another of our colleagues has said many times, we. And that we means bureaucrats deciding what they’re going to allow.

SNYDERMAN: But you’re one of those bureaucrats. You’re my bureaucrat!

BLACKBURN: But I’m not, no. And you see, I don’t think a bureaucrat should be between a patient and a doctor. See, I don’t want to be that bureaucrat.

SNYDERMAN: Excuse me, I think that’s exactly where you are right now
.

You will be forgiven for thinking it hypocritical that only one Republican House member (Rep. Ileana Ros-Lehtinen of Florida) is among the 79 co-sponsors of legislation proposed by Rep. Jerry Nadler (D.-NY) requiring insurance companies to cover diagnostic mammograms and annual breast cancer screening for women aged 40 and above. Mike Lillis of The Washington Independent quips

The message from the Republicans seems to be: We’re wary of the government recommending fewer tests based on independent research, but it’s OK for private insurance companies, driven by profit motives, to deny access to the same services.

It is an essential part of the GOP narrative that government, and only government, practices "rationing." Republicans appear never to be exorcised about the rationing which insurance companies routinely practice every business day throughout the country, in this case in California:

In late April, Shelly Andrews-Buta was scheduled to undergo treatment for breast cancer that had spread to her brain, threatening her life....

But instead of having doctors working to remove her brain tumors on the day the surgery was scheduled, she sat in a San Francisco hotel room. Why? Because at the last minute, her insurance company, Blue Shield, decided it wasn't going to pay for the treatment her doctors at UCSF Medical Center had recommended.

Without treatment, her doctor told her she in fact would die: tumors had invaded 15 separate areas in her brain.

"I wanted to rapidly get control of these lesions," said UCSF radiation oncologist Dr. Penny Sneed. "I felt there was a great time urgency, and we couldn't wait."

Just two weeks prior to the scheduled date for surgery, Andrews-Buta could still walk. Now she's almost paralyzed and unable to walk without assistance.

Dr. Sneed told her that her best chance of survival lay with a high-tech machine called a "gamma knife."

There's no actual cutting with the knife. Instead, the beams of radiation called gamma rays target a tumor from multiple angles.


It's really a difficult task Republicans have staked out for themselves: convincing the American people that government, not the private sector, rations care. Difficult, but not thankless; insurance companies generously offer their appreciation with huge campaign donations.

Even with the tyranny of the insurance industry, there are questions begging to be raised about pending health care legislation. Unfortunately, the opposition party chooses instead to demagogue the issue in the media while attempting to avoid any discussion in Congress. Forty Republicans in the House of Representatives and not one of them thought health care a worthy enough issue, a sufficiently serious problem, to warrant debate on the floor. (Ohio's George Voinovich missed the vote but had indicated he would vote with his party.) Evidently, not one of them, even those "pro-life," believe there is any problem with the American health care system or that they should waste their time thinking about people like Shelly Andrews-Buta.


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