Cancer screening advice raises ration fears

By Rob Stein
Washington Post / November 23, 2009

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WASHINGTON - President Obama’s vision for making health care in America more effective and efficient collided last week with the realities of the nation’s medical system and fears that broad administrative changes would lead to rationing of care.

Days before the Senate voted to send its health bill to the floor for debate, two independent advisory groups released new guidelines for mammograms and Pap tests.

Although neither set was aimed at cutting costs, both were based on the kind of objective analysis of scientific research that the Obama administration has embraced in its bid to make care better and more economical.

But after the recommendations unleashed fierce criticism, the administration appeared to quickly distance itself from the mammography guidelines to try to prevent the uproar from endangering a domestic priority.

“This tells us an awful lot more about where we are as a country in terms of our relationship to the health care system and health care reform than they do provide new information about how often women should get screened,’’ said John Abramson, a clinical instructor at Harvard Medical School and a leading proponent of eliminating unnecessary care.

Nancy-Ann DeParle, director of the White House Office for Health Reform, said the debate over the guidelines goes to the heart of “the unique doctor-patient relationship in the American health care system and the desire to preserve that.’’

“Today many of these decisions are being made by insurance companies and bureaucrats, and we want to make sure those decisions are made by doctors,’’ DeParle said.

Yesterday, Dr. Bernadine Healy, a director of the National Institutes of Health under Republican President George H.W. Bush, joined other officials in urging women to disregard the new mammogram recommendations.

Senator Kay Bailey Hutchison, a Texas Republican, said that the new data is “the beginning of rationing.’’ She said it will provide the government with an excuse not to provide payments for more frequent screenings and that insurance companies would then follow suit.