Sunday, November 22, 2009

The Mammography Controversy: How Government Runs An Insurance Benefit

What took the the US Preventive Service Task Force so long?

Years ago, the young and inexperienced medical director Disease Management Care Blog became aware of a burgeoning body of literature (examples here and here) questioning the value of mammography for women less than age 50 years. Its health plan considered the option of denying coverage of mammograms in this age group, but ultimately decided against it. We calculated that the HEDIS, marketing, public relations and political downside of reducing a women's health insurance benefit was just too radioactive in our network. Based on an assessment of what our customers wanted, we put that idea down and slowly backed away. Problem solved - quietly and more than 10 years ago.

The 2009 mammography controversy shows how difficult it is to create a one-size fits all insurance benefit that reconciles the a) science, b) market expectations and c) politics. As government increases its role in the nation's health care, readers can expect the same slowness and rhetoric to intrude into countless other coverage decisions.

In a perfect world, women could choose an insurance plan that meets their price point (the monthly premium) and benefit plan (mammograms expensively covered every year vs. another less expensive option). As we all know, all Americans should have anything they want, just so long as they pay for it. Ms. Sebelius is once again reminding us that in rhetoric-driven government dominated health care, all Americans should have anything they want, and we're all going to pay for it.

One last point: this should give readers some insight into HHS Secretary Sebelius' pain. Ironically, during her confirmation hearings Sebelius was roughed up by Senators who were fearful that she'd use comparative effectiveness research to interfere with the doctor-patient relationship. Her flexible stance on mammography shows she is keeping her word.

All things considered, good for her.

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