The Corner

‘The Bureaucrat in the Exam Room’

That’s how Tennessee Republican Rep. Marsha Blackburn characterized the preventative-care sections of the Democrats’ health-care bill:

BLACKBURN: And, George, this is exactly how it happens.  If you go to page 1,296 of the House bill, the engrossed copy, and you began to read in title three of that bill, on preventive and wellness services, and you get down to section 2301, this is what happens.  In section 3131 of that bill, it changes the Preventive Services Task Force to the Clinical Preventive Services Task Force. Then, you go back and you see that that task force on preventive clinical services is tasked with rating A, B, C, D, or I all preventive services.  Then you go back into section 222 of the bill…”


BLACKBURN:  Yes, I have read this bill.  And that indicates what would be paid or covered.  And this is where the actual link comes, and I’ll read it for you.  In section 2301, it says, “All recommendations of the Preventive Services Task Force” — that’s the group that did the mammograms — “and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this act, shall be considered to be recommendations of the Task Force on Clinical Preventive Services.” […]

BLACKBURN:  And when you look at what is going to happen with these 118 new bureaucracies with 62 directives that are given by the health choices commissioner on what insurance can be offered in this country after 2013 and what is going to be paid, you know that this is the bureaucrat in the exam room.  This is how it’s going to happen.

Last week, Health and Human Services Secretary Kathleen Sebelius released a statement stressing that the task force’s recommendations ”do not set federal policy and they don’t determine what services are covered by the federal government.” But under the Democrats’ health-care legislation, they would. In the House bill, only preventative services receiving grades of A or B from the task force would be part of the “essential benefits package.” The task force’s new recommendations on mammography downgrade routine screening in women aged 40 to 49 years to a C grade.

Of course, many states already require insurance companies to cover at least one mammogram per year. These and other mandates have driven up the cost of insurance and led conservatives to call for reforms that would enable people to buy health insurance across state lines. The point is not that all mammograms should be covered, or that none should be. It is that people should be allowed to buy insurance coverage that meets their needs, based on their family health histories, their doctors’ advice, etc. They should not be required to buy coverage — or denied coverage — based on the edicts of some task force in Washington.

As James Joyner pointed out last week, the vacillations of the medical community on issues like mammography draw into question “the rigors of medical scholarship, which seems to frequently draw wide conclusions based on studies of very small, self-selected samples.” We shouldn’t be forced to buy one-size-fits-all insurance policies in any case, but certainly not when they are designed by bureaucrats reacting to the health crisis du jour.