The breast-cancer screening guideline has put Secretary of Health and Human Services Kathleen Sebelius in the midst of the most contentious debate of her tenure thus far. It looks like she’s decide to throw the U.S. Preventive Services Task Force under the bus.

In an interview with NPR’s Mara Liasson, Sebelius said the House-passed health bill gave her, not the task force, the authority to decide what health insurance will and will not cover. That isn’t quite true. The statutory language says that if the task force recommends some service, health insurance has to cover it. The HHS secretary can decide to cover something that is not recommended (e.g., routine mammography for women ages 40 to 49), but she could not decide to take away coverage of something the task force recommended. (Senator Reid’s plan is similar.)

The much more important point is that the HHS secretary would have plenary power to decide what health insurance must cover. Not just preventive services, but all services. That is the essence of political health insurance and what distinguishes the system of private health insurance we have now from a system of political health insurance. Some of the questions that will be politicized are predictable: Should health plans be required to cover contraceptives and assisted fertility treatments? Others will be pure interest-group politics: Should every health plan be required to cover the services provided by some medical subspecialty or some new surgical procedure or device that the FDA has just approved?

Sebelius’s position on the task-force recommendation is, “Trust me, not them.” The task force had science on their side, but what will the politicians have on their side?

– Hanns Kuttner is a visiting fellow at Hudson Institute.