WASHINGTON — A core tenet of the healthcare overhaul President Obama is pushing through Congress is that medical care can be improved -- and costs contained -- if the country relies more on experts to determine which procedures and treatments work best.
But Monday's mammography report by the U.S. Preventive Services Task Force delivered a swift and stark reminder that few ideas are more explosive in healthcare.
The expert panel -- which recommended that women in their 40s should no longer get annual mammograms to screen for breast cancer -- sparked an outcry from those who say that the federal government is more interested in saving money than in improving women's health, even though the panel did not consider costs in its analysis.
Some Republicans jumped on the report as the kind of government intervention in medical decisions that Obama's healthcare plan would bring.
"This is really the first step toward that business of rationing care based on cost," said Rep. Phil Gingrey (R-Ga.), a physician.
The uproar also provided a likely preview of future battles. A potentially revolutionary improvement in the medical system would almost certainly bring controversy, confusion and uncertainty along with it.
Proposed changes to standard medical procedures, even when supported by scientific evidence, almost always challenge someone's expertise and someone's bottom line. And even the most careful scientific evaluations cannot always provide definitive answers on what works best for all patients.
"Unfortunately, there is no magic way to make these decisions," said Dr. Sean Tunis, a former chief medical officer for Medicare and Medicaid in the George W. Bush administration who works on ways to evaluate medical technology.
The problem, Tunis and others experts say, is that leaving the decisions to the marketplace -- as the U.S. healthcare system has done for decades -- has not produced very good results, even for patients.
Doctors in one hospital may favor one surgical procedure or drug regimen, while those in another favor something else. Individual insurance companies decide to cover some procedures and not others, often varying their policies from patient to patient.
Even state lawmakers have gotten in on the act, passing hundreds of laws requiring that insurance companies provide particular benefits such as prostate cancer screening or, in one case, varicose vein treatment. According to the Council for Affordable Health Insurance, an industry group, there are more than 2,000 insurance mandates nationwide.
