This afternoon, the House Subcommittee on Health held a hearing about the Preventive Task Force’s ‘C’ – grade guidelines advising primary care physicians against recommending mammograms to women under 40 years of age. While the guidelines were the result of comprehensive scientific review of the benefits of mammogram testing for women under 40 and have no bearing on coverage decisions, Republicans have presented the Task Force as a poster child of health care rationing — a one-size-fits all approach to medicine that places the cost of care ahead of patients’ well being.

Today’s testimony by Task Force Chairman Dr. Ned Calonge highlighted the desperation of the Republican attack. President Bush may have left the White House but Congressional Republicans continue to scare women and wage war against science. Some highlights from today’s hearings:

- “Our job is to review scientific evidence, politics play no role in our deliberative processes. Costs were never considered in our considerations. We voted on these recommendations long before the last Presidential election.”

- “For ‘C’ recommendations we recommend that the patient be informed of the potential benefits and harms and then be supported in making his or her informed choice about being tested. The specific C language that we recommend against routine provision was intended for consideration by primary care clinicians.”

- “We expect clinicians to do what they’re trained to do in order to address the needs of the individual patient and his or her best interest.”

Watch it:

As Rep. John Dingell (D-MI) observed, “From the things I’ve heard said about you on the other side of the aisle about you folks at the agency, I was afraid you’d appear with horns, tail, fangs, and in red suit breathing fire. Demanding that we immediately terminate all health benefits for the the unfortunate, weak, sick, and especially with regard to mammogram and pap smears.”

Yesterday, I appeared on the Senate Doctors Show to ask Sen. John Barrasso (R-WY) about his recent claim that page 1190 of the Senate bill allows the Preventive Task Force “to decide what care is given and not given.” I read from page 1190 of the bill, pointing out that the Task Force does not have the power to mandate coverage.

Barrasso disputed my claim by arguing that the first line of page 1190 would prohibit the government from paying for preventative services that “has not received a grade of A, B, C, or I by such Task 5 Force”:

Watch the exchange (starts at 5:57):

So who’s right? Pages 1189 and 1190 of the Senate health care bill give the Secretary of Health and Human Services the authority, “if the Secretary determines appropriate,” to modify existing preventive care guidelines for Medicare and Medicaid only. If the Secretary chooses to modify the existing package of preventative services, the legislation instructs the Secretary to rely on scientific guidelines (instead of industry lobbyists, for instance). The bill specifically contradicts Barrasso’s claim that care or treatment would be rationed in lines 6-9 on page 1190. “Nothing in the amendment made by paragraph (1) shall be construed to affect the coverage of diagnostic or treatment services,” the bill states:

If the Secretary were to adopt the Task Force’s grade ‘C’ mammogram decision, the guideline would advise the doctor that the Task Force “recommends against routinely providing the service.” The recommendation stipulates that doctors should “offer or provide this service only if other considerations support the offering or providing the service in an individual patient.” In other words, providers like doctors Barrasso or Coburn, can use the recommendations as a starting point to examine a patient’s particular needs.

If the doctor decides that the patient needs the test, it will be paid for by Medicare. If the doctor relies on the recommendation and does not order a treatment, a patient would have to pay for her own mammogram. If that test is positive, lines 6-9 specifically state that cancer treatment would be fully covered. In short, the Task Force has no power to “decide what care is given and not given.”