Late last year, when the Preventive Task Force advised primary care physicians against recommending mammograms to women under 40 years of age, I defended the ruling. While physicians should take every patient’s unique medical history into consideration, if the science shows that for the average woman the test only raises raises stress levels without improving health outcomes, then the guidelines should reflect this. No health care system can accommodate an environment in which doctors order CAT scans for simple headaches or complicated surgeries for problems that can be solved with a regimen of medication, particularly when those treatments often lead to more harm than good.

Yesterday, Emma Sandoe pointed to data which showed that Minnesotans have a higher than average rate of using MRIs for lower back pain, “despite professional guidelines advising doctors” to try other treatments first. Today, NPR’s Scott Hensley reported on a study which found that “most men with low-risk prostate cancer get aggressive treatment, even though the therapies carry big risks”:

Most of these men turned out to have low-risk, slow-growing cancers, yet the great majority of them got aggressive treatment anyway. The findings appear in the Archives of Internal Medicine.

The researchers say that many American men with prostate cancer aren’t likely to benefit from this aggressive treatment. Instead, their cancers could be monitored and many would never pose a threat.

An accompanying editorial calls the nation’s experience with the PSA test a “cautionary tale.” More bluntly, the authors of the commentary write, “Unfortunately, some 2 decades into the PSA era, the promise of early detection has been tarnished.”

Widespread PSA testing and early identification of prostate cancer have led to an epidemic. Aggressive treatment of the many low-risk cancers found is the bigger problem because men who probably won’t get many benefits can suffer life-changing side effects.

This is the kind of unnecessary and harmful overtreatment that the health care law (and Don Berwick) should discourage, despite the politics or optics of the debate. Congress may have overruled the Task Force’s mammogram decision in December and then promptly politicized Berwick’s views on care quality just last month, but any serious discussion about controlling health care costs is meaningless if it doesn’t develop techniques to discourage unnecessary and harmful treatments. Hopefully, Berwick will engage in this debate once he finally testifies before Congress.

Center For Public Integrity is reporting that five of the nation’s largest health insurance companies are considering forming a nonprofit organization to better influence the implementation of health care reform and bolster the industry’s image. “The insurers’ goal will be to help elect members who can be allies in the all important regulatory writing process now underway to implement key parts of the health care legislation that was signed into law earlier this year“:

The two sources tell the Center for Public Integrity they expect millions of dollars will be pumped into issue advertising in a number of races where candidates sympathetic to health industry concerns have a shot at winning.

“The objective is to make the House more accommodating to concerns that have been raised,” says one industry source. “They’re looking at toss-up candidates,” adding that the companies want to “focus resources to influence campaigns.” [...]

The sources stress that insurers are particularly concerned at this stage about a provision in the new law that mandates they spend 80 cents of every premium dollar received on the welfare of patients. The high financial stakes mean insurers have been pushing hard with state regulators to allow for broader definitions of what constitutes patient welfare expenditures. This issue is “probably the most important one right now,” explains a source.

The campaign may be an alternative to the industry’s long-time lobbying group America’s Health Insurance Plans (AHIP), which has represented the industry throughout the health care reform debate. Industry sources are telling Politico’s Pulse that “they feel the group wasn’t strong enough during the reform battle and they’re not convinced it has the muscle to deliver during implementation.” “The insurance industry sources argue that the industry got little out of the year-long Hill battle: the individual mandate is relatively weak and the industry is still getting hammered by reform supporters.”

AHIP has already promised to work alongside federal and state regulators to implement the new reform law “effectively” and to the extent that the industry’s goals intersect with the objectives of reform, a partnership with insurers could lead to some real progress. The government can rely on the industry and its expertise to adapt the payment reform models in Medicare to the private sector, develop administrative simplifications, or encrouage Americans to enroll in insurance coverage. As Jon Kingsdale, former director of the Commonwealth Connector Authority, has pointed out, the implementation process would probably benefit from this kind of industry input.

But if insurers are only looking to inflate their medical loss ratios by reclassifying certain administrative services as “medical” or undermining the rate review processes, then they’re working against the public interest and it will be up to us to publicly involve ourselves in the implementation process and counter the industry offensive.