California Senatorial candidate Carly Fiorina is exploiting her recent bout with breast cancer to lie about the role of the U.S. Preventive Task Force and fearmonger about the consequences of health care reform. “This Task Force was explicitly asked to focus on costs, not just prevention. As it turned out, costs were a significant factor in this recommendation,” Fiorina says in this week’s Republican address. “Will a bureaucrat determine that my life isn’t worth saving?,” she asks before suggesting that the Senate health care bill would allow the Task Force to ration cancer treatments:
Do we really want government bureaucrats rather than doctors dictating how we treat things like breast cancer?…The health care bill now being debated in the Senate explicitly empowers this very Task Force to influence future coverage and preventive care. Section 4105, for example, authorizes the Secretary of Health and Human Services to deny payment for prevention services the Task Force recommends against. Another section requires every health insurer in America requires to cover Task Force recommended services….While some defend the idea of a government Task Force, my experience with cancer tells me it’s wrong.
The U.S. Preventive Services Task Force is an independent panel of experts first convened by the U.S. Public Health Service during the administration of President Ronald Reagan. The panel “is financed by the Department of Health and Human Services but works at arms length from it, making its decisions without consulting the agency.” Panelists are prohibited from “considering costs when they make guidelines.”
“Our job is to review scientific evidence, politics play no role in our deliberative processes. Costs were never considered in our considerations,” Task Force Chairman Dr. Ned Calonge testified last week before the the House Subcommittee on Health.
The task force issues recommendations that help doctors decide on a course of treatment. Providers can use the recommendations as a starting point to examine a patient’s particular needs, but the task force has no authority over coverage or treatment decisions. “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,” Calonge said in his testimony. For the mammogram decision, which received a Grade of ‘C’ from the Task Force, “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 Senate health care uses the recommendations of the Task Force to establish minimum requirements. Section 4105 gives 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. The bill specifically contradicts Fiorina’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 — which Sen. David Vitter’s (R-LA) amendment already invalidated — the guideline would advise the doctor that the Task Force “recommends against routinely providing the service.” But, 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.” Doctors could use the recommendations as a starting point to examine a patient’s particular needs; they would not replace professional clinical judgment.
On Thursday, the Senate also accepted an amendment from Sen. Barbara Mikulski (D-MD) that prevents private insurers from charging women for mammograms and specifically states that “nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force.’’