Don’t get between doctor and patient

When my committee marked up the House version of healthcare reform last year, we voted to prevent rationing. In fact, it wasn’t even close enough for either a Republican or a Democrat to ask for a roll call vote, because nobody was in favor of rationing care.

That was then, at the end of July, but by November something had changed. Between our committee and the bill’s arrival on the House floor, the bipartisanship ended and the anti-rationing provision vanished along with seven other Republican amendments that had won broad committee approval.

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In the dark of the night, some Democratic staffer or a Democratic member of Congress decided the votes of the committee didn’t mean anything.

Worse, along with the disappearance of bipartisanship went any concern about unelected members of the U.S. Preventive Services Task Force making more policy decisions like the one they made on breast cancer screening, and having their new ones enforced by a Health Choices Commissioner.

Democrats called this a “fairytale.” But there shouldn’t be talk about fairytales by anyone who reads the legislation and sees that in the bill that we passed in the House, on page 1,762, the Task Force was given the authority to determine the “frequency,” “the population to be served” and “the procedure or technology to be used” for breast cancer screenings covered under the Indian Health Service. Dig deep to Section 303 and you’ll also find that “the Commissioner shall specify the benefits to be made available under Exchange participating health plans.” Those widely separated sentences combine to mean the Task Force and the Health Choices Commissioner will determine what preventive services, including mammograms, are covered under both the public and private insurance plans that are envisioned in the House healthcare reform bill. In my book, that’s a recipe for rationing.

The Task Force is an outside, independent council of doctors and scientists who make recommendations to the government. They are not in the business of dictating what services may be covered, but the language of the legislation transforms recommendations into regulations that have the force of law.

Before it burst onto the front pages of newspapers by proposing the elimination of mammogram screenings for women in their 40s, the Task Force was an obscure outfit. It is obscure no more.

I’m familiar with the underlying issue that got the Task Force in hot water as a result of family experience. My wife has annual mammograms to guard against breast cancer, and my sister was diagnosed with it in her 30s. She’s had proper treatment and has been cancer-free for the last decade. Also, I have a good friend who was just diagnosed with breast cancer in her mid-40s; she’s undergoing treatment and hopefully she’s going to have a good outcome. It doesn’t always end well, though. I know because my aunt died in her early 50s from breast cancer.

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Those are the real-life events that shaped my policy view on breast cancer screening. I want government agencies to reach out for and carefully weigh outside advice from experts, but it was dangerously mistaken for the Task Force to make the recommendation that it made, and it will be disastrously wrong for the Congress to invest in unelected bureaucrats the authority to ration care, whether for breast cancer or any disease, by making healthcare decisions like who will get mammograms and who won’t.

Bipartisan majorities of the Health Subcommittee and the full Energy and Commerce Committee consistently approve legislation increasing research, prevention and the early detection of breast cancer. In the past, we’ve gotten the rhetoric right and we’ve gotten the policy right, but that’s not likely to continue without substantive changes in the pending healthcare reform legislation to prevent the rationing of healthcare that we all say that we oppose.

The unhappy truth of what happens next is not going to be the product of a scary fairytale. It’s simply true that the House’s version of healthcare reform invests the U.S. Preventive Services Task Force with the authority to wedge itself between doctors and patients, and to make decisions that will dole out care in just the way that they proposed to ration mammograms.

Barton is the ranking member on the House Energy and Commerce Committee.