Monday, November 23, 2009

Mandating insurance coverage of mammograms

So, in the week since the new recommendations on breast cancer screening there has been a lot of discussion.  There is an article in the Baltimore Sun today in which one of my colleagues was quoted.   This article discusses a number of things ranging from some using the entire discussion as a political issue (is this the start of rationing?) to the mention of the fact that many people know someone who was diagnosed with breast cancer in her 40s.

What I want to comment on directly is the following quote by Sen Barbara Mikulski (from Maryland)

"We've fought to make sure women have access to early detection and screening for breast cancer to help save lives while we are working on a cure," she wrote. "I believe that where data is conflicting, it is better to be safe than sorry."

She has proposed an amendment to the health care reform legislation that would guarantee access to regular mammograms to all women at age 40.

First, let me remind everyone that the USPSTF which made the recommendation did not actually consider economics at all.  

Second, let me remind everyone that there are a lot of things that can save lives.  If we paid for everything that could save lives for every person it would possibly help we'd be spending a lot more money on health care than we are already.  

If we as a society are willing to spend every cent for every service that might help someone, then we have to be prepared to spend more money.

Otherwise, we need some criteria to allocate resources.  Particularly resources that are either public or mandated.

One alternative would be to mandate coverage for those at high risk or for whom there is a clear medical justification.  Otherwise leave women who want to obtain a mammogram to pay for it themselves.  

Could this create two-tiered medicine?  Well, it could certainly contribute to that and we really already have two-tiered MEdicine in so many ways that it would not be "creating it".  It would simply be "adding to it".

As my colleague, Lisa Dubay, said in the article I referenced at the top, these types of discussions of what we are willing and able to pay for will not be easy but are ultimately necessary.


  1. Hi Dr Fick
    I think that mamograms are necessary. I believe that early diagnosis is more cost effective and as a society will save more money. Early detection of breast cancer and I believe any disease is more cost effective in terms of treatment and prevention of complications which will necessitate a decrease in money spent, decrease in loss of days possibly months from work. Edith Onua

  2. Renee McLeod-SordjanDecember 7, 2009 at 1:39 AM

    I believe that we have to be prudent economically but social justice also dictates that we are careful about the message we send to the public. Prevention for women is focused on preventition of breast cancer, cervical cancer and domestic violence. Although it is economically true that we spend billions on needless cervical and breast biopsies these procedures are health practitioner driven. First, defensive medicine and lawsuits dictate investigating every complaint of breast pain. Secondly, these guidelines discuss screening not diagnostic services. I believe if we decrease litigation, teach appropriate use of disgnostic tests we could decrease the cost of healthcare. But sending mixed signals to the public about screening will actually increase the demand among the middle classes who fear a loss of service. Renee McLeod-Sordjan