Notes on Politics: Sebelius Stands Up for Cancer Patients and a Supreme Court Mom

Sebelius Stands Up for Breast Cancer Patients

It was with supreme outrage that I read a Reuters report last week claiming that a health insurance company was targeting women who were freshly diagnosed with breast cancer for audits of their insurance policies in order to find a reason to cancel said policies.

Reuters highlighted two women who’d faithfully paid their insurance premiums, but soon after they were diagnosed with breast cancer were flagged for audits had their policies canceled. “They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer,” Reuters reported. “The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.”

Reuters continued, “Once the women were singled out, they say, the insurer then canceled their policies based on either erroneous or flimsy information. WellPoint declined to comment on the women's specific cases without a signed waiver from them, citing privacy laws.”

In response, an irritated Secretary of Health and Human Services Kathleen Sebelius not only said that this practice – called “rescission” – will soon be illegal “thanks to the recently-passed Affordable Care Act,” but rapped the company, WellPoint, on the knuckles. Hard.

“WellPoint should not wait to end the unconscionable practice of deliberately working to deny health insurance coverage to women diagnosed with breast cancer,” wrote Sebelius. “I urge you to immediately cease these practices and abandon your efforts to rescind health insurance coverage from patients who need it most.”

A Supreme Court Mom?

Peter Beinart, writing on The Daily Beast, makes a case for President Obama to appoint a woman with young children to the Supreme Court. Pointing to the paucity of women with children in high profile positions in government and politics, Beinart wrote that in addition to having a woman justice who’s “more sensitive to the problems women face,” adding a mother to the court is important:

“. . . [B]ecause otherwise, the message you’re sending young women is that they can achieve professionally, or they can have a family, but they can’t do both. And without quite realizing it, that is the message our government has been sending. According to the Census Bureau, 80 percent of American women over the age of 40 have children. But look at the women who have held Cabinet posts in the last three presidential administrations. Only two of the Clinton administration’s five female Cabinet secretaries had kids.”

He also contrasted this issue to the fact that, “Men with children don’t have a role-model problem. After all, every one of the male Supremes has kids. (Antonin Scalia alone has nine.)”

Beinart continued:

“Soon after John Roberts was confirmed as chief justice, USA Today ran a syrupy feature entitled ‘Roberts Plays Dual Roles: Chief Justice and Father’ filled with sentences like ‘He takes the children to swimming lessons. He tries to keep 5-year-old Jack from using 6-year-old Josie’s violin as a pretend weapon. At the end of the day, he helps put them to bed.’ Message to little Johnnies everywhere: You can have a great job and a great life all at the same time. Compare that to Pennsylvania Governor Ed Rendell’s comment after Barack Obama nominated Janet Napolitano to head the Homeland Security Department. ‘Janet’s perfect for that job,’ Rendell quipped. ‘Because for that job, you have to have no life. Janet has no family. Perfect. She can devote, literally, 19 to 20 hours a day to it.’ Message to little Janets: Go ahead, shoot for the stars. Just be prepared for a life devoid of anything but work.”

Image credit: U.S. Department of Health & Human Services via More Magazine.

Health and Human Services Sec'y Says, Nevermind About Those New Mammogram Guidelines

Following days of uproar after a federal government panel told fortysomething American women that regular mammogram screening doesn't save enough of their lives to justify the costs or the "anxiety" caused by biopsies and additional tests (which don't often result in a cancer diagnosis), the U.S. Secretary of Health and Human Services yesterday told everyone to basically ignore the new guidelines.

Maybe all those women who said their cancers were detected through routine screenings when they were in their 40s and said they would've been dead if they'd waited until age 50 -- as the new panel suggests women now do -- had an impact. Secretary Kathleen Sebelius said in a statement released yesterday:

"The task force has presented some new evidence for consideration but our policies remain unchanged. Indeed I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

Given that during his speech to a joint session of Congress earlier fall President Obama said that under his health care reform plan ". . . [I]nsurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives," it would be nice for the federal government to send a consistent message and not tell people that preventive care is important, then recommend that they not get it.

In the meantime, USA Today reported today that major health insurance company spokespeople are saying that they won't stop covering mammograms for women in their 40s as a result of the US Preventive Services Task Force guidelines:

"Some of the companies that told USA TODAY that they will continue paying for mammograms for women in their 40s include Kaiser Permanente, Aetna, Cigna, Geisinger Health Plan, Group Health Cooperative and WellPoint, which operates Blue Cross/Blue Shield plans in 14 states. Together, these plans cover more than 73 million people.

A spokeswoman for Kaiser Permanente, Farra Levin, says, 'We believe that focusing on prevention and early detection is critical in improving women's health and saving lives.'"

So that means that saving the lives of fortysomething women IS worth the cost of mammograms?

Gov't Task Force: Mammography for Fortysomethings Saves Lives, Just Not Enough to Justify the Cost$$ & Stress

It’s about money, these new recommendations unveiled yesterday by a federal task force which tell women between the ages of 40-49 that, unless they know that they have the breast cancer gene or have had extensive chest radiation, there’s no need for them to get mammograms.

You see, even though there’s data which says that women’s lives ARE SAVED by preventative screenings, such regular screenings of fortysomething women (particularly those with dense breast tissue) cause those women angst because they’re oftentimes told to come back for more screenings or require a biopsy when, most of the time, those women don’t have breast cancer. The angst caused by mammograms and those biopsies which don’t turn up cancer aren’t worth the risk of screening fortysomething women for cancer, the government task force says. That, and the fact that it’s all about the money.

The New York Times summarized the US Preventative Services Task Force's (USPSTF) new mammography guidelines (which, it's not hard to envision, being adopted by health insurance companies) saying:

“Over all, the [USPSTF] report says, the modest benefit of mammograms – reducing the breast cancer death rate by 15 percent – must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 60.”
 
Aw, what’s the big deal if you ONLY reduce the death rate of fortysomething women by 15 percent with regular mammograms? Why make all those other fortysomething women so very nervous with biopsies when they likely don’t have cancer. It’s too much bother. That, and it’s all about money. And if you’re a woman who's 75 or older, you don’t need the screening ‘cause the task force thinks you’re too old and you’re likely to die from something else so they don’t want to waste money screening you anymore.

Twice, during my own experience getting mammograms (two members of my family have had breast cancer), I experienced some angst when I had to come back for another mammogram or get an ultrasound to check out a suspicious area, but I was wildly relieved when I got the all clear. I’d rather live with the anxiety experienced while awaiting test results and for a negative biopsy to learn that I DON’T have breast cancer than roll the dice that I’ll never get it, at least when I’m in my 40s, because a government panel doesn’t think it’s likely that I have it.

The New York Times explained what the task force members saw as the downside of regular mammograms for women in the fortysomething age group:

“While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further test, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.”

I guess a fortysomething woman can avoid the horrid and "real" side effect of "extreme anxiety" from having to go back for a second mammogram or having a biopsy if she’s already dead because she was unlucky enough to develop breast cancer when she was in her 40s. She’d certainly save lots of money for the bottom line. (I think I’d have more anxiety if I were being audited by the IRS than I've had while sitting in the mammogram waiting room.)

Many doctors and breast cancer specialists quoted by news outlets today are livid.

Dr. Daniel B. Kopans from Massachusetts General Hospital Cancer Center told the Boston Globe that the task force’s recommendations “will condemn women ages 40-49 to unnecessary deaths from breast cancer.”

Dr. D. David Dershaw, a mammography specialist at New York’s Memorial Sloan-Kettering Cancer Center, likewise, put it bluntly to the Globe saying:

“How many cars do you have to put seat belts in to save a life? How many colons do you have to screen in order to save a life? How many people do you have to immunize for the flu in order to save a life? These numbers are totally within the acceptable range of what we routinely do as part of a civilized society.”

The American Cancer Society says on its web site that, after examining the same data used by the federal task force, that their organization continues to recommend regular mammography for women starting at age 40 because “lifesaving benefits of screening outweigh any potential harms.”

It continued:

“With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening.”

Most poignant have been the personal stories of women -- those with no family history of breast cancer -- who were diagnosed with breast cancer in their 40s who say they wouldn’t be here but for mammograms.

The Times quoted a now 54-year-old Manhattan woman who found out she had breast cancer when she was 48 after getting an annual mammogram: “You’re going to start losing of a lot women. I have two friends in their 40s who were just diagnosed with breast cancer. One of them just turned 41. If they had waited until she was 50 to do a routine mammogram, they wouldn’t have to bother on her part – she’d be dead.”

Bottom line: It’s about money. It should be about lives.

A prediction: These recommendations, issued by a panel established by the federal government to create standards for medical care, will help to kill, or seriously wound, the attempts to federalize the health care system, especially when that panel says that saving a fortysomething from breast cancer through routine screening is only considered a “modest” benefit and that her life isn’t worth the cost.