Mandates don’t stay modest, a continuing series

by on December 3, 2009 at 2:53 pm in Medicine | Permalink

Breaking a three-day stalemate, the Senate approved an amendment to
its health care legislation that would require insurance companies to
offer free mammograms and other preventive services to women.

The vote was 61 to 39, with three Republicans joining 56 Democrats and the two independents in favor.

This happened directly after the release of evidence showing that many mammograms do not pass a comparative effectiveness test.  Once the test became a public issue at all…well, now you see what happens.  CBO, take note.

Kevin Miller December 3, 2009 at 3:02 pm

And military bases never get closed, either. There are ways to do this, but having politicians vote on particular treatments isn’t one of them.

mk December 3, 2009 at 3:37 pm

It would be reasonable to hypothesize that “battles” like this will have to be lost in the service of the greater plan, which is to (1) establish near-universal coverage, and then (2) systematically attack health costs.

It may not actually play out that way, but bear in mind that this mandate creep you point to is consistent with a different interpretation of the plot arc here.

MostlyAPragmatist December 3, 2009 at 4:00 pm

What piffle!

Just because health insurance companies are required to provide them, doesn’t mean that women will decide to have them. I suppose my health insurance company provides colonscopies for free, but I have real incentives to avoid them.

Colin December 3, 2009 at 4:38 pm

Everyday Congress is in session brings forehead-slapping economic illiteracy like this:

“The insurance companies take being a woman as a pre-existing condition,† [Sen. Barbara Mikulski (D-MD)] said. “We face so many issues and hurdles. We can’t get health care.†

R. Richard Schweitzer December 3, 2009 at 5:18 pm

Here we have an indication of Congress setting the benefit requirements of a private contract of insurance. I have not yet read whether this will be required in any government offered “plan.”

Also, I am not sure about the “free” part. It may be required at “no additional premium” for the benefit, which will simply redistribute the cost of this benefit (and costs of related claims administration) to fall on all insureds.

Such redistibution is the purpose and effect of the proposed legislation.

Anonymous December 3, 2009 at 5:31 pm

Nationalizing a business automatically politicizes its products. Politics will determine what you get, not supply and demand. Before I was in fear of us becoming a banana republic. Now I fear that we have already become one. Remember from now on, the government owns your body, not just your money.

Gabe December 3, 2009 at 6:07 pm

I agree. It is so funny to see a annoying democrat who is really truly shocked, SHOCKED! That after they helped the government get support of a industry…somehow the annoying republicans suddenly get to start making all the rules for that industry!

The marxist wanted universal compulsory education and then the schools are used to help brainwash kids and recruit them for cannon fodder in WW1…then made them into cogs for the very robber barons that the democrats think their political heores castrated…..later Strom Thurmond’s start teaching the kids creationism, prayers, abstinence and more shock. There has never been a people more naive, docile and outright stupid than the state worshiping democrats and republicans alive in this country right now.

mw December 3, 2009 at 6:52 pm


Military bases do get closed. Fort McPherson in South Atlanta will be closed down soon.

It would be real tough though to close a big one, a Fort Hood or a Fort Bragg.

Gabe December 3, 2009 at 7:09 pm


It will take just one bad year for the US bond market to shut down all the US bases around the world.

A bad year in the bond market isn’t too hard to imagine…a strong economically informed populist uprising in China after a economic crash would be enough to end the funny money parade.

Adam Hyland December 3, 2009 at 8:25 pm

We shut down plenty of enormous bases (or downsized them considerably) at the end of the cold war. Arguably we shut down too few, but even those closing were vigorously protested by congressmen from the affected districts, leading to obvious distortions in outcomes. House Ways and Means committee member Dan Rostenkowski kept his base in Waukegan IL, while the training centers in Florida and San Diego were shuttered or downsized. Doesn’t seem too bad until you go to basic training in November.

Bernard Yomtov December 3, 2009 at 9:04 pm

I think you are being a bit unfair here.

The study recommendation was not based on cost but on purely medical considerations. It concluded that various negative consequences of under-50 mammograms outweighed the medical benefits. If this is correct then in general women under 50 should be reluctant to have mammograms barring special circumstances.

Presumably, though, there are situations where the mammogram is indicated. Perhaps, for example, there is a history of breast cancer in the patient’s family. The amendment says that if the woman and her doctor decide that it is worthwhile then insurance must cover it.

That doesn’t seem outrageous to me.

Barbar December 3, 2009 at 9:54 pm

Putting aside the health care debate for a second, I was really struck by how a certain class of people can be “scummy politicians” in one context and “our dear democratically elected officials” in another (say, if you want to overturn a controversial judicial decision). The exact same people.

I’m not sure there is such a thing as political neutrality, although people like to pretend there is.

Neal December 3, 2009 at 10:52 pm

she lambasted Republicans for using the new guidelines as evidence of coming rationing of services.

I have honestly never understood why the Republicans started screaming about that. Do they somehow think a free market makes health care costless? I mean, scarce medical resources have to be rationed somehow. The argument over health care is really an argument over how we want to ration them.

Al Brown December 4, 2009 at 3:32 am

yeah, we want something to happen but are unwilling to pay the price. I know! lets dump the cost on someone else and then they’ll pass the cost back to us and we can complain about how evil they are for gouging us.

And lets do this many times throughout the economy so nobody will really know who’s actually causing all the trouble.

Andrew December 4, 2009 at 4:27 am


Free market rationing is by definition NOT an argument over rationing. It is fundamentally different from government rationing which IS an argument over rationing.

Lonely Libertarian December 4, 2009 at 8:58 am

I violently object to describing the mandated mammograms as free -this is exactly the kind of thing that gets us further on the slippery slope to unaffordable health care that bankrupts us in the end.

the will NOT BE FREE – they will have costs attached to them that must be recovered in premiums from folks like me that have no need for them – and would prefer to pay for them out of pocket if I did.

Another example of thievery – unlawful taking of my money by someone else without my permission

Tyler you need to call this what it is – theft!!!!

Jacob December 4, 2009 at 11:04 am

And the mammograms fell from heaven like manna. FREE! … TANSTAAFL!!

@ Neal: “Do they somehow think a free market makes health care costless? I mean, scarce medical resources have to be rationed somehow. The argument over health care is really an argument over how we want to ration them.”

Tomatoes have to be “rationed somehow.” LA apartments have to be “rationed somehow.” In fact, isn’t the first assumption of economics unlimited wants and limited resources? Cleverly restating this assumption in different ways and using it as a reason for the government to control of an economic system sends us back to the rhetoric of the Soviet Union.

barghest December 4, 2009 at 11:24 am

I think that visible cost cutting will face political pressure, not cost cutting that isn’t so easily noticed. What fraction of all health care expenses is visible in the way that mammogram screenings are? Will you really notice whether your doctors suggests that you come in for a routine check of (insert generic condition) every year or every six months? And even if the issue is visible, once there is a prescedent for how the issue is dealt with, public outcry may take some time to cause a change. Even though Aids was visible starting in the 1980′s it still took much effort to change the criteria the FDA was using for the approval of new AIS drugs.

Dan Weber December 4, 2009 at 1:17 pm

I have honestly never understood why the Republicans started screaming about that.

Politics. It could be the best idea in the world, but if your opponent suggests it, you fight it.

This isn’t limited to Republicans, obviously. Everyone does it.

Andrew December 5, 2009 at 5:02 am

Bottom Line: Did direct cost to the consumer and the incentive to obtain information to make an informed decision increase or decrease?

Paul Krugman’s of the world believe that medical consumers can’t make informed decisions. Is this because information is scarce and controlled by providers?

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