December 7th, 2009
02:06 PM ET

Controlling the cost of care? Something had to give – and it did

By Caleb Hellerman
CNN Medical Senior Producer

The fight over changes to the health care system has been so fierce for so long, the turning points aren’t always clear. But for me, the past two weeks answered a big question: Are Americans willing to sacrifice their health care to try to hold down costs? To me, it’s clear the answer is no.

This question has been hanging over the debate all along. President Obama and Democrats in Congress are selling the bill as cost-control. Health care costs have risen much faster than wages or inflation over the past two decades, and these Democrats (along with some Republicans) say that if we don’t get that under control – soon – it will crush the economy, and force drastic cutbacks for all kinds of health care. Supporters of the bills say we don’t have to sacrifice, as long as we emphasize preventive care – catch problems while they’re minor– and if we’re more “efficient,” avoiding unnecessary tests and treatments. Just like that, they say, we can save almost $500 billion from Medicare alone. The Congressional Budget Office, the definitive bean counter, agrees.

But one person’s “efficiency” is another person’s “rationing.” That led to accusations about “death panels” and unelected boards withholding vital care. In fact, the bills do set out a big role for government experts to shape what procedures are covered by insurance. Many people don’t like this, on ideological grounds. Others, right or wrong, fear the government will be stingier than private companies that currently administer insurance for two-thirds of the population.

We were reminded recently that we live in a democracy - and that Congress doesn’t like controversy. This tension started coming to a head with something that wasn’t even part of the health care bill: a recommendation from a federal health advisory panel that said most women can wait until age 50 to have regular mammograms – instead of starting at 40, as most doctors now recommend.

Opponents of the health care bill, mostly Republicans, called this evidence that the federal government is hankering to ration care. No matter that the mammogram panel has no power over insurance – for weeks, members of Congress have been jumping over one another to denounce its recommendations and to say – in effect – that only over their dead bodies will there be limits on mammograms.

A few jumped the shark into outright falsehood, like Florida Rep. John Shadegg, R-Arizona, who asserted that the health care bill would prohibit millions of women from purchasing mammogram coverage. But the result was a Senate vote, 61-39, to expand preventive health screenings for women, and a unanimous vote to prevent the panel’s recommendation from restricting mammogram coverage – a non-existent power in the first place.

The details of the mammogram debate are beside the point. The bottom line is that the recommendations were deeply unpopular, and so Congress stepped up to avoid even the hint of limiting coverage. That’s a good sign for democracy, but it doesn’t suggest we’ll be cutting the cost of care, any time soon.

To see how your senator voted on amendments to the health care bill, you can click right here.

Do you trust the government or private insurance companies more, to decide what treatments should be covered?

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