Tyler Cowen writes:
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.
It’s a problem when one branch of the government recommends less screening and then another branch recommends that all screening be made free. As Cowen notes, it’s even worse than that, in the sense that it was the reduced-screening recommendations that got the controversy started and led to the free-screening mandate.
But the story is a bit more complicated, if you get into the details of the politics and the decision analysis.
First, the politics. This is getting pretty confusing to me, because the last I heard, it was the Democrats who were supporting guidelines to limit mammograms for women under 50, and it was the Republicans who were leading the fight to disregard those recommendations. None of this makes sense to me.
Second, the decision analysis. The interesting thing about the comparative effectiveness studies is that mammograms aren’t really all that expensive. The key reason that mammograms for most women under 50 fail the comparative effectiveness test is that the tests are likely to result in false positives, causing unnecessary pain and anguish to the women thus affected.
The reason I’m bringing this up is that, to a large extent, the new recommendations imply that for younger women without risk factors probably shouldn’t want frequent mammograms even if they’re free. At least, whenever I’ve seen guidelines about this sort of thing, cost issues are downplayed. (For example, in the National Cancer Institute recommendations, the question “How much does a mammogram cost?” is answered as follows:
The cost of screening mammograms varies by state and by facility, and can depend on insurance coverage. However, most states have laws requiring health insurance companies to reimburse all or part of the cost of screening mammograms. Women are encouraged to contact their mammogram facility or their health insurance company for information about cost and coverage.
The recommendations really seem to be set up without considering the dollar cost of the procedure. So if people really do follow the recommendations, it’s not clear that much is lost by making the mammograms free.
This same argument goes for other moderately-priced health care items, I think. If certain forms of medical care are overused by some people, then I agree there’s something counterintuitive about turning around and offering them for free. But it’s not clear to me that it’s actually such a bad idea.
P.S. To put it another way, what seems more important to me is not who pays the small cost of a mammogram, but, rather how often people choose to have mammograms. Currently, lots of simple procedures are billed at many thousands of dollars even though the underlying cost is low.
P.P.S. To put it yet another way, even when medical procedures are free or nearly so, it’s not like people are going to the doctor and getting scans all the time.