Is health care for women under attack?

Women pay approximately 48% more for health care than do men in the United States.  Even after paying high health care premiums to health insurance companies, women are sometimes denied coverage of pregnancy and childbirth care because it is deemed a pre-existing condition.  

In the latest form of the health care reform bill, Bart Stupak, (D), MI., proposed an amendment that would exclude abortion care and treatment from health insurance for women, not just government funded health care such as Medicare or a public option but by any private health care insurance company as well.  The Stupak amendment passed and if it isn't cut from the bill, women will find themselves with few choices. 

While the latest version of the health care bill promises to prohibit the practice used by private health insurers of charging women up to 48% more in health care premiums than their male counterparts,  the Stupak amendment eliminates rights that women currently have to buy insurance coverage that would provide abortion services.  It isn't a fair tradeoff;  women will have to give up certain rights to finally gain equal footing with men on the cost of health insurance premiums.  

Coming just days after the Stupak amendment was voted on and passed, a private sector task force commissioned by the Health and Human Services division of the U.S. government announced that it would recommend that physicians forego advising female patients under the age of 50 to have  annual screening for breast cancer.  The U.S. Preventative Service Task Force (USPSTF) panel of 16 included three private health insurance company representatives but no oncologists.  The panel measured some number models and came up with the recommendation, ostensibly because of a higher number of 'false positives' among women under 50, causing anxiety and sometimes, unnecessary followups and testing.

It's widely known that the United States ranks far below other developed nations in health care costs, treatment results, and lifespan but one of the few areas in which the U.S. has excelled has been in preventing cancer deaths.  It is unclear why the USPSTF has recommended suspension of annual mammograms for women under 50.

The USPSTF's recommendations have generated a lot of criticism.  But there are some who believe the recommendation is a good one.  Proponents for changing routine breast cancer screening recommendations  claim that false positives have caused a lot of anxiety among women and in some cases have led to disfiguring biopsies. 

According to the Washington Post, "Many experts have begun to raise questions about routine screening methods, including the PSA blood test for prostate cancer and mammography, because they often trigger false alarms and catch precancerous growths and tiny tumors that would never become life-threatening but nonetheless prompt treatment."

But so far, the USPSTF hasn't recommended suspending  testing for prostate cancer in men under the age of 75.  

The Washington Post also reports that,  "Annual mammography for all women beginning at age 40 reduced the death rate from breast cancer by at least 15 percent."

The USPSTF panel recommends that women don't need to perform breast self-examinations as part of their routine but the National Breast Cancer Foundation disagrees.  Founder Janelle Hall discovered a lump in her breast at the age of 34 through self-examination and a mammogram detected she had breast cancer.  She writes on the NBCF website that she "would not be alive today" had she followed the recommendations made by the USPSTF. 

Another breast cancer survivor, Representative Debbie Wasserman Schultz, (D), FL., spoke to Chris Matthews of Hardball on MSNBC about detecting a lump in her breast during a self-examination that led her to have a mammogram that detected cancer.  She was in a higher risk group for the disease but wasn't aware of the risk until she was diagnosed.   

The USPSTF was, as is stated on its website, "first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services."

"The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care."

But there is some evidence that their ideas on cancer screening differ by gender. Though the controversy over breast cancer screenings and prostate cancer screenings for women and men respectively, has been debated for several years, the USPSTF has very different recommendations for cancer screenings for men than for women.  The only consistency is that the USPSTF doesn't recommend breast or prostate cancer screening in women or men over the age of 75.

In August of 2008, the USPSTF made recommendations regarding prostate cancer screening that is very different than its recommendations for breast cancer screening.

"Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms."  

So in 2008, the USPSTF in essence,  recommends that physicians discuss the benefits and risks of prostate cancer screening with their male patients under the age of 75 and decide what action to take, if any.

Both prostate cancer and breast cancer screening effectiveness has been controversial in the last decade but the USPSTF appears to believe that physicians and their male patients can discuss the controversy and come to a decision about whether or not to be tested and how to be treated. Yet their recommendations that physicians forego recommending any sort of breast cancer screening to their female patients seem to indicate that the 15% of women between 40-49 whose deaths are prevented by screening aren't worth the bother of having to explain what the options, benefits and risks of breast cancer screening are to women.

The recommendations by the USPSTF come at an odd time.  After some 70 years of trying, the government seems posed to finally produce health care reform for all Americans that will have some benefit for women by prohibiting the extortive premiums women often pay health insurance companies. But the same health care reform, as it is written now, will take away other rights of women. 

With recommendations by a panel that includes three private sector health insurers urging physicians to forego recommending breast cancer screening for women even though breast cancer screening has prevented breast cancer deaths in significant numbers of women, it seems frighteningly clear that women's health care is under attack.