Head Strong: The true cost of freedom from anxiety

Give me anxiety or give me death. If Patrick Henry were watching last week's new wrinkle in the debate over national health care, he'd have said something like that.

You can move aside the battle over single-payer systems, covering illegal immigrants or even abortions. After months of consternation over the direction of health-care reform, something called the U.S. Preventive Services Task Force kicked off a real debate last week by suggesting that women ages 40 to 49 should not automatically be screened for breast cancer, that women 50 and older get mammograms every other year, and downplaying the need for self-exams.

Seven years ago, the task force recommended that women ages 40 to 49 get regular mammograms, and that women from 50 and 74 schedule them annually.

The consternation is understandable. The new recommendations seem like a legitimate motion to ration health care.

Why?

Consider the reasoning behind the changes. Proponents said they would reduce the unnecessary dangers - expenses, pain, or anxiety caused by false positives or more frequent testing and follow-up - to younger women who get regular mammograms. Women in their 40s are more likely to experience those harms, but they're significantly less likely to actually be diagnosed with breast cancer.

Though the panel said it didn't take costs into account, there's also an undeniable financial effect of the shift as well. Approximately 37 million mammograms are administered every year. Each one costs about $100. So reducing the number of mammograms could result in billions of dollars in savings.

But as Marie Savard, former director of the Center for Women's Health at the Medical College of Pennsylvania and an ABC News medical contributor, pointed out to me last week, nobody is suggesting that mammography isn't a lifesaving tool for thousands of women younger than 50. So encouraging fewer mammograms - and thus less anxiety and patient costs - means putting some women at greater risk.

"We know that it saves lives. I just can't imagine that they're willing to look at numbers and evaluate death vs. cost of treatment. That's basically what they're doing," Savard said in an interview. "They put on one side death, and they weighed on the other side cost of treatment. And they didn't feel it was justified."

That doesn't make this the health-care cabal that President Obama's conservative critics have been predicting for months. The guidelines of an expert panel don't equate to concrete changes in federal policy. Last week, Health and Human Services Secretary Kathleen Sebelius assured the country that the task force "is an outside independent panel" that doesn't "set federal policy and they don't determine what services are covered by the federal government."

But the new guidelines could potentially cause insurers to change how they cover annual mammograms. Managed-care organizations might decide to stop rating doctors based on whether they performed mammograms on women under 50. And it's possible that Medicare, which Savard said "follows this government panel to the letter for the most part," would no longer cover annual mammograms - even for women older than 50.

It has happened before. The same task force concluded last year that virtual colonoscopies, which use CAT scans, were an insufficient means of screening men for colon cancer. In part because of that recommendation, Medicare stopped covering them as an alternative to conventional colonoscopies. Similarly, this year's recommendation that doctors not teach women to administer breast self-exams only heightened the concerns of many that the guidelines could imperil potential breast-cancer victims.

"They're looking at statistics and they're looking at numbers when, as physicians and health-care providers, we're looking at patients and we're looking at faces. And those women have names and families and it's a very different issue," Beth DuPree, a breast surgeon and medical director of the Breast Health Program at Holy Redeemer Hospital, told me last week.

That's true, and it's a calculation that affects men as well. Six years ago, I had a full-body scan at a newly opened private facility because it had recently become a radio advertiser of mine and wanted to showcase its services. I had the test despite lacking any symptoms.

The scan revealed "an approximately 2 mm nodule see in the lingular segment of the lung peripherally." The report came just as a friend, a fellow cigar smoker, was dying of lung cancer. The finding, if that is what it was, was frightening and necessitated additional intervention.

My primary care physician referred me to a pulmonologist, who in turn ordered a CAT scan of my chest (which was then to be repeated annually for two years). Where my insurance company hadn't covered the initial full-body scan, it was now on the hook for the cost of this subsequent care.

I knew that at the end of the monitoring I would either thank the radio sales manager who arranged the body scan for having saved my life, or curse him for causing me concern (and costing my insurance company thousands of dollars).

Thankfully it was the latter. Still, I'd take the anxiety that comes with a false alarm over a missed opportunity for intervention anytime. Just like the women who've grown accustomed to having mammograms starting at age 40.