Friday, February 17, 2012

Government Committee Mandate

A committee is organic rather than mechanical in nature, it is not a structure but a plant. It takes root and grows and flowers, wilts, and dies, scattering the seed from which other committees will bloom in their turn.

C. Northcote Parkinson (1909-1993), Parkinson’s Law(1957)

February 17, 2012 - Scott Gottlieb, MD, a physician and resident fellow at the American Enterprise Institute, former deputy commissioner of the FDA, and senior advisor to CMS, wrote a 2/16/12 WSJ Op-Ed, “Meet the Obamacare Mandate Committee.” It was Gottlieb’s version of the maxim,” A committee is a camel designed as a horse.”

Gottlieb’s thesis was: “Under Obamacare, a single committee – The United States Preventative Services Task Force – is empowered to evaluate preventive health services which will be covered by health insurance services.” Gottlieb implies this Committee, like the camel, he implies suffers from poor design.

The committee will rate services from “A” to “D”, or as ”I” if there is insufficient evidence to earn a rating. Those services rated as “A’ or “B”, e.g. colon cancer screening for adults aged 50-65 or mammography in women over 50, will be covered “free” without co-pays, Those rated as “C” or “D” –e.g. routine screening for prostate cancer for men over 65 or women at any age for ovarian cancer – may not be covered at all.

In November 2009, the Committee ruled woman, aged 40-49, should not get routine mammograms. Women and doctor organizations were outraged Recently, the Committee ruled routine PSA and cervical cancer screening was a bad idea.

As far as I know, the Committee has not committed itself on the ticklish issue of whether health plans should offer oral contraceptives and other birth control measures for free, but that too may come. It will probably follow President Obama’s lead.

The Committee’s grade require a randomized prospective screening. Consumers and physicians often react with outrage because the Committee’s findings are often out of sync with their expectations or traditional practices.

No matter. The Committee is exempted from government’s traditional advisory and regulatory services rules, just as the Independent Payment Advisory Board will be. The Committee’s meeting are private. It has no obligation to release its minutes. Its decisions are not open to public hearings and cannot be appealed.

Gottlieb says, at a minimum, the Committee should be subject to the Federal Advisory Committee Act. This would make its deliberations public and subject to the rules of the Administrative Procedure Act that binds other regulatory bodies. All of them are required to consider public comment and provide avenues for appeal.

The Committee can now make unilateral edicts, like forcing insurers to pay for pregnancy prevention or termination. This, he adds politely, is an “initial exploit of an elaborate new system, ” signaling more “exploits “ will follow.

This Committees’ actions, in turn, raises questions:

--Should a government committee have the power to dictate to private employers and health plans to provide something for “free’?

--Is this the American way of democracy? Should private companies be forced to pay for, even it violates their moral sensibilities and religious consciences?

--Should the public and the profession have a voice in these matters?

--Does one-size-fit-all in a pluralistic society?

Federal government has a Committee, the Preventative Services Task Force, that decides what health plans must offer for “free.”

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