The Engage with Grace movement (see post below) was so impressive because it sought to bring about real and meaningful conversations about important - but difficult -- health care topics. If we are to succeed as a nation in improving our health outcomes and lowering cost (or at least lowering the rate of cost growth), we need to get much more comfortable having these difficult conversations. Yet, we continue to allow certain voices to poison the well, as occurred earlier this year with bogus claims of "death panels", which was followed by the immediate stripping of reasaonble provisions from reform legislation in order to avoid the topic like the plague.
It looks like this may be happening again on another topic: whether women under 50 should get routine annual mammograms.
I have no idea what the right approach is on this issue. But what I do know is that we need to talk about it in a reasoned and thoughtful way. That now seems unlikely, as it is being widely dismissed, including by Health and Human Services Secretary Kathleen Sebelius, not for scientific flaws, but apparently for fear that health reform opponents will use it to poison another well. Washington Post columnist Steven Perlstein, in a recent opinion piece on the subject, discusses this lost opportunity:
"The political argument from the White House was that it was necessary to duck this fight over evidence-based medicine in order to save it. The better approach would have been to see this as one of those teachable moments that could be used to reaffirm the entire rationale for reform. For while debate continues over whether some women may be getting too many mammograms, there is evidence that there are women who, because they lack insurance, are getting too few -- and dying unnecessarily as a result. What health reform is about is correcting that imbalance while devising new mechanisms for improving health outcomes and getting better control over costs."
Maybe the 60-vote majority is still to tenuous to have a real discussion now. But some time soon -- with or without reform legislation -- we are going to have to figure out a way to have candid conversations about real health care issues like this if we are to have any hope of transforming our system.