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Health bill opponents make most of mammogram advisory

By Michael D. Shear and Dan Eggen
Washington Post Staff Writer
Saturday, November 21, 2009; A01

As a health reform bill endorsed by President Obama marches toward its first Senate floor vote on Saturday, his opponents stepped up efforts to define the legislation as big-government ambition run amok that will interfere with intimate medical decisions and threaten the pocketbooks of average taxpayers.

A dozen Republican senators spent Friday in an orchestrated, hours-long session of floor speeches, assailing the health-care bill as a vehicle to higher taxes, Medicare cuts and premium increases. Meanwhile, the surprise recommendation this week by a quasi-government panel that women should have fewer mammograms injected a volatile issue into the health debate.

Conservatives on radio and television have seized on the controversial recommendation as an example of the big-government medical care that will follow if Obama gets his way.

Phil Kerpen, director of policy at Americans for Prosperity, an advocacy group opposed to Democratic reform plans, said the guidelines are "very helpful for our side" because they illustrate the perils of greater government involvement in health care.

"Seeing a government panel coming out with a recommendation that is so personal to people really focuses attention on what these changes would mean for patient care," Kerpen said.

But White House officials dismissed that as overheated rhetoric and expressed little concern that the issue would resonate with Democratic lawmakers or average Americans.

"Many of the opponents of health reform stopped relying on truth, facts and reasoned argument a long time ago," said Dan Pfeiffer, White House deputy communications director.

The immediate concern for Obama and his allies in Congress remains collecting the votes of wavering, moderate Democratic senators who hold the key to moving the process forward. The Senate will vote Saturday night on whether to begin extended debate on the $848 billion health-care bill, and Majority Leader Harry M. Reid (Nev.) said he is confident he will have the 60 votes necessary to pass that motion.

Sen. Ben Nelson of Nebraska, one of those moderate Democrats, said Friday that he would vote to begin debate. Reid still needs the votes of two other key Democrats, Sens. Mary Landrieu (La.) and Blanche Lincoln (Ark.), who have yet to publicly announce their position.

Trying to increase the political pressure on the holdouts, the White House released a statement Friday night saying that the administration "strongly supports" the Senate bill and "urges quick action on this landmark bill."

As Reid counted votes, Republicans on Capitol Hill and conservative pundits searched for ways to frame the mammogram recommendation in a political context.

Congressional Republicans said privately this week that the issue perfectly illustrated their concerns about government expanding its role into private health-care decisions, and they expect it will be highlighted often throughout the remainder of the health-care debate. Republican women in the House have already started criticizing the recommendation.

"This is how rationing begins. This is the little toe in the edge of the water," Rep. Marsha Blackburn (Tenn.) said Wednesday on Capitol Hill. "This is when you start getting a bureaucrat between you and your physician."

The issue has also grabbed the attention of conservatives such as radio show host Rush Limbaugh and Fox News host Glenn Beck, both of whom fanned discredited allegations earlier this year that the administration wanted to create "death panels" to hasten the demise of terminally ill patients. Beck jokingly referred to the mammogram recommendations as "good news for the government" because it would reduce "the expense of those pesky people."

Obama administration officials strongly reject that contention, saying the U.S. Preventive Services Task Force, which issued the guidelines, has no power to affect coverage decisions by insurance companies. Nor does the task force "determine what services are covered by the federal government," Health and Human Services Secretary Kathleen Sebelius said Wednesday.

The officials also pointed out hypocrisy in the GOP objections: The Republicans' health-care alternative would not provide coverage for mammograms or other preventive services. And they noted that conservatives have long complained that the threat of frivolous malpractice lawsuits leads doctors to overuse costly and unnecessary tests, including mammograms.

Administration officials said they first became aware of the task force's recommendation in early October, after a medical journal accepted its report and prepared to publish it Nov. 17.

The task force provided a routine notification to HHS officials, though the department had no say over the findings nor control over when they would be published, according to senior department officials.

White House aides said the political team leading the fight to pass health-care reform first heard about the mammogram report in the past two weeks and viewed it as potential fuel for opponents, one official said.

But there were no more than a few brief conversations about it, the official said, in part because the administration had no control over the findings, their distribution or the timing.

"It occurred to us that it could be twisted and distorted," said one official who was not authorized to speak publicly on the issue.

The task force is made up mostly of primary-care doctors and nurses who serve four-year terms and are appointed by the director of the Agency for Healthcare Research and Quality. The current members were appointed during President George W. Bush's administration; no new members have been nominated since Obama took office.

On Capitol Hill, Nelson's announcement that he would vote to begin debate was followed quickly by a statement that made clear he still has problems with the bill, including language aimed at restricting federal funds from covering abortions.

"It is not for or against the new Senate health-care bill released Wednesday," Nelson said of his intended vote. "It is only to begin debate and an opportunity to make improvements. If you don't like a bill, why block your own opportunity to amend it?"

If the Saturday vote fails, Reid will head back to the drawing board to rework the bill. The most vulnerable provision is one that creates a government-supported insurance option -- a proposal that is opposed by Nelson and Lincoln, along with Sen. Joseph I. Lieberman (I-Conn.) and several other members of the Democratic caucus. But Reid has reassured senators that the bill can be changed on the floor through amendments.

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