Want a Glimpse of the U.S. Health Care Future?
Look at Mammography.
All you need to do is look at the story of mammography and the Mammography Quality and Standards Act of 1992. Want to see what you are in for? Here’s a synopsis. In the coming days I’ll give you the whole juicy story.
PRIOR TO THE 1992 GOVERNMENT SEIZURE OF MAMMOGRAPHY WITH THE MQSA (FEDERAL MAMMOGRAPHY ACT)
1. Women’s imaging is booming – competition for business is brisk
2. Women’s centers being built everywhere with parquet floors and vaulted ceilings, furnished with overstuffed chairs and couches providing a private, comfortable milieu
3. Medical device manufacturers are eagerly in the game, developing stereotactic minimally invasive biopsy machines; MRI of the breast and digital mammography are both rapidly being developed to advance sensitivity and specificity of diagnosis
4. Diagnostic Imaging residencies open a new subspecialty: Women’s Imaging. Interest among radiology residents is high
DEUS EX MACHINA:
1992: THE FEDERAL GOVERNMENT SEIZES THE MAMMOGRAPHY INDUSTRY WITH AN ACT OF CONGRESS--MQSA IS SLAMMED THROUGH CONGRESS.
Perceived quality issues are championed by television “investigative” reporters, and then picked-up by nonmedical women’s activists and disease-specific lobbyists as a political, social and moral cause. Mammography is assumed to be tainted by the male-dominated health care industry and it becomes de facto evident to all that because of the second class social status given to women, this most valuable diagnostic examination is poorly supervised, and, as a result, cancers are being missed and women are being harmed (by the health care system).
Popular female political figures like Olympia Snowe team up with grass roots organizations like The National Breast Cancer Coalition and The National Black Women's Health Project to take up the cause with Congress. Congressional hearings ensued and the lack of formal studies and empirical data to support the notion that mammography was seriously and significantly amiss were ignored in the rush to right the wrongs done by Western civilization on women in America. A gargantuan wish-list of regulations, oversights, and QA controls were compiled and thrown at mammography practitioners along with serious and disabling price controls which permanently set the price of mammography too low to pay for any of the unfunded mandates foisted on the industry.
Why price controls in the face of new massive regulation? The proposal was that too many women were not getting mammography, despite the fact that out-of-pocket expenses for health care had not changed in 30 years and have not changed yet, to this very day.
But the facts were never an issue at the hearings and the government sailed this massive legislative ship which has devastated mammography.
In summary: The media fanned the anecdotal flames and activists seized their opportunity to effect CHANGE, despite the facts, and Congress marched in lockstep behind the forces of political and social activism against which they are incapable of fighting and, in a worst-case-scenario, massive legislation was enacted without appropriate data collection and consideration -- and why did they act so quickly?
Because they claimed WIDESPREAD PROBLEMS that were out of control and needed to be acted upon quickly because the mammography industry was:
What was the government’s response to this CRISIS in mammography?
What was the Mammography Quality Standards Act (MQSA)?
Did government intervention fix the perceived problems that lead to the avowed CRISIS?
What has happened to mammography since the MQSA?
This tale will tell you a lot about where our health care is going…