A government study has suggested routine mammograms should be started at age 50 instead of age 40. The evidence-based analysis seems clear – we’re spending billions of dollars to screen for cancer, only to find no evidence of the disease in the vast majority of women under the age of 50.

That’s good news – unless, of course, you’re one of the women below the age of 50 whose undetected breast cancer could be diagnosed by a mammogram.

Just to note, the average cost of a mammogram in Maine is $220 according to healthweb.maine.gov , a Web site that lists hospital costs for common medical procedures. At that price, it’s fair to say that most women could be screened by directly paying for its cost, but that would be taking away a benefit and, for some, an entitlement. The furor over this report is as much about threatening an entitlement as it is about challenging the common wisdom of a long-standing practice.

For proponents of national health care, the controversy couldn’t come at a worse time. Opponents are screaming “It’s government rationing!” as a rallying cry to defeat national health-care legislation. In a swift counter action, the secretary of Health & Human Services announced that, despite the report, women should continue getting mammograms and that the government would continue to pay for those who are financially eligible. So much for data, rational discussion or cost containment. That’s what makes unpopular policy recommendations as much fun as a mammogram or a prostate exam. It’s the right thing to do, but it comes with some pain.

This mini-debate is just the beginning of a long-overdue discussion: government promising more than taxpayers can afford and, taking away benefits we have come to expect. This debate also should be about demanding and using good information to arrive at rational decisions that serve the broad interests of our nation, states and communities. America has made policy choices that have impaired our economy and that means rationing of resources.

Today, the cost of federal entitlement programs is rising because a majority of politicians keep spending and promising. In addition to collecting and spending our taxes, Washington now has borrowed and spent an additional $12 trillion, more than twice the amount we owed to our creditors when George W. Bush began his presidency. The expansion of prescription drug coverage is only one of the new entitlements that was passed by Congress with borrowed money and enthusiastically signed by Bush. It was an irresponsible gesture to placate an aging population whose members vote in big blocks. Shame on everyone for letting it happen.

Our friends in Washington are allowed to borrow and run up unfunded deficits that American workers who have yet to be born are expected to pay. Washington is out of control, which is why President Obama was just lectured by our Chinese creditors that they have little patience for continued fiscal tom-foolery.

In the meantime, however, the debate in Congress is not where to cut, but where to spend to get the biggest return at the ballot box and amass further power. The give-aways that buy loyalty continue, in part because special interests threaten to have a hissy-fit if they don’t get what they want, no matter who has to pay.

In contrast, Maine legislators and the governor are making changes that will balance our state budget without raising taxes. The question will be whether or not they prioritize spending or make across-the-board-to-share-the-pain cuts. Will they eliminate programs, change eligibility and renegotiate contracts, or will they simply pass the buck to towns and school boards? With a growing $400 million hole to plug, expect all of the above.

Voters in Maine have proved that they act on the information they are given. For example, a majority of voters rejected reducing the excise tax because they didn’t want to see road maintenance diminished. A majority rejected TABOR II and gay marriage out of fear as they certainly understood the information they were given, whether it was true or not. Finally, they also soundly rejected an increase in the beverage tax that was intended to fund the failing Dirigo health plan. But, despite the voters’ decision to repeal the tax, a majority of legislators returned to Augusta, ignored the voters and passed a new tax on health-care services to fund Dirigo. Something to remember.

Perhaps if we were as demanding with preventive screening at the polls as we are about our health, we might replace those politicians whose spending and taxing habits are as insidious as an aggressive cancer. Nov. 2, 2010, is our next screening. Even if it’s a little uncomfortable to vote out incumbents who just don’t get it, know that preventive medicine has a real and lasting benefit.

 

 

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Tony Payne is executive director of the Alliance for Maine’s Future and a Falmouth resident and town councilor. His column is published biweekly, and he can be reached at tpayne@midmaine.com.

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