The federal government has decreed that many medical tests and some types of medical care must be provided by health insurance companies without any co-pays. Among the new “free” services are some which are clearly of no overall health benefit. For example, cholesterol screening (which is specifically mentioned as a test that must be provided without additional cost) is useless. As I’ve mentioned here earlier, primary prevention of vascular disease with cholesterol lowering drugs does not prevent vascular disease. You don’t need a blood test to go on a “heart healthy ” diet. So what benefit is expected by mandating “free” cholesterol testing?

The rules stipulate that no co-payments can be charged for tests and screenings recommended by the United States Preventive Services Task Force. This is the group that got the Senate in a tizzy when it recommended that routine mammography not start until age 50. It also does not recommend routine PSA testing. It will be interesting to see how long it takes to override the USPSTF. Also on the list of no extra charge allowed items are prenatal care and aspirin to prevent heart disease. I’m not sure what the latter means. A baby aspirin cost almost nothing and imparts no overall health benefit when given to patients who don’t already have heart disease. The decrease in coronary disease observed when aspirin is given to patients who don’t have heart disease is obliterated by increased GI and intracranial bleeding. It is useful in patients with coronary heart disease. Predictably, the Planned Parenthood Federation of America says insurance plans should be required to cover contraceptives without co-payments. The “free” bandwagon is just getting started. Any group that has something to sell that’s remotely related to health will lobby the army of rule writing bureaucrats in the department of health and human services to be included on the “free” list.

Kathleen Sebelius, the secretary of health and human services, said the rules would extend benefits to 31 million people in new employer-sponsored plans and 10 million people in new individual plans next year. She’s being modest; these mandates apply to all 300 million Americans. Ms Sebelius is in charge of the Nibelungen in the subterranean vaults at 200 Independence Avenue, SW who are writing the rules that will implement the recently enacted healthcare bill. All these thousands of pages of ukases soon to appear in the Federal register, useful or not, will cost money; a lot of it. The insurance companies will either absorb these new costs or pass them on to the consumer in the form of higher premiums. If the government doesn’t allow higher premiums the companies will likely go out of business (or shift to another category of insurance) before too long, which is likely the whole point of all this medical and fiscal legerdemain. When the evil insurers are gone or fatally attenuated the government will be “forced” to institute or impose (depending on your health orientation) a national healthcare scheme.

Ms Sebelius believes that her new rules will save 100,000 live a year. Identifying these saved lives will likely be as difficult as identifying the jobs save by the recent stimulus bills. It’s a coin toss (maybe the coin will have both heads and tails on it) whether the public will see through this pills and circuses ploy. What’s certain is that this armada is just slipping its moorings.