A meeting cancellation has raised speculation over what Health and Human Services Secretary Robert F. Kennedy Jr. has in store for the U.S. Preventive Services Task Force (USPSTF)
The task force is an advisory panel that recommends what preventive services health insurers must cover fully under the Affordable Care Act.
The task force was scheduled to meet on July 10. On July 25, The Wall Street Journal reported “people familiar with the matter” said Kennedy was planning to remove all 16 members of the panel because he views them as too “woke.”
The last-minute meeting cancellation set off alarms in many quarters. AcademyHealth, the American Medical Association, and the American Public Health Association were among 104 health care organizations that signed a letter to the Senate Health, Education, Labor, and Pensions (HELP) Committee asking it to protect the task force’s integrity.
The meeting had been scheduled to discuss diet, physical activity, and weight loss to prevent cardiovascular disease in adults.
Court Confirmation
In June, the U.S. Supreme Court affirmed the process to appoint members of the voluntary panel was constitutional, in Kennedy, Sec. of H&HS v. Braidwood Management.
“Task force members are inferior officers whose appointment by the secretary of HHS is consistent with the Appointments Clause,” the majority opinion stated.
The plaintiffs, two Christian-based businesses, argued task force members are officers subject to the Senate confirmation process and their decisions violated their religious beliefs by making them “complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.”
The decision, which triggered a strong dissent from Justices Thomas, Alito, and Gorsuch, worked in Kennedy’s favor because it affirmed his appointment power. Fears that Kennedy would reconstitute or even disband the task force were realized when he cancelled the meeting weeks later.
The American Conservative on July 9 published a commentary urging Kennedy to “kill the USPSTF.” The article pointed out that all USPSTF recommendations must be fully covered by health plans under the Affordable Care Act (ACA).
“It has used that authority to launder left-wing ideological orthodoxy into its preventive care recommendations, from gender theory (referring to women as “individuals born with a cervix”) to critical race theory (urging doctors to take into account “systemic racism”),” wrote Joseph Addington.
HHS has not given an official reason why Kennedy cancelled the meeting. On July 26, HHS spokesman Andrew Nixon told Medpage Today, “No final decision has been made on how the USPSTF can better support HHS’ mandate to Make America Healthy Again.”
Ideology v. Science
Ideology is a likely reason why the USPSTF’s future appears in jeopardy, says Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons.
“I think that the USPSTF and HHS have ideological goals, contrary to the presumption that they are or ever have been objective and scientific,” said Orient.
“They use the power of government to enforce those goals, such as requiring abortion coverage,” said Orient. “There are also political goals and financial conflicts of interest. Change is needed.”
When the ACA went into effect, it elevated the USPSTF in a way for it to become too powerful, says John Dale Dunn, M.D., J.D., a policy advisor to The Heartland Institute, which co-publishes Health Care News.
“One is that recommendations of the task force have the effect of law,” said Dunn. “Another is that they are not allowed to consider cost in their recommendations, which is not the way health care policy should be enacted. Cost and benefit are not to be ignored. Health care dollars should be spent with a cost-benefit analysis as a guide.”
Ignoring Trade-Offs
The task force has pursued unrealistic goals, says Dunn.
“Economics are governed by a rule that Thomas Sowell articulated very well: that solutions are always tradeoffs,” said Dunn. “Tradeoffs are measured as cost versus benefit. The ‘precautionary principle’ that guides the task force is not only an immature and ignorant way to approach risk assessments, it is not sensible in any way: risk management is what adults do in life. Pretending that the solution is intolerance to risk is ludicrous.”
The panel has strayed from its advisory mission, says Orient.
“I think that the agency has assumed too much power, which should be challenged in the light of recent SCOTUS decisions,” said Orient. “There is no evidence that its diktats have saved lives or that their benefits have exceeded the cost.”
Insurance Interests
The “prevention” mission of a task force makes little sense when it involves insurance, says Orient.
“Insurance is supposed to protect people against unanticipated, catastrophic costs,” said Orient. “Preventive care is not an insurable risk. Additionally, the federal government does not have the constitutional authority to dictate what care people should receive or to force them to pay for care they do not want or do not receive.”
The 104 health care associations defending the USPSTF have a powerful financial interest in the task force’s decisions, says Orient.
“The 104 organizations are probably mostly concerned about having mandates to cover the things they provide,” said Orient.
There is a better solution to keeping ideology out of health screening recommendations, wrote Peter McCullough, MD, MPH, in his Focal Points Substack.
“The best action may be to disband USPSTF and allow individual medical societies to manage their own guidelines which always seem to be more assertive and proactive than USPSTF,” wrote McCullough.
Kevin Stone ([email protected]) writes from Arlington, Texas.
