The New York Times - November 23

Republicans have been pouncing on the recommendations -- made by the U.S. Preventive Services Task Force -- as an example of what they said would be government intrusion into health care. On ''Fox News Sunday,'' Senator Christopher S. Bond, a Missouri Republican, said that the Obama administration was ''playing around with excessive government control and this administration and, regrettably, this Congress has been all about more government control, more government intrusion.''

But Senator Debbie Stabenow, a Michigan Democrat, also underscored that the task force report was only a recommendation -- one that the Obama administration has distanced itself from -- and that the ''bigger issue here'' is that the bill will make sure that women ''actually have mammograms covered.''

On the same program, Senator Arlen Spector, a Democrat of Pennsylvania, shrugged off criticism by his former party that the Senate bill would end up vastly increasing the federal budget and widening the deficit. He pointed out that the Congressional Budget Office, the respected arbiter on what legislation costs, said that the bill would save $130 billion in the first 10 years and $650 billion in the second 10 years.

But Senator Lamar Alexander, a Republican from Tennessee, was skeptical, saying ''I don't think one out of 10 Americans believes that.'' The bill, he said, would lead to higher premiums, higher taxes, cuts in Medicare and it would put ''15 million more low-income Americans into a medical ghetto called Medicaid.''

By contrast, he said, the Republicans were trying to take smaller steps to reduce costs by letting small businesses poll their resources to buy insurance, by reducing ''junk lawsuits'' and by letting people buy insurance across state lines.

''And I think most people would be much more comfortable with us biting off what we could chew instead of this arrogance of thinking we can fix the whole system at once,'' he said.

Health Haggling Heats Up --- Deal Making Takes Spotlight Now That Overhaul Bill Has Reached Senate Floor

Wall Street Journal - November 23

The 60-39 vote Saturday night set the stage for as many as three weeks of debate and compromise in December and perhaps more in January, a struggle that is sure to color the 2010 fight for control of Congress. If the bill passes the Senate, it will then need to be reconciled with a version already passed by the House and then the final bill will have to pass the entire Congress before being sent to President Barack Obama for his signature.

Republicans, even in the minority, have leverage to shape the Senate debate. They portray the legislation as a huge long-term liability for U.S. taxpayers. "It raises premiums," said Sen. Lamar Alexander (R., Tenn.) on "Fox News Sunday." "It raises taxes. It cuts Medicare."

For GOP, Health Is Only One Battle on Road to '10 Elections

Wall Street Journal - November 23

With the 2010 election year looming, Republicans forced Democratic leaders to demonstrate that they can pull together a 60-vote majority for the bill. All 58 Democrats and the two independents allied with the party joined together, voting to avert a Republican filibuster that threatened to stall action.

"Our goal is to let the American people know what it does for them and to them," Sen. Lamar Alexander (R., Tenn.) said on "Fox News Sunday." Among other things, the bill would raise Medicare payroll taxes for the wealthy and cut Medicare payments to health-care providers, while expanding eligibility for Medicaid, the federal-state health program for the poor. "We think if the American people know that, the bill will collapse of its own weight," Mr. Alexander said.

The defeat isn't likely to cause a fundamental rethinking in Republicans' strategy of delaying the bill and pointing to what they see as its flaws. Even if a bill ultimately passes, Republicans hope to delay that moment until well into 2010 -- when all seats in the House and one-third of those in the Senate will be contested -- then make the case to voters that Democrats took their focus off the economy and an unemployment rate above 10%.

The danger for Republicans is that their delay tactics begin to look like political opportunism and they appear to obstruct a bill that contains some popular elements such as restrictions on health insurers.

In the give and take on the Senate floor, where the bill will be debated in December, Republicans hope to drive a wedge among Democrats, potentially peeling off centrists on key issues. Republicans also hope to force attention to their own proposals for changing health care, such as limiting medical-malpractice claims and enhancing the ability of small businesses to buy insurance.

"I think people will be more comfortable with us biting off what we can chew instead of this arrogance, thinking we can fix the whole system all at once," Mr. Alexander said.

She says she will "very powerfully ignore" the U.S. Preventive Task Force recommendations this week because it will "increase the number of women dying of breast cancer."

According to Dr. Healy, women in their 40s can have a very aggressive kind of breast cancer and they tend to progress fast.  She says not screening women in that age group goes against the advice of doctors who are actually caring for patients.

"You may save some money," she admitted, "But you're not going to save lives."

Dr. Healy also warns of "hidden government rationing" in the Democratic health care reform plan.

"Pretending it's coming from experts and that it's going to be for your health and well being. These guidelines are not.  We're going to see more people die of breast cancer.  And breast cancer is 25 percent of the cancers that are out there," she said.

For more practical advice from Dr. Healy, watch our web exclusive on when women should have breast and cervical cancer screenings.  She also gives some surprising cancer statistics.

For even more, read an exclusive preview of Dr. Healy's upcoming column on the topic this week.

Republican Conference Chairman, Senator Lamar Alexander, in what might become a familiar GOP battle cry, immediately went after the new legislation claiming, “it has higher premiums, higher taxes, Medicare cuts, puts 15 million more low-income Americans into a medical ghetto called Medicaid.”

Michigan Democratic Senator Debbie Stabenow countered saying the status quo is not working and everyone agrees reform must be done.

When questioned about the likelihood of Senate Democrats being able to muster the 60 votes needed to pass reform, Stabenow replied, “We're working on a number of different options that will bring us together.  And I believe at the end of the day we will be together because we know that we can't afford not to act, whether it's saving lives, saving money.”

Missouri Republican Kit Bond linked the current effort for health care reform to the breast cancer recommendations released earlier in the week.  Bond made the assertion that the government task force behind the study is a harbinger of more government influence down the road. 

"They are playing around with excessive government control, and this administration and, regrettably, this Congress has been all about more government control, more government intrusion," Bond said.

Senator Arlen Specter, a Democrat from Pennsylvania who’s a cancer survivor himself, accused Republicans of not being on the side of governance.  He articulated this point by calling for a civil debate to figure out what’s the best way to move forward. 

"Let's take up the amendments one at a time.  If the amendments offered by anyone are good, but the one option which is not present in my judgment is the option of doing nothing,” Specter explained.

Finally, Senator Stabenow made clear her stance on a key piece of the health care reform bill just passed in the House of Representatives.  When asked directly if she would agree to the Stupak amendment, which specifically banned government funded abortion, Senator Stabenow replied she would not support a similar measure if it were placed in the Senate bill. 

“This is something I want to see changed because I don’t think we should change what we’ve been doing for 30 years,” she said of the Stupak amendment.

U.S. Preventive Services Task Force (USPSTF):

Screening for Breast Cancer

Recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.

Recommends biennial screening mammography for women aged 50 to 74 years.

Concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.

Recommends against teaching breast self-examination (BSE).

Concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.

Concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

Read more here.

The American College of Obstetricians and Gynecologists (ACOG):

First Cervical Cancer Screening Delayed Until Age 21 Less Frequent Pap Tests Recommended

Women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended.

Most women younger than 30 should undergo cervical screening once every two years instead of annually. Those age 30 and older can be rescreened once every three years. Women from ages 21 to 30 be screened every two years instead of annually.

Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every three years.

Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents which can have economic, emotional, and future childbearing implications.

Previously recommended that cervical screening begin three years after first sexual intercourse or by age 21, whichever occurred first.

Recommendations on the upper age limit for discontinuing cervical screening remain the same. It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years.

Read more here.

Plus, President Obama continues to deliberate over the US’s future involvement in Afghanistan.  We’ll talk to four influential thinkers from the Senate’s highest ranks to get their thoughts on these and other important issues.

Segment 1 Guests:

Sen. Lamar Alexander, (R) Tennessee / Chairman, Senate Republican Conference

Sen. Debbie Stabenow, (D) Michigan / Finance Committee

Sen. Kit Bond, (R) Missouri / Ranking Member, Select Committee on Intelligence

Sen. Arlen Specter, (D) Pennsylvania / Appropriations Committee

This week brought significant and controversial news for women about screening guidelines for two different types of cancer.  On Friday a new study recommended that women can delay their first Pap test for cervical cancer until age 21.  This announcement came on the heels of Monday’s news about breast cancer prevention, which instructed women to delay their first mammogram until age 50.  We’ll sort through both studies when we’re joined by a leading women’s health expert.

Segment 2 Guest: Dr. Bernadine Healy, U.S. News & World Report's Health Editor & Former Director of the National Institutes of Health (NIH)

And our Power Player of the Week is letting his voice be heard, in the battle to remake the Republican Party.

Power Player: Chris Chocola, President of Club For Growth