Why is health care so hard to fix?

The great mammogram debate provides some answers. It's a microcosm of the larger struggle to overhaul and improve America's incredibly expensive health care system.

An independent panel of medical experts this month recommended that most women don't need mammograms until age 50, after which they only need one mammogram every two years.

That runs counter to what the American Cancer Society has been urging for decades - yearly mammograms starting at age 40 to try to detect breast cancer early and save lives.

Many women were understandably suspicious and angry about the new guidelines from the U.S. Preventive Services Task Force. You can't preach prevention for years and then, in an instant, suggest an entire decade of testing for breast cancer no longer matters.

Yet the task force cited extensive research suggesting annual mammograms for women in their 40s were leading to minimal benefit compared to the harm of frequent false-positive readings and unnecessary biopsies.

Which brings us to the lessons for Congress and the public as the debate over reforming America's health care system nears a key vote:

• More government control of the health care system - starting with a "public option" to private insurance - might streamline coverage decisions to save money.

But is also could limit the freedom of doctors and patients to make the health care decisions they believe are best for individual patients.

That's why many Americans fear a single-payer system - because it cedes too much control to Washington. A better path is to encourage more competition among private insurers while allowing states the flexibility to cater care to their own populations.

The political left often cites European nations as examples of strong, government-driven health care. The European standard for giving mammograms is already age 50.

Are they ahead of us? Or are they more willing to accept higher risk from breast cancer to save money?

• Change that sounds good in theory can be hard to accept in practice. America voted for change last year. But understanding how the Senate and House health bills will effect change is difficult. No matter which bill moves forward, unintended consequences will result.

• More health care doesn't mean better health care. The government task force recommending fewer mammograms was striving to avoid harm to healthy people from unnecessary procedures. By one estimate, as much as one-third of all health care isn't needed. Yet it's hard to put a price tag on peace of mind.

• The job of fixing health care may be daunting. Yet America's current path is financially unsustainable. By one estimate, keeping our health care system as it is now would cost a staggering $28,000 per employee in 10 years.

The Senate needs to press ahead with smart reform that gets virtually all Americans covered by private insurance under tougher rules protecting patients from being denied or dropped. The goal should be to reward quality care and good outcomes without taking away the freedom most Americans now enjoy.

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