I'm ashamed to say that I didn't see this one coming.

I was so caught up in my fear of death panels that it didn't occur to me that lawmakers would use health care reform to neuter Roe v. Wade.

The legislation now in the Senate would require insurers covering abortion to "segregate" federal dollars and the policyholders' dollars so that the government, in what can only be described as a parallel universe, wouldn't be paying for any abortions.

Compared to the draconian language in the House version, the Senate bill is considered a good compromise. But I keep thinking of the scene in "It's a Wonderful Life" where Jimmy Stewart puts the building and loan's last two dollars together in a drawer and orders them to procreate.

The boys in Congress - the anti-abortion Democrats and, you guessed it, all the Republicans - don't want to pay for a decision you reach in consultation with your doctor if they find that decision abhorrent, no matter what the Supreme Court says.

Still. I didn't see this one coming.

But the new federal guidelines suggesting women in their 40s don't need mammograms was not a surprise. Neither was the recommendation that women under 21 - even if they've been having sex since middle school - don't need a pap smear.

We can't seem to decide whether finding breast cancer in one 45-year-old woman is worth the anxiety of all those false positives and, not to put too fine a point on it, the cost of all those follow-up procedures.

And, since cervical cancer - often caused by the human papilloma virus that is epidemic these days - doesn't actually show up for years and years, what's the rush?

We can't decide whether hormone replacement therapy, eggs, red meat and red wine or high fiber diets are good ideas either.

So it's not surprising that the medical establishment can't decide whether the wildly uneven skills of radiologists across the country are reasonably applied to all those milky breast X-rays.

What a coincidence. I can't decide whether recommendations that women wait longer to have their first Pap smear and then not so often is the first blush of heath care rationing.

(The American College of Obstetricians and Gynecologists said the timing of its Pap smear recommendation was "an unfortunate perfect storm." And there was no political agenda behind it. As the kids say, LOL.)

What did surprise me was the Preventive Services Task Force suggestion that doctors stop telling their female patients how to examine their own breasts for lumps (and perhaps soon, where babies come from).

The reason? Too much anxiety.

Seems to me that the problem with a screening test that produces too many false positives is not the anxiety and the expense of all those false positives. The problem might be that this is a crummy screening test, and we need a better one.

But that's just me.

The insurance companies are saying they are not going to stop providing coverage for mammograms for women in their 40s - coverage that is mandated by law in every state but Utah. And we're probably going to hear the same thing about Pap smears.

But those laws were written by many of the same guys who don't want to pay for abortions, so there is no real telling how this is going to turn out.

These are the same guys - lawmakers and insurance company executives - who decide to provide coverage for Viagra but not for birth control pills.

After all, we live in a country where pharmacists believe they can decide for themselves whether to fill a birth control prescription for an unmarried woman, and where hospitals can decide on their own whether to offer the morning-after pill to a rape victim.

And we were worried about having to wait in line for heart bypass surgery? Health care reform is starting to look every woman for herself.

Susan Reimer's column appears Mondays.

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