Get ready for restricted health care in Maryland.

Not everyone has to worry, yet. But if the U.S. Senate health care bill passes, mammograms will not be the only diagnostic test or treatment harder to come by in Maryland and throughout the United States, as experts in controlling costs gain power and money at the expense of doctors and patients.

State regulators already follow guidelines set by the U.S. Preventive Services Task Force. The task force recently recommended women should start to receive mammograms every two years at 50 instead of yearly checks beginning at 40, causing an uproar among doctors and patients locally and around the nation.

Because of the outcry, Sen. Barbara Mikulski, D-Md., sponsored an amendment to the health care legislation that would guarantee women access to mammograms starting at 40. But it is not stopping Maryland regulators from reviewing state policies.

Dr. Rex Cowdry, executive director of the Maryland Health Care Commission, said changing the mammography guidelines will be one of a number of measures the commissioners will discuss to contain costs at an upcoming meeting.

Other ideas to be considered include closing the Maryland Health Insurance Plan to new enrollment and increasing premiums for participants, about 16,000 people unable to obtain private insurance because of pre-existing conditions. State hospitals and their patients spent about $90 million last year subsidizing those enrolled in the program.

Those 16,000 are not the only ones potentially affected by task force recommendations, however. The Maryland Health Care Commission oversees regulations for the small group-health market, which covers 407,983 people in the state. Any regulatory changes for both MHIP and the small group market would become effective July 1.

Employers who self-insure, generally large companies with a multistate presence, also can change guidelines. The General Assembly would have to pass legislation to change coverage for those with individual insurance or covered by insurance from large employers in the state.

Dr. David Rothfeld of Shady Grove Radiology, which opposes the new mammography guidelines, said he thinks there would be a large public outcry if the legislature tried to change the rules on mammography. But the Senate legislation may make it very difficult to ignore recommendations on any type of care from future task forces.

It would create panels who publish patient "decision aids" to help patients choose the appropriate (read: Cost-effective) care and discriminate financially against groups who do not follow the shared decision-making process the government recommends.

While some legislators may be able to create exceptions for certain treatments like Mikulski did, the whole point of the health care reform is to save money, which requires restricting access to care.

"This is about saving money. We're not talking about quality of care," he said. He expects "a lot more panels" to decide when someone deserves treatment if health legislation passes.

The worst part about it is that there will be no recourse for bad decisions. "You can't sue them. They are not answerable to anyone," he said.

That fact means a two-tiered health care system will emerge in the United States as it has in Canada and other countries with universal coverage. One will ration care to contain costs, cover everyone and treat people like data points to meet government regulation. The second will treat people as individuals and charge them large fees for "concierge care" as some already do.

No one can deny the rich do not fare better under this scenario. But so long as the government is OK with poor women dying of breast cancer, old people being denied hip replacements and middle-aged moms being denied liver transplants that may not work, just in order to make a budget the government will no doubt exceed exponentially, the new system will work just fine.

Examiner Columnist Marta Mossburg is a senior fellow with the Maryland Public Policy Institute and lives in Baltimore.