The first rule of politics is generally understood to mean respecting your voters.

But recently unveiled legislation proposing changes to insurance coverage for mammograms could only have reinforced the increasingly widespread view that Parliament is the place where respectful behaviour goes to die in Bermuda.

In a brusque, bloodless and overly bureaucratic Ministerial statement, Government last month announced new guidelines which will see Bermuda “adopt the standard of personalised decisions for under 50s and biennial screening for women aged 50 to 74 years”.

In other words, the recommended annual screening interval for breast cancer is to be pushed back to once every two years. And those under 50 who insist on having a mammogram “if (their) doctor does not see clinical reasons” for them to do so will end up paying for the screening themselves as “you would for any medically unnecessary procedure”.

The proposed new policies have dismayed many Bermuda women who have grown up being told that to skip a yearly mammogram will put them at risk of finding breast cancer too late.

Indeed, for decades the message from health authorities has been clear and entirely unambiguous: annual screenings are de rigeur for early detection of breast cancer – the most common form of the disease among women.

It’s possible the benefits of annual mammograms have been oversold in recent years given medical researchers understanding of cancer has changed dramatically since the call for such screenings became a focal point of women’s health care both here and elsewhere.

Of the four kinds of genetically distinct breast cancers scientists have identified, most slow-growing types would be found and successfully treated with or without screening. And, sadly, the most aggressive cancers, the so-called “bad cancers”, tend to be fatal whether or not they are found early.

An increasing number of countries are moving away from routinely recommending annual screenings for women under the age of 50, including the UK and Australia. But no such changes have been introduced prior to mounting major public awareness campaigns to explain the science behind the decisions and consultation with all interested parties.

Locally there is no consensus for such a change among doctors or cancer advocacy and support groups.

While Bermuda’s two oncologists have signed off on Government’s proposals, many gynecologists and obstetricians along with the Bermuda Cancer & Health Centre stand by the American Cancer Society’s current position that mammography screening should be offered annually to women beginning at age 40 years.

And in terms of public awareness the first most people knew of the proposed modifications was when they were tabled in the House of Assembly, camouflaged in the almost impenetrable official bafflegab of Government legislation, in May.

The public has good reason to be both confused by the revised breast screening protocol as well as confounded by the casually nonchalant manner in which Government floated the plan.

In an intelligent, informative and sensitive after-the-fact rationale for the proposed move, Dr Katherine Michelmore, a founder of the One Bermuda Alliance and a former Government Senator, this week acknowledged the “understandable ... shock and disbelief” which greeted the legislation.

Dr Michelmore marshaled any number of sound medical arguments for amending the existing screening interval for mammography in Bermuda.

She also touched on the need to better rationalise a ruinously expensive health care system — which may not be sustainable in the long-term in its current form — without compromising basic patient needs.

“Bermuda is striving to provide a quality health system for its citizens, whilst also balancing costs,” she said. “. . . It should be recognised that a change to the mammography screening interval for women who are not in the high risk group, will have cost saving implications for the health system.

“The decision to change the interval has been based on good quality evidence and is in line with other high quality health care systems worldwide. This decision will ensure that funding can be allocated where it can do the most good for all Bermudians.”

Neither the scientific nor the economic facts she raised can be easily disputed. But what flies in the face of both common sense and the political self-preservation instinct is the fact such a reasonable and compelling case for the changes is only being made now.

Fully two weeks have passed since fully half the electorate was made to feel if not actually disrespected then certainly unworthy of consultation on one of their primary health concerns.

The damage control should have started directly after the legislation was introduced, not after public misgivings — and some associated political mischief-making — were allowed to reach a roiling boil.

All administrations inadvertently violate the first rule of politics from time to time; it’s an almost unavoidable occupational hazard of governance. But to then glibly go on to break the second rule — continuing to dig when you already find yourself in a deep hole — tends to owe more to willfulness than carelessness.

And whether born of stubbornness or simple tone-deafness to the public mood, that’s not a trait which will make exasperated voters feel any more respected — or which encourages them to respect their politicians.