Good intent, bad health policy

So it isn’t surprising that in recent years more than half the states (plus the District of Columbia) have passed laws making screening tests for colorectal cancer a mandatory health-insurance benefit. Nor does it come as a surprise that the American Cancer Society would lobby to get such mandates enacted in states like Massachusetts that haven’t yet done so.

Accordingly, when Bay State lawmakers took up the issue at a hearing last week, the society’s spokesman made a seemingly straightforward argument: More Americans would get these potentially life- and cost-saving tests if their health insurance policies covered them, so the law should require such coverage. He buttressed his case with data suggesting that colorectal screening rates have risen faster in states that adopt screening mandates. And he cited a study concluding that the pricetag of such a mandate in Massachusetts would be about $8.50 per health-plan member per year — far less than the $300,000 and up it can cost to treat a patient with late-stage colorectal cancer.

Case closed, then? Not so fast.

“From a distance, cancer screening seems to be the exact sort of thing that we should mandate,’’ observes David Gratzer, a Canada-trained physician and health-care policy expert at the Manhattan Institute. “It’s important; it saves lives; it seems right.’’ Question the wisdom of making it a compulsory insurance benefit, he says, and people demand to know: “Why don’t you believe in cancer screening?’’

But no one disputes the importance of screening for colorectal cancer, least of all insurers. Even without a statutory mandate, commercial health insurance companies in Massachusetts have for years been covering the cost of screening for colon and rectal cancer. That undoubtedly helps explain why screening rates in the state have been among the nation’s highest.