Colorectal cancer kills nearly 50,000 Americans each year, making it the second-leading cause of cancer death in the United States. Yet when diagnosed early, colorectal cancer is highly treatable; it generally turns life-threatening only when it has time to metastasize to other organs. That means that colorectal cancer screening, which can detect the disease in its earliest stages, is one of the best ways known to reduce cancer mortality -- and reduce as well the enormous costs involved in treating patients with late-stage cancer.
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 price tag 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 an expert on health-care policy 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?"