HEALTH CARE/Joan Retsinas

The Battle of S1955

The Battle of S.1955 should not have been joined. In a just, rational world it would not have been fought. But insurgents wanted to change the status quo. This time, the insurgents lost; the status quo remains.

Most Americans didn't know about the Battle of S.1955. It didn't garner press coverage -- even page-36, below-the-fold coverage. It never made it to the 60-second television blips. The internet bloggers largely overlooked this foray into healthcare insurance minutiae.

S.1955 was fought on a legislative battlefield, buried in the Health Insurance Marketplace Modernization and Affordability Act of 2006.

The bone of contention was "mandated" screenings -- specifically, screenings for cancer.

Over the past few decades states have ruled that insurers doing business in their state must offer screenings for breast cancer, colorectal cancer and cervical cancer, along with coverage for off-label prescription drugs and participation in clinical trials. Most insured Americans assume that "of course" their plan will cover mammograms, pap smears and colonoscopies. And most Americans with cancer assume that if their physician prescribes a legal medication, their plan will cover it. Ditto for clinical trials: Patients assume that if they can get into one, their plan will cover the expenses.

The "of courses," of course, are not set in stone. Many are buttressed by state laws.

S.1955 proposed to change that. Under S.1955 plans would not have had to cover these services. Plans would have had to offer to cover these services. The semantic distinction masks a potent assault. Employers could choose "bare-bones" plans stripped of these benefits. We have a new "of course." These stripped-down plans would of course be cheaper. That was the point.

The point wasn't to improve the nation's health. Screenings save lives; they allow for early detection of cancers that might otherwise prove fatal. Incorporating screenings into regular medical coverage is presumably the best way to get all Americans screened.

Maybe after a few years without mandatory screening, statisticians could test that hypothesis -- measuring the number of people who elected to be screened on their own, the number of employers who elected to include screening in their policies and the number of subsequent deaths that might have been prevented. But we already have statistical affirmation that screenings work: The United States' low mortality rate from cervical cancer is traced to routine Pap smears.

Mammograms are not so effective a preventive, but they are the best we have. And gastroenterologists can point to patients whose polyps were detected on routine colonoscopies.

So whatever money S 1955 promised to save, it would have come at a cost. Of course, employers wouldn't have borne those costs, just the families of the people left without a parent, a breadwinner, a child.

And the legislators who voted for S.1955 wouldn't have borne those costs. The federal government would not be cutting the health insurance coverage of our solons. As for those solons' constituents, maybe they are so wealthy they would pay for screenings on their own. Maybe they are so healthy they don't fear cancer. Or maybe they are so distrustful of government, so trusting in business, that they want to leave decisions about coverage solely to America's employers.

The bill needed 60 votes (for "cloture"). The bill got only 55. Most legislators voted along party lines. Republicans wanted S.1955; Democrats didn't. Check to see how your legislators voted. The American Cancer Society is cheering the victory. I'm worried about the margin of victory. I'm frightened that S.1955 made it to the Senate floor.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, Aug. 1-15, 2006

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