The case seemed so compelling: Dr. Christopher S. Walsh, operator of a cancer-treatment clinic in rural Westmoreland County, pleaded with a legislative/citizen commission to require insurance companies to cover a novel radiation therapy known as solid compensator Intensity Modulated Radiation Treatment. He lined up expert witnesses to testify on his behalf and cancer survivors to tell how the treatment saved them.
But Anthem Blue Cross and Blue Shield, which dropped its coverage of the treatment earlier this year, claims that the advantages of the expensive procedure have not been clinically proven. “If IMRT eventually is not found to be the safest and most effective . . . we would be forced to pay for treatment that may not be safe and effective,” said Dr. Mae Ellen Terrebonne, vice president medical director for Anthem in Virginia.
According to Lawrence Latane with the Richmond Times-Dispatch, a report by the Joint Legislative Audit and Review Commission calculated that a full battery of treatments would cost about $16,500. That one set of procedures would be expensive enough to raise median monthly medical premiums by $1 per month if mandated by the state.
At one time, Virginia had more medical mandates than any almost every other state in the country — and it may still. The result was fantastic coverage for those who could afford the insurance — and no coverage at all for those who couldn’t. Small businesses who can’t afford to self-insure and exempt themselves from the mandates have little flexibility in the kind of insurance policies they offer. Mandates make it impossible, for instance, to offer bare-bones coverage that protects against catastrophic illnesses and allows patients the benefits of negotiated rates on routine expenses — which is certainly preferable to no coverage at all for those one million Virginians who lack it.
The decision of which procedures get covered should be left to the medical experts and the actuaries who design insurance policies for different market segments — not to the political process, where decisions can be manipulated by heart-wrenching anecdotes.
