The American Cancer Society has given Utah a failing grade because the Legislature doesn't require insurance companies to pay for cancer screenings, a fact that has generated some negative publicity for the state.

Utah is the only state in the nation to fail.

But before firing off angry missives to lawmakers, first consider what the report does not say: Most Utah insurance companies already cover a range of cancer tests. So a law that requires what many in the industry already do may have little point.

From an insurance company's perspective, covering cancer screenings is good business. It is cheaper to catch cancer in its early stages, when it can be treated relatively easily and effectively, than to wait for it to advance to the point where more aggressive -- and expensive -- treatments are required and recovery less likely.

The insurance industry says that a legislative mandate could push up the cost of insurance for all Utahns. That's because when a state requires coverage, insurance rate-setters assume that more people will be tested. It's a phenomenon known as "utilization." When more services are available, utilization rises, whether it's really needed or not. Insurance rates would be adjusted upward to cover the added expense.

Statistically speaking, a 20-year-old man with no family history of colon or prostate cancer would not need a screening for those ailments. But an insurance company would assume that some 20-year-olds will ask for it anyway.

We find this highly unlikely.

The bone of contention is a cancer test called a colonoscopy, which is such an invasive and uncomfortable procedure that it's self-correcting for insurance purposes. We cannot imagine there would be much increased demand no matter what the Legislature does. A normal person would not likely submit to a colonoscopy unless his medical condition indicates clearly that he must.

So the insurance lobby, while noting possible rate increases, may be overstating its case a bit. We suspect that little would change.

The basic principle, it seems to us, is this: A doctor should decide whether a procedure is medically necessary. If it is, then an insurance company should pay for it. While it's a fair guess that most insurance companies already defer to doctors on medical necessity, there may be some companies that need a nudge.

If a doctor cannot say that a procedure is medically necessary, who canfi A person should not have to look into his wallet to find out how sick he is. That's why we buy insurance in the first place.

This story appeared in The Daily Herald on page A10.