Friday, August 31, 2007

August 31, 2007 - Another Risk Factor for Cancer

Today's New York Times contains an article reporting on a dramatic change of strategy for the American Cancer Society. They've decided to dedicate $15 million – their entire advertising budget for next year – to a series of ads dramatizing the plight of the uninsured.

Some are charging that this strategy is too political – although the Society's leadership is quick to point out that the ads are non-partisan, and don't call for any single solution to the crisis of the uninsured (such as universal health care coverage). They are, however, going to be spending heavily for ads in states with early Presidential primaries, in an effort to influence the direction of the debate.

I can see why the Society would want to do this. They spend millions every year encouraging people to get early-screening tests for cancer. These tests save lives, no doubt about it. Yet, the uninsured are much less likely to go for these tests. Who's going to go out and get a colonoscopy for routine cancer screening, if it means paying the full cost of $3,000 or more out of pocket? People without medical insurance are highly unlikely to have this kind of money just sitting in a bank account somewhere (if they did, they would probably have used it to buy insurance).

"I believe, if we don't fix the health care system, that lack of access will be a bigger cancer killer than tobacco," says John R. Seffrin, chief executive of the Cancer Society. "The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue."

Here are some eye-opening statistics from the article:

• According to the U.S. Census, the number and percentage of people in the United States without health insurance is on the rise. Last year, 47 million people – 15.8 percent of the population – lacked medical insurance. That's one in seven people who are at a higher risk for cancer, because they probably won't be going for screenings.

• One out of every 10 cancer patients is uninsured. I can't imagine trying to pursue the costly treatments for lymphoma without insurance. It's hard enough affording them with insurance! It's also hard enough managing the paperwork, keeping track of appointments, and all the rest. If I had to do that as a charity-care patient – filling out endless forms for financial assistance, and having to endure long waits for scarce appointments – obtaining treatment would seem like a full-time job in itself.

• One out of every four families affected by cancer will be impoverished as a result of the disease – including one out of every five who do have medical insurance.

• Uninsured breast cancer patients are more than twice as likely to have their cancer diagnosed in late stages as those with private insurance. The same is true of those suffering from cancers of the larynx and mouth.

• This advertising expense, large as it is, is just a drop in the bucket, compared to commercial advertisers. The American Cancer Society's planned expenditure of $15 million on this campaign in the next year is just a quarter of what just one auto-insurance company, Geico, is spending on its "caveman" series of ads.

People are literally dying because they lack health insurance. When is the nation going to wake up and realize that – voting only for politicians who have a concrete plan for doing something about it?


Vance Esler said...

First, let me say that the ACS strategy is a worthy effort. So I am not arguing against it.

Having said that, I will say that there is more than one way to interpret the statistics.

It is true that uninsured patients tend to seek attention after their cancers are already advanced, that they do not take advantage of cancer screening. But you have to ask why they don't have insurance in the first place? For many, it is because they are personally irresponsible people who do not or cannot work. They wouldn't get screening done even if they had insurance. How do we know? Because we can compare them to the number of patients who have similar profiles who do have insurance (Medicare, Medicaid). (I don't mean this as a criticism, simply as an observation of the reality of human nature.)

I practice oncology in Texas, the state with the most uninsured. I have many patients who have no insurance. Yet I have not had a single one who could not be treated with expensive chemotherapy.

The system is currently taking care of uninsured patients much better than people think. The case is being overstated for political purposes.

On the other hand, resources are limited, so eventually the charity could run out.

Politicians oversimplify the problem. They make it sound as if people are denied care because they lack insurance. It may happen some, but not near as much as they would have you think.

In fact, the uninsured sometimes get better care than the insured because they don't have a case manager telling the doctors what they cannot do...

Think about that...

Carlos ("Carl") said...


I believe it's a well-established fact that many of those lacking medical insurance in America today are employed, but in low-wage jobs that don't offer medical insurance. Are they in such jobs because they are "personally irresponsible"? Maybe some are - but a great many hard-working people are in such jobs because that's all they are qualified to do, or it's the only employment available to them in their area. Of course, any self-employed person (a small-time, non-union building sub-contractor, for example, or the owner of a struggling, Main Street retail shop) is at a huge disadvantage in finding affordable health insurance, compared to someone who works for a big company.

These people are often in a worse situation, when it comes to finding medical insurance, than those who are on public assistance - because those on public assistance qualify for Medicaid.

I'm glad to hear the system has many fail-safe devices that have evolved over the years, so most uninsured cancer patients can get charity care eventually - either from their doctors, or from assistance funds provided by pharmaceutical companies or hospitals. It's a great, great thing that these programs are in place. I know the pharmaceutical companies, in particular, spend millions on these programs every year. I think the point of the American Cancer Society's initiative, though, is that lack of insurance is one more disincentive for people to seek preventive care.

What would you recommend to a healthy 50-year-old in a minimum-wage (or slightly above-minimum wage) job, who's never had a routine-screening colonoscopy, and wants one? Do you know of a hospital out there who would provide such a test at a sharply reduced rate, as part of its charity care program? I'd be surprised if there is one.


Kay said...

We have had insurance all our lives until I was diagnosed the 2nd time and it caused a rate increase for everyone. The company fired my husband because one of his helper"s did not follow protocol and caused an accident with the owner watching. Their only explanation was !?)? rolls down hill. We later found out from the Insurance HR they didn't want me on their group policy (COBRA) but to purchase a continuation of insurance, which was untouchable financially for us. With Stage IV no one wants to insure me.

I am far from irresponsible. Just unfortuantly not prepared for an employer to make a decision that affected our lives so severely.

I think I would like to move to
texas because FL does not have the same mentaiity. And our doctors - without assumptin of people being irresponsible - are frustrared. I have had radiation, but not one drop of chemo yet. I was re-diagosed in July 2006 - one year ago. My savings are exhausted, my home equity is dwindling fast.

Vicky said...

I'm convinced that in some instances, people who don't seek treatment (especially chemotherapy) might just be better off than those who keep getting blasted with the stuff!

Too often we're made to think that chemo helps, when many times there is no proof that it does help and in fact makes people feel worse and causes it's own set of problems.

I tend to agree with Vance's observations on this insurance issue!

Bill Morris said...

Hi Carl,

I agree with you; and, by the way, great comment! It is a great & bold move by the ACS

I had seen a similar report about the extended (the "true") health costs to society of the uninsured / under-insured -- battling cancer. Costs, and deaths, might be lowered!

And, as a "community", we in our nation would all be better off!

Thanks!! By the way, similar words made a sermon or two of mine the past several months.

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