Health Insurance Inadequate for Cancer Care and How That Relates to the Economic Recovery Package

For people stricken with cancer, having health insurance is no guarantee they will be able to afford the care they need. That sobering fact is illustrated in a new report with the stories of real people suffering needlessly in their time of crisis. As if fighting the disease were not difficult enough, cancer patients too often have to fight our dysfunctional health care system as well.

The report, Spending to Survive: Cancer Patients Confront the Health Insurance System (PDF), was produced by the American Cancer Society and the Kaiser Family Foundation. It tells the stories of hardship faced by 20 cancer patients and survivors while navigating the bewildering world of health insurance and cancer treatment. According to the report, the stories featured in it "are among the more than 20,000 people who have called the American Cancer Society Health Insurance Assistance Service because they are having trouble finding adequate and affordable health insurance or are struggling to pay for health care despite being insured." For example:

"Keith always made sure he paid for health insurance and got annual physicals. But now that he is fighting stomach cancer and paying high health insurance costs, he had to cash out his 401K and has amassed thousands of dollars in medical debt.

"Jamie had health insurance through her job at a nursing home, but once she was diagnosed with breast cancer, she quickly exceeded her plan's annual cap and now has about $30,000 in debt. She sometimes receives three calls a night from collection agencies regarding her medical debt.

"Thomas' prostate cancer was diagnosed early and eradicated with surgery in 1999. Due to his past cancer diagnosis, he had trouble finding coverage after he retired, and he now pays about one-quarter of his income toward his health insurance."

The report outlines five key findings about the current private health insurance system and how those with cancer and other serious diseases may be exposed to high financial burdens and, at times, may be unable to access care:

• High cost-sharing, caps on benefits and lifetime maximums leave cancer patients vulnerable to high out-of-pocket health care costs.
• People who depend on their employer for health insurance may not be protected from catastrophically high health care costs if they become too sick to work.
• Cancer patients and survivors are often unable to find adequate and affordable coverage in the individual market.
• While high-risk pools are designed to help cancer patients and others who are uninsurable, they are not available to all cancer patients and some find the premiums difficult to afford.
• Waiting periods, strict restrictions on eligibility, or delayed application for public programs can leave cancer patients who are too ill to work without an affordable insurance option.

President Obama knows first hand what it is like to see a loved one suffer through this. He has often told the story of his mother's battle with ovarian cancer and her insurance company before she died. He even featured the story in one of his campaign ads to make it clear that he will fight for health care reform:

"My mother died of cancer at 53. In those last painful months, she was more worried about paying her medical bills than getting well. I hear stories like hers everyday. For 20 years Washington has talked about health care reform and reformed nothing. I've got a plan to cut costs and cover everyone. But unless we stop the bickering and the lobbyists we will be in the same place twenty years from now. I'm Barack Obama and I approve this message because to fix health care we have to fix Washington."

Well, the lobbyists and special interests are at it now, even before health care reform really begins. We have to stand up to them now if we are going to make sure everyone has access to quality affordable health care when they need it most.

Drug and device manufacturers have teamed up with right-wing ideologues like Rush Limbaugh to fight the health care measures in President Obama's economic recovery package and some Members of Congress seem willing to block these important measures.

The Wall Street Journal reports that drug makers and medical device manufacturers are fighting health care provisions in the legislation:

"The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.

"The fight over the provision is highlighting the tensions behind President Barack Obama's plan to overhaul the health-care system. The administration hopes to expand coverage while limiting use of treatments that don't work well, but any efforts that might reduce coverage are politically sensitive.

"The House version of the stimulus package sent shudders through the drug and medical-device industry. In a staff report describing the bill, the House said treatments found to be less effective and in some cases more expensive 'will no longer be prescribed.'"

For companies making millions out of drugs and devices that may not be as good as other treatments, there is a lot at stake. But we cannot let their bottom line be ours. We have to make sure what we are paying for is actually helping people.

For example, everyone knows that brand-name drugs are much more expensive than generic drugs. But people often assume that a new brand-name drug is better than an older generic drug. Comparative research is the only way to know for sure.

Take for instance the brand-name drugs used to treat cardiovascular disease. They were found to be no better than generics by a review of the available medical evidence published in the December 3 issue of the Journal of the American Medical Association. Dr. Aaron S. Kesselheim, the studies lead author said:

"Generic drugs are available for nearly every condition but generally are underused in the marketplace, and one of the reasons they're underused is that there is a perception out there among physicians and patients that brand-name drugs are better than generic drugs. We found no evidence that a brand-name drug is clinically superior."

Dr. Kesselheim reviewed existing medical evidence. Too often, the kind of studies that lead to that medical evidence is not done because there is not enough funding for it. That is the type of studies that the legislation would support.

Opponents are trying to use fear to block the measure, arguing the government could use the information to deny certain treatments or ration health care options for patients. Bill Vaughan, health policy analyst for Consumers Union, the nonprofit organization that publishes Consumer Reports, put the fear mongering in perspective:

"It's a very clever effort by a bunch of well-paid lobbyists funded by people who don't want the American people to know some pills work better than others."

It is clear why drug and device manufacturers would be against it. It is mind-boggling why any of our Representatives and Senators in Congress would be against it.

Call your Members of Congress and tell them not to listen to drug lobbyist lies and keep health care measures in the economic recovery package!

02-12-09 By Monica Sanchez | Comment (0)