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The Honolulu Advertiser
Posted on: Tuesday, August 4, 2009

Reform would help cancer patients


By Nancy G. Brinker

Hawaii news photo - The Honolulu Advertiser
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Congress is now on its annual August recess. Yet after failing to meet President Obama's self-imposed deadline for action on his No. 1 domestic priority — health care reform — this traditionally sleepy month junkets and district town halls will be transformed into a national grassroots debate over every item in the bills.

Many town halls are likely to feature average citizens — including countless cancer survivors — who will gladly share their story with the current health care system. Their experience should be very informative, and should illustrate several changes that must be made to our health care system.

One of the chief issues Congress is confronting is what to do with the nearly 46 million Americans who lack health insurance. Some may ask, from a health outcome perspective, whether it really matters if people are insured or not. Considering cancer, the answer is clearly yes — it does matter.

A lack of adequate health insurance has a decidedly negative effect on cancer screening rates, as well as the stage at diagnosis, and a person's chances of survival. Patients with private insurance, for example, are more likely to be diagnosed at earlier stages, and survive at all stages of diagnosis than their uninsured counterparts.

Further, cancer patients who were either uninsured or covered by Medicaid when they were diagnosed are 60 percent more likely to die within five years than those with private insurance. It is critically important to increase access to insurance, regardless how it is accomplished.

The experience of cancer patients also shows that access to insurance doesn't necessarily mean a patient will have access to treatments, through innovative clinical trials, that may save their lives. Each year, thousands of people gain access to the highest-quality cancer care and receive new treatments before they are widely available by participating in a clinical trial. Millions more benefit from the findings.

Yet, while more than 1.4 million Americans are diagnosed with cancer each year, fewer than 5 percent will participate in an approved clinical trial. One reason so few participate is that not all insurance companies cover costs for extra tests that you might need as part of the trial, but not as part of your routine care. These barriers must be removed.

Another disturbing reality of today's system that is uncovered if you consider the experience of cancer survivors, is that having insurance may not protect you from financial ruin. In fact, a recent study by Harvard University found that half of all bankruptcy filings were partly the result of medical expenses, and 68 percent of those who filed for bankruptcy had health insurance. During a recent news conference, President Obama highlighted the case of a breast cancer survivor from Wisconsin, who has insurance, yet has racked up $50,000 in medical debt.

How can this be? Many health insurance policies have annual and lifetime caps on benefits or other limitations and exclusions. Patients may be exposed to large out-of-pocket expenditures because cancer treatments can be very expensive — some therapies run hundreds of thousands of dollars a year and may require extensive and long-term monitoring and follow-up.

The exposure to these high costs can be disastrous. To protect patients, Congress should consider prohibiting health insurance companies from placing annual or lifetime limits on the benefits, or establish an annual maximum limit on out-of-pocket medical expenditures. Cancer patients also understand all too well that being diagnosed may actually cost you the insurance you have and prevent you from getting coverage in the future.

Due to the rigors of treatment, cancer patients may lose their jobs or at least have to cut back on their hours, ultimately costing them access to their employer's group insurance. Forced to find insurance in the individual market, they often find it close to impossible to attain quality affordable coverage due to their "pre-existing condition" — even for survivors who have been in remission for years with a good long-term prognosis.

Many other cancer patients or survivors experience "job lock," in which they cannot leave their current job for fear of losing their health insurance. Thus, Congress should require health insurance companies to provide coverage to all, with no pre-existing condition limitations.

Devising a health care system for 300 million people is a complicated endeavor. Yet it is an exercise that is aided by the extensive experiences of the community of cancer survivors — experiences that should be considered before any reform is enacted. And as we do so, the world will be watching. Health reform provides us with the opportunity to create a shining example of how a generous and compassionate nation cares for the most vulnerable of its citizens.

With incidence and mortality rates increasing across the globe, this example is needed now more than ever.

Nancy G. Brinker is the founding chair of Susan G. Komen for the Cure and chair of its sister organization, the Susan G. Komen for the Cure Advocacy Alliance.