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Tuesday, February 10, 2009

Costs and Cancer Care: Ruinous

Mainstream medicine costs are driven by the high cost of insurance and the high cost of pharmaceuticals for the most part.

I received a comment on my post Cancer Responds to Love and Natural Medicine and found it to be very positive, but long, and have posted it on my web site.

Related to the cancer issue and mainstream medicine is this about cost, and who ends up paying.

This also pertains to the discussion I had with Katherine Albrecht, and you may still review that program.

Some related links to health care issues may be found here -
Cost of Cancer Care Can Be Ruinous — Even for the Insured

Nick Mulcahy
Medscape Medical News 2009. © 2009 Medscape

February 10, 2009 – Cancer patients with private health insurance are at risk for huge medical debts, personal bankruptcy, and delaying or forgoing treatment.

These findings come from a new report by the Kaiser Family Foundation and the American Cancer Society, which details the lives and illnesses of 20 patients and their struggles to maintain affordable health insurance and to pay for health care.

"A lot of the time, for a variety of reasons, people with cancer fall through the cracks, and [the heath insurance system] just doesn't work as well as it should. It just does not work," said Drew Altman, PhD, president and CEO of the Kaiser Family Foundation, in Menlo Park, California. He was speaking at a press conference in Washington, DC, to unveil the report, entitled Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System.

The report details major fault lines in health-insurance plans and business practices that leave individuals at risk for financial and personal catastrophe.

For example, high cost-sharing, caps on benefits, and lifetime maximums are all insurance practices that leave cancer patients vulnerable to high out-of-pocket healthcare costs, says the report. Some of the patients profiled in the new report amassed more than $100,000 in medical bills, despite having an insurance policy throughout treatment.

High out-of-pocket expenses are not uncommon. For instance, although the median total out-of-pocket treatment cost for breast cancer patients is $2616, 1 study found that 5% of privately insured breast cancer patients had total out-of-pocket costs that exceeded $31,000, said the report.

"If you get cancer, you may as well kiss everything good-bye," said prostate cancer survivor Tom Olszewski, a 62-year-old retiree from Texas. He talks about the medical costs and consequences of cancer in a video that accompanies the report.

Furthermore, new and more costly treatments are expected to increase the cost of cancer treatment further, added the report.

The patients in the new report were selected to illustrate typical phone callers to the American Cancer Society's Health Insurance Assistance Service. The service helps families navigate the healthcare system.

"Cancer patients too often find out that their insurance doesn't protect them when they need care the most," said John R. Seffrin, PhD, national chief executive officer of the American Cancer Society, in a statement.

Too Sick to Work and Other Problems

Among the pitfalls for the insured is the fact that employment-based health insurance can run out for those too sick to work. Cancer patients who are unable to work can usually continue employer-sponsored insurance coverage for up to 18 months. However, the individual must pay the full premium — an additional cost that can be burdensome for patients typically living on a reduced income, noted the report.

Punitive medical underwriting is another major obstacle for cancer patients. Adequate and affordable coverage is often unavailable to cancer survivors and cancer patients, including those with good long-term prognoses, who lose or change jobs or somehow lose insurance.

Government Programs Also Problematic

High-risk pools designed to help cancer patients are not available to all and may be cost-prohibitive, notes the report. Not all states offer coverage through high-risk pools and, when this coverage is available, it is often much more expensive than other plans in the market.

When cancer patients are too sick to work, they may qualify for Social Security Disability Insurance income. After 2 years of receiving this income, patients can qualify for Medicare coverage.

However, these waiting periods can mean that some cancer patients — those who are too ill to work and have limited incomes — have no insurance coverage during that time, adds the report.

Furthermore, tight eligibility restrictions exclude many cancer patients. For example, cancer patients with low or limited incomes who are unable to afford comprehensive private insurance may still not qualify for Medicaid because of their income levels.

"While public programs, such as Medicare and Medicaid, are a crucial source of coverage for millions of Americans, limits on eligibility prevent these programs from providing a safety net for many cancer patients," noted the report.

Delaying Treatment

A 2006 public poll found that 5% of insured cancer patients reported delaying or forgoing treatment because of costs, according to the report.

One cause of delayed treatment can be pre-existing-condition exclusions. A full year of continuous coverage is required under the federal HIPAA rules that govern pre-existing-condition exclusions for employees who switch to a new employer, noted the report.

The report chronicles the trials of Michael Courtney, a 41-year-old auto mechanic from New York with cutaneous T-cell lymphoma. He switched employers after his diagnosis and chose the same insurance company that he had at his previous job. However, he learned that the insurer was able to consider his cancer a pre-existing condition because he did not have 12 months of continuous coverage prior to changing jobs.

In the end, Mr. Courtney decided to delay his treatment for 3 months until he exhausted his pre-existing-condition exclusion period.

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