Almost half of cancer patients in the US deplete entire life assets by second year of treatment
After a colon cancer diagnosis, Deb Genetin, a 57-year-old resident of Springfield, Ohio, just outside Dayton, was denied a life-saving surgery at Mercy Health hospital because, in the words of the hospital, her “financing wasn’t in place.” Genetin has not had health insurance in 10 years and makes only $20,000 a year as an administrative assistant in a law firm.
Last month, Genetin told the Times-Reporter, “They never told me how much money they needed, how much money I had to come up with. It was just a ‘No.’” Genetin had previously applied for financial aid through Mercy Health but was rejected. Genetin then sought cheaper care at Ohio Valley Surgical Hospital, where she received the necessary surgery.
A team of surgeons operate on a patient [Source: Flickr.com]
While Genetin is currently cancer-free and now has health insurance, she is struggling to both meet her payments and pay off medical debt. “I had to drop my hours and my income to get [health insurance] and now I struggle to pay the house payment,” she told reporters.
Genetin is one of thousands of cancer patients in the United States who struggle to afford adequate treatment. In the last decade, researchers and physicians have begun to further explore the patient-level financial and health consequences of high-cost cancer treatment.
A 2018 study from the American Journal of Medicine (AJM), titled “ Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer, ” evaluate d the extent of financial damage caused by a cancer diagnoses in the United States. The study ’ s large sample size of 9.5 million is a significant extension of previous studies that gathered data on a smaller or state level. The data was pulled from the Health and Retirement Study sponsored by the National Institute on Aging and Social Security Administration. Data was collected from 1998 to 2014 on people over 50 years old.
Inclusion criteria for the AJM study involved new cancer diagnoses of any type excluding minor skin cancer. Based on the year of diagnosis, a baseline financial value was gathered from two years before the diagnosis to act as a control. The trajectory of the patient’s finances was examined at two years and four years following the initial diagnosis. Changes in the patient’s net worth were calculated based on total wealth, a figure including assets and properties and subtracting debts such as mortgages and consumer debt.
The study found that 42.4 percent of the 9,527,522 new diagnoses of cancer between 2000 and 2012 had lost their entire life’s assets by year two. Thirty-eight percent had depleted their life assets by year four. The average net worth by year two was $92,098, depleted from the average initial net worth of $644,031.
Large decreases of net worth were seen among those with both worsening and improving cancer status. The largest overall decreases were seen in patients over 75 years old with an average loss of $115,000. Comorbidities such as hypertension, current smoker, and lung disease increased the odds of total net worth depletion. Those with Medicaid as compared to private insurance were independently associated with financial losses at year two and four.
This is not a new phenomenon. In 2013, cancer physicians and researchers wrote a two-part manuscript, “Financial Toxicity: A New Name for a Growing Problem” in which they coined a new term, “Financial Toxicity,” to describe the patient-level financial impact of cancer care. The term encompasses both the objective financial burden on the individual and society as well as the subjective experience of financial strain during a period of illness and healing. The inclusion of the word “toxicity” in the term is carefully chosen, as researchers have found that the financial stress of cancer treatment is a risk factor for mortality.
In a study titled “Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer” published in the Journal of Clinical Oncology in 2016, authors Scott D. Ramsey, Aasthaa Bansal and Polly Newcomb linked cancer registry records with federal bankruptcy records. A previous study by the same researchers showed that individuals with cancer are two and a half times more likely to file for bankruptcy compared to those without cancer. With this knowledge, the results of the 2016 study are all the more shocking.
While results varied based on the type of cancer, those who filed for bankruptcy after a diagnosis of breast, lung, colorectal or prostate cancer had significantly higher mortality rates. Patients suffering from prostate cancer who filed for bankruptcy were twice as likely to die. The risk of mortality was 2.5 times as high among patients with colorectal cancer who filed for bankruptcy compared to those who did not. While bankruptcy is at the extreme end of financial desperation, other studies have also found an association between high out-of-pocket costs and poor clinical outcomes.
There is no one reason for the correlation between financial toxicity and poor clinical outcomes. Financial insecurity may lead patients to seek out underfunded hospitals where risks of infection or medical errors may be higher. Patients may skip doses of medications or cut pills in half to stretch their prescriptions, in some cases resulting in subtherapeutic, and thereby insufficient, blood levels of medications.
Patients forced to handle large out-of-pocket costs are also more likely to forgo or delay necessary treatments. Cancer patients often work longer hours or cancel vacations to cover medical expenses sacrificing periods of rest and putting undue stress on their bodies during a period of healing. Many lose their jobs after long hospitalizations, or cannot work due to lowered immune systems or fatigue, further dragging them into debt and financial distress. For many, extra expenses for healthy food or even safe, comfortable housing is cut in order to pay for treatment.
In the US, cancer is one of the most expensive diseases to treat, second only to heart disease.
According to the National Cancer Institute (NCI), many chemotherapy agents cost more than $10,000 a month. Many treatment regimens require multiple chemotherapy drugs working in tandem, increasing the cost two- or threefold. And the cost is growing as new pharmacological breakthroughs and treatments carry impossible price tags.
Immunotherapy, for example, is a groundbreaking new treatment that activates the body’s immune system to fight cancer cells. It has been approved in the US and elsewhere as a first-line treatment for many types of cancer. While typical chemotherapy kills all cells, immunotherapy is more precise, sparing healthy cells resulting in fewer side effects and a higher quality of life during treatment. Immunotherapy also capitalizes on the immune system’s ability to continuously adapt in order to kill even the most rapidly changing cancer cells. Relapse rates are reduced with immunotherapy because the immune system has “memory,” and it can remember cancerous cells and fight them if the cancer returns.
While the development of immunotherapy is a result of decades of scientific research across the world—most of which took place in publicly funded institutions—the final, packaged, life-saving product, is only available to a select few. Without insurance, immunotherapy costs roughly $100,000 per person when taken for a year. Like chemotherapy, immunotherapy is often used in combination, which doubles or triples the cost. One immunotherapy agent, named Kymriah, used as a one-time dose to treat refractory non-Hodgkin lymphoma and B-cell acute lymphoblastic leukemia, costs $475,000.
Recent lawsuits against major pharmaceutical companies have shown that the cost of high-priced drugs are not simply a product of research and development—as companies claim—nor are the profits they generate used to fund future innovation. Instead, profits are funneled into stock buybacks, boosting the company’s stock profiles and increasing the wealth of the executives.
Even with private insurance, many patients are denied coverage for immunotherapy or forced to cover up to 25 percent of the cost. Furthermore, drug costs are just one aspect of cancer treatment. Hospitalization, teams of specialists, new advancements in imaging, surgery and radiotherapy collectively contribute to a systemic rise in cancer treatment cost that shoots past the rate of inflation. At the same time, average deductible costs for job-based health insurance have increased from $376 in 2006 to $1,300 in 2019. In a country where 70 percent of people live paycheck-to-paycheck, a single overnight stay in the hospital could deplete a family’s savings.
Young adults, while less likely to be diagnosed with cancer, face an even higher chance of financial ruin after diagnoses. With insufficient savings accounts, student debt, lower-income jobs and lack of eligibility for Medicare, young adult cancer survivors begin their lives buried in debt, many relying on crowdsourcing websites like GoFundMe or private charities to stay afloat.
The upsurge in research on the financial impact of cancer treatment has spurred many health care workers to advocate for screening patients for financial toxicity as well as initiating open conversations about the financial stress of treatment. However, aside from connecting patients with resources like private charities that cover a limited portion of treatment costs, conversations and awareness about financial toxicity are not a solution, as the problem finds its source in the capitalist system and the historic levels of social inequality that it has produced. Among rich and middle-income countries, the US has some of largest income-related disparities in health care. In the face of a cancer diagnosis, this translates directly to financial ruin and higher mortality among poor and working-class Americans.
Healthcare
access has declined in past two decades, despite Obamacare: Study
Health Care Doom on the
Horizon
It Pays to be Illegal in California
Providing free, American taxpayer-funded
healthcare to all illegal aliens is just the latest effort to use mass
immigration to turn the United States into the sanctuary state of California,
Rep. Mo Brooks (R-AL) says.
Healthcare
access has declined in past two decades, despite Obamacare: Study
Financial access to healthcare services has declined over
the past two decades, despite the implementation of Obamacare and other
government insurance programs, according to a new study.
The analysis, published
in JAMA Internal Medicine,
traces the drop in access to the rise in premiums, deductibles, co-pays, and
other costs, which have weighed against higher insurance coverage. It concludes
that "over the past 20 years, the proportion of adults aged 18 to 64 years
unable to see a physician owing to cost increased, mostly because of an
increase among persons with insurance."
The authors, three doctors, interpret the results as
evidence in favor of government-financed healthcare.
“With private insurance, we’ve seen significant worsening
in the amount that patients are expected to pay, like premiums, deductibles,
out-of-pocket costs, co-insurance, and co-pays,” said Dr. Laura Hawks, a
researcher at Harvard Medical School and co-author of the report.
The study finds that the share of insured adults who had
trouble affording the cost of seeing a physician increased from 7.1% to 11.5%
between 1998 and 2017. Meanwhile, insured people with chronic health conditions
struggled frequently to pay for visits to specialists. About 1 in 5 patients
with a chronic medical condition, such as diabetes or heart disease, said they
could not see a doctor because of high costs. In 2017, for instance, the
proportion of insured people who have chronic conditions, including heart
disease, yet were unable to afford a visit to the doctor was 6.9 percentage
points higher than in 1998.
The decline in access has occurred even though health
insurance coverage has risen, from 83.1% in 1998 to 85.2% in 2017.
Hawks said government-run health plans, such as Medicaid,
give people higher-quality coverage because they lack the same cost-sharing
measures as private plans, including premiums and deductibles, that restrict
access to health services.
“Our interpretation Is that the increased cost-sharing
that’s required for private insurance companies to exist is the reason for
these rising costs,” Hawks said. “So, if we were to reform the healthcare
system, we’d want it to be universal as well as comprehensive, and the only way
we could accomplish this is through a single-payer insurance system.”
Presidential candidates Bernie Sanders and Elizabeth
Warren have each proposed Medicare for All healthcare plans, which would
eliminate all premiums, deductibles, and co-pays by enrolling everyone living
in the United States into a government plan.
Democrats and President Barack Obama enacted Obamacare to
provide access to private health insurance for people who did not have
employer-provided or government insurance plans. The law did improve access,
according to the study. However, a single middle-class earner making about
$48,000 or more annually makes too much money to qualify for tax subsidies for
premiums, making a private plan through the Obamacare marketplace too expensive
for individuals and families.
One of the study's authors, Dr. David Himmelstein, a
public health policy professor at the City University of New York and a
supporter of “Medicare for all," said Obamacare accomplished a lot but
came up short.
“The study is an endorsement of the fact that we need
more reform of the healthcare system, but it doesn’t suggest a specific
reform,” Himmelstein said. “What it says about [Obamacare] is that it brought
more people into the system, but it didn’t fix the system.”
Health Care Doom on the
Horizon
The relationship between Americans and
their health care delivery is about to make a dramatic change for the worse. Consumers
of health care are poised to vote for a federally managed
system. Why would they go down this predictably awful rabbit
hole? They'll do it because they are overwhelmed and frightened in
the current system. They'll do it because this may be the only
option that a typical voter understands. They'll do it because our
elected leaders do not have the courage to enact changes that could make things
work and don't want to give up power. And it will happen because the
media will demonize and target anyone who isn't on the socialist bandwagon.
Currently, we have a situation in America
where the insured among us are utilizing health care less than in the
past. This is because of the financial implications of
high-deductible insurance policies, most people's only affordable
option. As a result, it is arguable that the very people who bear
the financial burden for our medical care — namely, the minority among us who
are insured Americans — are among those getting the worst care in our
country. It is well known that Americans often live on the edge of
their finances. So when it comes to budgeting for our deductible
when health issues arise, we are frequently left with hard
decisions. This often results in the insured tolerating illness
rather than seeking appropriate, expensive care.
The result of this development will most
assuredly result in even conservative voters being swayed toward a federally
managed health delivery system. With the elderly freely using
Medicare and Medicaid participants getting treatment with seemingly no
debilitating financial consequences, it would be easy to desire something
similar for the rest of us. After all, what could be more messed up
than the current system, where a simple visit to the emergency room can lead to
bankruptcy?
The federal option for health care
delivery will undoubtedly be wretched. Ask any veteran or doctors
who trained at those hospitals about their experience with the V.A., the best
example of a federally run health delivery option. You'll hear
stories that will curl your toes. It is not possible for government
to provide quality care in a timely manner affordably, just as equality and
liberty can't coexist without one sacrificing itself to the
other. Add on the layers of bureaucracy in a federally run hospital
to the inefficiencies and redundancies they mandate, and the results are
predictable.
Yet the people may opt for it anyway,
because it is hard to imagine relying on the current system creating a more
affordable market. We are not using the economic tools that work to
bring down costs. There is no such thing as capitalism or a free
market in health care delivery. If a group of doctors think they can
provide better care at cheaper prices than your community hospital, they cannot
easily do so. Government regulations would not grant them
permission, because it is more "in the community's interest" to keep
the inefficient and expensive existing hospital afloat than to allow the
creative destruction that capitalism provides. Ending local government's
control over "certificate of need" would lower costs, but politics
keeps these laws going.
Additionally, hospitals are allowed to
charge much more for services than private practitioners of medicine and
surgery. This is because they have convinced local governments that
this is justifiable because they have to take care of the
indigent. A lot of the recent dramatic rise in health care costs is
a result of the incestuous relationship between hospital corporations and the
government. Doctors are getting absorbed into hospital employment
with the lure that their pay will not go down as precipitously if they are paid
the higher allowable fees that they can bill through the hospital.
You can add the insurance industry to the
hospital corporations and the government as the three players that keep the
system unaffordable and non-competitive. Many competitive options
for insurance coverage could decrease cost. But these are opposed by
the industry and are lobbied away. The laws that could make these
legal are unlikely to be enacted because power would shift from government and
insurance companies to the individual.
One such idea is insurance
pooling. Suppose that someone who would normally be almost
uninsurable, like a 33-year-old waitress with Crohn's disease, could join in
with other waitresses and shop as a group for policies across state
lines. This would put market forces to work and necessarily drive
down her costs. This is because most waitresses are young and fairly
healthy, and the actuaries in the insurance companies would jump to bid for
this business. For particularly difficult to insure populations,
there could even be federally subsidized pools. This could work for
the uninsured and unemployed.
For this concept to work, there would have
to be allowances for buying insurance across state
lines. Politicians have too many pet causes to allow this to
happen. Most insurance coverage in New York City mandates coverage
for transgender operations. Years ago in Connecticut, insurance had
to cover hair plugs. As you might suspect, insurance can run much
higher in these environments when compared to similar coverage (not including
these boondoggles) in the upper Midwest. If a resident of New York
or Connecticut could buy the Midwestern policy for similar coverage without the
local mandates, costs would go down.
Another priority would be transferring
ownership of insurance to individuals rather than through their
employers. But tax incentives encourage the
opposite. Policies that do not end when changing jobs or crossing
into other states would be preferable, but business tax deductions change the
game. If individuals could deduct insurance cost, as businesses have
traditionally done, it could work.
Tort reform would remove a lot of dysfunction
and wasteful spending. But most lawmakers are lawyers, so the
possibility of goring this cash cow is remote. (What will happen to
this sector if the federal government runs medicine?) Allowing
information technology to evolve naturally rather than instituting top-down,
central control to the medical records, billing, and other information systems
would result in savings, too. But I.T. is essential to maintaining
power, which makes any change non-negotiable.
Americans may have had enough, egged on by
progressive media. Plots to make medical care more affordable by
re-introducing the free market and capitalism through changes in the current
laws seem to have died off. The fawning hero-worship directed toward
former president Obama by the media glorified the idea of health care as a
human right, with support for this wrong-headed idea achieving his goal of
"fundamentally changing America." Medicare for all is
depicted in the press as a desirable idea despite common sense suspecting the
contrary. When it is shown that the cost of administering health
care through the existing system proves that insurance companies eat up around
a third of the health care dollar, it does seem ridiculous to maintain the
status quo. After all, the cost of administration in the Veterans
Administration is far less. But we know intuitively that care will
be worse. And, as anyone who knows history can tell you, giving them
power over our health care decision-making will be the final nail in the coffin
of our freedom.
Yet, when the simple idea of a Health
Savings Account, a necessary pillar of any health care reform, is above the
heads of many voters, we have lost. Because the media will shoot
down any politician brave enough to try anything but a federal option (remember
Tom Price, [R-GA]?), it is harder than ever to have any kind of inertia for
reasonable change. With the shortsightedness of insurance companies
and hospital corporations essentially pricing themselves out of existence for
access to more money today, it looks hopeless. And when federal debt
continues to be viewed as a "so what?" by politicians and citizens
alike, we are done.
It Pays to be Illegal in California
It certainly is a good time to be an illegal alien
in California. Democratic State Sen. Ricardo Lara last week pitched a bill to
permit illegal immigrants to serve on all state and local boards and commissions.
This week, lawmakers unveiled a $1
billion health care plan that would include spending
$250 million to extend health care coverage to all illegal alien adults.
“Currently, undocumented adults are explicitly and
unjustly locked out of healthcare due to their immigration status. In a matter
of weeks, California legislators will have a decisive opportunity to reverse
that cruel and counterproductive fact,” Assemblyman Joaquin Arambula said in
Monday’s Sacramento
Bee.
His legislation, Assembly
Bill 2965, would give as many as 114,000 uninsured illegal
aliens access to Medi-Cal programs. A companion bill has been sponsored by
State Sen. Richard Lara.
But that could just be a drop in the bucket. The
Democrats’ plan covers more than 100,000 illegal aliens with annual incomes
bless than $25,000, however an estimated 1.3 million might be eligible based on
their earnings.
In addition, it is estimated that 20 percent of
those living in California illegally are uninsured – the $250 million covers
just 11 percent.
So, will politicians soon be asking California
taxpayers once again to dip into their pockets to pay for the remaining 9
percent?
Before they ask for more, Democrats have to win the
approval of Gov. Jerry Brown, who cautioned against spending away the state’s
surplus when he introduced his $190 billion budget proposal in January.
Given Brown’s openness to expanding Medi-Cal
expansions in recent years, not to mention his proclivity for blindly
supporting any measure benefitting lawbreaking immigrants, the latest fiscal
irresponsibility may win approval.
And if he takes a pass, the two
Democrats most likely to succeed Brown – Lt. Gov. Gavin Newsom and former Los
Angeles Mayor Antonio Villaraigosa – favor excessive
social spending and are actively courting
illegal immigrant support.
COST to AMERICANS of the LA RAZA
MEXICAN OCCUPATION in CALIFORNIA ALONE: $2,370 per legal.
All that “cheap” labor is
staggeringly expensive!
"Most
Californians, who have seen their taxes increase while public services
deteriorate, already know the impact that mass illegal immigration is having on
their communities, but even they may be shocked when they learn just how much
of a drain illegal immigration has become." FAIR President Dan Stein.
Californians bear an enormous fiscal burden as a result of an illegal
alien population estimated at almost 3 million residents. The annual
expenditure of state and local tax dollars on services for that population is
$25.3 billion. That total amounts to a yearly burden of about $2,370 for a
household headed by a U.S. citizen.
Exclusive–Mo
Brooks: Healthcare for Illegal Aliens Latest Democrat Effort to Turn U.S. into
California
JOSH EDELSON/AFP/Getty Images
JOHN BINDER
5 Jul 201971
3:34
Providing free, American taxpayer-funded
healthcare to all illegal aliens is just the latest effort to use mass
immigration to turn the United States into the sanctuary state of California,
Rep. Mo Brooks (R-AL) says.
As Breitbart News reported, the majority of
2020 Democrat presidential candidates have endorsed a plan to force taxpayers
to pay for free healthcare for all 11 to 22 million illegal aliens living
across the country. The plan would cost taxpayers at least $660 billion a
decade.
Brooks told SiriusXM Patriot’s Breitbart News Tonight that
Democrats’ “primary motivation” behind offering healthcare to illegal aliens is
not compassion, but rather an effort to transform the U.S. into the state of
California through mass illegal and legal immigration.
LISTEN:
Brooks said:
The motivation for all for this is
even worse. They don’t have compassion for these illegal aliens. That’s not
their primary motivation. Their primary motivation is the desire to
acquire raw political power. That’s what it’s all about. [Emphasis added]
If you limit votes to American
citizens, Democrats do not fair to well with us. So what they’re trying to do
is import people who do not understand the foundational principles that have
combined to make America a great nation and who … are
much more likely to vote Democrat once Democrats give them voting rights.
[Emphasis added]
Brooks detailed how California, the
state where former President Ronald Reagan was governor, has been forever
changed due to the country’s mass illegal and legal immigration policy that
imports about 1.5 million foreign nationals a year.
“Let’s learn from history. California
used to be a purple state. Remember, Ronald Reagan came from there … the
Democrats have flooded California with noncitizens,” Brooks said. “And why do
noncitizens vote Democrat so often? Well, let’s look at illegal aliens. The
data shows that 70 percent of households that have an illegal alien in them are
on welfare. The data shows that 60 percent of households that have a lawful
immigrant in them are on welfare. So, you’ve got three different themes that
the Democrat Party now relies on: One is racism, two is sexism, and three is
socialism.”
“In California, what used to be a
purple state, now out of 53 congressional seats, only seven are Republican … 46
are Democrat and seven are Republican,” Brooks said. “So they have seen how
that strategy of importation of foreign voters has worked in California.
They’re trying to do it in Texas, Nevada, New Mexico, Arizona, in every state
where they can possibly do it. They want to flood the voting booths with people
who are dependent on welfare and who do not understand the principles that have
made us a great nation. That’s how they change the voter pool and they’re doing
it successfully.”
Health insurance expert Linda
Blumberg told the New York Times that any of the
Democrats’ plans that offer free health care to illegal aliens is could likely
to drive a mass migration of foreigners with “serious health problems to enter
the country or remain longer than their visas allow in order to get
government-funded care.”
Likely U.S. voters, by a majority,
said they oppose being forced to pay for the healthcare of millions of illegal
aliens living in the country, as Breitbart News reported. The latest
Rasmussen Reports poll found that 55 percent of voters said they opposed such a
plan, including 8-in-10 Republican voters, about 6-in-10 swing voters, and 62
percent of middle-class voters.
In the next two decades, should the
country’s legal immigration policy go unchanged, the U.S. is set to import about 15 million new foreign-born voters. About eight
million of these new foreign-born voters will have arrived through the process
known as “chain migration,” whereby newly naturalized citizens are allowed to
bring an unlimited number of foreign relatives to the country.
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