Wednesday, April 15, 2009

Freedom from fear: Cancer is bad enough; fearing one's ability to pay for treatment to stay alive must be resolved -- universal health care

Having cancer is bad enough. But to have this killer inside your body and not be able to pay for your medicines to fight it and stay alive can be the real Hell of it all.

The New York Times reports today that cancer treatment is advancing toward more treatment by pills at home, instead of IV bags hanging above you and needles piercing your flesh in hospital cubicles -- requiring nurses to supervise your treatment.

A quarter of all cancer treatment will soon be by pills. Incredible. Most merciful. Less than 10 percent is now. Surely, this shift should produce savings in health care costs for the industry and employers.

But insurance companies are not keeping up with this advance, and chemo bills for pills are devastating household budgets. Insurance covers medicines delivered in the hospital where things are more expensive but not pills at home where people can continue to live and work and contribute.

That does not make sense, except when greed is taken into account.

This nation's safety net is so terribly worn. Reform of this industry, as is one of President Obama's priorities, will save money by virtue of reduced costs right there on the surface. And it will save lives by reducing fear and stress on the sick. Some cancer sufferers have to drive hours for treatment in a hospital. The mere trip is debilitating.

The health care industry has been allowed to remain so cockeyed for so long, because it makes money for its principals. This nation can no longer afford to let this kind of greed continue, particularly as more Baby Boomers get sick. When an industry fails to police itself, government has to get involved. And that means universal health care where coverage is required, along with common sense, savings.

That public policy change will free millions of Americans from unnecessary fear when cancer is more than enough to keep them scared.

I know.

And I know how it is to put your household on the financial edge of bankruptcy because of one's expensive treatment. I've worked since I was 13. I've paid for my health care coverage since I was 21.

Still, it wasn't enough. And it's the same for millions of Americans. None of us meant to get cancer, let alone leukemia. It just happens when you least expect it.

The scope of this problem will only grow wider. This nation is aging. Reforming the health care industry by extraordinary measures will become a must.

No one wants to hear about another government program on tax filing day. But we've known about this problem for a very long time. And a recovered economy will produce less jobs with health care benefits. Contract work will become more of the rule as businesses change their ways to save more on labor costs.

So, then, where are the people to go?

The Times reports:

Chuck Stauffer’s insurance covered the surgery to remove his brain tumor. It covered his brain scans. And it would have paid fully for tens of thousands of dollars of intravenous chemotherapy at a doctor’s office or hospital.

But his insurance covered hardly any of the cost of the cancer pills the doctor prescribed for him to take at home. Mr. Stauffer, a 62-year-old Oregon farmer, had to pay $5,500 for the first 42-day supply of the drug, Temodar, and $1,700 a month after that.

“Because it was a pill,” he said, “I had to pay — not the insurance.”

Pills and capsules are the new wave in cancer treatment, expected to account for 25 percent of all cancer medicines in a few years, up from less than 10 percent now.

The oral drugs can free patients from frequent trips to a clinic to be hooked to an intravenous line for hours. Fewer visits might save the health system money as well as time. And the pills are a step toward making cancer a manageable chronic condition, like diabetes.

But for many patients, exchanging an I.V. bag for a pill is a lopsided trade because the economics and practice of cancer medicine have not caught up with the convenience of oral drugs.

Start with the double ledger of drug insurance. Drugs that are infused at a clinic are typically paid for as a medical benefit, like surgery. Pills, though, are usually covered by prescription drug plans, which are typically much less generous; for expensive cancer pills, patients might face huge co-payments or quickly exceed an annual coverage limit. Sometimes, as in Mr. Stauffer’s case, a single insurer is involved.

Many times, though, a separate company — a so-called pharmacy benefit manager — provides the prescription drug coverage.

The growing use of cancer pills is also thrusting patients and doctors into new roles they have not yet fully mastered. Without a physician’s direct supervision, side effects can be missed. Some patients do not take all their medicine, raising the risk their cancer will worsen. Others take too many pills, risking toxic reactions.

For doctors, the new drugs also pose financial challenges. Physicians can profit from infusing drugs in their offices but not from writing prescriptions that are filled at a pharmacy.

With oral cancer drugs, “the technology has outstripped the ability of society to integrate it into the mainstream in a smooth fashion,” said Carlton Sedberry, a pharmacy expert at Medical Marketing Economics, a consulting firm.

Oregon, partly in response to Mr. Stauffer’s case, has passed a law requiring insurance companies to provide equivalent coverage of oral and intravenous cancer drugs. Some other states are now considering similar measures.

So far the health reform debate in Washington has not drilled into specifics like cancer pill coverage.

1 comment:

dennie hall said...

Dennie Hall, Okllahoma

Tim, we hear a lot about health insurance, but that alone is not the solution to the medical care crisis in this country. I have two health insurance plans and yet the out-of-pocket costs for my wife and me totals more each year that all our other living costs combined. Such costs have plunged many into bankruptcy and home loss. The greed I see among health care professionals is enough to sicken one. Also, the insurance premiums alone are staggering for most people. Something has to give!