Cancer, health insurance, bankruptcy

17:31 GMT +00:00

Cancer, health insurance, bankruptcy
Posted :
http://www.economist.com/blogs/democracyinamerica/2009/09/cancer_health_insurance_bankru.cfm
Categories:Health care
COMPLAINTS have been made around the blogosphere of late, including, quite astutely, by my colleague here, that too much bandwidth is being devoted to ridiculing the rantings of crazy people, and not enough to saying useful things about important stuff. Point taken. So, apropos of not very much, let's talk about cancer, and its relationship to health-insurance systems. What country's health system does the best job of treating people who get cancer? And if we change America's health insurance system, how might that affect things?

The best international comparison we have, published in the British Medical Journal in 2008, shows that in the 1990s, America had the best survival rates for breast and prostate cancers, while France and Japan had the best survival rates for colon and rectal cancers. The overall cancer survival rate was highest in America. Note that the data reflect cancers that were diagnosed between 1990 and 1994, when far fewer European women received regular mammograms; today, women in France, the Netherlands, and Sweden are more likely to have had a mammogram in the last two years than American women. (And beware of professional propagandists like Betsy McCaughey who say cancer survival rates are far better in America than in "Europe": she is using a 47-country definition of Europe that includes Poland, Hungary, and other poor Eastern European countries. In comparisons with countries like the Netherlands, France and Sweden, with incomes and health systems closer to America's, the differences shrink radically, and in some cases the European countries come out on top.)

So, what about how this treatment gets paid for in American and Europe? Well, in France, there's a modest co-pay for most health services and products. But not for cancer. If you get cancer, treatment is free. Insurance covers it. That's why they call it "insurance".

In America, on the other hand, it depends. A 2006 survey by the Kaiser Family Foundation and the Harvard School of Public Health found that 25% of cancer patients and their families had used up "all or most" of their savings paying for treatment; 11% said they had been unable to get health insurance again afterwards; 6% said they had actually lost their insurance because of having cancer. In all, 12.5% had been uninsured for at least some of the time since they were diagnosed. Better hope that doesn't happen to you: 46% of them reported they had at some point been unable to pay for necessities like food, housing, or heating. Overall, 10% of cancer patients said they had maxed out their insurer's cap on total reimbursements, meaning they had to start paying for everything themselves.

This is the system that explains America's high level of medical bankruptcies. Another Harvard study released in May found that in 2007, 65% of personal bankruptcies had involved high medical bills. Most of those people had insurance. But even with insurance, their annual out-of-pocket medical bills averaged over $17,000. Yup, that'll do it.

So, where would you rather get cancer? In America, you have a modestly better chance of surviving most cancers for 5 years. But there's a 1 in 4 chance you will lose your life savings and a 1 in 10 chance you will have to beg for food or rent, while in France, the whole thing will cost you nothing. What'll it be? But wait: why are we even asking this question? Why don't we just change our insurance system to fix the payment problem, but keep our great treatment system? We could eliminate rescission and lifetime caps on coverage, mandate that insurers have to ignore pre-existing conditions so that a cancer diagnosis doesn't mean you can never get insurance again even if you're cured, and use government subsidies so people who are too rich for Medicaid can still afford insurance, and nobody has to blow their kids' college fund on chemotherapy. In other words, we could do what the House health-insurance reform bill does! How is insuring everyone, and making sure that "insurance" actually means insurance, going to make cancer treatment in America worse? Are cancer-treatment centres all eager to preserve a situation in which their patients may abruptly lose insurance coverage and have to mortgage their house to afford drugs? Is someone really going to argue that in order to have the world's best cancer-treatment system, we need to arbitrarily bankrupt a million or so unsuspecting saps every year? That our treatment outcomes are so great because of our fine insurance system? Surely no one could take that claim seriously.