How single payer can improve the access to cancer care

The call came in the middle of a busy office day; the radiologist had found a suspicious area on the mammogram. I had received similar calls many times in my primary care practice. This time was different; the patient was me.

My first thought “thank God I’m insured.” My second thought was for all those who are not. It was hard enough waiting the week, until further testing could be performed; I can’t imagine the stress of not knowing how or if I would be able to get treatment should I learn I had cancer. For many of our patients that is a real concern. An estimated fifty million Americans do not have health insurance; another twenty five million are underinsured. In the event of a serious diagnosis such as cancer, they face the high cost of out of pocket expenses. For women with breast cancer, the uninsured are more than twice as likely to have their cancer diagnosed in an advanced stage than those with coverage. An estimated fifty thousand deaths a year are attributed to the lack of health insurance.

One in four families impacted by cancer finds themselves in financial straits. A Kaiser Family Foundation and Harvard Public Health study found half of cancer patients use up most or all of their life savings. Studies have found that over half of bankruptcies in the United States resulted from medical bills.

These troubling trends have led the American Cancer Society (ACS) to launch a campaign Access to Care to raise awareness to how the lack of health insurance leads to delays in detection and survival for cancer. John Seffrin, chief executive of ACS has noted that lack of access could hinder our ability to move forward in the fight against cancer. ACS is calling for a health policy that is adequate, affordable, available and administratively simple.

A single payer system would meet these criteria. Physicians for a National Health Health Program has been working on behalf of a universal health plan that would cover all Americans. A single payer system would simplify and streamline the process of getting health care.

Under the single payer model; patients would no longer need to fear the egregious practice of rescission in which insurers drop a patient from their plan when they are diagnosed with a serious condition; such as cancer. The insurers defend the practice as a way to guard against fraud; however for patients it means that failing to mention even a trivial bit of history on the application could mean they are facing cancer with no health insurance. Indeed, a Reuter’s investigation revealed that WellPoint used a computer algorithm to initiate fraud investigation for women newly diagnosed with breast cancer; many of whom last their insurance, just when they needed it most.

A study from the journal Health Affairs found that those enrolled in Medicare, the national single payer plan had fewer problems obtaining needed medical care, less financial hardship and higher satisfaction scores than those in private plans. They were less likely to file bankruptcy due to medical expenses. There are also less socioeconomic disparities in health for the population on Medicare. Overall, Medicare patients report greater satisfaction and security than those enrolled in private plans. A single payer plan could guarantee these benefits to all.

I was lucky to have a quick evaluation and reassuring results. My experience only increased my resolve to work harder on behalf of a single payer plan so that everyone can receive comprehensive and universal coverage.

Aldebra Schroll is a family physician.

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  • thugpunt

    Single payer could help but may not have a significant impact in improving outcomes. Insurance coverage does not equal access to care.  Physician reimbursement and the organization of health systems have a bigger impact on access to care.  Policymakers should move beyond a single minded focus on expanding coverage and look to improve the efficiency and performance of care delivery.  

  • ninguem

    Studies have found that over half of bankruptcies in the United States resulted from medical bills.

    Only if you define addiction as a “medical bankruptcy”.

    You get so sick and tired of this nonsense. As soon as I read this, I know the author has no credibility.

  • Jimmy_Peanut

    Ask an elderly cancer patient in the UK how well a single payer system works for them.  I’ve seen 2 of them in the last 6 weeks that had to come to the US just to get further evaluation, much less treatment.

  • 07rescue

    Ask any of the uninsured cancer patients facing end stage disease who are unable to afford treatment in the US how it feels to be dying of cancer because we cannot work or otherwise afford insurance or to pay for the horrific costs of treatment and then try to justify the cruelty and inhumanity of a health care [non] system built on greed here in the US…

    And yes, to the earlier commenter about the costs of futile care for the elderly who are terminally ill in a single payer system; as a society we will have to face the ethical decisions about when to consider curtailing paying for extensive medical treatment that has no evidence of efficacy or palliative value in elderly cancer patients, as the NHS has done. When there is no proof that continued treatment will either prolong life or contribute to quality of life for elderly patients, do we agree to provide treatment at huge cost? Is that really kind, or compassionate? Or does it merely prolong suffering, to keep alive some failing vestige of the illusion of “hope” for the patient, as well as provide remuneration to the providers of care? Which conclusion in this situation is truly the humane and ethical response?

  • arnold

    In the past 20 years my thought process has cahnged 180 degrees. It is not only the uninsured who suffer, it is the “underinsured.” Many persons forego cancer treatment due to excessive co-pays and deductibles. Many physicians use up health care maximums by the use of unnecessary staging and surveillance testing. Finally, obtaining an authorization for a consultation, work, and/or treatment may take such an inordinate amount of time, the cancer becomes upstaged by beurocracy. Now, one can say that this is the cancer’s natural history, but who needs the outside inflences, when the influence of the cancer is devastating on its own volition.

  • davemills555

    Single payer is the answer to most of our health care problems!

    Top ten benefits of single payer…
    1) All healthcare providers would bill one entity for their services.
    2) Comprehensive medical benefits for all.
    3) Care would be need based, not on ability to pay.
    4) Hospital billing would be virtually eliminated.
    5) The employer would no longer serve as administrator. The Government would be the administrator.
    6)  Nearly everyone will pay less for their healthcare than they are currently paying.
    7) The massive administrative staffs needed to handle itemized billing to nearly 1600 private insurance companies would be eliminated.
    8) Private insurance companies? Gone! 
    9) Businesses would see a limit to their health costs.
    10) Doctors’ incomes would change little, however, incomes would be flattened among specialties.

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