More Bad News for the Uninsured

Here's more discouraging news about the consequences of living without health insurance:

Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.

In this study done by the American Cancer Society, researchers looked at a database of 600,000 cancer patients from 1500 different hospitals and documented the percentage alive five years after their diagnosis. The patients were all under age 65 and were separated into three different groups: private insurance, Medicaid, or no insurance. The results, please:

They found those who were uninsured were 1.6 times more likely to die in five years than those with private insurance. More specifically, 35 percent of uninsured patients had died at the end of five years, compared with 23 percent of privately insured patients.

This is not surprising to me, as I see patients without health insurance regularly in my practice and have come to appreciate their plight. Although the article summarizes the possible reasons why uninsured cancer patients have lower long-term survival rates, let me paraphrase them.

SCREENING FOR CANCER: "Honey, it says here in the paper everyone should get a *mammogram* *colonoscopy* *skin exam* - maybe you should do it."

Insured patient: "You're right. I'm calling my doctor today."
Uninsured patient: "Yea, right - as soon as I come up with the next mortgage payment."

EARLY DETECTION: "Dad looks awfully tired. Has he lost weight?"

Insured patient: "I'm getting him in tomorrow to see his internist."
Uninsured patient: "He won't go to a doctor. He says he just has heartburn."

MEDICAL EXPERTISE: "What did the surgeon say?"

Insured patient: "She's going to have my pathology slides reviewed by the Mayo Clinic to make sure we know what it is and if she got it all."
Uninsured patient: "Not much. They said I should apply for Medicaid."

ADJUVANT TREATMENT: "What did the oncologist say?"

Insured patient: "I'm going to get a new treatment that will improve my cure rate."
Uninsured patient: "He said I could try chemo but it is very expensive. I can't afford to pay the hospital now as it is."

PALLIATIVE TREATMENT: "Did you agree to try that new pill your doctor wants you to take?"

Insured patient: "Absolutely yes. I want to live as long as I can."
Uninsured patient: "I have to apply to the company for free samples. I hope I last long enough to get it."

In other words, patients who have no way of paying for testing are more likely to present with advanced stage cancer, which lowers their chance for cure. Patients who have no way of paying for modern treatments, whether adjuvant or palliative, are less likely to be alive as the years roll by.

As scientists continue to assiduously unlock the secrets of disabling and killing the malignant cells that cause cancer, and as these secrets are transformed into promising medicines, the irony of the uninsured patient hangs in the air like the stench from a rotting carcass. Do we continue to hold our noses, or do we roll up our sleeves and dispose of the source of our revulsion?