How single payer can improve the access to cancer care

By Aldebra Schroll, M.D.
KevinMD blog, May 4, 2012

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 who resides in Chico, California.