Monday, January 18, 2016

Cancer and money

At Memorial Sloan-Kettering (MSK) the question of money rarely comes up – but not because it isn’t an important question. From what we’ve learned so far, MSK is prepared to back up its medical judgments by paying for treatment that it considers necessary even if an insurer refuses to pay for it, and it also covers the costs of treatment for patients in its clinical trials. These are the kinds of decisions only a well-funded, and conscientious, institution can make. But even though MSK’s fundraising must cover some of its costs, it’s in no position to provide care without charge.

My care so far has come partly from New Jersey providers whom I saw before we went to MSK, and partly from MSK (plus an emergency room visit during my first week of chemotherapy). The total charges up till now are well over $26,000 – all accumulated since the end of October, 2015. Actually I think that number may be low; the bills come quickly! Fortunately, very fortunately, my insurer (Cigna) has covered almost all of this – often by paying discounted rates far lower than the original charges.

Of course these bills are going to go up and up. The providers have to be paid, and few people without health insurance will be able to pay. I assume that people whose health insurance is limited will be in difficulty as well. If you are fortunate enough to have good health insurance – for example, as my wife Teresa has pointed out, if you’re part of a public employee union that has successfully negotiated for this benefit – then you may have ready access to institutions like MSK. But if you have, for instance, a “bronze” plan now available on the Obamacare site, you may face potential uninsured spending of up to $13,700, a lot of money. My own plan, through my employer, is not unlimited, but I’m very grateful for how inclusive it is. It’s really expensive, for individual patients and for society as a whole, to have cancer.

One more obvious point about cancer and money: The people in the waiting room at MSK are a diverse group, but they are not as diverse a group as the people of the New York area. There seem to be fewer African-Americans; probably there are fewer low-income people of any race. Those who aren’t there are probably absent partly because of the cost of treatment and of insurance. Perhaps they are also absent because of the whole network of personal connections, support and resources, the personal capital, that lead some people to reach for the care available at institutions like MSK while others do not.  (All of these factors also play out geographically; it is a great advantage to live near a leading cancer center.) None of this is really surprising; in a society as shaped by inequalities of wealth and race and other factors as ours is, every social good including medical care will be unequally distributed too – despite the best efforts of the dedicated physicians and others who make up our medical care system.

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