While Congress seems paralyzed or, at best, willing to shrink significantly its efforts to help Americans deal with the punishing costs of care in the U.S. medical system, could federal lawmakers be confronted at the same time with more compelling evidence about the need for aggressive, not timid, action?
Do beleaguered constituents need to barrage members of the House and Senate with copies of an excellent, painful series from NPR and the nonpartisan Kaiser Health News service on the crushing effects of medical debt on regular folks, especially cancer patients? Must voters write, call, and email representatives to ensure they see the research findings of the Kaiser Family Foundation or the Commonwealth Fund about how nightmarish the U.S. medical system has become?
In detailing the “financial toxicity” that cancer patients experience with bankrupting treatment, KHN reporter Noam Levey mixes poignant human stories with scary economic data to detail how care for a leading killer of Americans may have improved medically but has become a calamity of a different sort. He makes these points among others (quoted liberally but without their sourcing, not fully included in these bullets for brevity’s sake):
- Cancer patients were 71% more likely than Americans without the disease to have bills in collections, face tax liens and mortgage foreclosure, or experience other financial setbacks.
- Researchers discovered that cancer patients were 2½ times as likely to declare bankruptcy as those without the disease. And those who went bankrupt were likelier to die than cancer patients who did not.
- Nationwide, about 1 in 5 indebted adults who have had cancer or have a family member who’s been sick say they owe $10,000 or more. Those dealing with cancer are also more likely than others with health care debt to owe large sums and to say they don’t expect to ever pay them off.
- Cancer patients’ debt is rooted in lifesaving therapies that come with whopping prices. The National Cancer Institute calculated the average cost of medical care and drugstops $42,000 in the year following a cancer diagnosis. Some treatments can exceed $1 million.
- While patients find many of their costs for cancer care are covered, they must cover larger and larger bills because of deductibles and other health plan cost sharing. The average leukemia patient with private health insurance, for example, can expect to pay more than $5,100 in the year after diagnosis. Even Medicare can leave seniors with huge bills. The average blood cancer patient covered by fee-for-service Medicare can expect to pay more than $17,000 out-of-pocket in the year following diagnosis.
- Surgeries, tests, and medications can make patients pay large out-of-pocket costs year after year. Physicians and patient advocates say this cost sharing ― promoted as a way to encourage patients to shop for care ― is devastating.
- About 4 in 10 cancer patients with debt have taken money out of a retirement, college, or other long-term savings account, while 3 in 10 have moved in with family or friends or made another change in their living situation. Doctors say they know of patients who turn to food banks and other charities to get by. One patient was forced to live in his car. Experts say half of cancer patients need financial aid but even then, many end up in debt.
- Researchers know of widespread self-rationing of care by patients. For example, while nearly 1 in 5 people taking oral chemotherapy abandon treatment, about half stop when out-of-pocket costs exceed $2,000.
For those who want further data on the grim toll that medical debt takes on U.S. patients and their loved ones, the Kaiser Family Foundation has posted information it has amassed as part of a big survey it conducted, partly to support the NPR-KHN series.
Poorer outcomes than our peers in advanced nations
The Commonwealth Fund, in two recent studies, has drawn a devastating comparative portrait of how men and women in this country view and experience our health care system versus their counterparts in other advanced economies. Based on its surveys, analysis, and research, Fund experts say men and women in this country give a much poorer rating than their peers do to the U.S. health care system, which earns high ratings from just a third of American men and a quarter of women.
American men, meantime, lead their peers in having the highest rates of avoidable deaths and the greatest likelihood of multiple chronic and serious conditions, while also facing the most issues in paying medical bills and skipping treatments due to costs, the Fund has found.
As for women in this country, they, too, have the highest rates of avoidable deaths, maternal mortality, multiple, serious chronic conditions, difficulties in paying for care, and most likelihood of skipping therapies due to cost, as compared with peers in advanced nations.
Both American men and women report high needs for mental health care.
Congressional paralysis
While voters keep telling pollsters and politicians that one of their top priorities for legislative action is health care and its soaring costs, a deeply riven Congress for months now into the Biden Administration term has failed to respond. President Biden proposed an ambitious social program, which became known as Build Back Better. It included major health care initiatives.
Republicans, who have adopted a theological fervor about resisting any federal role in the health care system, have throttled Democrats efforts to advance changes to the nation’s medical system. The GOP has been abetted by two notable Democrats in the Senate, Arizona’s enigmatic Kyrsten Sinema and West Virginia plutocrat Joe Manchin.
Manchin, who spends his time in the nation’s capital residing on a yacht parked on the Potomac River, has become an untrustworthy, hyper mercurial negotiator over his demands for what legislation he will support, allowing it to advance with the narrowest Democratic margin. He and others have torched Build Back Better, so that advocates at best might hope for two health care changes before the midterm elections freeze congressional work — a plan to finally allow Medicare to negotiate some drug prices and a two-year renewal of subsidies that have expanded Obamacare to millions more poor, working poor, and middle-class Americans needing affordable health insurance.
Biden has urged party faithful to get these two items passed in Congress, even if larger, needed changes in the health system won’t occur for now.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Our current health system has giant flaws, especially in its staggering, relentlessly increasing costs and outcomes that are poorer than those experienced by our peers in advanced nations. It is unacceptable that special interests and partisan politics persist in trumping evidence-based reforms that would benefit patients who are now so beaten down by the existing system.
The latest canard, particularly espoused by Manchin — who purportedly serves the residents of a state that is ranked as a bottom-dweller for its health outcomes, education, infrastructure, and in many other categories — is that any health care changes could increase already hugely problematic inflation in this country. Skyrocketing prices for gas, food, and other key needs have become an economic menace.
But it is worth watching how Congress, while frozen on taking on domestic needs, somehow is racing ahead with boosting the nation’s military spending by tens of billions above what the administration has sought. Lawmakers with little fuss — save for jaw-dropping GOP resistance to requiring the Pentagon to root out racist, anti-democratic extremists in our armed forces — are ready for taxpayers to spend $850 billion in the next fiscal year on the nation’s military and defense. That money isn’t inflationary when pumped into the economy?
Sure, the U.S. must be mighty, and the personnel in our great services need our grateful support. But do the math and figure how those hundreds of billions of dollars spent on the military stretch out to a goliath decade’s sum. It towers over the $2 trillion or so expense that Build Back Better would have run up to boost an array of domestic needs. Really?
We have much work to do to ensure that health care is a right not a privilege for all of us in the world’s wealthiest nation. We need our health system to provide care that is safe, accessible, affordable, efficient, and excellent.
