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I am a 44 year old single mother of two beautiful children; Brian 20, and Nicole 17. Being a mom is the thing I am most proud of; I could sit and ta...
 
 
 
 

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Cancer: How Much Does Your Health Insurer Think Your Life Is Worth?

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Can you afford to get cancer?  The answer may surprise scare you.

The cost of cancer treatments are skyrocketing, and more and more insurance companies are choosing to pay less and less for life-saving treatments.  Did you know that 20% of people with insurance still can't afford their cancer treatments?   And that's not counting the millions who have no health insurance at all.  Basically, if you're rich or you have exceptional medical insurance, this isn't something you need to worry about.  But for the rest of us, it's a real concern.

I wanted this post to ask the question -- How much is your life worth? But it's a lot more complicated than that.  The real question is -- How much does your health insurance company think your life is worth? Let me tell you, it's often not very much, and sometimes it's even worth nothing.

In a recent Associated Press story, the sad reality for cancer patients is being brought to our attention, and it's not pretty.

How Much Is Your Life Worth?

Cancer patients, brace yourselves. Many new drug treatments cost nearly $100,000 a year, sparking fresh debate about how much a few months more of life is worth.

Job losses have led some people to stop taking Gleevec, a $4,500-a-month drug by Novartis AG that keeps certain leukemias and stomach cancers in remission. Three such cases were recently described in the New England Journal of Medicine, and all those patients suffered relapses.

Another big problem that cancer patients are running into is that more effective and less invasive cancer treatments are not only more costly than the traditional intravenous treatments, but patients are often not given a choice because their insurance company makes the final decision.  So even if the oncologist recommends an approved chemo treatment that is less invasive and more effective, insurance companies are saying NO.  In other words, a decision that should clearly be made by the doctor along with the patient, is being made by insurance companies (whose interests are with making money not saving lives).

BALTIMORE - AUGUST 15:  In this photo illustration, leading chemotherapy treatments for lung cancer patients are displayed at the Kimmel Comprehensive Cancer Center at Johns Hopkins hospital August 15, 2005 in Baltimore, Maryland. Since its inception in 1973, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins has been dedicated to better understanding human cancers and finding more effective treatments.  (Photo Illustration by Win McNamee/Getty Images)

My main thought is that you can't (and shouldn't) put a price on what someone's life is worth.  Everyone should have equal access to effective cancer treatments, regardless of the cost.  And I don't believe that just because intravenous chemotherapy has been the mainstay for administering chemo, that insurance companies should be allowed to put new pill forms of chemotherapy in the category of prescription medications (thus making them more costly to the patient).  Chemo is chemo, and it shouldn't matter how it is administered.  Chemo drugs should be paid for equally by insurance companies, and the decision about what treatment is best for each patient should be made by the patient and their doctor (not by for-profit insurance companies).

What do you think?

In most other cases, when it comes to medical treatments, the less medically invasive option is also the least expensive.  And because it is less invasive, the risks for infections and other complications related to treatment are minimized as well.  A good example of how invasive treatments are more costly than less invasive treatments is heart bipass surgery vs. stents.

For many patients with triple-vessel or left main disease, drug-eluting stents provide similar outcomes to bypass surgery -- and for less money.

[t]he stented patients reported feeling better overall and, in the two month period following the procedure, stents patients recovered their quality of life far more quickly. In the end, at one-year, the results for both arms of the trial coincided with no significant difference.

Dr. Cohen's

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Catherine Morgan 5 pts

Yes, they are a for-profit industry...But when does the profit part turn into white collar crime? I would argue, it already has.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

bbott 5 pts

I don't know about you but I'm tired of reading every year that the insurance companies have record profits. Then on the other hand your premiums are going up next year. I'm sick of it.

My mother is going through breast cancer for the second time and it's ridiculous the amount of fighting one has to do with the insurance companies. The doctor even has to get on the phone to the insurance company and explain why this treatment is necessary. Like he doesn't have anything better to do than to talk to the insurance company. What a joke! You should not have to be arguing with an insurance company while going through chemo. You should have nothing on your mind other than getting well again and trusting your doctor's decisions. Not worrying about what your insurance company will or will not cover.

What happened to the day when insurance companies were there to help you, not argue with you. What happened to the day when they paid for the treatment that the doctor prescribed and not argued with you about which treatment would be better.

Talk about greed. As far as I can see, insurance companies are at the top of that list. You're screwed with them and you're screwed without them.

joanne3482 5 pts

If you have employer sponsored health insurance, it isn't the insurance company that is upping the copay, it is your employer. It is one of many ways to grind down spiralling health care costs for an employer. (As is raising deductibles and changing networks).

Gleevec, the cancer drug you spoke of, is $4500/mo for life. It puts the cancer into remission, yes, but it is risky to stop taking it because the cancer could, and obviously will, come back. That's over 50k per year for the drug. Who pays for that? If it is an employer sponsored plan, you do in the form of higher costs to health insurance and/or lower salary increases. Where I currently work, an employee premium is only 565 (which is a lot I believe, my past employer it was only 480/mo) per month $6780/year. If I were taking Gleevec, I'm making out like a bandit on that deal. How often do you get a 500% return on your investment? Admittedly, I've got cancer, so it isn't like my life is all peaches and cream.

I am not against health care reform, and by no stretch of the imagination will I say that insurance providers are so awesome and wonderful and special, but I will cut them some slack because it isn't necessarily their fault that a drug co is charging $4500/mo for a drug that a patient needs and that patient's employer sure as heck doesn't want their rates to go up even 10%.

Catherine Morgan 5 pts

Hi Jenna, I'm so sorry to hear about your grand-mother. The whole "increasing the co-pay thing" is something the insurance companies have been getting away with for so long, and it's getting worse. I told my mother it's like a "bait and switch" scheme...The HMO representative comes out and convinces you how wonderful it will be to have low co-pays, but in a year or two the co-pays go up (and continue to go up until you are paying for coverage you can't even afford the co-pays for).

True story...I few weeks ago, I had to have an x-ray, normally an x-ray had a $5 co-pay. I go over to the imagining center and they tell me my co-pay for x-rays has gone up to $50.00 (and the actual x-ray only costs $45.00). It's so wrong.

Thanks for commenting, and I hope your grand-mother does well with her treatment.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

Catherine Morgan 5 pts

Thank you for commenting Lori, let me try to explain myself a bit. First, I was in no way implying that government run health care would solve this problem. In fact, when it comes to medicare, most people are pushed to choosing from a variety of private carriers (mostly HMO's)...And HMO's are the worst when it comes to telling the doctor how they can and can not treat their patients.

And like I mentioned in my comment to Melissa, I know insurance companies aren't the only ones to blame for this problem. However, they are the ones that are getting final say as to whether or not they will cover (newer, more effective, less invasive, life-saving) treatments, and they are the ones who gain the most by refusing treatment. So I stand by my statement that life-saving treatment decisions should be made the the doctor not by insurance companies.

Obviously, this is not something that has a cut and dry solution, and when it comes to treatments that only extend a dying patient's life by a few days or weeks and costs thousands of dollars, I don't think insurance companies should be forced to pay. However, when it comes to treatments that extend a patient's life months or years, and they are already covering an equivalent treatment (such as IV Chemo), the insurance companies should not be able to force a patient not to try the newer (less invasive) treatment just because it is more costly.

Thanks again for your comment.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

JennaHatfield 9 pts

My grandma finished radiation just over a month ago. At a follow up appointment, her doctor said that her skin was burned but not badly broken. He said that he had wanted to do a less invasive form (something about an implanted pump) but that her insurance had turned it down. Of course, she ended up paying $90 per visit for her radiation -- 5 days per week for over 6 weeks -- because her insurance upped the copays.

I have no faith in healthcare -- or drug companies -- as it stands. None.

Contributing Editor Jenna Hatfield (@FireMom ( http://twitter.com/FireMom )) blogs at Stop, Drop and Blog ( http://stopdropandblog.com ) and The Chronicles of Munchkin Land ( http://thechroniclesofmunchkinland.com ). She is a freelance writer and newspaper photographer.

Catherine Morgan 5 pts

Hi Melissa. I totally agree with you, the blame doesn't fall completely on the insurance companies, but they are the group that is making the most profit by denying coverage the coverage. Like you pointed out, the pharmaceutical companies are at least making an effort to offer medications for free to people can't afford it.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

ms_lorelei 5 pts

...about the health care insanity that really troubled me was the "You don't want anyone between you and your doctor!" suggesting that somehow government funded health care put some mysterious bureaucrat between you and access to services.

COMPLETELY ignoring (or hoping that we didn't remember) that there already IS a bureaucrat between you and your health care, who has a fiscal incentive to minimize the costs associated with you.

I lived and worked in the UK at a hospital that had some of the best cancer treatment around. And no one - NO ONE - had to worry about what the treatments would cost or who was deciding what would or wouldn't be paid for.

I don't think our recent changes do what they needed to do, although I can't be too upset that someone finally galvanized people into movement.

We have to be honest about why our health care - with less access, less efficacy and higher mortality - costs MORE than countries with better, well, everything.

But as long as health is for-profit, it will be this way.

Lori, speech pathologist, writer, and business owner, blogs home-family-working-mom drama at In Pursuit of Martha Points. ( http://inpursuitofmarthapoints.com )

Melissa Ford 5 pts

Absolutely not on the side of insurance companies (and reading posts like this always freak me out because we don't have fantastic coverage), but I think it's a shared problem. Drug companies are also for-profit, and while they need to recoup the money spent creating the drug as well as create opportunities for future studies, $4500 a month seems awfully high for a drug that will be taken over a long period of time. Hospitals and doctors often are charging prices that patients can't pay (especially for highly-skilled specialists). And in all cases, you also hear the altruistic stories -- the doctors who gave their skills for free to save another person's life, the drug company that donated drugs, the insurance ... well ... the insurance company that didn't make the patient bang their head against the wall. Sorry, I don't know a lot of feel-good insurance stories :-)

Melissa writes Stirrup Queens ( http://stirrup-queens.com ) and Lost and Found ( http://lostandfoundandconnectionsabound.blogspot.c... ). Her book is Navigating the Land of If ( http://thelandofif.blogspot.com/ ).