COST: Cancer Costs Can Be A Killer Too...

Michael Courtney was 41 years old when he was diagnosed with a rare form of lymphoma. It started on his tongue, but spread quickly. He has had radiation and chemotherapy. Treatment will continue indefinitely. So will his bills.

An auto mechanic, Courtney was hesitant about changing jobs because he didn't want to lose his health insurance. But a new employer promised immediate benefits so he took the job. He was even able to stay with the same insurance company that he had at his old job. But a month into the new job, he found that the new policy wouldn't cover his cancer for three months. His disease was a pre-existing condition. Already strapped with medical bills, he postponed treatment.

Courtney's story is one of 20 real-life experiences of patients that gives the human dimension to a new report by the American Cancer Society and the Kaiser Family Foundation released Thursday. Based on calls to the Cancer Society's insurance help line, the study called "Spending to Survive" concluded that after a cancer diagnosis, the financial implications may not be the first concern "but for many, it soon becomes one." Even people with health insurance face enormous financial obstacles to care.

"This should set off alarm bells," said Kaiser president Drew Altman. People tend to think their insurance covers them when they become seriously ill. That is not always the case.

Cancer patients too often find out that their insurance doesn't protect them when they need care the most," said John Seffrin, CEO of the Cancer Society. "High out-of-pocket costs coupled with the high cost of insurance premiums can force cancer patients to incur huge debt, and to delay or forgo life-saving treatments."

Here are some of the common problems cancer patients face:

• High cost-sharing. Deductibles and co-pays can add up fast, and it doesn't take much to send a struggling family into bankruptcy.
• With treatments costing tens of thousands of dollars, cancer patients can breeze through insurers' annual or lifetime caps on benefits.
• People who become too sick to work may lose their employer-sponsored coverage, and COBRA is expensive.
• Individual policies generally have less comprehensive benefits than job-linked plans—if the patient can even get coverage in the individual market. Both patients and long-time survivors often find it impossible to get coverage.
• State high-risk pools are not open to all cancer patients. Some have waiting lists to get in, waiting periods for certain treatments, and very high costs. Waiting can mean the difference between life and death for some cancers.

Of course for the uninsured, it's even worse. There's long been data that uninsured people with cancer fare worse than the insured. But the discrepancies can be truly shocking. Seffrin said that an insured person diagnosed with stage two colon cancer has a better prognosis than an uninsured person with stage one. Stage one is the earliest and most treatable stage which, he said, "one could argue no one should die of."

So as we as a nation get to work at fixing our health care system, we have to remember the underinsured, as well as the uninsured. We need to address the cost of care and develop ways of learning more about what works and what doesn't work for cancer patients. And we need to remember, as Georgetown University health policy expert and 13-year cancer survivor Karen Pollitz said at the panel discussion at Kaiser, that "pretty good" insurance isn't good enough if it leaves people broke. "We need to look at health insurance first through the lens of people who get really sick," she said, recalling how stressed she was during her treatment even though she had excellent coverage. People need insurance that "won't leave them in a lurch, that won't leave them bankrupt, that won't leave them stressed out and crying on their kitchen floor." Or as Seffrin put it, "We need a rational health care system that gives people what they need, when they need it."