Will Insurance Access Save Lives? This Cancer Advocate Says Yes.

Doctor_consults_with_patient_(8)In yesterday’s New York Times, columnist Ross Douthat made a startling contention: he says that research shows that access to health insurance doesn’t have a measurable effect on overall wellness. He cited data from a RAND study conducted in the 1970 and a new study based on outcomes from people enrolled in Medicaid in Oregon. In both studies, he says, insurance “seemed to have little or no impact on common medical conditions like hypertension and diabetes.” He goes on to say that what insurance  doesn’t saves lives, as was promised by Affordable care Act proponents. What he says it really saves is  money for individuals since they aren’t hit with catastrophic medical bills. His conclusion is that insurance would be better if it only covered catastrophic care and left ordinary medical care and bills in the hands of individuals.

I kept came to the end of the piece incredulous. Mr. Douthat completely ignored the second leading cause of death in America: cancer. And that’s not a disease that can be readily ignored. One in two American men will get cancer and one in three American women. That means every family in America will be dealing with cancer at one time or another. And cancer outcomes DO differ by levels of insurance.

In my opinion, the studies that Mr. Douthat is relying on for his assertions are both insufficient for measuring cancer outcomes. The RAND study is from the 1970s, before current screening standards for cancers like breast cancer or colorectal cancer. At that time, diagnosis was likely to happen once the cancer was symptomatic and at a more advanced stage, thus rendering treatment less effective. Moreover, treatment options 40 years ago were far less sophisticated and effective than today’s cancer regimens. Comparing cancer outcomes for patients in the 1970’s and patients today is like comparing night and day.

As for the Oregon Health Study, the longitude of it is just at the five-year mark. Since five-year survival rates are the standard measure of success in cancer treatment, we are only seeing the first wave of successful outcomes for patients in that cohort. The NYT reported an increased in uptake for screenings such as mammography in Oregon after the expansion in 2008. For women being diagnosed through routine screening in the years following the original expansion, we won’t have data as to their five-year outcomes for another few years. Whether their survival rate is better than uninsured women is still in question.

Or rather, confirmation is still in question. There is already a body of work that shows that being insured and having access to preventative services such as mammogram and colonoscopy leads to better outcomes. In particular, a study from the American Cancer Society shows that:

Disparities in cancer stage and treatment are the main reasons why Medicaid-insured and uninsured rectal cancer patients are twice as likely to die within five years as privately insured patients. That is the conclusion of a new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society.

As I said earlier, the reason for poorer outcomes among the uninsured is the lack of access to early detection screenings. Tests such as colonoscopy, mammograms, and Pap smears catch cancer at earlier stages when cancer is more treatable. Those tests are all part of the Affordable Care Act: coverage is guaranteed under new insurance plans without co-pay. That means no out-of-pocket costs for patients to get screened for cancer.

I can see where it’s tempting for Mr. Douthat to use some handy data to try to disprove the claims that the Affordable Care Act will save lives. Perhaps it really won’t prevent deaths related to heart disease and diabetes, the only two diseases Mr. Douthat mentions in his piece. But by ignoring cancer, he ignores the elephant in the room. Over 1.6 million people will be diagnosed with cancer in 2013 and more 580,000 will die from the disease. Many of those people will be uninsured and their outcomes will not be as good as their insured peers. Expanded insurance coverage that includes access to screenings and treatment will save lives. Suggesting otherwise is incorrect.

Biographical note on the author: Rebekah Kuschmider was an employee of the American Cancer Society Cancer Action Network from 2004 until 2011. During her tenure there, she worked on advocacy campaigns related to funding for cancer research and programs and access to cancer care, including the push for passage of the Affordable Care Act.

Image via Wikimedia Commons/National Cancer Institute/Bill Branson

  • Susanna

    This is only anecdotal, of course, but I have personal experience from other sides of this argument. I grew up in the UK in 70s and 80s, so I have a deeper understanding of what it means to take for granted that you can go and see a doctor whenever you need to without incurring any costs. Not having to worry about paying for the visit, or its tests means, usually, people will make an appointment as soon as they think something is not right, because they don’t have to worry about anything other than the time off work to attend the appointment. No one went bankrupt from a health care crisis. And no, I did not ever experience any examples of health care that was poorer than it is here in the US for all its being socialized.

    I have lived here in the States for 21 years and experienced the other side too – the anxiety at the possible doctor’s and hospital bills, the difficulty with dealing with insurance companies, the massive worry that is part of so many people’s lives. And at the moment, a friend of mine is dying because she had no insurance and could not justify the cost of seeing a doctor for an annoying eye thing that didn’t seem all *that* important – not enough to justify the extra hundreds of dollars in possible tests and visits anyway, when she didn’t have the dollars (though she worked and hard). She has cancer and they didn’t catch it until it was too late. She is in her 40s.
    So I believe she would fall solidly in the group of people whose lives *would* be saved by insurance or a system of subsidized care. Or would have been, had it been enacted early enough for her – or if she had been able to afford the insurance available now.

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