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.