Toni Campbell
Ms. Robinson
Period One
November 18, 2008
Healthcare Coverage: Is it really that helpful?
It is the one thing that unites us all: child or adult, black or white, male or female; we are all the same in the eyes of this disease. This disease is cancer. Hearing the words “you have cancer” can cause confused feelings, a sense of hopelessness, and is sometimes interpreted as a death sentence. Cancer can be treated in many ways such as chemotherapy, radiation therapy, and clinical trials; all have yet to cure it indefinitely. As if having cancer is not stressful and disheartening enough, financial problems just add to the list of worries brought upon patients. Most of these worries come from the actual cost of treatment, troubles with healthcare, and the unpleasant outcomes that coexist with lack of proper healthcare coverage. All of these are serious problems and require immediate attention.
Cancer is a nondiscriminatory disease that is becoming a problem to the young and the old alike, mainly due to how difficult and expensive treatment is. There are a countless number of expenses involved with getting treated for cancer: traveling from doctor to doctor in search for the correct diagnosis, the extended amount of time spent in the hospital, the exasperating tests and procedures that the body has to endure, home health services that have to be provided enable for the patient to return home, the payment of the doctors and nurses, and the actual medicines that are given for treatment. (American Cancer Society). The cost of these medical necessities alone can range anywhere from $5,000 (EBSCO Industries, Inc.) to $30,000 (Sather) per month. These statistics do not include out-of-pocket expenses like the cost of fuel, hotel accommodations, long-distance phone calls to doctors and relatives, special foods and supplements, and special clothing and equipment (American Cancer Society). “I didn’t think we should have been charged for parking at the hospital,” says Kristi McKinney, whose son had Acute Lymphatic Leukemia. The usual situation with common diseases is that their treatments are effortlessly and commonly given, but this is the polar opposite of cancer. Treatments are recklessly expensive mainly due to the pharmaceutical companies having monopolies on their life saving drugs (Sather). Jeanne Sather is a woman with cancer whose drugs cost a little over $30,000 per month, noticeably more than most people make in a year. She takes Herceptin and Avastin, drugs produced at Genentech, Inc. in San Francisco, California (Sather). There are no generic brands of Herceptin or Avastin, which creates the perfect opportunity for Genentech, Inc. to charge whatever they wish for the drugs that keep Sather alive, and they do. Not only do drug companies, such as Genentech, overcharge for drugs; they also persuade doctors to over treat patients. This is a tactic used by pharmaceutical companies to sell more drugs – at the expense of the patients, literally and figuratively. In the literal standpoint, as Shannon Brownlee from the New America Foundation states, “Americans spend over $500 billion dollars on treatments they do not need […] This carelessness with treatment makes our healthcare prices increase.” Over treatment not only effects the economy but, it can cause further health issues. “30,000 people die each year from receiving care they did not need.” declares Brownlee. By spending money on what is not needed the prices of healthcare increase as well.
The most common way Americans obtain insurance is through their employer. (EBSCO Industries, Inc.). For people who only use their insurance merely for annual physical exams and the occasional cold, this is not a major problem for the employee or employer. However, the populace using their insurance to help pay for the expenditure of cancer treatments can put a large financial strain on their company, especially if they work for a small business (EBSCO Industries, Inc.). This can make it hard for workers with an illness to receive healthcare coverage from employers for fear of crumbling their businesses.
For those fortunate enough to receive healthcare, there are several different plans and policies to choose from. A Fee-for-Service plan is when an annual deductible is paid, along with monthly premiums; once the patient meets the deductible, the insurance pays for a percentage of each medical bill (American Cancer Society). This type of healthcare plan gives the patient the luxury of choosing a hospital anywhere in the United States, choosing any doctor, and changing doctors at any time during treatment. Health Maintenance Organizations, known as an HMO, is the type of plan that covers a majority of the expenses with a minimal co-payment; unfortunately, it limits you to only going to doctors and hospitals within their approved provider network (American Cancer Society). A type of HMO that is commonly used is a Point-of-Service plan, called a POS. A POS allows for doctors outside of the approved provider network to be used, but only if they are referred by someone inside the network (American Cancer Society). A spin-off of an HMO is a Preferred Provider Organization, abbreviated PPO. A PPO is a mix between a Fee-for-Service plan and an HMO, which allows for most of the bill to be paid but only when a certain doctor or hospital is used (American Cancer Society). A Flexible Spending Account is a type of insurance that allows patients to use pre-tax dollars for treatment and is paid for by directly taking it from the paycheck (Blue Cross Blue Shield). A similar insurance plan is a Health Savings Account which permits members to save money into a tax-advantage account, in which money is withdrawn and used to pay for treatments tax-free (Blue Cross Blue Shield).
There are other ways that healthcare is given to people who are particularly financially strained. According to the American Cancer Society, “Many insurance companies make it possible for life insurance policy owners to collect all or part of their death benefits early – before dying – to cover extraordinary expenses.” These are called accelerated benefits and are typically only used by patients with a terminal illness. For people who have to spend long amounts of time in the hospital, there are hospital indemnity policies; which pay a certain amount of money for each day the patient is hospitalized (American Cancer Society). Unfortunately, these policies only pay for a certain number of days per year (American Cancer Society). A catastrophic illness clause is also turned to by people with terminal illnesses, and they have high deductibles but fairly low premiums (American Cancer Society). This clause comes into play whenever someone has already used their “lifetime limit,” which is a cap as to how much money total an insurance company will provide during a person’s lifetime (American Cancer Society).
With all this confusion, it would appear that insurance pays adequately for medical bills, but in fact, only two-thirds of the $2.3 trillion dollars used for healthcare actually pays for medical bills (Brownlee). Out of those two-thirds, $500-700 billion dollars is used for treatments and procedures that we do not need (Brownlee); and to add to the expenses and carelessness, 50% of the tests and procedures that are given have no scientific origin (Brownlee). The other third of the $2.3 trillion pays for administrative costs (Brownlee). That is $759 billion dollars, an overwhelming amount of money to be paid for by people who think their hard earned cash is going towards helping with their treatments, not office supplies. Is if comforting knowing that most health insurance is going towards the purchasing of staples, pencils, and ink cartridges?
. Almost half of our healthcare is either wasted or used for administrative costs.
There are some people who so severely struggle to pay for treatment that they have to turn to using a viatical. A viatical is when a person has to “black market” their life insurance policies (American Cancer Society). This is a very unfavorable method of obtaining money for treatment. Many people use a viatical because they have to pay for medical bills, hospital visits, hotel rooms, and even food (American Cancer Society). The biggest downsides to a viatical are that it is irreversible and the patient’s heirs receive no insurance money to pay for final expenses such as unpaid bills and the patient’s funeral.
Cancer in itself is stressful: all the doctor visits; the medicines; the painful side-effects linked with chemotherapy, radiation therapy, and clinical trials; the special foods and specials treatments needed; gas to get from hospital to hospital, hotel to hotel, pharmacy to pharmacy, and the list of expenses is nearly synonymous with a black hole. They are always in motion, there is always something to be paid for and always something that needs to be done. With all the chaos associated with fighting cancer, financial struggles should be the last of the patient’s worries; however, this is rarely ever the case. Healthcare dominates the people of the world’s lives. The costs of treatments can be almost unbelievable at first, and then a glimmer of hope shines through when healthcare steps in, but only then do patients realize that these are empty promises. Healthcare is nothing more than wishful thinking, but usually results in being uncompensated in the end by turning to the use of accelerated benefits, viaticals, and others. Healthcare is a serious matter that needs to be resolved. $2.3 trillion dollars is just too much to waste. Resolving these problems will be hard, but worth it in the long run. To resolve them, we need to have some type of healthcare reform and break monopolies drug companies have.
Works Cited
Brownlee, Shannon. “Why does health care cost so much?.” Health 2008. AARP. 11 November 2008. <http://www.aarpmagazine.org/health/health_care_costs.html>
“Healthcare coverage: flexible spending accounts.” 2008. Blue Cross Blue Shield. 16 November 2008. <http://www.bcbs.com/coverage/types/healthcare-coverage-flexible.html>
“Health insurance and financial assistance for the cancer patient.” Cancer Reference Information 2008. American Cancer Society. 11 November 2008. <http://www.cancer.org/docroot/MLT/content/MLT_1x_Medical_Insurance_and_Financial_Assistance_for_the_Cancer_Patient.asp>
“Health insurance and financial assistance for the cancer patient.” Managing Day to Day 2008. American Cancer Society. 11 November 2008. <http://www.cancer.org/docroot/MLT/content/MLT_1x_Medical_Insurance_and_Financial_Assistance_for_the_Cancer_Patient.asp>
“Health insurance and financial assistance for the cancer patient.” Topics and Resources 2008. American Cancer Society. 11 November 2008. <http://www.cancer.org/docroot/MIT/content/MIT_3_2X_Medical_Insurance_and_Financial_Assistance_for_the_Cancer_Patient.asp?#Financial_issues>.
McKinney, Kristi. Personal interview. 14 Nov. 2008
“Ouch! my employees’ drug therapy costs how much?.” EBSCOhost 2008. EBSCO Industries, Inc.. 06 November 2008. <http://wf2dnvr5.webfeat.org/erzxK1194/url=http://web.ebscohost.com/ehost/detail?vid=1&hid=14&sid=9d167c0b-2bc8-4de8-97b6-8bb4bc9fd714%40SRCSM1&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=34548065>
Sather, Jeanne. “The (high) cost of cancer treatment: i.” The Assertive Cancer Patient 2007. The Assertive Cancer Patient. 11 November 2008. <http://www.assertivepatient.com/2007/02/the_high_cost_o.html>