Because I had good health insurance when I was diagnosed with colon cancer in 2004, one thing I didn’t have to worry about was how I would pay for surgery, chemotherapy treatment, and follow-up care. Over the course of about 15 months – from the time of my first colonoscopy that discovered the offending polyp to follow-up tests, surgery to remove eight inches of colon and five lymph nodes, another surgical procedure to install a port for chemotherapy, twelve chemo treatments in an oncologist’s office, regular blood tests, about ten $3000+ shots of Neulasta to maintain my white cells during chemo, twelve home visits by critical care nurses, three full-body CT scans, and a follow-up colonoscopy – my health insurance paid for almost everything. I paid co-pays for office visits and some incidental prescription medications, but those totaled considerably less than $1000. On the other hand, my health insurance paid more than $135,000 to various doctors, other personnel and health care facilities for my treatment and care. And I am on what my surgeon calls the three-year plan for colonoscopies, meaning that I have had multiple procedures since the original, each costing $5,000-10,000 to cover the fees for the surgeon, the anesthesiologist, the surgical center, etc. (See “Poster Woman: Surviving Cancer” for more about my cancer journey.)
What would I have done without health insurance? Who would have paid for my care? Would I have even had the original colonoscopy if my insurance had not covered it as a preventive measure? Would we have had to go into debt to pay the expenses? If I hadn’t had the original colonoscopy, would I be alive today? And how would I know I am still cancer-free without regular follow-up colonoscopies?
These are serious questions for me personally, and I am beyond grateful that I had and still have access to excellent and affordable health care that makes it possible for me not to have to answer the questions. They are also serious questions for the current ongoing debate about health care reform, in particular the implementation of the Affordable Care Act. I don’t know how to make sense of forty (yes, forty!!) attempts to repeal the legislation (and now attempts to “defund” it), even after the Supreme Court has upheld it as constitutional, when so many people currently without access to affordable health care will benefit from it. How can those who have health insurance seriously recommend that those without health insurance refuse to sign up with one of the emerging health insurance exchanges? I know the bill isn’t perfect, but its provisions move us closer to health care for all, which is something people on all sides of the political spectrum have been advocating for decades. But enough of my political rant; let’s look a little closer at the questions I asked about my own health crisis.
If I had not had health insurance, I might not have had a colonoscopy. As it was, the day before, in a pre-admittance conversation with the hospital, I was told there was a question as to whether my health insurance would cover a routine colonoscopy. Was there a reason I was having one, they wondered? You mean apart from the recommendation that everyone over the age of 50 have one, I wondered? When I acknowledged I had some symptoms that heretofore I wouldn’t have thought were significant, the doctor changed the “prescription” and the insurance company was satisfied. So it’s not a beside-the-point question for me whether I would have had the original procedure – for a short time I was seriously considering if it was worth the money to pay for it ourselves.
If my health insurance had not covered the colonoscopy, or if I had not had health insurance and therefore not had the colonoscopy, at some point the cancer that was already growing in my colon (unknown to me) would have caused symptoms indicating something was wrong. Without insurance, would I have gone to the doctor, and if I had, would I have proceeded with the tests and treatment that would certainly have been recommended? Or with no health insurance, would I have ignored the symptoms until something happened to send me to the emergency room and precipitate what probably would have been a much more expensive course of treatment to save my life?
If in a desire to save my life, I had the necessary treatment knowing I couldn’t pay for it, what then? Would the hospital and all the other medical personnel have simply “eaten” the cost of my treatment, or would they have passed it on in the form of higher costs for everyone else? And would the bill have actually been a lot higher because there was no insurance company to negotiate the rates they would pay? (I have heard stories of individuals who pay their own way being asked to pay higher fees than those with insurance.) Would Dale and I have taken out a loan to pay for my treatment, arranged some kind of payment schedule like a 30-year mortgage, or dipped into retirement savings? Would I be following recommendations to be tested every three years to help prevent recurrence of my cancer or catch it early? Finally, what if I had tried to apply for health insurance after cancer; would I have been denied because of my “pre-existing condition” or have to pay outrageously high rates because of it?
Dale and I have been fortunate enough to have been part of employer group health plans throughout our working lives, for a long time through Dale’s employment and then for the last 15 years before I retired through my employment. It was never free and as health care costs continued to rise, our premiums increased along with changes in deductibles and co-payments, but it was always affordable and covered not only routine care but also so-called “catastrophic” care like my cancer diagnosis and treatment. We had the peace of mind that comes with knowing we would not be bankrupted if we became seriously ill or injured. And now we have the same assurance through our Medicare-related coverage.
This peace of mind regarding health care has been important to my overall sense of well-being. The possibility of serious illness or injury is always there for everyone, and if and when it happens, the anxiety and stress associated with making decisions about treatment, dealing with pain and not feeling well, and harnessing one’s energies in the effort to heal is enough to handle; worrying about how to pay for it all shouldn’t have to be on the list too. In a wealthy country like the United States, it’s not right that I should have this peace of mind but many others don’t because they can’t afford it, their employer doesn’t offer health insurance, or they have a pre-existing or chronic condition. Access to affordable health care seems basic to the “life, liberty and pursuit of happiness” the U.S. Declaration of Independence lists as “inalienable rights” given to us by God. Health care for all really does matter!