U.S. cancer case the best? It is if you can pay for it…

July 22, 2009

Angela Kegler McDowell thought she was doing everything right.

A 38-year-old small business owner, she had bought her own personal health insurance and kept paying her premiums, even as they rose from $293 a month to $804 a month.

The insurance company said it had to raise her premiums when her breast cancer came back and she was forced to undergo expensive chemotherapy.

“When the renewal came up in January, they told me I was a high risk to insure and they were dropping my insurance,” McDowell told Reuters in an interview. “Even if I had a million dollars a month to pay for insurance, I couldn’t get it.”  See her on video here in a related story, young adults.

McDowell has been lobbying her members of Congress to ask them to make sure the healthcare reform plan ensures that private insurance — sure to be part of any reform package –cannot drop patients if their coverage becomes too expensive.

Plans also need to be more affordable, says McDowell, who estimates she spent $42,000 out of pocket on her 20 percent co-pays and wiped out her family’s life savings even before her insurance company dumped her.

McDowell was struggling to hold her company together, battle cancer, and fight with her health insuance company– which she doesn’t want to name because she is still negotiating to be reinstated. “It was truly more than a medical battle. It was a financial battle,” she said.

Congress is considering ways to reform the U.S. healthcare system, which leaves 46 million people without health insurance at all but which also often fails people like McDowell, who did have health insurance and who was willing to pay even high premiums.

A national insurance plan for all, akin to the systems Britain, Canada and France have, is not even on the table — dismissed by conservatives as “socialized medicine”.

Studies have shown that these systems are cheaper per capita than the U.S. system, keep patients healthier by many measures and satisfy their customers.

But Congress is struggling to pay for reform with a budget already deep into deficit and an electorate unwilling to pay higher taxes. McDowell knows the precise language to use when lobbying. “We need an American solution,” she says.

Proponents of a market-based system say people would spend less if they knew, and had to pay, some of the costs.

McDowell has had to do this herself. She decides what follow-up care she needs to make sure her cancer has not returned based not on which test is best, but on how much it costs.

Positron emission tomography or PET scans are considered the best way to see if a tumor has reactivated. But McDowell has learned that a PET scan costs $7,000.

A CT scan – a computerized X-ray- costs $1,000 if you shop around. A mammogram costs $400 to $700. “It’s not as effective as a PET scan” at detecting cancer, McDowell said. “But I usually get the mammogram.”

She is unhappy with the choice.

“People shouldn’t have to choose between losing their house, losing their life savings, losing their business to save their life,” McDowell says.

12 comments

We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of Reuters. For more information on our comment policy, see http://blogs.reuters.com/fulldisclosure/2010/09/27/toward-a-more-thoughtful-conversation-on-stories/

Deplorable.Incidentally, a PET scan does not cost $7,000. That’s how much they are charging. It is this difference that is keeping the health industry an “industry” rather than a service.

Posted by Max | Report as abusive

““People shouldn’t have to choose between losing their house, losing their life savings, losing their business to save their life,” McDowell says.”Sorry, but yes, they do. It is nice to say that just because a medical procedure exists and is the “best” or just “better” than something else, you are entitled to it and just expect the insurance company to pay for it. The sad truth is that all companies – yes, every single one of them – are in business for one thing – to make money. If you develop something (like a medical procedure or a piece of equipment), you have a right to be paid for it.Even in the case of insurance companies, same thing. If you have a person that is only paying a small percentage of what it is costing you to perform a service for you, it is ludicrous to demand that they pay for it “just because”. Don’t get me wrong, I don’t advocate that the insurance company just drop you or increase their rates to the point where you are effectively dropped because you can’t pay. I think that their business model should reflect that some will cost more and some will cost less, but the decision should be theirs and it should be agreed upon when you sign up.Just my .02

Posted by Alex Brewer | Report as abusive

This is truly the most concisely written story of how insurance companies will be happy to take your premiums and co-pays until your not paying enough to shoulder your own cost.My parents carried private health coverage for 67 years in the business they owned and were dropped after my mother developed C.O.P.D. at the age of 89.The Administration must make raising insurance premiums, cutting benefits and the dropping of coverage altogether an integral part of the National Insurance Plan. If you wipe out people’s savings and ability to make money, then you have two problems; TAXPAYERS PAYING FOR HEALTH CARE OF THE ILL AND FOR UNEMPLOYMENT BENEFITS, simply because the Insurance Companies have convinced people they have the right to make a profit. Insurance is like taking a chance, sometimes you need it, sometimes you don’t.Perhaps this might work; if Insurance Companies can raise premiums to any level they want and drop high risk people they don’t fell are profitable, how about a cap on how much money they can make on those of us who are not ill.

Posted by T. Barrow | Report as abusive

The US has the worst and the most expensive health care system in the industrial world. Yet, so many people are defending it, it boggles the mind. (I bet the defenders don’t pay much or anything for it and do not depend on it either.) Americans are late comers to the debate, just as they were when motorcycle helmets became mandatory, or when cigarette smoking came under attack. And the debate is going very much the same way as it did then. Never mind the lessons learned by others already, people go back to the beginnings and raise all the silly, proven long ago to be wrong about issues that others did before. Like no one has learned anything. Truth is, Americans by and large are ignorant about pretty much everything that goes on outside their borders, and seem to be in no mood to make an effort to learn from others. Many of the arguments, like loosing the ability to chose their doctors under a public system, or having the government decide what treatment they will qualify for, are based on the so called French or Canadian experiences they know nothing about and are factually inaccurate. Even experts appearing on public radio routinely echo those same sentiments. Fact is, in all the public health care systems in use in the developed world today the only thing the government decides is how much funding the country is able to dedicate to health care in general, and to the infrastructure supporting it. Even these decisions fall under scrutiny and prior decision making by parliament, that is to say the public itself. Who gets treated for what and how is decided by doctors.The current debate is so loaded with fear of the new and the unknown, with individuals’ adherence to their favorite parties’ political line and sometimes just plain selfishness (the current system works for me, screw everyone else) as to make it all but useless. This debate isn’t getting anyone closer to a solution, it isn’t clearing up issues, it just pits one against the other.The point of any public effort is to share the load among all participants, regardless of who needs it the most. For such a system to work what people need is being informed (better than they currently are) and, first of all, to feel and show compassion for others. Maybe it is the latter that is missing from this debate the most.Perhaps if we included pets in the program…?

Posted by Laz | Report as abusive

This is ridiculous, the insurance company is happy to have you as long as you are healthy, but as soon as you get sick they drop you? what the!!! Just ridiculous…Unbelievable that this happens in an industrialized country.And what’s wrong with socialize medicine, it works in the rest of the west…why not learn from it?

Posted by Miguel | Report as abusive

Why bother getting insurance at all, if they won’t pay out when you need them.

Why doesn’t Obama ever address the gross shortages of money in medicare and social security? If the government cant pay for medicare, how can it pay for national health care? The real issue is why does an american have to pay $100 for a medication and everyone else in the world pays $20 for the same medication? We need to quit subsidizing the worlds use of medications which would lower the cost of health insurance for US consumers.

Posted by PC | Report as abusive

“We need to quit subsidizing the worlds use of medications which would lower the cost of health insurance for US consumers” HA. American’s pay such a ridiculous amount for prescription drugs because the Pharma companies can get away with charging you for it. The Canadian goverment buys the drugs from these companies for a price which is negotiated between two parties (like any other business-capitalist transaction). If they want to pedal their wares in Canada they have to play by their rules, and like every other business they aren’t out to lose money. So if they can sell drugs to Canada for $20 and still make a profit (no one sells for a loss) then they should be able to sell to American’s for the same price. Anyhow, even though Canada has a “socialized” health care system I sure don’t lose sleep any night worrying if I get ill or sick if I’ll have to put my house up for a 2nd mortgage just to cover my hospital costs.

Posted by Dood | Report as abusive

It’s incredibly sad, and all too common, for people to be facing a life threatening illness AND fight for their financial well being at the same time. You fight for your life just to keep breathing. Then you struggle to live and support your family after expending your life savings.

One item that is a large source of increasing rates, and which does not even seem to be discussed in any of the liberal reform plans is the cost of frivolous lawsuits. I realize that the trial lawyers have a powerful lobby in Washington, and contribute a lot of money to Democrat lawmakers, but if we are truly looking at ways to reduce costs, this has to be on the table.Another fact that is always glossed over by the people who want universal health care and a single payer (government) system, is the fact that this HAS to result in rationing. There are not enough doctors now to care for all of the new people who would be put into the system. This means longer wait times and reduced individual care. Secondly, with government reducing the payments for health care, fewer students are going to choose medicine as a career. Again, you will have a shortage of doctors (as you do in Britain right now.) Senior citizens are really going to get the short end of the stick. Many procedures or treatments will be denied as too expensive. Delays in diagnosis and treatment will result in more seniors going blind from macular degeneration or dying from advanced stage cancers – all because of delays in being able to see a specialist.I realize that our current system of health care needs reform, but the Democrat version is a recipe for disaster. Like Medicare and Medicaid, it will be too expensive, and loaded with corruption, mismanagement, and fraud.

Posted by perseus317 | Report as abusive

Regarding the cost of socialized healthcare, In Britain we spend 8.9% of National Income on the NHS.While America spends 8.0% on Medicare, as well as 16% on Private Healthcare insurance!Socialized heathcare is far more effiecient and will not break the bank. (Figures from Tuesdays Financail Times)

Posted by Siobhan | Report as abusive

Why’s everyone claiming that Medicare [in the U.S.] doesn’t/can’t work? Everyone over the age of 65 in the U.S. is on Medicare, as I am. It works quite well, I use Kaiser HMO Senior Advantage which requires paying an extra supplement. Through my work pension, what I pay extra also includes Dental and Vision. [My family had been using Kaiser for about 40 yrs. already.] My sister has Medicare without any extra supplement. The only difference is co-pays & prescriptions cost more, and there’s some difficulty in finding doctors which will take on new Medicare patients since they get paid less per visit by Medicare than they do otherwise. My brother, a veteran, uses Tri-Care, and is able to use any doctor.I agree with the previous poster who talked about folding all U.S. citizens into the same Govt. health program that congressmen, servicemen, and presidents use.I also agree with the person who said the Pres. should take the Govt. employees’ health care away, forcing Congress to find their own insurance until they solve the Health Care problem!MF

Posted by M.F. | Report as abusive