The New York Times, Nov. 20, 2009
Your editorial on the U.S. Preventive Services Task Force recommendation against routine screening mammograms for healthy, low-risk women under the age of 50 takes a wise and balanced view. Nonetheless, this controversy has demonstrated a broad national consensus about the value of breast cancer screening. After practicing family medicine for nearly 30 years, I would observe that a critical aspect of this issue has been totally ignored: the deadly impact of lack of health insurance.
Uninsured women are much more likely to be diagnosed with advanced-stage breast cancer than their insured peers. This is well documented in a 2008 report by the American Cancer Society. In 2005 while 75 percent of women with insurance had had a mammogram in the past two years, only 33 percent of women uninsured greater than 12 months had this test. Just 8 percent of insured women aged 18-64 of all ethnic groups had Stage III or IV breast cancer at diagnosis, compared with 18 percent of uninsured women. All breast cancer patients with insurance had an 89 percent five-year survival compared with only 77 percent five-year survival for those who were uninsured.
Clearly lack of insurance coverage increases the likelihood that a condition like breast cancer will go undetected and, when found, be less responsive to treatment.
A new Harvard study in the American Journal of Public Health shows being uninsured increases a personās risk of death by 40 percent. Furthermore, the American Cancer Society report āSpending to Surviveā published in February of this year documented 25 representative cases of cancer patients who were fully insured yet had to limit or give up treatment or even declare bankruptcy because of insurance policy co-pays, deductibles or policy limits. I recently had a patient who refused a mammogram because she feared that if anything was found she would become uninsurable.
The current health reform bills in Congress are very complex. They seem to trying to impact some of these problems, but they leave many insurance company policies unmentioned and untouched such as time-consuming and resource-expensive prior authorization and payment procedures and increasingly high co-pays and deductibles for care, diagnostic tests and medications. At best they would limit middle-class family costs to 20 percent of income (!) and leave at least 17 million uninsured. In contrast, a single-payer, Medicare-for-all program would be vastly less complex and less expensive, be truly universal and save tens of thousands of lives annually.
Jeoffry B.Gordon, M.D., M.P.H.
San Diego, CA