By Deven C. Patel, M.D., M.S.; Hao He, Ph.D.; Mark F. Berry, M.D.; Chi‐Fu Jeffrey Yang, M.D.; Winston L. Trope, B.E.; Yoyo Wang, B.S.; Natalie S. Lui, M.D.; Douglas Z. Liou, M.D.; Leah M. Backhus, M.D., M.P.H.; Joseph B. Shrager, M.D.
American Cancer Society, Cancer, March 29, 2021
Background: A Medicare effect has been described to account for increased health care utilization occurring at the age of 65 years. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear.
Methods: Patients aged 61 to 69 years who were diagnosed with lung, breast, colon, or prostate cancer from 2004 to 2016 were identified with the Surveillance, Epidemiology, and End Results database and were dichotomized on the basis of eligibility for Medicare (61‐64 vs 65‐69 years). With age‐over‐age (AoA) percent change calculations, trends in cancer diagnoses and staging were characterized. After matching, uninsured patients who were 61 to 64 years old (pre‐Medicare group) were compared with insured patients who were 65 to 69 years old (post‐Medicare group) with respect to cancer‐specific mortality.
Results: In all, 134,991 patients were identified with lung cancer, 175,558 were identified with breast cancer, 62,721 were identified with colon cancer, and 238,823 were identified with prostate cancer. The AoA growth in the number of cancer diagnoses was highest at the age of 65 years in comparison with all other ages within the decade for all 4 cancers (P < .01, P < .001, P < .01, and P < .001, respectively). In a comparison of diagnoses at the age of 65 years with those in the 61‐ to 64‐year‐old cohort, the greatest difference for all 4 cancers was seen in stage I. In matched analyses, the 5‐year cancer‐specific mortality was worse for lung (86.3% vs 78.5%; P < .001), breast (32.7% vs 11.0%; P < .001), colon (57.1% vs 35.6%; P < .001), and prostate cancer (16.9% vs 4.8%; P < .001) in the uninsured pre‐Medicare group than the insured post‐Medicare group.
Conclusions: The age threshold of 65 years for Medicare eligibility is associated with more cancer diagnoses (particularly stage I), and this results in lower long‐term cancer‐specific mortality for all cancers studied.
Lay Summary: Contributing to the current debate regarding Medicare for all, this study shows that the expansion of Medicare would improve cancer outcomes for the near elderly.
By Don McCanne, M.D.
This study is certainly intuitive. “Contributing to the current debate regarding Medicare for all, this study shows that the expansion of Medicare would improve cancer outcomes for the near elderly.” Think of the innumerable other studies that have shown that Medicare for All would improve health care outcomes.
Now think of the innumerable health policy studies that have shown that Medicare for All would ensure universality, comprehensiveness, affordability for individuals, affordability for society, removal of financial barriers to care, return of free choice of health care professionals and institutions, elimination of hundreds of billions of dollars of administrative waste, and, above all, it would ensure equitable health care for all.
What further studies do we need before we decide to enact and implement single payer Medicare for All? None? Well then, let’s get on with it.
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