More Advanced Cancer Among Uninsured and Medicaid Patients

The Madville Times continues its volunteer work for the Zaniya Project task force (are you reading, Mr. Forsch, Mrs. Hollingsworth, Mr. Sinclair...?) with this news from the American Cancer Society: folks without health insurance and folks on Medicaid are diagnosed with advanced stages of cancer more frequently than folks with good insurance policies.

"It's a very consistent picture in terms of being uninsured or underinsured having a significant effect on advanced disease -- it's not just that it appears in one type of cancer and no place else," says Michael T. Halpern, MD, PhD, strategic director of health services at the American Cancer Society and coauthor of the 2 reports.

Halpern and his colleagues used the National Cancer Data Base to compare stage at diagnosis and insurance status in nearly 534,000 breast cancer patients between 1998 and 2003, and in more than 40,000 men and women diagnosed with oropharyngeal cancer (cancer in the mouth or throat) between 1996 and 2003. The team is conducting similar analyses on several other types of cancer, as well.

The oral cancer analysis, the first of its kind, found that patients who were uninsured or on Medicaid were significantly more likely to be diagnosed with more advanced (stage III or IV) cancers compared to people with private insurance. They were more likely to present with larger tumors and with tumors that had spread to the lymph nodes.

The breast cancer analysis showed that just 8% of women with private insurance had stage III or IV breast cancer at diagnosis, compared to 18% of uninsured women and 19% of women on Medicaid. Advanced stage disease was also more commonly diagnosed in African-American and Hispanic women compared to white women.

More advanced tumors are harder to treat successfully, and patients often face harsher side effects from that treatment, Halpern notes.

Now don't read these studies as a general endorsement of private insurance over government programs for health care. Dr. Halpern contends that the real issue is adequacy of coverage and availbility of services. For South Dakota's uninsured, the solution is not for the Zaniya Project to recommend a mandate that everyone carry private insurance and then let the market create a bunch of high-deductible policies that minimally fulfill that mandate (like the bare-bones liability insurance we buy for our junker cars just to meet the requirements of our auto-insurance law). Remember, the Zaniya Project's goal is "to provide access to affordable, comprehensive health insurance to all South Dakota residents."

To be affordable and comprehensive, the Madville Times says create a single-payer system that covers regular check-ups, and many of these patients could catch their cancer sooner and spare themselves punishing chemo and radiation therapy. Yes, we would increase utilization of services at the preventative end, but we would reduce overall usage of health care resources as we could increasingly avoid the more complicated and expensive advanced treatments. Catch that cancer, get better health outcomes, and save money: create one plan for all South Dakotans. Let's show that South Dakota spirit and take care of each other.