Published a few months before her death, It’s Always Something is the autobiography from the great Gilda Radner, who died of ovarian cancer 20 years ago at the age of 42.
In the case of cancer, that “something” is all-too-often the case of under-insurance to cover treatment. High out-of-pocket costs for treatment, coupled with insurance premium payments, can force cancer patients to incur big debt or, ultimately, forgo treatment.

Spending to Survive is a comprehensive and detailed report from Kaiser Family Foundation (KFF) and the American Cancer Society (ACS). The report’s subtitle, “cancer patients confront holes in the health insurance system,” summarizes the theme of the paper.

The report deals with five financial obstacles to patients getting needed cancer treatment:
  • Cost-sharing and caps on benefits leave many cancer patients financially vulnerable — at the same time they’re trying to combat the disease.
  • People with employer-sponsored coverage may not be protected from catastrophic high costs if they have to quit work.
  • Cancer patients and survivors without insurance are often unable to find adequate and affordable coverage in the individual market.
  • High-risk insurance pools are not available to all cancer patients. For those who may find them, the premiums are financial out-of-reach.
  • Waiting periods, restrictions on eligibility, and delayed application for public programs leave people too ill to work without affordable insurance options.

Health Populi’s Hot Points: The report’s researchers do not calculate exactly how many privately insured citizens are at-risk for high out-of-pocket costs. Nonetheless, it does not take a brain (or cancer) surgeon to forecast the following trends for the next couple of years:

In the current economic downturn, employers are scrutinizing their prescription drug bill and increasing the cost burden on their insured population. Plan sponsors are looking at the fourth tier, specialty drugs, as an opportunity to manage these costs. Formularies are being carefully managed.

Medicare spending on cancer drugs has “skyrocketed,” according to the February 7th 2009 issue of The New England Journal of Medicine. As the nation grapples with long-term Medicare financing, the tactic of Federal negotiations for cancer drug prices will be in the national budgeter’s radar. Peter Orszag, the new head of the Office of Management and Budget, recently pointed to Medicare as a key driver of the long-term deficit in the U.S.

Getting arms around what comparative effectiveness (more than a buzzword) could look like in U.S. health care will be important for all stakeholders. Start by understanding NICE in the UK, then assess other countries models such as Danish Centre for Evaluation and Health Technology Assessment (DACEHTA), and Germany’s Institute for Quality and Economic Efficiency in the Healthcare Sector (IQWiG).

A growing percentage of people will face increasing out-of-pocket costs for health care. People will beg, borrow, and proverbially steal funds to help cover these costs in the face of life-threatening diseases.

As a result, more Americans diagnosed with cancer will go into medical debt. Medical debt has been increasing in the U.S. for the past couple of years, as I noted in the Health Populi post, Medical debt is increasing-even for the insured in August 2008.