XXXVIII. Health Care Reform and Cancer Prevention and Control

Two years ago the American Cancer Society (ACS) made the bold decision to address severe deficiencies in the United States’ health care delivery “system” as its major concern. This was both startling and perfectly understandable. Startling because those of us in the cancer research community were (and to a large extent still are) committed to primary prevention of cancer as our primary goal. Understandable, because the debacle that healthcare has become in this country impedes everything else that we do promote health.


While the Cancer Prevention and Control Program remains strongly committed to scientific discovery that will lead to improvements in primary prevention of cancer, we also recognize that many severe deficiencies in our health care delivery “system” lead to a variety of poor outcomes for people who receive a cancer diagnosis. In general, and more starkly evident here in South Carolina than just about anywhere else, poor outcomes are most disparate for the poorest and most socially deprived among us. Unfortunately, like metastatic cancer, these social and economic problems are spreading in our population. Along with other major problems facing us at this critical time in human history, such as global warming, the denial must stop before we can mobilize the will, energy, intelligence, and creativity of the scientific community and its allies and supporters before we can make effective change.


In the preceding paragraphs I was very deliberate in using quotes around the word “system” because it really is fanciful to call the haphazard and profoundly unfair way health care is delivered in the US a “system.” For a very long time now individuals and groups have called upon government to create a fair, efficient, and accountable system of health care. Such voices were first raised in the Roosevelt and Truman administrations. This dallying over true health care reform has gone on for far too long. Besides denying care for easily treatable conditions it has allowed Americans to become profoundly unhealthy by implicitly promising to provide treatment that has little or no chance of improving quantity or quality of life; a promise on which it often delivers at great expense to all of us who pay ever-increasing taxes and insurance premiums.


Congress has an opportunity to include a strong public health insurance option this year, thus providing that option to anyone who chooses to participate. Such a broad-based plan would have real bargaining clout – especially important in keeping both the insurance and pharmaceutical companies honest. In order to control costs, a strong public health insurance option must be available nationwide and be accountable to us, the taxpayers. It also needs to stress personal responsibility to improve and maintain good preventive health practices. Unlike the current corrupt and profoundly unfair system of health care financing, it should be sufficiently transparent so that it can be monitored by our representatives in Congress.


There is no precedent, anywhere in the world, for anything but government to do this. What’s much scarier than the silly rhetoric about “socialized medicine” that began nearly ¾ of a century ago is the reality that we are spending an obscene amount of money making insurance companies and their chief executives fabulously wealthy while:
1. We experience some of the worst health indicators, including those associated with many cancers, in the civilized world
2. Our doctors spend more and more time dealing with insurance industry-induced red tape and regulatory requirements rather than the important issue of patient care for which they were called to their profession in the first place and spent many years being trained
3. Those of us who are insured experience red tape in the form of improperly denied claims that take many hours of our precious time to battle (and for which the insurance companies gladly pay their employees as a devious, but reliable, way to maximize profits)
4. Those of us who are uninsured or underinsured (who, together, now constitute the majority of Americans) are forced to use grossly inefficient methods for receiving health care and, when we do get seriously ill, are often left paupers by a “system” gone badly awry


For those of us who have experienced government-supervised health care in other parts of the developed world we know that:
1. These systems are much more efficient and easily accessible than the monstrosity that exists here
2. Health outcomes are much better than they are here, virtually across the board
3. These systems are humane and have shorter waiting times for most routine procedures than those experienced here
4. Doctors and other health professionals have higher morale and better measures of job satisfaction than their counterparts here – largely because they are allowed to actually practice evidence-based medicine most of the time that they are at work
5. Health professionals make reasonable salaries that are comparable to, and often exceed their counterparts here – except for some subspecialties


Having just experienced how well the greed-based financial services industry regulated itself while looking out for our interests, we should seize our rightful power to make the system of delivering health care accountable to the people. While we are at it, we actually might start paying better attention to the issue of health.