Cancer is costly. What if I did not have health insurance or a steady paycheck? Would I have fallen through the cracks and died of metastatic breast cancer before anybody told me I was sick?
Inspired by political conversations regarding health care, I put my question to the test by imagining a different cancer journey in my rural Washington County, Virginia, home. With a population of 54,387 in latest figures, 14.7 percent live in poverty in this community. The U.S. Census estimates that 10.6 percent under 65 in 2017 did not have insurance.
We know that early detection saves lives – or at least makes the remaining days of a life less uncomfortable. My insurance pays for an annual mammogram as well as a routine check-up. While it covers oncology check-ups and other medical care after I reach my deductible, the insurance company weighs in on what I should pay before then. What if I had fewer resources? How would I have even learned about my cancer?
Many communities have special clinics for those without insurance or those with low income or some combination of the two. Near my home, there is a sliding-scale clinic operated by Southwest Virginia Community Health Systems. If I did not have insurance, or if I felt a lump in my breast, I could go to Meadowview Health Clinic. If I were very sick, I could trust the medical professionals there to link me up with other services.
Along with routine care, mammograms are available in my community through the Virginia Breast and Cervical Cancer Early Detection Program of the Virginia Department of Health. The program Every Woman's Life assists low-income women and women without insurance. The Mountain Rogers Health District in Marion, Virginia, about 20 miles from me, is a provider that assists women in Washington County and surrounding counties.
What if a free mammogram diagnosed cancer? What would my path be? As a hypothetical patient without insurance, I would end up at the same facility I used in real life, Johnston Memorial Regional Cancer Center, a not-for-profit facility that offers "financial assistance to qualifying patients who need help with emergency or other necessary medical care."
Even before talking to the financial advisors at Johnston Memorial Regional Cancer Center, I might consult CancerCare, which publishes "A Helping Hand. The 2018 Resource Guide for People with Cancer." This booklet, available online, lists documents resources in Virginia. The American Cancer Society also provides information about resources on navigating cancer-related expenses on its website.
With cancer treatment, there can be expensive prescription drugs. One anti-nausea drug I took was exorbitant as a prescription pill. My oncologist helped me out by adding it to the chemo infusion, which worked better with nausea anyway. I know that this drug was available to people who could not afford it because I heard nurses speaking quietly to my neighbors in the chemo unit about access. We can look up drugs in the database of Partnership for Prescription Assistance, an invaluable resource for people with limited means.
The difficult part of any kind of assistance, I think, is finding a way to ask for help. Thus, my best advice is to learn to ask for help or to help your loved ones ask for help. Ask for them if they cannot or are hesitant to. Once you make the first step, help should follow. There is assistance out there, I have come to see, even for the uninsured and/or low-income patients with insurance. Nobody has to suffer through cancer alone.
Of course, it is easy for me to hypothesize about what it would be like to seek assistance from my comfort zone. I am fortunate to have a job with subsidized insurance. My high-deductible plan works because of the job and a modest lifestyle that allows me to save for medical expenses along the way. But in the end, after wondering about the "what if," I realized that I am alive today not solely because of a steady job and health insurance.
Cancer is a costly and life-changing experience. Until we do have universal health care, and we may not soon, we need to realize that there are alternatives to suffering needlessly. I live in rural Appalachia and there is care here along with caring professionals. Find out what is available for you or your friends and family members where you live.