Bankruptcy and Cancer
My father died on the 7th floor of Weill Cornell Medical Center, one of the finest medical institutions in the world, at the age of 54. He was diagnosed with Stage 4 lung cancer 88 days prior. His health insurance was spectacular and he received some of the finest care one could ever hope to receive in a situation as dire as that one. There were almost no co-pays to speak of. Had we not had this type of insurance, my family would have been financially ruined. Thousands of people are not as lucky. The double punch of Bankruptcy and Cancer are killing thousands of people a year with no end in sight.
A common misconception is that individuals who file for Bankruptcy cannot manage their money. What’s rarely discussed is the tremendous impact medical debt has on an individual being forced to file. Time and time again I filed Chapter 7 Bankruptcies for individuals who had one form of medical debt or another. One particular client was fighting an aggressive form of cancer and had approximately $300,000 worth of medical debts to his name when he filed. He was, in a strange sense, lucky. Many times, people have to make a Faustian bargain between their health and their financial well being, which, of course, thereby negatively impacts their heath. File Bankruptcy and stop harassing phone calls now but be responsible for any other medical debts you incur from the day you file, or wait to file and deal with the garnishments, account freezes, credit collection agencies calling. Pick your poison.
The Rate of Filings
A variety of studies have shown that those afflicted with cancer are more than twice as likely to file for personal bankruptcy. This CBS story links to a Health Affairs article:
We found that cancer patients were 2.65 times more likely to go bankrupt than people without cancer. Younger cancer patients had 2–5 times higher rates of bankruptcy than cancer patients age sixty-five or older, which indicates that Medicare and Social Security may mitigate bankruptcy risk for the older group.
If interested, you can find the full pdf of the study and it’s results here (paywall). The article goes on to classify the cancers that have led to the most bankruptcy filings across the U.S., with lung cancer far ahead of others. The study results also find that “Combined, about six out of every 1,000 cancer patients went bankrupt, the researchers found.” This, by the way, says nothing of those afflicted with cancer that were too financially strapped to file:
Melissa Jacoby, a professor at the University of North Carolina School of Law in Chapel Hill who was not involved in the research, told Medscape that bankruptcy filings are “the tip of the iceberg” in terms of financial distress, and some people may not have been included in the study because they were too broke to pay a lawyer’s filing.
The most likely to file? Non-white young females. The least likely? Those over 65. The belief is that Medicare and Social Security makes a big difference in whether you can afford your meds, and, therefore, whether you’d be forced to file Bankruptcy.
So, what happens if you’ve been diagnosed and you have to treat? The American Cancer Society has a section on their website which is devoted to “Managing the Costs of Your Cancer Treatment.” One specific paragraph jumps off the page-Oral Chemotherapy:
Today, more and more chemo drugs are taken by mouth. (This is often called oral chemo, and includes drugs known as targeted therapy.) In most cases, this means you get a prescription and take the drugs on your own, at home.
Chemo taken by mouth is as strong as the other forms and, when taken properly, works just as well. But you need to know that oral chemo drugs cost a lot – sometimes many thousands of dollars per month. And most health insurance plans don’t pay for the oral drugs the same way they pay for the IV drugs (those put into a vein in the hospital, clinic, or office).
Oral chemo drugs are often treated like regular prescription drugs. You have to pay for them and, even if your insurance covers them, you might have a very high co-pay. For example, some insurance companies require a co-pay of 25% of the drug cost. This can be thousands of dollars. And this isn’t a bill that you can pay later – you have to pay when you pick up the drug at the pharmacy.
Make sure you know how much you’ll have to pay for each treatment. Many drug manufacturers have patient assistance plans to help people pay for their drugs. Ask your pharmacist, doctor, or nurse about this.
Let’s say you don’t have $50 in your pocket to cover your cancer co-pay? What then? Well, you could very well petition the drug company to issue you a waiver for the fees, but you’re not getting the chemo you need that day. You’re also likely feeling incredibly anxious over the fact that you’re not getting your chemo that day, and that’s not helping your health. That same individual, however, if they have Medicaid, will not be faced with this anxiousness.
Another, ughh, “tip”, is searching for grants, which is exactly what one wants to do when in the throes of pancreatic cancer. If you’re still feeling somewhat upbeat, you could take a look at this Reddit thread to really make you lose all hope for humanity.
The most egregious part is, statistically speaking, “cancer patients who go bankrupt are nearly 80 percent more likely to die than patients who don’t.Prostate cancer patients who filed for bankruptcy were almost twice as likely to die; bankrupt colorectal cancer patients were 2.5 times more likely to die as those not done in by debt.” Let that sink in for a moment. Filing Bankruptcy as a cancer patient is akin to not having treated your cancer at all. If you’re thinking that maybe the people who filed had more aggressive forms of cancer, you would be wrong:
“The study, which looked at two groups of around 3,800 cancer patients (one group bankrupt, the other not) diagnosed between 1995 and 2009, found that the mortality rate was not related to whether patients were diagnosed with metastatic disease. It also hinted that cancer patients who had “financial difficulty short of bankruptcy” might also be at risk.”
Bankruptcy and Cancer
It’s not hyperbole to suggest that an individual with cancer is extremely more likely to die as a result of the financial pressures put on as a direct result of treatment.
There is no simple solution to this problem. The Affordable Care Act, still in it’s infancy, has had a very small impact on this type of medical debt. This seems to be more of a byproduct of (1) a broken health care system motivated by profit and (2) a lack of political will/courage to stand up and pass legislation that would deal with this problem.
Until that happens, we’re thousands upon thousands of people will die because of the stress related to financial debt and their treatment options. There is no happy ending here. Not for a long time.