This is going to be one of those posts that’s going to get me in hot water. That’s ok – I’ve been there before!
This week is the annual San Antonio Breast Cancer Symposium, perhaps the largest and most noteworthy of them all from which emanates some of the biggest Breast Cancer headlines. The magnificent Alamo Breast Cancer Foundation provides a truly INCREDIBLE service to advocates (even above and beyond their scholarship program) by bringing together top people to summarize the day’s headlines. Tonight’s “mentor session” was live-streamed thanks to Dr. Jay K. Harness at BreastCancerAnswers.com.
As always the presentations and questions were outstanding. One sparked a little discussion in the twitter feed.
The question began when Karuna Jaggar, Executive Director of Breast Cancer Action, raised a concern about inequities in access to care, which in turn was a result of findings that patients with incomes of $100,000 or more per year were more likely to afford, and therefore take their prescribed medications. (Karuna’s post is at BC Action). And it will come as no surprise that better adherence translates to better health outcomes.
The twitter conversation went like this:
It is a horrifying reality for one of the richest countries in the world! In fact I suspect we’re going to have more of these challenges as time goes on. But as the Affordable Care Act begins its rollout, with fewer hospitals taking individual or ACA plans, and insurance companies finding loopholes where they can, it seems to me we still haven’t had the REAL conversation about health care in America.
And like so many things we seek to avoid, I suspect we haven’t had it because it makes us uncomfortable. Very uncomfortable.
I wonder of some of that discomfort is our own hypocrisy. And I use “our” because I’m part of the problem, too.
Here’s the crux of it:
How can a health care system provide unfettered access to an unlimited number of treatment options for every member of a society irrespective of income and regardless of the proven benefit of the treatment without bankrupting the entire country?
I’m fairly certain that as a breast cancer advocate I’m not supposed to say these things. The party line is something like: everyone deserves whatever care they need, at a price they can afford, in a location that is accessible.
And everyone DOES deserve that. And not just breast cancer, right? It’s about everyone with cancer. And diabetes. And AIDS. And rare diseases. And on and on. Everyone deserves the very best that we, as rich a country as we are, can provide.
But our expectation is that time, money and other resources be unlimited, and that those unlimited resources be available to all. A noble cause, to be sure. But how many of us have unlimited access to any one of those things, let alone all of them? We don’t. Nor does our government.
We can argue about how money is spent, and believe me, I’m as horrified as anyone about the damage sequestration has wrought on medical research and services, and the inequities I’m starting to see in ACA coverage. I know and hate that poverty is a risk factor for disease. It is simply unacceptable, it is biased and probably racist and class-ist. And honestly, I believe the only resolution is a new system from the ground up. Sadly I don’t think that is going to happen.
But look across the globe. Show me one, just one society that offers its citizens whichever treatments they want whenever they want them at an “acceptable” price. Can’t happen. If drug selection is unlimited, money becomes a problem. If money is limited, choice of treatment is curtailed. Our propensity to spend unlimited amounts of money we don’t have is part of how we got to where we are as a country and as a society of over-spenders.
I’m certain I’m preaching to the choir here, right?
So my question is about our advocacy. We want it all. And we should – there is nothing wrong with wanting it all. But we need to acknowledge that we can’t possibly have it all. We can’t continue to insist that we get it all.
And I’m not talking about all of us, I’m talking about each of us! Our health is personal and for each of us, our treatments will someday have to be reconciled with the fact that none of us, so far as I know, has unlimited money and unlimited choices.
As advocates our passion needs to come face-to-face with our reality, and it is our passion that must bend. We must find a way to move from passionate rhetoric to realistic solutions. We must continue to dream, but also to find solid ground. Our seat at the table depends on it.
My question for you: how do we get there?