If Reform Dies, So Will Thousands of Women

by Harold Pollack | August 26, 2009

is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

A colleague received the following fundraising letter from an organization I had not previously encountered: the Independent Women’s Forum. The letter says:

Dear —-/

More American women are going to die of breast cancer if you and I surrender to President Obama's nationalized healthcare onslaught.

It's as simple as that...

Why? Because nationalized healthcare does not let doctors and their patients decide what's best. Because nationalized healthcare means fewer treatment options.

And because, at the end of the day, you and I are much more likely to do all it takes to keep ourselves alive than some faceless government bureaucrat...

With the bombast (but without the goofy charm) of Billy Mays, the letter proceeds to lambaste the administration for trying to “con America with a nationalized healthcare shell game.” The narrative builds up to a crescendo before throwing the main pitch:

[W]ill you please take one more look at our new ad, and then send me a tax-deductible gift of $25, $50, $100, $250, $500 or even more today?

A little hyperbole and balderdash seems mandatory in mass fundraising. Yet IWF’s materials are outstanding in their deep foray into the territory of the untrue.

IWF’s television ad is especially sad, and especially misleading. With soft piano music in the background, a no-doubt sincere breast cancer survivor named Tracy Walsh warns women that they will get shoddy breast cancer care if health reform passes. Providing now-standard misleading references to the Lewin Group, conflating the public plan option with a full-stop National Health Service, she adds that in England, "if you find a lump, you could wait months for treatment."

This advertisement is especially misplaced in light of many studies documenting poor outcomes among uninsured American women with breast cancer. It’s been known for many years that uninsured breast cancer patients are diagnosed later, require more invasive and costly treatment, and die sooner than their insured counterparts. Lack of health insurance is a major risk factor for delayed mammography, and for delayed response to abnormal mammography that requires diagnostic resolution.

Not every difference in medical outcomes would be eliminated through insurance coverage. Confounders such as race, poverty and low education matter, too. Yet studies which account for these factors still find large differences in medical outcomes associated with lack of health coverage.

To pick one study among many, a strong recent analysis by Cathy Bradley and colleagues examined treatment outcomes at Virginia’s Massey Cancer Center. These authors found that uninsured women were far more likely to present with late-stage cancers and large tumors that required aggressive treatment, were less likely to complete chemotherapy, and–contra Tracy Walsh–were many times more likely than others to wait 90 days or more between their initial diagnosis and their breast cancer surgery.

Then there is the other elephant in the room. Women in other industrial democracies do not go bankrupt because they have breast cancer. That’s an everyday occurrence across America–among both insured and uninsured citizens. Democratic health reform bills will not create "nationalized healthcare" or a single-payer system. The current bills are surely imperfect. They would provide every woman the opportunity to buy affordable and decent insurance that covers diagnosis and treatment of breast cancer.

It’s as simple as that. That’s something worth fighting for.

Source URL: http://www.newrepublic.com//blog/the-treatment/if-reform-dies-so-will-thousands-women