We Won’t Prevent Your Cancer, You Have To Start Dying First
Killer tits and healthcare horrors
Jamie Paul here. This week’s post is by contributor Timothy Wood, but I also reviewed the film Good Luck to You, Leo Grande, for Queer Majority. Check it out.
I have a friend with a fairly rare genetic disorder that virtually guarantees she’ll get breast cancer. It’s not a matter of if, but when. Otherwise, she’s healthy. She’s not overweight and doesn’t smoke or drink. She’s a well-educated mother in her 30s, and the nicest person you’ll ever meet. Her risk is high enough that she’s seeking a proactive double mastectomy, but her health insurance informed her, in no uncertain terms, that this preventative measure would be considered “elective” by their calculations, and therefore not covered. She must instead wait patiently until she gets breast cancer, and only then, when she is dramatically closer to death, will the insurance kick in. It’s enough to make me want to burn the whole world down, or at least the US healthcare system. But even when cooler heads prevail, and anger subsides into despair, the only mantra I can fall back on is that we have to do better than this.
Nobody seems to know how insurance companies generally handle genetic disorders related to breast cancer, so much so that the official government guidance is essentially “talk to your insurance and figure it out” — and that’s just to get the testing to see if you’re at risk. Federal law requires that insurance must cover reconstructive surgery for women who undergo a mastectomy, but no federal law requires health insurers to cover preventative mastectomies, apparently regardless of genetic risk factors.
There’s so much to unpack there, but let’s not lose the person in our unpacking. Our kids are about the same age. She has one younger than mine. Her youngest literally sleeps in the same bed mine used to sleep in. We gave it to her after we made the harrowing transition to a “big girl bed.”
I struggle to contemplate the existential horror of looking down in the shower to consider cutting your breasts off, knowing that if you don’t do it, they’re going to kill you. I know So Brave™ has become its own meme, but damn. Then, after you’ve mustered the courage to pull the trigger, you’re told by some actuary that you’re not sick enough yet. You’ve come to mental and emotional terms with seeing the scars in the mirror and figured seeing your kids graduate high school was more important. Now you get to stare into the mirror and imagine what you’ll look like with no hair, because that’s where this train stops. That’s the point where we’ll foot the bill.
This next bit is going to get real gross, real quick. A few years ago, I had an abscess on my ass. We’ll call it an ass-cess for fun. I really don’t like doctors, but it eventually reached the point where I could barely walk. So, I got to enjoy the indignity of having a bunch of people look at my ass, and have some lady poke a needle in my ass, and some dude take a knife to my ass and release what can only be described as death incarnate. Then I, as a grown man, got to wear a sort of maxi-pad for three weeks so that the unholy liquid plague leaking out of my ass didn’t soak through my trousers at work.
I can reflect back on it now as a bit of medical slapstick, but I would have been mortified to have my coworkers know that I was going to the bathroom to change the maxi-pad for my leaking ass-cess. I can’t imagine the feeling of having your friends and coworkers know you tried to get your breasts cut off and they wouldn’t let you. Under your blouse are two timebombs, and the insurance won’t cover the bomb squad. All you can do is look forward to chemo and share this horror story with somebody because desperation compels you to seek some kind of solace.
The result of all this is that my friend has to have extremely regular mammograms. They have to detect the cancer, so she can get the coverage, so they can reactively treat what they already knew was coming — and they need to spot it early so she doesn’t die. So, there’s the added indignity of having to schedule regular time off of work so some nurse can shove your tit onto a cold x-ray and having to explain all that to your boss.
To add insult to injury, she got a message the other day saying that her hospital cut ties with her insurance, and so her previous exam must be paid out-of-pocket. This is someone who has always worked full time, who has a degree, who has a security clearance. She’s a wife. A mother. A friend. A person. But you wouldn’t know it from how she’s treated.
Even if you’re not on board with the whole compassion thing, the cost of cancer treatment can exceed a million dollars in some cases. Spending a fraction of that to drastically lower the risk saves money. Even that doesn’t count lost productivity due to treatment or, you know, death. The only sure things in life may be death and taxes, but you can’t have both, because dead people tend not to pay very much in taxes. Not to mention the unpaid but vital time spent providing child care, which, like it or not, women still do at a much higher rate than men, a fact they share with “people who get breast cancer.”
We spend almost $800b annually to get people through high school. That doesn’t count the billions more in federal, state, and local subsidies for higher education. By the time you throw your graduation cap in the air, we as a society have invested a boatload of money in you with the expectation that we’ll get a return on our investment by having another productive member of society. Yet we still refuse to invest in our health.
The problem is that insurance companies aren’t in the business of investing in the future of society. Insurance companies don’t care about making productive citizens. They don’t care about saving hundreds of millions of dollars several decades from now if it means spending millions now. They don’t care about these things because they can’t care — and any CEO who did would soon be out of a job for failing to do everything in their power to deliver maximum short-term profits to shareholders and investors. It all makes perfect sense, but it remains perfectly unacceptable. To think that we cannot do better than this seems to indicate some kind of serious condition — but one that we won’t cover until it’s already killing you.
See also: “The Things You Bought But Don’t Own”
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Horrible!