Prostate Cancer: The Cost of Staying Well

Christopher Lukas Health Guide December 11, 2006
  • When I was diagnosed with prostate cancer, I was 65 years old and just becoming eligible for Medicare. Due to an unfortunate error on my part, I didn’t sign up for Part B, which pays for doctors’ services and other outpatient care, in January of that year, though I rectified that mistake within a month. (I had thought that treatment at a hospital would be inpatient; it isn’t. It’s outpatient.)

    Due to an unfortunate error on Medicare’s part, they hadn’t corrected my mistake by the time I went in for radiation treatment. This meant that the cost of 44 radiation treatments and diagnostic tests – approximately $40,000 – at a major New York City cancer center, was to be picked up by me!

    Clearly, this news was upsetting.

    I was not in any position to pay that kind of money. Pleas to Medicare and to the hospital made no difference. I went into a deep funk. Then, luckily, I realized that my senator (Daniel Patrick Moynihan) might be able to help. A wonderful specialist in his office quickly rectified Medicare’s error. In the end, Medicare and my Medigap policy paid the bills.

    All of this came to mind today when I read a report in the Journal of the American Medical Association (JAMA) that says that 49 million Americans are spending 10 percent or more of their family income on healthcare, and that this constitutes a “burden” on those families.
    The Federal Agency for Healthcare Research and Quality (AHRQ) looked at the costs of Americans under the age of 65 and found that one in five are burdened by health costs, in other words spend more than 10 percent of the family income. Eighteen million Americans spend more than twenty percent of family income on healthcare.

    Without even beginning to argue whether 10 or 20 percent of income is burdensome (after all, we spend 30 to 40 percent on housing costs) let’s look at what that would mean for someone pre-Medicare (i.e., before 65) and then ask what it means for someone with Medicare coverage.

    First, the costs of prostate cancer care:

    This depends when and how you’re diagnosed, and where and how you’re treated; while my particular costs soared past $30,000 (or, at least, that’s what the hospital charged for radiation), according to the Mayo Clinic, for surgery, radiation, or seed implantation, the average cost was about $6,500, no matter which treatment was chosen.

    If I had been making $60,000 a year (gross), that would certainly mean that my prostate cancer costs were already more than 10 percent of my income.

    Health insurance costs Americans – on average – about $2,700 per family (if the costs are shared with an employer), about twice that if paid for without employer help. But what about health insurance? Maybe you’re one of the 40 million Americans who don’t have it.

    All of this makes figuring out how prostate cancer affects you extremely difficult.

    If you’re paying $5,000 for insurance, then you pay only 20 percent of the cost of treatment – or $6,000 in the case of my example above, or $1,200 as a co-pay if you have that lower cost treatment.

  • Now, what about if you do have Medicare? Well, that’s a much smaller cost for the insurance itself (for Part B, I pay about $90 a month, and that comes out of my social security payments -- $1100 annually.) Then, I have to pay the 20 percent co-pay, drugs (or Part D insurance), so if I have prostate cancer treatment costs between $6,500 and $30,000, my part of that payment (plus my insurance costs) is $2,500 to $7,000. Then there are all the other co-pays for the year.
    If I also have Medigap insurance, add about $3,000 to my yearly costs, but subtract the co-pays.

    Confusing enough? Now, start figuring out your family’s income for the year, and do the math.
    Are you spending more than 10 to 15 percent of your family’s income on healthcare each year?

    Is that burdensome to you?

    One thing we all can do, however, is to check out whether we need certain treatments; whether there are options that are both safe, effective, and lower in cost.

    • There’s always watchful waiting for those of you with a low Gleason.
    • Some experts are now looking at a new kind of ultrasound that can do the job of C.T. scan in some cases.
    • Others are suggesting that cryotherapy (using very low temperatures to freeze tumours) may be cost-effective.

    It’s up to you to assess your own situation. But one thing the AHRQ study makes clear: millions of families are spending more and more on healthcare, and that’s problematic.