Sick, strapped and stressed
While the study only looked at the association between bankruptcy and mortality, not what exactly led to the deaths, Ramsey did offer theories as to why cancer patients in dire financial straits were more vulnerable.
Stress over finances could be one factor, he said, something that rang true for Bernstein.
“I can’t tell you how much PTSD-type stress I have around this issue, dating back to the first time I was diagnosed with cancer in 1994,” she said. “Before that, I had perfect credit and always paid my bills on time. [This has] happened to me three times. It takes a toll on you trying to get your life back, to be in survival mode all the time.”
Bankrupt cancer patients also may not have received adequate or timely treatment, Ramsey said, either because they couldn’t afford it or because they refused it, not wanting to burden their families further. Previous studies have shown that in some cases, cancer patients in financial distress will refuse or miss treatment because of its high cost.
“There may have been significant delays due to patients having to deal with the financial issues or even perhaps with the institutions that were treating them stopping due to them going into receivership,” he said. “We haven’t looked at this but it is certainly feasible. [Maybe] the centers are still offering therapy but the patients just stop coming because their bills are piling up and they say, ‘My family’s already devastated and any more treatment is going to put them further in the hole.’
“There’s a whole lot of stuff in between [bankruptcy and mortality] that we don’t know,” he said. "That’s why we want to do more research.”
While there are questions about what, exactly, led to patients’ deaths, no research is necessary to understand how a cancer diagnosis could bankrupt someone.
The cost of cancer drugs has soared in the last decade; ditto for the out-of-pocket share patients are expected to pay. Insurance plans have become more expensive with higher premiums, higher deductibles and higher copays and cancer care often entails pricey surgeries, chemotherapy infusions, targeted treatments and weeks of radiation.
“People will rack up a quarter million dollars in bills in one year,” he said, adding that even patients with insurance may find themselves overwhelmed by debt.
“I think the general public can’t assume that insurance is going to cover everything anymore,” he said. “Or that they’re going to come out the other end financially intact. I think most people should worry just a little bit, unless they’re Bill Gates or Jeff Bezos. A lot of people live paycheck to paycheck. They don’t have those kinds of reserves.”
Cycle of medical debt
Even those with reserves have found themselves buried under debt.
After weathering her first diagnosis (and its related financial hit) at age 29, Bernstein started socking money away as soon as she was back on her feet – just in case.
“Instead of buying a house and doing what all my peers were doing, something told me I needed to have an emergency fund,” she said. “And 11 years after the first diagnosis – boom! – I got the second one.”
This time around, she had cancer in her other breast. At age 40, Bernstein started off on what she thought would be a routine lumpectomy and radiation regimen but was soon hit by complications, infections, an ER visit, a slew of follow-up appointments and, of course, all of the accompanying bills. To make matters worse, she wasn’t able to work because of treatment side effects, a common scenario with young cancer patients.
“I thought, I’ve done this before and I have the financial reserves, but radiation basically cut my legs off,” she said. “I lived upstairs in a building with no elevator and it was like climbing Mount Kilimanjaro every day. I wasn’t able to work. The fatigue wouldn’t dissipate.”
Her nest egg dwindled to nothing while she recovered and, eventually, started working again. But four years later in 2009, cancer came back. This time, she had to have a double mastectomy and chemo and began the process of breast reconstruction. But again, she ran into complications leading to more hospitalizations and even more debt.
“By the time I was diagnosed for the third time, I’d used up all of my money, all of my investments, all of my savings,” she said. “A year and a half after treatment, I couldn’t afford my rent-controlled apartment anymore because I wasn’t back on my feet enough to work. I had to move out and stay with friends and start rebuilding. I have bills that need to be paid off but I can’t go into it or I’ll likely have a panic attack. Basically, advocacy and the realization that I could [use this] ordeal … to help others is one of the very few things that has kept me ‘alive’ and fighting to rebuild my life.”
