Search Our Site

Can Senator McCain Be an Unwitting Healthcare Hero?

Can Senator McCain Be an Unwitting Healthcare Hero?

by Peter Borans and Jason Marcewicz

After Senator McCain was admitted to the Mayo Clinic in Phoenix on July 14 to have a blood clot removed from above his left eye doctors found that he has cancer. Specifically, he was diagnosed with an aggressive type of brain tumor referred to clinically as Glioblastoma Multiforme.

Glioblastoma Multiforme, a type of Brain Cancer, is highly malignant. In lieu of treatment, life expectancy is approximately three months. Treatments can include surgery, chemotherapy, and radiation—all options McCain and his family are currently exploring. These are considered palliative with goal to improve quality of life and achieve a longer survival time. For most patients who are over 70 years of age (like the senator, who is 80) less aggressive therapy is recommended.

Senator McCain has two things in his favor: 1. He is a proven fighter, having endured wartime torture and other physical maladies; 2. Unlike many Americans, as a Member of Congress (MOC) he has access to low medical insurance rates and outstanding coverage.

The latter is no small thing, especially for someone with such disease. The cost of cancer drugs continues to rise at a rate of approximately 10% each year. According to the National Cancer Institute, financial hardship becomes a stark reality after someone is diagnosed with cancer. To pay for their medical expenses:

  • Up to 34% will borrow money from friends or family
  • Between 33% and 80% of cancer survivors will deplete their savings
  • One third of working-age cancer survivors will go into debt

Bankruptcy rates among cancer survivors are 270% higher than among similar households without cancer.

It isn’t known whether Sen. McCain actually signed up for Affordable Care Act (ACA, aka Obamacare) coverage, but as an MOC he can enjoy its benefits: government ACA enrollees pay approximately 28% of their annual healthcare premiums through pre-tax payroll deductions; the federal government (i.e., American taxpayers) subsidizes approximately 72% of the premium cost. Not to mention that routine exam visits, such as the one that detected McCain’s clot, are also inexpensive, or even free.

Problem is, despite whatever you may think of the ACA (or the Republican options to replace it thus far) healthcare costs are opaque. The public, whether well-insured or uninsured, is not privy to what the medical devices, procedures and treatments really cost. Further, the prices that are charged to our insurance companies can often be arbitrary amounts, inflated to adjust for rebates, discounts, vendor fees, network access fees, below the line deals, or simple profit margin.

This is where McCain can leave a legacy beyond heroism. There is no doubt as his family, friends, colleagues, and constituents rally around the ailing senator to support him that this is an unprecedented opportunity for McCain and the rest of our Senators to deal with the true underlying problem of healthcare in America. By putting the spotlight on the cost of healthcare vs. the cost of insurance they can transform a fundamentally flawed and skewed system.

Let’s take his terrible disease of Glioblastoma as an example. The list below outlines all the different therapies currently available and their expected billed charges.[1]

  • Surgery (per event): $129,000 to $157,000
  • Radiation: $57,000 to $75,000
  • Stereotactic Radiosurgery: $95,000 to $109,000
  • Gliadel Wafer (for eight 7.7 mg wafers, if indicated): $67,070
  • Chemotherapy/recurrence: $155,000 to $190,000
  • Temodar (for forty-two 100 mg tablets): $26,507
  • Avastin (for 400 mg vial): $6,333
  • Optune/Alternating Field Therapy (monthly): $21,000

Glioblastoma is a very aggressive tumor with a poor prognosis under the best of circumstances. Senator McCain had surgery to remove it and reportedly all the visible tumor was resected. However, this tumor type is insidious with tentacle like extensions and often patients require multiple surgical events to contain the tumor as best as possible. Temodar is the most common chemotherapeutic agent used for Glioblastoma. Despite being an oral drug, it is expensive: As seen above, six weeks of therapy can be $26,507, and patients can be on this long term if there is tumor regression. (Note: For fourteen 100 mg Temodar tablets the price has gone up from $293.66 just three years ago to $497.28 today—an increase of 18% each year.)[2]

Senator McCain may also have access to the Optune Device (formerly known as NovoTTF). This is a portable medical device applied to the scalp that generates low-intensity alternating electric fields. The device is intended to be worn continuously or at least 22 hours per day. Many patients receive treatment indefinitely or until tumor recurrence. Patients using the device and chemotherapy (Temodar) survived for an average of 20 months versus 15 months with chemotherapy alone. The monthly expenses for this are approximately $20,000.

His treatment bills will rise quite rapidly if an aggressive course is taken. He could incur $200,000-$225,000 in billed charges in just 6 months for standard of care therapies. Senator McCain’s insurance may cushion the financial blow, yet he is subject to the same gross inaccuracies of the current healthcare system as everyone else. As Mark Gaunya, founder and CEO of Captivated Health, often says in his trademarked phrase: health insurance is expensive because healthcare is expensive.™ While this is certainly true, the system is being gamed. Is 50% off an arbitrarily inflated price a good discount? Who should get the rebates? In short, what was the real cost and how much profit is too much?

McCain’s unfortunate diagnosis and the staggering bills associated with it should provoke a redirection of focus towards greater price transparency. Yet with all the political discord around healthcare this single most important issue is conspicuously left out. Why? Because hospitals, large healthcare systems, and lobbyists often oppose such measures.

According to its website, the American Hospital Association’s position is that health plans—not hospitals—are responsible for telling insured patients about their out-of-pocket costs. This finger-pointing of blame between hospitals and health plans adds to an already complex situation, leaving patients to twist in the wind. And while other entities within the healthcare payer chain enjoy bulk discounts, pharmacy rebates, and other cost saving measures, as usual it’s the insured who is left holding the bag—to say nothing of the uninsured.

Yet even if our leaders can redirect focus towards price transparency, and for the first time a consumer can actually learn what drugs, medical devices, and procedures will cost prior to actually buying, that will only be a half measure.

The second part of the problem is that prices may vary by a factor of 100 for the exact same service performed by the same provider. The Tru TV series Adam Ruins Everything recently aired an episode entitled Adam Ruins The Hospital. In it, a segment dubbed “The Real Reason Hospitals Are So Expensive” does an excellent job of succinctly explaining and demonstrating why that is. Here is the five-minute segment:

https://www.youtube.com/watch?v=CeDOQpfaUc8

This is where we are now, effectively doomed to an ever increasing chargemaster without constraints. Change seems so hopeless when up against the single most powerful lobbying group in the United States. But one may only need to turn to a law already on the books for inspiration.

Enter the Durbin Act, an amendment to the 2010 Dodd-Frank Wall Street Reform and Consumer Protection Act. In its most basic form the Durbin Act sharply lowered debit card interchange fees—charges that stores pay banks when a customer makes a purchase. Previously these fees were in excess of 50% of the charge amount. However, through this reform act the government stopped the gouging. “Dodd-Frank said that interchange fees must be ‘reasonable and proportional’ to the costs incurred for the cards. In other words, the government intervened directly and told monopolistic credit-card companies what rates they could set and what rules they would play by.”[3]

By using the established Dodd-Frank legislation that protects the consumer from a controlling entity, politicians can similarly enforce price transparency on a chargemaster. Reasonable mark-ups for profit and implementation of a national payer rate setting would ensure that everyone pays the same reasonable prices for the same healthcare services. Yes, McCain and his colleagues have it in their power to roll the clock back to where things started, effectively eliminating our current chargemaster complexities.

In spite of—indeed, because of—his dire predicament McCain can become a legendary figure; the personification not just of triumph over tragedy, but clarity over obfuscation and common decency over corporate avarice. He is already a war hero. However, by revealing medical cost transparencies and taking away the power of the chargemaster, thus creating a fairer healthcare system for all Americans, McCain will have transcended that. In a way, he will become immortal. Because heroes get remembered; legends never die.

 

 


 

Peter Borans and Jason Marcewicz are, respectively, President and Special Projects Manager of Advanced Medical Strategies, an industry leader in delivering technology-driven solutions for payment integrity, risk management, and high dollar claims issues.

 

 

 

 

 

 

 


 

[1] Advanced Medical Strategies, PredictDx database (as of 08/01/17), https://www.mdstrat.com/directories/predictdx/

[2] RED BOOK Online database (as of 08/01/17), https://truvenhealth.com/products/micromedex/product-suites/clinical-knowledge/red-book

[3] Mike Konczal, “This Small Regulation Shows Us How the Economy Could Work for Everybody,” https://www.thenation.com/article/this-small-regulation-shows-us-how-the-economy-could-work-for-everybody/ (July 27, 2017)

 

 

 

 

 

Related Posts

Comments are closed.