"I know that God can take care of this. But how’s he going to do it?"

Bob Herbert, an Op Ed columnist for the New York Times, wrote the piece below and it got me to thinking about so many of the clients I work with every day who wander the streets homeless, sick and dying from what my recently diagnosed with breast cancer sister in law calls "the big C." A great many of these individuals were at one time productive, house-living citizens of our great country when they learned they had cancer. Like Dan and Sharon Brodrick in the story below, they spent every last dime trying to cure themselves or their loved one and one day awakened destitute. You'd be surprised just how little compassion there really is out in the real world when you suddenly aren't able to pay your rent and bills any longer because you've spent your last dollar on medicines and transportation fees to visit the doctor. The "we'd like to help but we just can't keep carrying you forever" statement, in one form or another, is something I hear from just about every person I have spoken to who has had to choose between life or paying the light bill and are now sleeping under a bridge because they chose life. And this isn't something that is new to me simply because I've been working with the Homeless over the past year. I spent enough time on an ambulance to hear plenty of financial horror stories from people who used our service simply because they couldn't afford a taxi to take them into the hospital; they'd long ago lost their vehicle to a repossession or were unable to perform a necessary repair and so were unable to drive even if they were able to. I cannot come to terms with the fact that we are allowing our fellow citizens to wallow in poverty as a direct result of an illness they really have no control over and we cannot find a way, here in the richest place on earth, to assist these people. Keep them warm, safe and comfortable as they battle the biggest threat to their lives they will ever face? Force them to choose between meds or groceries? What are we thinking? And yet, we will almost certainly provide another 46 billion dollars to wage a war for oil across the ocean while paying for the devastation we cause as a result of that war. There's something seriously wrong with this picture..... The American Cancer Society The Long, Dark Night

By BOB HERBERT

Published: October 23, 2007

I was making small talk with Dan and Sharon Brodrick in a waiting area filled with anxious-looking patients on the first floor of St. Thomas Hospital. Mrs. Brodrick seemed tired, but she managed a smile. Her husband, a former truck driver who is now an ordained minister, was the talkative one.

“We found out five days after her 56th birthday,” he said. “How’s that for a happy birthday?”

While maintaining a pleasant facade for the outside world, the Brodricks, married 37 years and still deeply in love, are spinning toward the abyss.

“We’re in big trouble,” said Mr. Brodrick.

Mrs. Brodrick learned last May that she had cancer of the duodenum and it had already spread to her liver and pancreas. Not only is the prognosis grim, but the medical expenses will soon leave the couple destitute. Mrs. Brodrick has no health insurance.

The emotional toll has been nearly as devastating as the physical. Mrs. Brodrick told her husband that she wasn’t ready to leave him. “I don’t want to die,” she said. When he told her they had to cling to their faith in God, she replied, “I know that God can take care of this. But how’s he going to do it?”

The American Cancer Society has been campaigning to raise awareness of the desperate plight of people trying to deal with cancer without health insurance. I offer Dan and Sharon Brodrick as Exhibit A.

The Brodricks never had much money, but they raised two boys and managed to buy a modest home in Gainesboro, a rural town about 90 miles east of here. Dan Brodrick severely damaged his back in an accident at work several years ago and is disabled. His wife has suffered from a variety of illnesses.

But by carefully managing their meager income, they have lived in reasonable comfort. “With a little bit of savings,” said Mr. Brodrick, “and with what I’ve been drawing in disability, we figured we’d be all right.”

But the absence of health insurance for Mrs. Brodrick left a gaping hole in their financial plan, and they knew it. She had been covered by her husband’s health insurance while he was driving a truck. But that coverage ended when he was forced to retire.

“We tried to buy insurance for her,” said Mr. Brodrick. “We applied to dozens of companies. But they wouldn’t touch her because she already had health problems.”

Without insurance, Mrs. Brodrick received treatment for her various ailments under a special program for uninsured patients at St. Thomas. But the cancer diagnosis was an entirely different story, a step for the Brodricks into a realm of dizzying, unrelieved horror.

First came the biopsy, accompanied by reassuring comments from doctors. Then came word that the tumor was indeed malignant. That was followed by surgery.

“They opened her up, and then they closed her right up again,” said Mr. Brodrick.

Not only had the cancer metastasized, it was moving very aggressively. Various estimates were given, each one shorter than the last, about how long Mrs. Brodrick might live.

While his wife was being prepped for chemo, Mr. Brodrick sat in the corner of another room and spoke about what it was like to have one’s life all but literally blown apart.

“It tears you down,” he said. “You’d like to fight this with your bare hands, but you can’t. We’ve been married 37 years September 2nd, and when I think about it, it was the quickest 37 years I’ve ever seen go by in my life. It went by in a flash. And we have leaned on each other that whole time.”

The hospital is not billing the Brodricks for its costs. “But,” said Mr. Brodrick, “I’ve still got to pay the doctors’ bills and pay for the drugs. And the drugs are very expensive.”

He reeled off a long list of charges that are coming at him like machine-gun fire, bills that he cannot afford to pay.

“So we’re selling the house,” he said. He sat quiet for a moment, then added in a soft voice, “You shouldn’t have to go live in a tent somewhere just because you don’t have insurance.”

He said he wanted to tell his story publicly because he knew there were millions of others without health insurance, and that there are many families, like his own, facing the long, dark night of devastating illness.

“Something has to be done,” he said.

Mr. Brodrick was able to get his wife into a renowned cancer center in the Midwest to get another opinion on the course of treatment she was receiving.

“They said it was the perfect treatment for her and they wouldn’t change a thing,” he said. “They said the success rate with that treatment was 5 percent or less.”

He looked at me. “We’ve got faith in God,” he said. “Without that you might as well throw yourself off a cliff, because there’s nothing else left.”

Cancer Society Focuses Its Ads on the Uninsured

By KEVIN SACK

Published: August 31, 2007

ATLANTA, Aug. 30 — In a stark departure from past practice, the American Cancer Society plans to devote its entire $15 million advertising budget this year not to smoking cessation or colorectal screening but to the consequences of inadequate health coverage.

The campaign was born of the group’s frustration that cancer rates are not dropping as rapidly as hoped, and of recent research linking a lack of insurance to delays in detecting malignancies.

Though the advertisements are nonpartisan and pointedly avoid specific prescriptions, they are intended to intensify the political focus on an issue that is already receiving considerable attention from presidential candidates in both parties.

The society’s advertisements are unique, say experts in both philanthropy and advertising, in that disease-fighting charities traditionally limit their public appeals to narrower aspects of prevention or education.

But the leaders of several such organizations, including the American Heart Association, the American Diabetes Association and the Alzheimers Association, said they applauded the campaign’s message that progress against chronic disease would be halting until the country fixed its health care system.

As in the past, the heart association is using its advertising dollars these days to promote more rigorous exercise and healthier diets. The most recent cancer society campaign encouraged screening for colon cancer, including a memorable commercial in which a diner plucked — and then ate — a lima bean polyp from the intestinal tract he had carved in his mashed potatoes.

But John R. Seffrin, the chief executive of the cancer society, which is based here, said his organization had concluded that advances in prevention and research would have little lasting impact if Americans could not afford cancer screening and treatment.

“I believe, if we don’t fix the health care system, that lack of access will be a bigger cancer killer than tobacco,” Mr. Seffrin said in an interview. “The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue.”

The two 60-second television commercials that form the spine of the campaign make that point.

One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.”

The other commercial depicts a young mother whose family has gone into debt because her insurance did not fully cover her cancer treatment. “Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.

Census figures released this week show that the number and percentage of people in the United States without health insurance rose last year, to 47 million and 15.8 percent. A 2003 study estimated that one of every 10 cancer patients was uninsured.

Other surveys have found that one of every four families afflicted by cancer, which is projected to kill 560,000 Americans this year, is effectively impoverished by the fight, including one of every five with insurance.

The cancer society plans to buy time on network and cable channels from Sept. 17 to Thanksgiving, said Greg Donaldson, the group’s vice president for corporate communications. There will also be advertisements in magazines and on Web sites.

With nearly $1 billion in revenues, the cancer society is the wealthiest of its peers and has spent about $15 million annually on advertising since 1999. By comparison, Geico, the automobile insurer with the “Caveman” advertisements, spent about $14 million on network advertising in the first quarter of 2007, according to TNS Media Intelligence, a tracking firm.

Advertising about the health insurance crisis is not uncommon among more broadly based medical organizations and other interest groups.

Last week, the American Medical Association kicked off a three-year campaign called “Voice for the Uninsured” that will begin with $5 million in advertising in early primary states. AARP, in conjunction with the Business Roundtable and the Service Employees International Union, recently began a similar effort called “Divided We Fail.”

This year, the cancer society formed a collaborative with the heart, diabetes and Alzheimers associations, as well as AARP, to promote awareness of the health access problem. The group adopted as common principles that all Americans deserve quality, affordable health care with transparent costs.

But the cancer society is the only disease-focused group ever to have dedicated advertising resources to the topic, said officials with other charities and with trade groups.“I’ve never seen anything like it before,” said Bill Novelli, chief executive of AARP and, in a previous career, a co-founder of the Porter Novelli public relations firm. “It’s taking a different tack for them.”

That a charity like the cancer society felt compelled to join the access debate reflects both the urgency and the resonance of the issue. Nonetheless, Mr. Donaldson said it was “risky business” for the tax-exempt group.

It steered away, he said, from promoting solutions that could be viewed as partisan, like mandatory insurance or single-payer government coverage. Rather, he said, the commercials are intended to urge action by the next administration, and to drive viewers to a Web site linked to the group’s advocacy and lobbying arm.

“We very much see a moral imperative to raising the discussion,” Mr. Donaldson said, “but we understand there’s a need to be appropriate.”

Cancer society executives said they had heard little dissent from volunteers and donors, and several regional officials said they supported the new approach.

But others called the campaign misguided. Valerie C. Robinson, a longtime board member of the Jacksonville, Fla., chapter, said expanded access to insurance coverage was “not our fight.”

“To me, it’s throwing away money that we could have put into providing free mammograms or free PSA tests or free colonoscopies,” she said.

Mr. Seffrin initiated the advertising campaign after being pushed by the society’s board to make faster progress toward its goals of reducing cancer death rates by 50 percent and incidence rates by 25 percent from 1990 to 2015. If trends continue, the actual reductions are projected to fall well short, perhaps by as much as half.

While the decline in death rates is accelerating, studies have shown that if cancer was diagnosed more in its early stages, the rates would fall faster. And new research is confirming that insurance status often determines whether a person’s cancer is diagnosed early or late.

One study published this year found that uninsured breast cancer patients were more than twice as likely to have their cancer diagnosed in late stages as those with private insurance. Other studies have found similar results with cancers of the larynx and mouth.

“The truth is we know what’s going to happen with cancer if we don’t intervene,” Mr. Seffrin said. “It will become the leading cause of death in the world, needlessly.”