From Medicare seniors, lessons on delayed care and importance of insurance

waitingroom-2-300x202Patients packed in their doctors’ waiting rooms in pre-pandemic times may have looked around and wondered: Why are there so many seniors here receiving medical care?

It isn’t just age that gets older Americans in numbers to treatment for illness or injury or preventive care — it’s also, of course, their qualification at 65 for government-supported medical insurance, aka Medicare. That, perhaps, unsurprising conclusion has been affirmed by Stanford doctors and researchers in newly published research. The study also offers important insights on delayed treatment and the crucial role played by health insurance.

The work involved running down a hunch of Dr. Joseph Shrager, a cardiothoracic surgeon who wondered why so many older patients he saw were diagnosed with lung cancer at age 65 — and not, say, at 61, or 64? He discussed the observation with colleagues who concurred in their curiosity about Medicare eligibility and its role in disease diagnosis. As the university news service reported of the insurance hypothesis:

“’If this were true, and patients were delaying screenings or treatments for cancer, it could impact their survival,’ Shrager said. A quick exploratory analysis of their own practices showed a twofold increase in lung cancer surgeries in 65-year-old patients compared with 64-year-olds. ‘We decided to explore this, and its broader implications, in a larger population,’ Shrager said. In a follow-up study published … in Cancer, the researchers found a substantial rise nationwide in new cancer diagnoses at 65 — not only for lung cancer but also for breast, colon and prostate cancer. The four are the most common cancers in the United States.

“‘Essentially we showed there is a big jump in cancer diagnoses as people turn 65 and are thus Medicare-eligible,’ said Shrager, the senior author of the study. The study’s lead author is Deven Patel, MD, a surgical resident at Cedars-Sinai Medical Center in Los Angeles who spent a year as a research fellow at Stanford. ‘This suggests that many people are delaying their care for financial reasons until they get health insurance through Medicare.’”

The government coverage matters to patients’ health:

“The study showed that insured cancer patients (lung, breast, colon, prostate) older than 65 are more likely to undergo surgical intervention, and they had lower five-year cancer-specific mortality rates than did their younger uninsured counterparts. Collectively, these results demonstrate that Medicare eligibility, an event coincident with becoming 65 years old, is associated with a rise in early-stage cancer diagnoses and a resulting survival benefit,’ the study concluded.’

It may be hard for a visitor from another country to fathom how older Americans could put themselves at higher health risk by delaying care until they qualified for Medicare. But the Stanford team zeroed in on challenges widely known to seniors and to others in health care about 60-plus patients:

“These individuals often lack insurance as a result of early retirement, pre-existing conditions hindering renewal, the high cost of private insurance and other causes,” the study said, noting that 13%-25% of this group of adults are uninsured or have a gap in medical coverage at some point preceding Medicare eligibility.”

Options to increase health insurance coverage

Politicians in Washington, D.C., of course, have fought ferociously for more than a decade over Americans’ health insurance, making it the central element of the discourse over the nation’s health care. It is not. It is a key for all of us — a blink away from a change and calamitous injury or illness — to share risk and slash at bankrupting medical costs. Democrats insist health care is a right and not a privilege, while Republicans have taken the opposite view.

The long combat over the Affordable Care Act or Obamacare appears to have subsided for now, with the Biden Administration aggressively pushing the program to help millions more Americans get health coverage.

The president, who declined in his campaign to embrace progressives’ push for a single-payer system that proponents dubbed Medicare for all, may be working with his party in yet more major health care actions, including to lower the eligibility age to 60 Medicare. This could be a boon for older patients but would be battled, big time, by doctors, hospitals, and other medical providers.

They argue that the federal reimbursements under Medicare are far too stingy and they have developed complex ways to balance out what they claim are their losses, including by sticking insured patients with higher costs and claiming significant tax benefits for what they term under- and un-compensated care.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

Perils in delayed care

During the coronavirus pandemic, we all, in effect, have become part of one of the major health care experiments in recent times. When the virus raged, the health system all but shut down, save for emergency treatment of Covid-19 patients. Research will help us understand in the years ahead how the resulting postponed or canceled medical tests and procedures affect our health, and what part of the trillions of dollars we spend on the health system is beneficial or wasteful.

Cancer experts already are warning that they are seeing patients with advanced disease that might have benefited from earlier diagnosis and treatment that was delayed due to the pandemic. This is not good. Cancer’s warning symptoms are well-known, and especially now, as so much of the country is re-opening and so many people are getting vaccinated, patients should call their doctors, asap, if they feel bad or their minds or bodies are giving off alarms.

It will be tragic to know the pandemic caused needless deaths due to other diseases and their impeded discovery or care. We also should ask whether it makes any more sense for older patients to wait a year or more for life changing or saving medical services that they will be covered for by Medicare. The Congress is so closely divided that all this administration’s aspirations will be tough to get passed. We have much work to do, however, to know that the richest nation in the world treats all its people with care and compassion, especially with their health care.

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