Tuesday, September 22, 2009

On Cancer, Health Reform, and Rural

According to the AP wire for September 19, Congresswoman Sue Wyrick, R-NC, recently spoke out in opposition to health care reform. She cited her own case, which she described as requiring “six doctors, three mammograms and one ultrasound” as taking “only a few weeks.” She asserted that in Canada and the UK, she might have had to wait “more than a month.” [1]

Leaving aside the question of whether there is a substantive difference between “a few weeks” and “more than a month,” and acknowledging the traumatic nature of breast cancer for any woman, the lawmaker could still use some education regarding health care in the US.

- All women do not have equal access to mammograms, and thus to the quick treatment received by Rep. Wyrick. Among age-appropriate women (over age 40), rural women are less likely to receive timely mammograms than their urban sisters (71% versus 78%). Among uninsured rural women, only 51% get screened. [2] That means barely above a coin flip that cancer will be detected among these women.

- For women who are not receiving routine screening and must wait till they detect a suspicious lump to seek out free screening for the uninsured, the clock starts a lot later than “more than a month.” This has real consequences: uninsured women are more than twice as likely to have advanced stage cancer when they first seek treatment (18% for uninsured versus 8% for privately insured women). [3] At that point, they likely would have traded "more than a month" waits to have had their cancer detected at Stage I.

The health care reform debate is not trivial for folks living “outside the Beltway.” We need lawmakers who are both passionate and informed about rural.


[1] “GOP lawmaker warns of dangers in health overhaul” http://www.thestate.com/nationalpolitics/story/949479.html

[2] SCRHRC Health Disparities Chartbook, http://rhr.sph.sc.edu/index.php

[3] Halpern et al, Cancer July 15, 2007, p 395-402.

Friday, September 4, 2009

Reform and Rural

The SCRHRC was fortunate enough to be a participant at the ORHP Grantee Partnership meeting in DC last week. An overwhelming message on the part of participants: let the wonks sort out the details, but let's have a beginning to health care reform now. We can tweak later.
The LA Times published an interesting analysis of the health reform paradox: rural states (South and West) would be the biggest "winners" if health care reform makes care more accessible, but residents in these areas are most likely to oppose change of any kind [http://www.latimes.com/news/nationworld/nation/healthcare/la-na-uninsured-rural2-2009sep02,0,1307203.story]. If it is difficult to bring change in good times, it may be even more challenging to effect change in bad times.

Lest We Forget

Arriving in DC for the ORHP Grantee Partnerships Meeting, I was fortunate enough to encounter the events pictured. USAirways flies WWII vets to DC, free of charge, to visit the WWII memorial. An honor guard of vets from subsequent wars was present to escort their brothers and sisters to the memorial.