On cancer and healthcare in the US

Dear Mr Kristof,

I'm so glad your brush with cancer filled you with such optimism and appreciation for the world around you, and for your future. As you note, 41% of Americans will be diagnosed with cancer, which undoubtedly means that many more even than that will be put through the ordeal of an unidentified tumor, like yourself. And it would be wonderful if all of us could experience these feelings of renewal of optimism and purpose as a result, like yourself, and your friend at the Times. My experience with cancer has been a little different, however.

I did not receive a lucky early diagnosis from a responsible doctor who ordered a $2000-$5000 test, and surgery, just to be sure. I was lucky, in that it was caught at all - the nurse practitioner at the free clinic I go to initially refused to give me an exam on the grounds that it had been less than 2 years and I didn't need one, as I was 'not at risk.' Upon my insistence (born of a strong family history of cancers), the exam was performed and a large tumor was detected; later, tests were done proving that in fact, I had a risk level so high it was almost certain I would develop cancer at some time in my life. Miraculously, I have responded well to treatment and it looks as though I may live. Cause for optimism, you say? For a new lease on life? Maybe so, but I'll tell you what I feel - afraid. I have been lucky enough to have insurance through this ordeal and, as a result, good care, but I have seen the care given to others with my cancer, and it is not pretty, or often even competent. I feel afraid of losing my health care and dying of a recurrence as a result of insufficient treatment options (still a very real possibility). I feel afraid that someone I love will be less lucky than me and be forced to endure treatment through the public health system, which as I have seen first hand, is terrifyingly inadequate.

My father had an experience both similar and dissimilar to my own. He experienced symptoms which led him to believe he needed exams, testing to find something wrong with him - but he was shuffled through the public health system here in San Francisco for nearly a year, as he grew sicker and sicker, seeing one doctor after another (though many months apart, naturally, as appointments for the poor are few and far between) who told him nothing was wrong, that he was only trying to shirk the work one is forced to do to receive public financial assistance. Until one day, a doctor found something, and told him that they were sorry, the now advanced stage of his disease meant treatment was no longer an option.

I think that these experiences are far more common, sadly, than your own. I think that cold-sweat-in-the-night, bone-chilling fear are in fact a rational and natural reaction to the state of health care in this country. I am glad that there are those in a position to be able to be oblivious to this reality - but I would like to remind you of the necessity to help us create a world where all of us can simply appreciate the fact that we continue to live instead of living in fear of what comes next. The new health care laws have some wonderful stipulations - the cancer community was overjoyed at the rules regarding pre-existing conditions - but it is not even close to enough to set at ease the minds of the millions of us who face the very real possibility of dying of being poor.

Sincerely,