American Cancer Society's Effort Could Also Benefit Diabetes

Can the American Cancer Society's marketing efforts benefit people with diabetes? We may find out next year. In what was arguably one of the biggest news stories in the nonprofit arena recently, The New York Times is reporting that next year, the American Cancer Society announced plans to devote its entire $15 million advertising budget to the consequences of inadequate health coverage.

Two 60-second television commercials that form the bulk of the campaign make that point readily apparent. 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."

While its certainly a change in the organization's marketing tactics, from the American Cancer Society's perspective, they see it as a critical element in the fight against cancer. After all, they know that the uninsured are less likely to get recommended cancer screenings, thus are more likely to be diagnosed in more advanced, and often more deadly, stages of the disease. As you might imagine, patients with diabetes are also caught in the dysfunctional U.S. healthcare system, and their prognosis is similarly poor.

According to a 2006 report published by the International Diabetes Federation, the authors used estimates that approximately 45 million people in the U.S. (roughly 17% of the working-age population) are not covered by health care insurance. Using simple, back-of-the-envelope calculations, given that roughly 6% of people in the U.S. have diabetes, of the approximately 45 million people with no healthcare cover, we can conservatively estimate that approximately 3 million people with diabetes in the U.S. lack healthcare insurance. According to a number of different studies, their prognosis isn't good. For example, analysis of a study done in 2002 revealed that when compared to people who had health insurance, people without any form of health insurance who have diabetes received fewer preventive diabetes care interventions and showed generally less-desirable diabetes outcomes. Specifically, a higher percentage of uninsured people had HbA1c levels of 9% or higher; fewer had an annual blood lipid test and/or annual foot exam. It's hard to imagine, but on average, fully one-fourth (25%) of people with diabetes go without a checkup for 2 years if they have been without health insurance for a year or more vs. only 5% of diabetes patients with insurance.

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. While the leaders of the American Diabetes Association, as well as the American Heart Association and the Alzheimers Association applauded the American Cancer Society's campaign, indicating that progress against chronic disease would also be halted until the country fixed its health care system, so far, none of the other organizations have altered their own advertising budgets to seriously promote the issue. But the Times reports that 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.

Healthcare reform is shaping up to be a key issue for the 2008 presidential election, and deservedly so. According to the Washington Post, candidates from both parties are developing plans to address this issue, albiet none of their approaches are terribly radical. But leadership in Washington, including the President and Congress, have largely ignored the issue since 1993, when then President Clinton and his wife attempted to reform the system with what was then derided as "Hillary Care" which died a very painful death. Since then, Congress has done little besides talk about the issue.

In August 2007, the U.S. Census Bureau released data showing that a record 47 million Americans did not have health insurance last year. In spite of these issues, the expense of the U.S. healthcare system has grown (and is expected to explode as the baby boom retires) while the U.S. rankings have slipped behind many countries, including most of Europe, Japan, and even countries including Jordan! Our life expectancy now ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.

Some candidates, notably Republican Mitt Romney, who credits himself for the Massachusetts plan (the nation's first), has recently said he would leave the responsibility up to individual states. Using California as an example, that may be easier said than done. The San Diego Union-Tribune is reporting that Governor Schwarzenegger's ambitious plan to overhaul the state's health care system and cover California's estimated 6.5 million uninsured residents is quickly running out of time. The Legislature is scheduled to adjourn Sept. 14, and Assembly Speaker Fabian Núñez recently threatened to bring the proposal for a vote of "no confidence" in the California Assembly, but then backed away. Meanwhile, other states are grappling with the issue in different ways.

Back in April, for example, The Wall Street Journal reported (if you have an online subscription to the WSJ, the article is accessible here) on a universal coverage program engineered by Tennessee Gov. Phil Bredesen, which won national attention as states try to develop plans for universal health care. The only problem is that Tennessee's plan may be more affordable for states that cannot afford plans as extensive as those introduced in more affluent states like Massachusetts or California, but participants in the Tennessee plan get coverage up to a maximum of $25,000 for health expenses annually, and only $15,000 of that can go to hospital bills. If a patient becomes seriously ill or has a major accident, they'll be just as vulnerable as they were before, being forced to either pay the bills themselves or ask the hospital for charity care.

To be fair, BlueCross BlueShield of Tennessee says that many people in the state can't afford comprehensive coverage and don't seem interested in high-deductible policies that offer protection against catastrophic expenses for as little as $100 a month. And for those who would otherwise go uninsured, a big advantage of the Tennessee plan is the steep discounts that BlueCross can extract from doctors and hospitals. That will stretch the $25,000 further, says Stan Roberts, health-practice director at Milliman Inc., a Seattle consulting and actuarial firm.

Until Washington approaches this issue seriously and there are Federal standards on healthcare coverage, we're likely to end up with a patchwork of different plans across the 50 states (some deride it as Balkanized coverage, but truthfully, all of the Balkan countries have better healthcare systems than the U.S.). But if the American Cancer Society's advertising campaign works, its possible our politicians will be forced to address the issue in a manner not seen since 1993, regardless of who is in the White House!