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.

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.

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!