“To qualify for Medicaid, I have to wait for my cancer to be incurable,” she said, “which is very depressing.”

I turn 75 in June.

Most days I feel pretty could.

In 2020, in the middle of the plague, I was diagnosed with kidney cancer. The surgeon removed it. The sticker price was $140,000.

I’m now cancer free.

My retired teacher insurance and Medicare covered most of it. My out-of-pocket cost was around $500.

I was recently diagnosed with Crohn’s Disease. Crohn’s is an autoimmune disease of the gut. I’m receiving monthly infusions of a biologic drug called Entyvio. Sticker price: $14,000 a dose. That’s over $100,000 a year.

Again, my insurance covers most of it.

I’m lucky.

But why, in the wealthiest nation on earth, do I need to be lucky?

A recent report in Kaiser Health News reports that many poor and therefore uninsured people with cancer are not as fortunate as I am.

“It is very random — that’s, I think, the heartbreaking part about it,” said Dr. Evan Graboyes, a head and neck surgeon. “Whether you live or die from cancer shouldn’t really be related to what state you live in.”

Or what form of cancer we have.

“If you’re lucky to be diagnosed with breast or cervical cancer, you’re good,” said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City, who studies cancer treatment access and affordability. “But otherwise, you may have some significant obstacles.”

In 2016 averaged $168,730 for lung cancer and $137,663 for colorectal cancer, according to a 2022 study that calculated insurance claims for several common malignancies diagnosed in privately insured patients.

Since uninsured adults can struggle to afford preventive care, their cancer may not be identified until it’s more advanced, making it costlier for the patient and the health system, said Robin Yabroff, an author of the study in JAMA Oncology and a scientific vice president at the American Cancer Society.

Patients who can’t get financial assistance through a safety-net facility sometimes rack up medical debt, use credit cards, or launch fundraising efforts though online sites, Yabroff said. “We hear stories of people who mortgage their homes to pay for cancer treatment.”

Cancer patients can purchase insurance through the ACA health insurance marketplace. But they often must wait until the regular enrollment period near the end of the year, and those health plans don’t become effective until the start of the next calendar year.

That’s because the federal law was designed to encourage people to sign up when they are healthy, which helps control costs, said MaryBeth Musumeci, an associate teaching professor of health policy and management at George Washington University in Washington, D.C. If a new diagnosis were a qualifying event for new coverage, she said, “then it would incentivize people to stay uninsured while they were healthy and they didn’t think they really were going to need coverage.”

Kaiser Health reports that although the rules vary, many patients don’t qualify until their disease has spread or the cancer requires at least a year of intense treatment.

That presents an inherent catch-22 for people who are uninsured but have curable types of cancer, she said.

“To qualify for Medicaid, I have to wait for my cancer to be incurable,” said a patient quoted in the KHN report, “which is very depressing.”

And is unheard of in most of the rest of the industrialized world which provides national healthcare to all its citizens.

Why in America is that a crazy idea?