The Cost of Cancer

I've had a few questions about the cost of my cancer treatment. I thought it was worth sharing a few facts here - particularly for those that might be about to embark on a similar journey. 

First, I have to say that I am tremendously lucky. I am lucky to live in a country with a fantastic public healthcare system. I am lucky to have had great insurances in place - mainly by virtue of my employer (I always just ticked the default options and didn't take any extra cover, which I now regret). I benefited from both medical insurance and income protection insurance. I am also a bit of a scrooge and so had a big buffer of personal savings at the time of my diagnosis. 

My best estimate is that my treatment to date has cost $140,000. This is purely my 'conventional treatment' i.e. it does not include any complimentary / alternative therapy costs. I arrived at this figure having downloaded and reconciled data from both Medicare (government single payer agency) and Bupa (my insurance company). By far the biggest expense has been all my hospital stays, then the cost of the surgeries (including anesthetists), and then the radiation therapy.  The cost of specialist visits, diagnostic scans and bloodwork has also added up to an eye watering figure. 

For the non-Australian reader let me briefly explain our system here. Australia has an excellent public health system. Medicare is the name of the Governments' primary universal health care agency and it is funded by a 2% income levy paid by most taxpayers. I could have elected to have all my treatment in the public system. The standard of care is high but I may have had to wait a little longer, and perhaps I wouldn't have had private rooms in hospital, the flexibility of treatment dates etc. For public patients hospital based treatment is all government funded and essentially free. Medicare should cover additional specialist services outside of hospital, though there can often be some gaps requiring payment from the patient. Because I'm a member of a private medical insurance scheme I elected to have private treatment. This means I was treated in a private hospital. The cost of my hospital stay was covered by my insurance company while my surgeons, oncologist, radiation oncologist etc were covered by a combination of my insurance company and Medicare. I should also mention the Australian Pharmaceutical Benefits Scheme (PBS). The PBS is a government program that subsidizes prescription drugs. The most expensive pharmaceutical I encountered during my treatment was my oral chemotherapy regime. In addition to Oxaliplatin infusions every three weeks I was taking Capecitabine tablets daily. Each 3 week cycle of drugs cost me about $100, while I know that the same prescription can cost over $1000+ in other countries where it is not subsidized.

While the Australian healthcare system is far from perfect, it is certainly way better than the US system that we experienced while living there for four years. I would argue that the US healthcare system is a disaster, especially when you consider that, in California, I was paying about the same level of income tax as I do in Australia. 

Because the local system is so good I was not expecting my treatment to be a big financial burden. My income protection insurance has been paying me about 60% of my normal base salary for the duration of my treatment, and my wife has continued to work at least a few days a week for all but a few months. For this reason I was really embarrassed when some friends and colleagues started fundraising pages for me shortly after I was diagnosed. I felt like so many other people were more deserving of that support and that I really wouldn't need the assistance. Nonetheless, a few people counseled me to accept all offers of assistance, be they monetary or otherwise. I am very glad I did.

Even with my fortunate circumstances Cancer has ended up being expensive. For a start, despite the great public system, there are gaps. I estimate I've probably paid around $10,000 out of pocket. Of course this is a tiny fraction of my total $140,000+ treatment bill, but it's still not an insignificant amount. Then there is all the additional treatment that is not covered by the system or insurance. Doctors or nurses would recommend things like massage and acupuncture to compliment my treatment but only a small % of these complimentary treatments are covered. I was extremely mindful of the cost of these therapies and, frankly, ignored some recommendations and referrals for that reason. You could argue that was foolish but as the father of three young kids I'd rather see that money being put away for them. In contrast I know of some people who have complimentary therapy costs approaching six figures. There is a huge industry out there ready to take money from cancer patients - clinics in Germany and Mexico (I'm not entirely sure why so many of these alternative treatment centers seemed to be based in these countries), mindfulness retreats in India, ozone therapy, hyperbaric therapy, countless supplements and medicinal compounds etc etc. I'm certainly not saying that all these therapies are a waste of money (though I will say I came across some that I believe are outright scams), I am just pointing out that it is very easy for the cost of cancer to quickly get out of control if you fully embrace all the alternative / complimentary treatment options that are suggested to you. 

It's very likely that my cancer journey is not over but, at least with respect to the financial dimension of cancer, I feel extremely fortunate. I know and know of many people who have been financially ruined by cancer. Business owners and professionals without adequate insurance, or denied their insurance. Entrepreneurs who were diagnosed right before key funding rounds and who lost their companies as a result. A plumber who lost his livelihood - there is no end to the bad stories.

It's bad enough to be battling a terrible, insidious disease, but it's so much worse when you're doing it in amongst a huge level of financial stress. I would suggest that everyone take a moment to consider their likely financial position in the event of a bad diagnosis, or any unforeseen life event for that matter. I know it's a cliche, but it really does pay to be prepared for the worst.