Tuesday, October 10, 2006

Why I Can’t Love Breast Cancer Awareness Month
Skip the Pink Ribbons, Give Me Policy Change - We Need Single-payer National Health Insurance NOW!

When I saw mannequins with pink ribbons in the Eileen Fisher store window, I thought nothing of it. A few days later, there was an ad for a department store offering to make a breast cancer donation for every woman who comes to be fitted for a bra. At first, that seemed like an interesting, meaningful tie-in but then I thought "how creepy - why make healthy women imagine needing a new bra size after surgery?" Other than that, clothing stores cynically aligning themselves with women’s health as a marketing tool seemed pretty standard. It was only when I saw it in the paper last week that I finally got it. October is Breast Cancer Awareness Month. My boyfriend “bought” the exciting privilege of wearing jeans to work one Friday in return for a donation to breast cancer research. Me, all I can think is: GET ME OUT OF HERE. Personally, I celebrate my NON-awareness of Breast Cancer every day I possibly can. That’s because I already had nine consecutive Breast Cancer Awareness Months of my very own, followed by Breast Cancer Anniversary Awareness Year (hey remember? this time last year my hair started falling out!). As I approach the second anniversary of my diagnosis, give me Breast Cancer Obliviousness Month, please.

But surely that’s just my personal reaction as a recent breast cancer patient (I hate the term survivor, we’re all survivors till the day we die of something)? Surely I do want people to be aware of the need for more research? Aware that mammograms when you turn 40 are your civic duty? After all, my cancer was diagnosed early because my terrific gynecologist made me start mammograms at 40 and two years later wouldn’t let me put off the annual checkup at which she found the lump. But I still can't get into Breast Cancer Awareness Month.

Is it because I was so lucky? My very treatable cancer was detected early. I got great treatment from skilled, well-equipped doctors. My employer was flexible and understanding. My partner, family and friends? Supremely supportive. The new anti-nausea drugs worked for me. Sitting in the tastefully decorated waiting room reading the calendar of free yoga classes, support groups and knitting clubs available to breast cancer patients at my hospital, I just wasn’t inspired to fight for something better. Except for one little thing.

What made me so lucky? Mostly? Good health insurance. I go for annual checkups because my company’s great health insurance pays for it. Would I have spent my own money to get a mammogram at 40? Probably not. Who knows when my cancer would have been diagnosed if I hadn’t had the health insurance, the gynecologist, the checkup, the mammograms? Maybe stage 3 instead of early stage 2? Maybe stage 4? I’m not sure my family would have been quite as calm then.

The luck didn’t end with my gynecologist. After the checkup, she sent me to a specialized radiologist for a mammogram. She read it and immediately did a sonogram, and then a biopsy. My surgeon? Chair of the department at a well-known teaching hospital; she does nothing but breast cancer surgery. And so on and so on, through my oncologist, my radiation oncologist, chemo nurses, and the free internet access in the resource center next to the waiting room. I got terrific care in a really comfortable setting. By the way, there are serious questions about whether all the mammograms and treatment this awareness is engendering actually save as many lives as we think, see Barbara Ehrenreich's terrifying yet hysterically funny article in Links. I'm glad the questions are being asked, but it's not my issue.

What does it take to be this lucky? Well, the bill for eight and a half months of treatment was well over 120 thousand dollars (and I’m still going back for checkups). That’s without a single night in the hospital or any reconstructive surgery. How helpful would my partner have been if I had had to pay those bills myself?

Am I scared of the cancer coming back? Sure. But I’m honestly more scared of losing my job and ending up with no health insurance. And that seems crazy. I can NOT make peace with the idea that in the richest country in the world so many people don’t have a guarantee of basic medical care.

One of my not-afraid-to-admit-her-elitism New York City friends says she doesn’t want universal health care because she wants me to get better treatment than other people. She wants that excellent treatment, which she thinks is too expensive to give every American, for herself and her husband and other people she cares about. But while I appreciate her concern for me, I can’t agree. It’s one thing to feel guilty because I can afford better food, a nicer apartment, more clothes than the poor – most of the time I can handle that. (Yes I know there are people who are regularly hungry in America and that’s crazy too. But that's not my issue, either. Sorry, really.) But when I think about people not taking their kids to doctors because they can’t afford it, while I sit and think about what to play on the personal DVD player attached to my chemotherapy armchair, call me a liberal, but I FEEL GUILTY.

Of course I’m not actually against research for a cure or education about mammograms. But what I really want is for everyone in America to have access to the treatment we already know about, not just for breast cancer, but for everything. It’s called single-payer universal health care. More simply: Medicare for everyone.

For those who call this liberal tax-and-spend nonsense, may I suggest Helping American Business Avoid Costs That Foreign Competitors Don’t Have Awareness Month? I think all corporations (except the health insurance and drug companies of course) should be screaming to have the government take over basic medical care. Look it up – you’ll save money.

If we do finally get universal single-payer health insurance in this country, will there still be some people getting better, faster, more comfortable, more high-tech treatment? Of course. This is America! The country is built on the energy of people striving to have more than their neighbors, even when that means more expensive anti-nausea drugs after your designer chemotherapy. But if everyone had access to the kind of basic care that all Americans over 65 do now, having that fancier medical care would feel more like buying fancy shoes while others get a basic pair of sneakers, and less like knowing that 50 million of your fellow citizens are walking barefoot in the snow.

I’m sure one of the reasons people give money to breast cancer research this month is a sort of guilty gratitude: "I am so lucky I don’t have to go throught that. What would it be like to have my breast sliced off or my hair fall out? Yuck who wants to think about that just take my ten dollars and make sure it never happens to me, please!” Even as someone who’s had her hair fall out (if you’re wondering: yes it’s a drag, but it doesn’t actually hurt and it grows back in interesting new colors and textures) I am grateful because I know that so many women had more surgery, longer chemo, worse side effects than I did (not to even think about the unmentionable, actually dying of breast cancer). Not only have I survived, I go days, even weeks, at a time completely forgetting that I had breast cancer until someone who hasn’t seen me in a while asks about my health and I realize they don’t mean I had a cold the last time I saw them.

Since I can’t get away from Breast Cancer Awareness Month, I’m making use of it. I’m telling my family and friends and anyone else who stumbles upon this in cyberspace: if you have some extra awareness this October don’t use it all dwelling on what would happen if a woman you love found a lump in her breast! Instead, ask why only if she has a full-time job is she considered to deserve the treatment she’ll need if that lump is malignant. Ask why if she doesn’t have insurance she’ll spend her time and energy not on taking care of herself, but trying to find treatment she can afford, volunteering for clinical trials to get drugs for free and feeling like a second class citizen. And then ask your elected officials, the local paper, the people who read your blog, whatever: why don’t all Americans deserve at least what we give people over 65? Call it America CAN Afford It: Medicare for Everyone Awareness Month. Maybe by next year we’ll have our own ribbon color.

* I can't figure out how to do captions - the drawings are by the talented Elizabeth MacKiernan.