Many first responders who put their lives on the line in the wake of the September 11th attacks, as well as those who assisted in cleanup efforts, continue to fight for their lives as they suffer from the physical repercussions of their exposure to toxins at Ground Zero. So far, however, federal legislation aimed at providing them with medical monitoring and care does not cover what many advocates say is a top health problem for those who served in the days after the attacks: cancer.
The exclusion—or inclusion—of cancer as a covered condition is critical for these first responders, not just for their physical and perhaps mental health, but for their long-term financial health.
Being diagnosed with cancer can be akin to a financial death sentence. It’s an enormously expensive disease. According to the National Institutes of Health, cancer cost Americans an estimated $263.8 billion overall in 2010 with direct medical costs totaling $102.8 billion; indirect morbidity costs (cost of lost productivity due to illness) at $20.9 billion; and indirect mortality costs (cost of lost productivity due to premature death) at $140.1 billion.
Researchers from Penn State found that cancer survivors pay $4000—$5000 more a year in medical costs than those who have not had cancer. Those who are treated for and survive cancer are susceptible to later health complications and their total medical expenses average about $9,300 per year.
Not surprisingly, the long-term financial prognosis for those who suffer from cancer is grim. A study presented at the American Society of Clinical Oncology in Chicago by Scott David Ramsey M.D. Ph.D. found that compared to the general population, bankruptcy rates were nearly twice as high among cancer patients one year after diagnosis, and that the median time to bankruptcy was two-and-a-half years after diagnosis. The study found the risk is highest for lung, thyroid and leukemia/lymphoma cancer patients—types of cancer that some of these first responders may well be fighting.
That means that if they manage to survive cancer, these workers may suffer the ultimate financial indignity and be forced into bankruptcy.
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At issue here is the fine print in the James Zadroga 9/11 Health and Compensation Act, named after NYPD officer James Zadroga who died January 5, 2006, at only 34 years of age from respiratory disease attributed to his work at the site of the World Trade Center during and after the attacks.
The Zadroga Act establishes the World Trade Center Health program and authorizes funds for medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers who responded to the September 11, 2001 terrorist attacks, as well as residents and other building occupants and area workers in New York City who were directly impacted and adversely affected by the attacks. First responders at the Pentagon and in Shanksville, Penn., may also be eligible.
Political infighting stalled the bill for a while, but Jon Stewart is widely credited with helping to move the legislation forward when he devoted an entire episode of the The Daily Show to the issue and blasted a Republican filibuster of the bill. President Obama signed it into law January 2, 2011.
The program does not currently include cancer among the diseases covered. According to the initial report for the WTC Health Program, there is not enough evidence to link cancer to exposure at Ground Zero. (A list of currently eligible conditions can be found here.) Periodic reviews will determine if other conditions, such as cancer, will be covered at a later date.
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A recent study published in the British Medical Journal The Lancet, however, suggests a higher incidence of cancer among firefighters who were exposed to potential carcinogens at the World Trade Center when compared to firefighters who were not exposed.
But including cancer in the list of covered diseases may make all the difference here. The study presented by Ramsey found that “patients over 65, who are typically on Medicare, have a much lower risk of bankruptcy than younger patients” making the case that having access to affordable care may make it possible for 9/11 workers to avoid financial catastrophe.
Waiting until the science catches up with the real-life illnesses that first responders deal with every day may take years. In the meantime, those who risked their lives are being dishonored when they are forced to dodge debt collectors, postpone care, plead for payment agreements from their medical providers, and even risk financial ruin because of their service.
We can do better.
Image: Mike G, via Flickr.com