When talking to your doctor about care, cost should be part of the conversation

For three decades I’ve worked with people who are aging or chronically ill, helping them figure out how the heck they are going to pay for old age or serious illness. One of the issues that’s gotten markedly worse during this time is financial toxicity — that is, the economic burden that too often accompanies the diagnosis of a dread or terminal disease. I see this most often with people battling cancer.

Well, as often happens in life, I recently found the proverbial shoe on the other foot when my mother was diagnosed with cancer. Thankfully, her prognosis is pretty good, and she has some resources and a great support system.

As we sat talking with medical pros in Baltimore regarding the best course of treatment, side effects, outcomes and alternatives, I segued from son Scott to professional Scott, asking questions I so often try to help strangers answer. To say Mom’s doctors were taken aback is an understatement.

They were polite and professional yet clearly not used to someone saying, “So, OK, what’s the price tag for all of this, and how much of that do you expect to end up being the patient’s responsibility?”

We all want to say, “Give us your best, spare no expense,” but the reality is that medical expenses can easily stress a family, and far too many face financially difficult choices and even bankruptcy.

Take this one example: There are different grades of cancer treatments, and many insurance companies are only approving the lowest grade of treatment; if you want the best treatments, you may have to pay for it yourself. And anyone who wants to pursue alternative, experimental or, especially, integrative treatments is often left to finance all or most of the treatment on their own.

Nearly 66% of cancer patients express interest in talking with their doctors about the costs associated with cancer treatments, according to the National Cancer Institute (cancer.gov). On the flip side, that same source says less than half of oncologists and 27% of cancer patients report actually having had those costrelated discussions.

Medical bills are one of the most unpredictable and unavoidable expenses. According to the Centers for Disease Control, one in five American adults struggles to pay medical bills, and 10 million adult Americans face medical bills they can’t pay each year despite having health insurance.

The increasing of average life spans also brings the irony of more chances for us to face illness. So, financial toxicity not only is here to stay, it’s going to get worse. It may not bankrupt you, but the psychological stress alone is a side effect no one’s mom — or other loved one — should have to deal with.

Whether you advocate for the current fee-for-service model, a single-payer alternative or something in between, I think we can all agree you should be able to chart a course toward wellness, eliminating all other clutter — including financial woes — and focus on recovery.

Still with the U.S. health care system pay model expected to be relatively static for now, I would encourage patients and, especially, their loved ones to not be shy about having the cost-of-care conversations, among themselves and with medical providers. On the flip side, I would ask medical pros to be open to the financial questions and challenges major medical treatment naturally and increasingly bring.