About a month ago, Donna Preece, held a car wash with some family and friends.
They stood out on Division holding signs. They took donations. They washed cars Friday and Saturday, and by the end they had enough money to cover one very, very, very tiny portion of the medical bills piling up around Butch Preece’s life-threatening illness.
Welcome to the health care system 2012, where a medical catastrophe always drags a financial catastrophe behind it.
Patrick “Butch” Preece lies in Providence Holy Family Hospital, a 48-year-old grandfather with late-stage, aggressive cancer, waiting to find out if his wife and daughters can somehow finagle a way to get coverage for a stem-cell transplant with a 1-in-5 chance of saving his life. The transplant has been denied by Medicare; they’re trying to get an unlikely rush approval from Medicaid. And day after day, bills that the Preece family cannot pay arrive in the mail.
“I think it’s just really sad that if he can’t get this transplant done, then he has less than a year to live,” said Donna Preece, 50. “We’re in limbo. We go day by day.”
The Preeces are a painfully concrete example of so many issues we discuss mostly in the abstract: the balancing of costs and benefits; the limits of publicly financed care; the soaring price of our advanced technology; and the best way to deliver care to people who can’t afford it.
Everyone’s got a lot to say about this lately. But it’s awfully hard to consider the Preeces’ experience and think of this system as anything but haphazard and ineffective – baroquely inefficient. The family is in a constant financial scramble – from car washes to bake sales, from insurance applications to benefit regulations – and whatever happens, they will emerge with thousands and thousands and thousands of dollars in debt they cannot pay.
Which is to say nothing of Butch himself, his illness and his pain, and the emotional toll on his loved ones, who wonder how long he will live.
He was diagnosed with cancer of the lymph nodes in April 2011. Butch has Crohn’s disease and draws a monthly federal disability payment for that; Donna worked as a sales associate at Wal-Mart. He was covered by Medicare, which pays 80 percent of expenses.
Butch went through a round of chemotherapy, then radiation, at Sacred Heart. The cancer hung on – it was then diagnosed as an aggressive non-Hodgkin’s lymphoma. Next he went through the Seattle Cancer Care Alliance, an alliance of Seattle organizations that specializes in the most serious cases and treatments.
There, at the Fred Hutchinson Cancer Research Center, Butch went through an autologous stem-cell transplant, a procedure in which some of his own stem cells were removed before he underwent chemotherapy, and then returned to his body to rebuild his bone marrow. That required him to spend four months in Seattle.
They downsized from an $800 apartment with a garage to a $500 apartment. Cut cable, TV, other expenses. While Butch was in Seattle, they had to live close to the hospital there, in a studio costing $1,500 a month – they got help covering all but $400. Butch went through the procedure in March and then spent a month in Seattle, where it appeared he was getting better.
“We were thinking it worked,” Donna said. “We were talking about how we were going to start living life to the fullest and enjoy every day. We were excited. I got back to work, and just … great spirits.”
In May, Butch’s pain returned. The doctors found the cancer had returned – three masses in his stomach. A return to Seattle for an evaluation left the family with grim news: He probably has a year to live. The only possible remedy – an expensive long shot – was a stem-cell transplant from a donor.
The doctor “asked Butch if he wanted to fight,” Donna said. “He said yes.”
Butch was hospitalized June 8, to begin chemo and preparations for the transplant. The return of the cancer had been a big blow. What came next felt worse: After first receiving approval, Donna was told Medicare wouldn’t cover it. Now the Preeces – and their Holy Family cancer care coordinator, Beryl Anderson – are in a full-court press trying to find a way to get the procedure covered. It’s likely to cost several hundred thousand dollars, at least, though the costs differ.
One possibility was Medicaid – the state-run program has different guidelines than federally-governed Medicare. But the Preeces may not have spent enough of their own money to qualify, and even if they have, Anderson’s not sure that the procedure would be covered.
There’s an outside chance they could find a private insurer to cover it, but Donna Preece would essentially have to give up her home to afford it. They might be able to get the transplant by agreeing to assume the full cost themselves.
“But at this point, they are totally out of money,” Anderson said. “Medical bills are just stacking up.”
Meanwhile, Butch has a limited window to get the procedure. He has to get it while his blood counts are good, following the latest round of chemo – if the cancer begins returning, the transplant won’t be an option.
However uncertain Butch’s prognosis, Donna’s financial prognosis is certain: debt and lots of it. In the past few months alone, bills of about $10,000 that she cannot pay have arrived.
Each little step comes with big costs. An example: Getting family members tested as possible blood-marrow donors costs $175 each. That expense is nothing compared to the mountain of costs associated with Butch’s care – it’s a drop in a drop in the ocean.
The Preeces covered that expense with money from the car wash, which brought in around $500 over two days.
“It would sure take a lot of car washes to pay for a transplant,” Anderson said.