After Health Care Reform, My Narrow Survival Won’t Be So Rare


Left: The author and his current wife, Beth Ann, 10 years ago, after preparatory chemotherapy, the night before a crucial transplant operation at Sloan-Kettering Cancer Center. Right: Adam and Beth Ann two years ago.

Ten years ago, a nurse carried a portable cooler onto the elevator at Memorial Sloan-Kettering Cancer Center and hit the button for the 13th floor. It was the same kind of cooler you might bring on a picnic, or to the beach. But in this case it wasn’t carrying sandwiches or Cokes or melon slices. It was carrying my immune system.

I had been battling a severe relapse of lymphoma, a deadly blood cancer, and had just undergone seven days of round-the-clock chemotherapy in preparation for a bone-marrow transplant. March 22, 2000, was the day of my “rescue,” when the nurse would defrost my frozen stem cells in the warm palm of her hand—they’d been harvested from my blood a few weeks earlier—and inject them back into my body, where they would somehow graft and, as if by magic, rebuild my bone marrow.

My odds of survival were not good: around 15 to 25 percent. Still, I considered myself lucky. I was at the best cancer hospital in the world and had received not only state-of-the-art treatment but a new, experimental drug, Rituxan, which had shown promising results. In addition, I was surrounded by loyal family and friends, who had taken care of my every need, and even paid my rent, since my diagnosis. But I also had one other thing going for me.

I had health insurance.It wasn’t great insurance, no Cadillac plan by any stretch. Just a catastrophic policy with a $10,000 deductible. (“Don’t worry,” my doctor joked at our first meeting as he drilled a biopsy needle into my hip. “We’ll burn through that by noon.”) But it was better than nothing, and it meant that (a) my financial future wouldn’t be completely decimated by the cost of treatment, and (b) I could go to the hospital of my choice, in this case Sloan-Kettering, where an ace team of doctors and nurses were specialists in treating my particular disease.

I tremble to think of it now, but I’d come within a hair’s breadth of canceling the insurance. I was in the middle of a divorce, and after my wife moved out I was drowning in expenses. Why not save a few bucks, right? After all, I’m a healthy, young man. What could possibly go wrong? Still, I could hear my mother’s voice in my head: “First you pay your rent, then you pay your health insurance, then you can buy food.” For some reason I listened, and just weeks later, as I adjusted my shirt collar on the way to a job, my fingers found a large, rubbery lump peeking out from behind my collar bone.

And if I’d canceled my insurance?

Simple. I’d be dead. Not probably dead. Or maybe dead. But as the Munchkins sing in The Wizard of Oz, “most sincerely dead.” At 37. Sure, some hospital somewhere would have taken me in, but there simply aren’t many in the world that could have pulled off what Sloan did for me, much less given me that new wonder drug (which, by the way, has since become standard treatment). Without health insurance I would have most certainly, like so many people every year, ended up a statistic. Instead, I’m now remarried, celebrating the 10th anniversary of my transplant, and looking forward to the birth of twins in July.

As you can imagine, I take the current health-care debate pretty personally. Yes, I was lucky. You could even argue that the system worked. But how many people die every day because the coin fell the other way for them? Because they either canceled their insurance or never had it in the first place? I have no idea whether or not the new government plan is a good one. My guess is that it falls far short of what is really necessary. Nor do I know what effect, if any, it will have on the pharmaceutical industry, which—brace yourself—I consider my pretty close pals.

But I do know a thing or two about what it’s like to lay in a hospital bed waiting for a nurse to deliver your future to you in a portable ice cooler. And trust me, when you’re in that situation, you just don’t have time for debate.