A Cruel Joke on Breast Cancer Victims

A cancer center named for the mother of Oscar De La Hoya was unveiled the other day in Boyle Heights. The fete was white-tablecloth, but the focus was low-income women. Had Cecilia Gonzalez De La Hoya understood the need for early detection of breast cancer, it was said, the boxer’s mom might have lived past 39. Not shown in the TV footage, though, was the rest of the picture, a dark little secret that, to the few who knew it, cast a nasty cloud: Though the government is pestering poor women right and left to come in for free breast cancer screening, California has hit bottom on its key source of money for actually treating them if they’re uninsured.

This situation goes far beyond California, though it’s hard to top this state for denial. Breast cancer screening has, for years, been one of those cushy dodges that have offered politicians a cheap way to “care” about women’s health without truly ante-ing up. Mammograms are cheap, chemotherapy much less so. Also, in California, “uninsured” has the touchy tendency to mean “illegal immigrant.”

Two years ago, then-Gov. Pete Wilson--perhaps fearful of wily nannies scamming free chemo--vetoed state-funded care for uninsured breast cancer patients, saying that he didn’t want another entitlement. The state was glad to tell women whether they were dying, it appeared, but too cheap to help cure them. The veto, if memory serves, inaugurated Breast Cancer Awareness Month.

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At the time, the most accessible backup for uninsured breast cancer patients--short of petitioning the county hospital as a medical indigent--was a little-known philanthropic program called the California Breast Cancer Treatment Fund. Ever heard of it? Me neither, until after the Wilson veto, when the folks running the fund finally got fed up. Established with one-time grants from two nonprofit foundations, it quietly worked through state-funded screening programs to identify breast cancer patients who needed help paying for their radiation and chemotherapy. It had limitations--it covered only a year’s standard treatment at Medi-Cal’s unconscionably low reimbursement rates, and stopped short of reconstructive surgery and treatment for complications. Still, in the past three years, it has saved nearly 2,000 women, more than half of them in Orange County and Greater L.A.

“When they told me it was going to be almost $60,000 just for the the radiation, I just thought, ‘Oh, my God,’ and walked out,” says Cathy Flynn, a 43-year-old court reporter from Redondo Beach. Flynn was working part time two years ago when she learned that the lump that had been festering in her left breast for months was malignant. “I was almost out the door when they yelled, ‘No, no, no, you have to get this treatment. A couple days later, someone called from the Breast Cancer Treatment Fund and said, ‘You’re gonna get well and we’re gonna pay for it.’ It was like some kind of miracle.”

Cindy Pearson, executive director of the National Women’s Health Network, says the fund “has been a stopgap,” but compared with most states, California has, until now, looked good. “Looked” because the fund is rapidly fading to past tense. After the veto, the fund’s backers declared that they were sick of fulfilling the state’s moral imperative to follow through on its own screening programs. The fund will be dry in less than a year.

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Two bills are pending in Congress to address this matter of follow-through on public screening, but they’ve come up before, only to die. Two more bills are on hold at the state level at the request of Gov. Gray Davis, who has put $5 million into the Breast Cancer Treatment Fund to buy time until some plan can be worked out.

One modest proposal would selectively expand Medi-Cal funding, as has been done for family planning--a sensible idea that carries a price tag of $20 million to $25 million a year. It’s just for breast cancer, though. It doesn’t address, say, cervical cancer, which also has publicly funded screening, or prostate cancer, which is also highly treatable if detected early, or the lack of subsidized screening for women under 40. Also, like so much in health care, it avoids the big picture here.

And that is that fear of being taken advantage of can make a state penny wise and pound foolish, and not just on the oncology wards. In the name of reining in entitlements and fraud, health care has been reduced to a contest among constituencies of sick people--a fight for resources, body part by body part. Yes, there are scammers, but Breast Cancer Treatment Fund payouts indicate that the scam quotient is nowhere near what alarmists claim. The rest of the picture is a cloud of shameful denial, in which false promises keep getting made.

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Shawn Hubler’s column appears Mondays and Thursdays. Her e-mail address is shawn.hubler@latimes.com.