There are so many ways that Angelina Jolie’s story touches my heart and disturbs my mind. Her choices to have a double mastectomy and to publicly disclose it are surprising for different reasons. Before reading about her choice on several different media sources, I defended her, thinking that she must have done this because she watched her mother die. In part that is true, though her mother died of ovarian cancer not breast cancer. I can understand her wanting to take steps to care for herself. As I’m not a doctor, I’m not here to judge her on her very personal decision. I do, however, think that her identity as a famous actor, her social status and class do too much harm to the large percentage of women living in the United States without the amazing healthcare access that Angelina Jolie can easily afford.
How many women who you know personally can afford to convalesce for three months for reconstructive surgery? How many will have insurance and co-pay coverage for an elective double-mastectomy? How many women do you know who feel confident that they’re getting good care from their doctors and that they’ll walk away with “a few tiny scars” but looking good as new? How many women do you know who have the resource to have the needs of their children met while all this is going on?
Sadly, I don’t know any.
That is what frightens me about the situation. Women are undergoing mammograms when they could have MRIs. Ultimately, it comes down to economics. Again, this is a financial situation more than a health issue. Women like Jolie get to make choices. Therefore, when we’re having this discussion, it has to include issues of socioeconomic class. I don’t think Mrs. Jolie has a problem making her co-pays, taking time off from work to heal or a difficult choice regarding elective surgery. According to Time Magazine, the test to identify the cancer gene costs about $600. I’m guessing that Kaiser and basic insurance providers don’t cover it.
*I’m amending this post in order to include some relevant information revealed by US Supreme Court’s June 2013decision to not allow patent rights for gene discovery. I applaud their decision as it gives normal mortals the chance to get help with preventative care. Furthermore, the decision revealed that the patent holder, of the so-called breast cancer genes BRCA 1 and BRCA 2, Myriad Genetics, is able to greatly profit from having sole access to the research and medical treatment associated with the genes. According the San Francisco Chronicle, Myriad’s diagnostic test to identify the cancer genes cost $3,000. That’s even more than my original estimate and that of Time Magazine. So now we get to wait and see whether tests such as Myriad’s will be made available to all patients, regardless of their economic status.
While I respect her choice, this discussion would be more realistic if she talked about the total expense. What kind of spiritual and psychological counseling did she undergo? Did she have to turn down a movie part, or did she postpone a potential role? What part of her personal wealth did she invest in her health? Did her healthcare choice lead to the endangerment of her home ownership, employment status or other hardship?
Most likely, Angelina Jolie can afford to ignore the issue of money; the rest of us cannot. For most of us, the solution to cancer is not preventive surgery with full reconstructive surgery. Most of my students can’t afford basic dental or medical care. I know that even the diagnostic tests that Angelina Jolie had would be prohibitive for them. I was relieved to hear that Brad Pitt supported his wife’s choice and that in a recent interview he acknowledged that the costs are largely prohibitive for most women though they shouldn’t be. So, yes, let’s talk about health, and please, let’s also talk about the costs.