Obamacare, Stress, and the “Overhang”

If, like me, you’re the owner of an advanced (Stage III or Stage IV) cancer that is currently in remission, the good news is that the disease is currently being held at bay, and we are able to get on with our lives. But the threat of recurrence always looms over us, a phenomenon that many cancer survivors call “the overhang.”

OverhangZion-arrowsFor those of us living under the overhang, one crucial strategy–along with paying attention to diet and exercise–is to minimize unneeded stress in our lives. We have an intuitive sense that excessive stress could too easily trigger our cancer’s return.

Although there have been studies that demonstrate links between cancer and stress, the medical community often discounts the role of stress. In the words of one journal article, “there is no evidence indicating a causal relationship between stress and cancer recurrence.”  (At least the authors were willing to admit, “attending to the reduction in a cancer survivor’s stress response can improve emotional well-being and quality of life.”)[1]

However, a recent study has confirmed that stress may indeed contribute to recurrence and even drive cancer metastasis.[2]

A “master control gene,” called ATF3, found in immune system cells, is “turned on” to attack cancer cells—at least initially.  However, researchers unexpectedly discovered that, by a process not yet fully understood, breast cancer cells can eventually hijack ATF3 and use it as a means to escape the tumor and spread through the body.

As one headline describing this study put it, “stress fuels cancer spread by triggering master gene.”[3]  Cancer survivors’ intuitions that reducing stress may stave off recurrence turns out to be well-founded.

So, what do stress and the overhang have to do with Obamacare?  Let’s assume that, the program’s botched rollout notwithstanding, Obamacare accomplishes its goal of reengineering the US healthcare delivery system. A government program that deliberately creates a tectonic shift in one sixth of the US economy creates numerous consequences: many intended, but doubtless many more unintended.

Unforeseen consequences have a habit of negatively affecting people’s lives–including cancer survivors–creating additional stress for those of us living under the overhang.

Case in point: in a recent article in the Wall Street Journal, cancer survivor Edie Sundby described how new regulations required by the Affordable Care Act (Obamacare’s formal name) caused her insurer, United Healthcare, to cease selling individual health policies in California, leaving her only the option of an inferior plan sold on the Obamacare-mandated “California Covered” insurance exchange.[4]  Through no action of her own, she found herself  blocked from the doctors and treatments she feels to be essential to her survival.  The stress this has created saturated every word of her essay.

Edie Sundby’s dilemma got me thinking: “What if the urologist and medical oncologist, who diagnosed me and continue to guide my treatment, are suddenly no longer available to me?  What if I am denied the best medicine for my particular situation because it is deemed too expensive by an anonymous bureaucrat?  What then?”  I’m sure thousands of other cancer survivors living under the overhang had similar thoughts as they read her story.

For those of us already on Medicare, we had assumed we would be isolated from Obamacare’s impact. But as Columbia University Professor of Journalism, Thomas Edsall, states in a recent New York Times op ed, “the Affordable Care Act can be construed as a transfer of benefits from Medicare . . . [which] over 10 years, according to the Congressional Budget Office . . . cuts $455 billion from the Medicare budget in order to help pay for Obamacare.”[5]

What if my doctors say, “sorry, Craig, we can no longer afford to see you under Medicare’s stingy payment terms”?

Worry produces stress. Stress is scientifically linked to cancer recurrence.

Amidst the inoperative websites, cancelled health insurance policies, financial shock, and the unceasing political sturm und drang from Washington and in the media, have politicians considered the ACA’s psychological and emotional impact on the public they ostensibly serve?  Have the bureaucrats thought about increased stress on cancer patients like Edie Sundby and thousands of survivors like me as they implement complex and seemingly arbitrary policies and rules?

Like most people my age, I realize life is hard. Having to live under the overhang of recurrence is unfair. Nevertheless, many of us have achieved a level of inner peace by consciously reducing and removing stress from our lives wherever we can.

Just as more stress not of our own making, but which has been generated far too casually and needlessly by our leaders, heads right toward us.

[1] B.L. Todd, M.C. Moskowitz, A. Ottati, and M. Feuerstein, “Stressors, Stress Response, and Cancer Recurrence: A Systematic Review,” Cancer Nursing (24 April 2013).

[4]http://online.wsj.com/news/articles/SB10001424052702303936904579177930307493584 accessed 25 November 2013 (may not be available to non-subscribers)


  1. PaulC says

    The stress of going without healthcare, of having no access to healthcare, or being uninsured is vastly greater than the stress of worrying about a possibility that something might or might not become more expensive.

    Of the men in one of my prostate cancer support groups, …

    • Two of them lack insurance of any kind. The older one managed to paying out-of-pocket (or doing without) until he became eligible for Medicare recently. He would have welcomed ACA instead. The younger has twice given up on the maze of finding care for people in his situation (namely: unpredictable feast-or-famine income with a long recent period of unemployment punctuated by minimum-wage jobs without insurance). He is overjoyed to be receiving coverage through ACA (called “California Coverage” in our state).

    • One had been a long-term dependent on his husband’s insurance, until his husband was laid off and turned first to an insanely expensive COBRA option (which required a ridiculous bureaucratic struggle that played out over eight months) and then, out of desperation, to a sub-par employment to prevent a “gap in coverage” that would legally allow future insurance to deny him coverage. He will be delighted to take advantage of ACA / CaliforniaCovered. The couple has the means to buy “platinum-level” coverage at a cost far far less than they had been paying for COBRA’s sub-par benefits.

    • One delayed his retirement, despite failing health and increasing humiliation at being unable to perform his job, because he would have had no insurance. He would have welcomed ACA / CaliforniaCovered if only it would had kicked in sooner.

    • The other eight are, so far as I can recall, either on VA benefits, Medicare, or private employer-provided insurance, unaffected by ACA. (Well, actually mildly benefited by it — at least one of us now has greater freedom to seek better employment, because he needn’t worry that if his gamble fails to pay off, or if his new employer doesn’t provide insurance, he would be hung out to dry without coverage).

    I claim no statistical power for this data set of 12 prostate-cancer diagnosees, for whom ACA is a significant stress-reducer in 4, is a mild stress-reducer in 1 or 2, and leaves the remainder unaffected. On the other hand, it is actual data, rather than speculation.

    • says

      Thanks for your thoughtful comment, Paul. No question the ACA will produce benefits over the status quo ante, such as the cases you describe, previously deemed uninsurable and denied coverage, which of course includes just about everyone dealing with cancer.

      My thesis rests not so much on cost as on the uncertainty created by complexity, which induces stress, albeit admittedly speculatively rather than anecdotally.

      It’s unfortunate that the prevailing political realities did not allow the entire private insurance edifice to be dismantled and replaced with a single payer system, e.g. “Medicare for all.”

      Or, alternatively, why a much simpler private solution was not proposed and implemented, e.g., forbid denial based on pre-existing conditions as the ACA has, but also allow health insurance to be owned by the beneficiary and his/her family rather than the employer, as well as including portability and availability across state lines, similar to other forms of insurance that we already buy.

      As it is, the ACA has emerged as a sub-optimal and needlessly baroque “solution,” engendered by intense lobbying by the insurance and corporate healthcare (hospital) industry, whose complexity requires 2000+ pages of apparently unreadable legislation, and which is now being abetted by gigabytes of implementation rules and regulations from HHS.

      As all of us who have cancer know, life is highly uncertain. Layering on more uncertainty and concomitant stress because of politically induced complexity when simpler solutions were at hand is unconscionable, IMHO.

      • says


        With reservations after reading your post, I agree completely with your comment reply to Paul.

        The one thing you missed in explaining this woeful “health care reform” is that at its essence, it is similar to Republican “reforms” of the past, which is likely why Obama went for it–to appease the opposition, which once again backfires on our sometimes “babe in the woods” president.

        As a senator, Mr. Obama was for the single-payer system. As a president in desperate need to play nice with rabid opposition, he decided to forgo principle, and what we have is more stress.

        Over the years, this thing is likely to work out to a single-payer system, but probably not until insurance companies decide there’s no more money to squeeze out of our misery and give the go ahead to our so-called leaders.

        As for personal stress and cancer–or any disease–reducing it works, no doubt in my mind about that.

        • says

          Thanks, Thomas. While Republican intransigence has certainly been a major issue, I’m somewhat skeptical that appeasing Repubs by rolling out “their” health reform was a primary motivating factor behind the shape that the ACA eventually took. Cynical as always, I think that the insurance industry can take primary blame since they saw a vast new untapped market of uninsured folks, generating substantial government-subsidized income for itself. The AARP’s endorsement of the ACA underscored that view for me, since IMO, that organization exists mostly to sell insurance, not to jealously guard the interests of its constituency.

          Be that as it may, I think something workable will eventually rise from the rubble. (See my earlier post re the ACA rollout written two days before the October 1 website catastrophe.) But it is going to be an unpleasant and in some cases, destructive process, which in the final analysis has been driven by politics and influence-mongering rather than by the public interest.

          • says


            Oh, I agree about the insurance company interest and activities, and I think that was part of the equation for the president’s decision to change from health care system reform to health insurance reform.. Essentially, he gave up principle to play politics.

            I also agree that this is probably the first step toward real reform, and it will be messy for some time. Even if guys like us outrun prostate cancer, we’ll probably never run long enough to see the U.S. health care system turn toward the public good.

            IIf you think you are a cynic, how about this: I think American capitalism will take us down before any insurance company can get to it…

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