I am writing to you to request that you support S.1684, known as the Breast Cancer Protection Act of 2003. This vital piece of legislation will supply a guarantee of adequate hospital care for the some 216,000 women who are diagnosed with the disease and who are obliged to undergo surgery on that account (Underwood, 1998; ACS, 2004). Currently, breast-cancer surgical patients have no assurance that they will not be shuttled out of their hospital beds even if they still require institutional postoperative care--all because of the enormous influence exerted by cost- and profit-conscious HMOs on health-care delivery.
Historically, breast-cancer surgery involves among the highest rates of postoperative pain, nausea, and vomiting of all types of surgery (Pierce, 2003). Yet in this time of managed care, HMOs, and merger-and-acquisition activity in the health-care industry, the rush to control costs has developed a life of its own. In recent years, breast-cancer patients have increasingly faced the all-too-real possibility of having to undergo what has been called the "drive-through mastectomy" (Hampshire, 2001).
In the early 1990s, outpatient breast-cancer procedures accounted for up to 2% of all complete mastectomies nationwide; however, by 1996, fully 22% of all such procedures were outpatient in (for example) Colorado, 8% in Connecticut, and 13% in Maryland (Case, Johantgen, & Steiner, 2001). The rates reach as high as 78% for less radical procedures, such as lumpectomies and so-called subtotal mastectomies.
In the late 1990s New York, Connecticut, and New Jersey passed laws regulating the length of postoperative hospital stays for breast cancer patients. However, it definitely matters where a breast-cancer surgical patient receives her procedure, since the rate of drive-through mastectomies varies by state. Equally, it matters what kind of insurance the patient has; HMO patients are up to 60% more likely to get drive-through tre...