I’m a breast cancer ‘pre-vivor.’ Why aren’t the presidential candidates talking more about health care?

October is Breast Cancer Awareness Month, which means that for the past few weeks, everything around us has been turning pink — football players, cookies, and buses will all be adorned with pink ribbons. Women will be reminded to do breast exams, both at home on their own and at the gynecologist. And we’ll be encouraged to get a mammogram, reminded that the vast majority of women over 40 can get a free screening either annually or biannually.

But what happens when the mammogram finds something suspicious, turning your worst fears into reality?

Biopsies and further diagnostic screenings are not free, nor are chemotherapy, radiation, or mastectomies. There is no free breast cancer care, only a free mammogram — which, for many, is no longer the recommended screening technique (many experts recommend MRIs or ultrasounds for clearer imaging).

I am unlucky enough to have BRCA1, a hereditary gene mutation that affects one in 400 people, and is much more common in Ashkenazi Jews like me. Because of this, my risk of breast cancer over my lifetime hovers somewhere around 70%. You don’t need to be a professional gambler to know those are pretty grim odds.

I still count myself as one of the luckiest people in this country, though: I have excellent health insurance that I pay no monthly premium for. I get screened twice a year, via mammogram and MRI, and this winter, I will have a preventative double mastectomy and follow-up reconstruction. It will be painful, no doubt, and recovery will be long — but at least it won’t put me in debt or bankrupt me. Many other people in this country can’t say the same about their own necessary medical care.

Presidential elections are usually a time when voters can expect to hear about health care from elected officials and those running for office. But health care has been noticeably absent from this entire campaign cycle, with neither Kamala Harris nor Donald Trump saying much at all about the crisis affecting ordinary Americans.

In 2016 and 2020, Sen. Bernie Sanders (I., Vt.) gave voice to the concerns of many voters and made health care a central issue of his presidential campaigns — and, in the process, helped change the national dialogue around insurance. Even in the richest country in the world, about half of adults say it is difficult to afford health care, and one in four say they or someone in their household struggled to pay for it in the past 12 months, according to a recent poll by the Kaiser Family Foundation.

That poll also found that a quarter of Americans have also skipped or postponed getting the care they need because of its cost, and this even included those with insurance — half of insured adults worry about affording their monthly health insurance premiums and other health-care costs.

Sanders’ signature policy proposal was Medicare for All, a single-payer, national health insurance program that would provide every single person in this country with comprehensive health-care coverage — with no networks, no premiums, no deductibles, no copays, no surprise bills, and no wrangling with insurance companies. This is the dream, but it seems further away than ever.

Health care in this country is very clearly a huge problem, so why did politicians stop talking about it? Both my husband and I have incredible health insurance thanks to our unions — and I don’t take my good fortune for granted.

But jobs and — sadly — marriages don’t always last forever. I would like to know that I would have quality health care no matter where I worked or whom I was married to. But in this country, that’s not likely.

Many women have stayed trapped in horrible jobs — and worse, in abusive and dangerous marriages — because of their need for health-care coverage. No woman should be dependent on someone else to get their basic needs met, but none of the breast cancer awareness organizations or campaigns ever mention this very basic and obvious issue.

Any organization focused on women and our specific concerns, like breast cancer, should also be focused on our economic independence — something that can be provided, in part, by a universal health-care system like Medicare for All.

The Susan G. Komen website makes no mention of Medicare for All, nor does the National Breast Cancer Foundation, nor does Breastcancer.org. It’s unfathomable to me that the organizations that are supposed to be leading on breast cancer awareness are not sounding the alarm for what breast cancer patients, survivors, and “pre-vivors” like me need the most: guaranteed health-care coverage that can both help us prevent breast cancer and also treat it. This is something a pink cupcake or pink shoelaces can never do.

There have been strides in this area, of course. The Affordable Care Act made it illegal to deny someone like me — someone with a “preexisting condition” — health care.

But access to health care doesn’t necessarily make it financially feasible, and many people are trapped in a situation where they don’t qualify for Medicaid but also can’t afford to purchase insurance through the marketplace. And insurance companies are constantly trying to squeeze every last penny from patients, even when those people are navigating some of the scariest and most painful moments of their lives.

Health care in this country is very clearly a huge problem, so why did politicians stop talking about it?

For example, the Blue Cross Blue Shield Association, a major lobbying organization for health insurance companies, asked the Centers for Medicare and Medicaid Services (CMS) to discontinue a trio of medical billing codes for breast reconstructive surgery that enabled doctors to collect much more money for a specific kind of reconstruction, DIEP flap operations.

Plastic surgeons and other experts believed this decision would limit access to this kind of reconstruction only to those able to pay $50,000 out of pocket — which would exclude me and just about everyone I know. This sounds like a niche issue until it’s one you are facing head-on, and it encapsulates the cold, hard greed of the insurance industry. Luckily, after backlash from cancer survivors, doctors, and surgeons, CMS reversed its decision.

For the rest of the month, we’ll be hearing about the need for breast cancer awareness. But everyone is already aware of breast cancer — it’s the second most common cancer for women. We all know someone who has been diagnosed with it; many of us sadly know women who have died from it.

What is the purpose of early detection if once cancer is found, you’re on your own? We need our elected officials to lead on this issue, and we need guaranteed health care that’s free at the point of service. This October, put down the pink ribbon, pick up the phone, and call your members of Congress and ask them to support the Medicare for All Act. It’s what those who have breast cancer — or just the looming possibility of it — need the most.

Mindy Isser works in the labor movement and lives in South Philadelphia. mindy.isser@gmail.com