A devastating new study in the Journal of the American Medical Association Surgery exposes what defenders of the status quo have spent years trying to deny: the American healthcare system is not the envy of the world. It is a lottery, weighted toward the wealthy, in which the difference between life and death routinely comes down to which insurance card sits in a patient’s wallet.
The study analyzes 2.7 million patients nationwide diagnosed with non-metastatic breast, colon, lung, pancreatic, gastric, and esophageal cancers between January 2012 and December 2023. Median wait times from diagnosis to the first course of treatment increased during the period for all cancers, ranging from nine to 14 days. That is not a failure of government. It is the predictable output of a multi-payer system built to generate returns, not health.
After adjusting for various risk factors, the study found that patients with private insurance faced the shortest wait times, and those on Medicaid experienced the longest — even longer than the uninsured. Patients on Medicaid were more likely to experience prolonged wait times than the privately insured for five cancers. Uninsured patients did for four cancers.
Across those five cancers, Medicaid beneficiaries were between 11% and 42% more likely than privately insured patients to wait more than a month for treatment. Medicare patients fared somewhat better but were still between 4% and 12% more likely to wait a month or more than individuals with private coverage.
The healthcare lobby and its editorial mouthpieces will tell you this is an indictment of Medicaid. They are reading the study upside down. The disparities this study documents are not an indictment of public insurance — they are an indictment of a fragmented system that sorts patients by ability to pay. When privately insured patients skip the line, everyone else waits.
The study does not single out the uninsured as the worst-off. Tax-exempt hospitals, which make up many large cancer centers, are required to have financial-assistance policies that provide charity care. A charity-care form is not the same as a guaranteed appointment with a specialist. The Medicaid patient is locked out — not by government failure, but by a reimbursement architecture that tells doctors and hospitals that treating the poor is a low-margin afterthought. Because of low physician reimbursement rates, Medicaid patients struggle to get appointments with specialists to be diagnosed in the first place. This can add another layer of delay, which can have life-and-death consequences.
“Specifically, delayed surgical care has been linked with an approximately 20% to 30% increased risk of both 90-day and 5-year mortality in lung cancer,” the study says, and “an approximately 10% to 15% greater likelihood of mortality in breast cancer.” These are working people. They are parents. They are taxpayers. They did everything the system asked of them, and the system condemned them to die because they had the wrong kind of insurance card. The moral arithmetic is inescapable: every additional day of waiting imposed by the current two-tiered queue is a life cut short.
As for why wait times have increased over time, the researchers suggest that cancer hospitals may have too few operating rooms and specialists to treat the patients referred to them. This capacity crisis is the predictable result of decades of fragmented payment and chronic underinvestment in the public-insurance programs that cover the sickest patients. A single-payer system would solve this by aligning reimbursement with patient need rather than ability to pay, by directing capital and personnel to where the disease is rather than to where the dollars are fattest, and by stripping out the vast administrative bloat the current multi-payer regime imposes on every hospital, clinic, and physician’s office in America. Anyone who insists single-payer would make this worse is defending a status quo that is already killing people.
Defenders of the status quo say a single-payer system without premiums and cost-sharing would turn American medicine into a disaster. In reality, it would replace a disaster with the only architecture that has ever delivered universal, equitable care: a guarantee. They are accidentally right that it would resemble Medicaid — in one crucial respect, everyone would have the same coverage. Unlike Medicaid, no one would be at the back of the line. Medicare for All would not endanger cancer patients — it would give every American the same access to the same specialists at the same speed. That is precisely what the JAMA Surgery study shows is missing today, and what a country this wealthy should have built generations ago.
