At 43 years old I am no longer a young puppy. I remember being a 20-something in the business wishing that I could be older because I would then have more experience and credibility. Naturally, somebody who is 20-something in this business is dealing with people that are multiples the age of him or her. Well folks, be careful what you ask for because the time comes quickly.
Do not wish away time. Which is a topic for another column.
Anyway, as we get older and more mature, we tend to reflect on things that we didn’t slow down to do when we were in our 20s. Recently I have had a couple opportunities to reflect in a similar manner that probably many of you readers have done. My “reflections“ have been about “I wish I were a little smarter with my body when I was younger.“ That may sound odd because those that know me know that I do try to take care of myself. I work out, I read a lot, and I am usually the first one to bed at night while others shut down the bar. So, what am I referring to?
Allow me to explain. Back in January I had a major colon surgery because I have been dealing with diverticulitis for about 10 years—since I was 33. Why would a 33-year-old get diverticulitis? Nobody knows for sure, but it likely has to do with the strain of going too hard with athletics, lifting weights when younger, along with all the other stress I put on my body by—paradoxically—wanting to better myself.
Like the herniated discs in my back. My wife says that when I put my mind to something, there is no moderation involved. She is right.
Finally, late last year, I got sick of dealing with the diverticulitis so I agreed to surgery. The surgery went great, and I was basically told to sit on the couch for eight weeks to recover. For those of you that are physically active, you probably have not sat on the couch for an eight-week period of time for decades. That was me. And I did exactly that! I followed the doctor‘s orders perfectly.
After the eight weeks of rest, I felt better than I have in a decade as the surgery worked! So, I got back into working out with my 14-year-old future basketball star son (proud dad). After about a month, we were going pretty hard again. Well, that led to a hernia! Although a hernia surgery is not a big deal anymore, it was still very disappointing because that meant another surgery, another x weeks out, another scar! Two steps forward and one step back.
As I was talking with my doctor to plan the hernia surgery and recovery time, I said “I wish I had not been so stupid with my body when I was younger.“ Again, this is something that many of you may ponder from time to time. Here was my doctor’s response which I thought was pretty profound. She said, “But your scars are what make you who you are. You would not be who you are today if you did not have those scars.“
That statement has never been truer. As I think about it, almost all my scars have come from driving forward and wanting to better myself and better those around me. Now, granted, I have a few scars from just doing stupid stuff that I never should have done, but a majority of my “scars“ are from trying to get better as a human being. My dad, who died at a young age of 62, had a ton of “scars,” primarily because of him working hard with construction to support his family. He often said “If I knew I was going to live this long, I would’ve taken better care of myself.“ Well, at the same time, he had a reputation in our small town as being one of the hardest working people that anybody had ever met. He made a great living as well. Without his hard work ethic, his scars would’ve never come. Or maybe, without his scars, his tough work ethic would have never come. Chicken or the egg?
Your scars define you many times. Of course, I am not just referring to the “scars” in the literal sense. I am referring to the process of getting those scars.
Now I am not suggesting that you don’t take protective measures like wearing a weight belt (as I do), wearing a seatbelt, managing your stress, etc… Like anything, it’s a matter of magnitude. Said differently, we could all go through life without one scar by being couch potatoes, but is that what we want? You face bigger risks in life by being a couch potato than the risk of a “hernia” (figuratively and literally).
What about stress and anxiety? Seeing life insurance medical information on a daily basis, I know that a significant number of people have stress and anxiety as a “scar.” Those people that are stressed and anxious are oftentimes exceptionally good at their jobs. We read about actors and singers in the media that seem flawless with huge talent, yet they deal with stress, anxiety and depression. I would argue that many times those “scars” are a result of them actually giving a damn about what they do! I would argue that maybe that stress is a requirement for them to be good at what they do.
My son complains about stress and “butterflies” before his basketball games. It’s because he cares! If he did not care, he wouldn’t have those side effects. Before I give a big speech to an audience, I experience the same “side effect” and I love it!
I don’t know if it is the chicken or the egg. As in, because of the scars that we have, we get stronger and therefore become who we are. Or, conversely, because of being who we are and pushing ahead (maybe too hard at times) we will get scars.
It doesn’t matter to me if it is the chicken or the egg, or both. All that I know is, sometimes you must accept the scars as the entry fee for being who you are. If you would take who you are along with your scars over being a couch potato without any scars, then listen to my experience. Because my experience, and the conversation with my doctor, makes my scars something that I can be proud of. Embrace your scars. But do not be stupid and go out looking for more scars. If you do, buy life insurance first.
Underwriting After Cancer
Advances in medical therapy have led to not only increased longevity after the diagnosis of cancer but in many cases an actual cure. Normal life expectancies are more often the case now after definitive cancer treatment, and extension of life after other cancer treatments are now reasonable expectations. Which cancers are most amenable to favorable underwriting and which may not be as favorable to long term survival are ultimate challenges for insurers. There are of course many different factors in making these estimations.
After a diagnosis of cancer, insurance postponement is the rule to better assess the degree of treatment and response to the therapy. Generally, this is done for a certain amount of years, and the clock begins not after diagnosis of the problem but after therapy is fully completed. There has to be definitive treatment for the cancer, otherwise the case remains a decline. There is a flat extra rating period after a certain amount of time, where an extra premium is charged until the risk of cancer recurrence equates to a standard mortality. At a certain point the insured’s mortality equals that of a standard premium and the flat extra falls off.
With many cancers the risk of recurrence is early in the process, and those for example which were amenable to complete removal are insured earlier and with shorter periods of added premium. Some however pose a risk of late residual mortality even after complete and radical treatment is accomplished. Breast cancer is one of those examples—there are recurrences even well after treatment and as such the added flat extra may persist for quite an extended time. Some types that are more notorious for adverse late outcomes may require a permanent flat extra for the duration of the policy to cover a possible cancer recurrence.
Not all cancers of a certain body organ or system are looked at or are rated equally. Each cancer is different and requires a specific focus on individual variables. Cancer cell type is important, as some types are more aggressive than others. The more the cells resemble the normal architecture of the organ involved, the better they do treatment-wise. Those that have wild growth, or anaplastic types, have poorer prognoses. The spread of the cancer is taken into account—those that spread to additional tissue or are larger in size have a different outcome than smaller more limited ones. Cancer is staged differently depending on whether it limits itself to the specific area or invades local musculature and lymph nodes. Cancer that has spread to other organs (metastatic) does the least well. Cancer may recur even after long indolent periods—even after 10 to 20 years of disease free periods.
Some malignancies are called indolent ones—they are not curable but are still compatible with many years of life. Leukemia (such as chronic lymphocytic leukemia), certain types of non-Hodgkin’s lymphoma, and skin disease which may eventually metastasize to organs (such as mycosis fungoides) may have very extended periods of survival. Those are insured at times with permanent ratings, because the risk of the cancer having adverse mortality is forever present. These types of cancers have to be looked at individually and ratings may gravitate to the side of caution because the underlying problem is perpetually present.
Second cancers are generally insured with higher ratings. The body’s immune system is key to cancer resistance and the appearance of a second malignant growth may signify an additional problem. Likewise, the long-term effects of cancer treatment may have to be taken into account. High dose chemotherapy and radiation treatments may have a beneficial effect on the primary cancer process but other body organ systems may fail over time due to the burden of treatment as cancer treatment affects all cells, not just diseased ones.
The key to insuring those with cancer rests on full staging information, confirmation of definitive treatment, and a lack of recurrence. Patient compliance and regular doctor follow-up is necessary in all of these instances—without them, estimates of survival and insurance offers are rarely possible.