Friday, November 26, 2010

Diabetes, Health Care, and Insurance

The subject of health care is a bit of a touchy one these days, so I probably won’t write as extensively as I would like to, just so I don’t ruffle anyone’s feathers. And before I get started, I just want to be completely transparent with you by telling you that I am now, and have been for a long time, a proponent of universal health care (which, by the way, is VERY different from socialized medicine, so let’s not get the two confused and please get more informed if you thought they were the same thing). So, just so you know, that’s part of my world view when it comes to health care.

The "System"

If you are a diabetic, you are automatically thrown into the health care system -whatever system that may be- whether you like it or not. At the very minimum, as a person with diabetes you have to see doctors and you have to take medicine (usually) on a regular basis. These are the minimum things you need to do in order to stay alive. So, automatically, at least in our current health system, those two things incur costs. If you are lucky enough to have insurance, you usually don’t have to bare the entire brunt of the costs of doctor visits and medicine yourself.

There are two main themes I want to get across with regards to diabetes and health care. The first is about access to insurance, and the second is about cost and prevention.

Access to Insurance

With regards to access to insurance, diabetics (and others with chronic illnesses) are totally screwed. It is virtually impossible for me to go out into our privatized insurance market and purchase insurance at a competitive price, and most often it is completely impossible for me to purchase it at all! Insurance companies use pre-existing condition clauses to eliminate the risk associated with insuring someone who has a chronic illness. My only option, right now, as a diabetic is to purchase insurance through a group plan (like through an employer) or receive it from the government (but only if I qualify by being disabled enough or poor enough). I am literally choked out of and not allowed to participate in the privatized insurance market. As it stands right now, I am not allowed to participate competitively in that market because I have a disease. I have no control over whether or not I have that disease, and I did nothing to bring it upon myself. In any other realm of society, being disallowed to fully participate in something other citizens can fully participate in because of disease or disability would be considered discrimination. For some reason, in the insurance market, it is legal to discriminate. And, let’s not mince words about this. Insurance companies bend over backwards to find ways to eliminate you from their competitive market. I have known plenty of people who have been denied the ability to purchase insurance as adults because they had been diagnosed with asthma once when they were a kid, because they took anti-depressants for 3 months in high-school, or because they had childhood cancer. Diabetics, and many other people who are seemingly totally healthy, have a very VERY difficult time getting health insurance.

Cost vs Prevention

The second main theme I want to get across in speaking about diabetes and health care is that of cost and prevention. Or, really, cost versus prevention. Diabetes, like any other chronic disease that has to be managed on a daily basis, is seriously expensive. There is a constant battle between spending money upfront and properly managing the disease, or not spending the money now and paying for it later when complications arise. From a patient’s standpoint, the decision is clear. Money spent now on proper treatment (like being able to test your glucose a lot, being able to take the best medication for you, being able to see the doctor as much as you need to, all in order to maintain good control ) will keep you from having severe complications (like foot amputations, serious infections, blindness, kidney disease, heart disease, etc.) in the future. Those future complications and resulting hospital stays, etc. will be MUCH more expensive than the money spent NOW on proper disease management. So, if it were up to a patient, and if it was always monetarily feasible for the patient, the patient would always choose the “pay now to prevent bad things later” option.

The problem comes from the fact that health care is just too damn expensive. There are a lot of reasons why it is so expensive, but I don’t want to get into all of that. I just want to point out that the exorbitant costs of health care literally remove a patient’s ability to decide whether or not to “pay now to prevent bad things later.” Faced with the decision, for example, to buy groceries to feed your children, or to regularly fill your prescription for your diabetes drugs, people will probably skimp on their drugs to feed their kids. This happens, every day in America, people!

In my opinion, most insurers and pharmaceutical companies aren’t doing much to help the problem either. Or if they are, they’re not doing a very good job at communicating that to the patient community. I think a lot of private insurers act under the assumption that “hey, we can be stingy with what we’ll pay for now, because later when complications arise, those patients won’t be covered by our insurance anyway, they’ll likely be on Medicare, and the government will have to worry about them.” This is probably true. Most older people, when they quit working, will receive health insurance through Medicare, and the consequences of earlier disease mis-management will fall on the government.

I think that reasoning is one of the big reasons why the new health care bill requires that all preventive care be covered in full buy insurance plans. If you keep people healthy now, by covering the basics, you won’t have this huge population of sickies on your hands once they are all on Medicare in the future. And trying to lower the cost of Medicare aside, isn't it just good, common sense to keep our bodies healthy now, so we can still use them in the future?

In Conclusion . . .

So, yeah, I’ve spoken my piece. I realize this post has been one long ramble, but I want you all to know the challenges I face on a daily basis in our health care system. I think everyone agrees that health care in the U.S. needs to change. I hope that we can create a system wherein those with disease or disability can fully, competitively and fairly participate in the system, and wherein we can treat our bodies well today, so that we can live a healthier tomorrow.

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