Money can’t buy you love

But if you’re like me and have a chronic condition that needs constant monitoring and equipment, it can help keep you healthy.

I spent over $1,000 last week. On purpose. For specific pieces of specialty made sterile plastic components I use to keep me healthy.

Being a diabetic using an insulin pump means that I have to frequently change the different components that both deliver the insulin into my body and hold the insulin in my motorized pump. So I have to change the plastic components every 2-3 days. I also wear a continuous glucose monitor that also needs to be changed every 8-10 days, so there is a brief respite from constantly changing it as often as my pump attachments, but not for long.

I was in need of a restock of supplies, so I called my pump supply company and was quoted over a thousand dollars for two months worth of supplies. So for the cost of a 64GB iPhone 11 Pro I can get two months worth of supplies that help me stay healthy and alive. That’s before insurance kicks in because of the deductible we have on our insurance plan. I am grateful that we are able to support that cost right now to help keep me healthy, but the cost of remaining healthy is outrageous.

The American insurance industry is ripe for being reorganized and restructured, but unfortunately for those with chronic conditions that need medicines and equipment replenished on a monthly basis, there are so many cogs in the insurance system that are slow to change or update themselves for the betterment of their policyholders. The insurance industry continues to lag behind in updating systems, treatment policies and coverage of conditions all in the name of profits for their stockholders. This New York Times article sums up a scholarly article regarding the costs of insurance coverage and where things could change to be more efficient and cost-effective without lowering the quality of care of the patients.

The article had a lot of eye-opening points for me, namely: “Because American health spending is so high — almost 18 percent of the economy and over $10,000 per person per year — even small percentages in savings translate into huge dollars. The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.”

I have lamented before that insurance companies need to have transparency with what they decide is covered or considered “in-network” for them before someone is assured they have coverage only to find out after the treatment that it’s not covered at all and the person is on the brink of bankruptcy because not all the doctors or treatment parts were approved providers for the patient’s insurance.

From this outsider’s perspective, the insurance industry (including drug companies and the pharmacy benefit managers) all seem to be on the same page about not taking blame about the explosive costs in drugs, insurance coverages (or lack thereof), and who to blame in the neverending saga about American healthcare costs.

“What stands in the way of reducing waste — especially administrative waste and out-of-control prices — is much more a lack of political will than a lack of ideas about how to do it.”

NYT article, link above

I believe that the three groups (insurance providers, pharmacy benefit managers and drug companies) don’t want to update and streamline their systems to better serve their patients and customers because the profits they see over time are too great to pass up. All three groups enjoy their profits and continually point fingers at the other two groups when asked why costs are continuing to rise. I will be highlighting the issues that concern me the most, so if you’re not aware that diabetics need some form of insulin to maintain their health, consider this your 30 second TED Talk.

This article shares that the average yearly healthcare cost for Type 1 diabetics is $2,500. The latest stimulus brought us an average of $1,400 per adult. While the stimulus is desperately needed for many Americans, for type 1 diabetics it wouldn’t fully cover the cost of staying alive. There have been some strides to make things more affordable for Americans across the board with caps for insulin costs, but there are more loopholes in the recent “changes” than a shag rug from the 1970’s.

Insulin was discovered in 1921 and was being used as soon as January 1922 to help those patients who were dying because the lack of insulin in their bodies was slowing causing their bodies to become dangerously acidic and kill itself. Since the amazing and life-changing discovery in 1921 insulin is still the only effective treatment for type 1 diabetics. If insulin was discovered almost 100 years ago, why then has the costs to manufacture and create synthetic versions of it continued to rise?

I don’t have the answers for why costs continue to rise, but I do want change. Preventative care may cost more upfront, but the lack of preventative care can lead to bigger issues down the line that are even more costly. Think about getting a small cavity but not being able to get it taken care of right away, even with daily brushing the cavity can continue to do damage to your teeth with the resulting care being that you’d need a root canal. Those are costly, but preventable if the cavity is taken care of earlier. Serious complications from uncontrolled diabetes can happen quickly if not treated in a timely manner. Though the root canal equivalent could be long-term damage to your eyes, unseen damage to your organs or a small cut or wound becoming infected.

The Mayo Clinic has an in-depth article about the costs of insulin and the devastating results someone can encounter if they try to cut costs and ration their insulin because they can’t afford the monthly costs. Simply stated, type 1 diabetics cannot survive without insulin. In response to the rising costs of insulin you may have seen memes or infographics about how the Walmart brand of insulin is a good stop-gap for those of us who are diabetic and in need of insulin.

While the basics of the information is true, there are discrepancies about the reliability of the insulin itself and how it needs to be administered. The Walmart brand insulin mentioned is one that’s been around for over 20 years now and the timing of when it’s taken and how long it is active in the diabetics system need to be taken into account. The use of the older insulins mean that there is much more structure about when to take them, how to time the food you eat in conjunction with them and even when during the day to take them. It’s like how effective a beeper is now that we have text messaging available on many phones. Good to have in situations, but not as useful in the long run.

The most commonly used forms of analog insulin cost 10 times more in the United States than in any other developed country.³ There have been many other recent reports of deaths in patients with type 1 diabetes because of lack of affordable insulin.^4,5 The high prevalence of diabetes, the chronic lifelong nature of the disease, and the fact that patients with type 1 diabetes will die without access to insulin make this an urgent problem that must be solved expeditiously. The price of insulin is also a stark and troubling example of the rising cost of prescription drugs in the United States and highlights a systemic problem with how drugs are priced compared with every other commodity.^6,7

Mayo Clinic article, link above (emphasis mine)

I’m not sure where to first demand changes in this complicated and convoluted insurance system, but I do know the status quo isn’t helping the average American to remain healthy and with minimal health complications. Until we demand changes from all groups involved, politicians included, there will be stories in the news, and on social media about diabetics forced to ration their insulin and dying from the lack of insulin available for them. I’m thankful to not be in dire straits about my medical condition, but there are too many Americans who aren’t in as comfortable situation as I am right now to afford over $1,000 for two months of diabetic supplies.

What changes would you want to see in the current insurance system that America has? Lower drug costs, no hidden costs for treatments? Share your ideas in the comments, I am interested to hear from you.