Here I am living with a chronic disease, and blogging my brains out about it, and yet I’ve been shielded so far from all the agonizing over health insurance. I’ve been lucky enough to be covered by my husband’s employer’s plan — since pre-diagnosis, so Hah!, they were stuck with me. But I do realize this arrangement may not go on forever, and that prospect scares the heck out of me.
Nobody’s arguing that healthcare reform isn’t sorely needed in this country. But it’s pretty obvious that this life-sustaining topic has become a very visible political football as the candidates queue up for the 2008 presidential election. And there will probably be a lot more TALK before we see much meaningful action.
The Census Bureau reported last month that nearly 47 million Americans lack health insurance coverage — including lots of wealthy families, because they can’t find any policies that make fiscal sense.
OK, so now California has come out with a ground-breaking plan to get all of its citizens covered, which could set the standard for the whole country, lobbyists say. Nobody’s fingers are crossed as tightly as mine for that experiment to succeed.
But in the meantime, if you have diabetes or any chronic illness, you’re still screwed. Because as healthcare industry consultant and guru Matthew Holt points out, “(Private) insurers will do anything they can to not sell insurance to people who might use it. That’s because healthcare costs are extremely concentrated among a very few people. Sell a few too many policies to sick people and insurance companies’ profits evaporate…”
And as all we sickies know, just “having coverage” is often not enough. Even WITH coverage, so many aspects of our care are a fight and a hassle and ‘DENIED’ for some inane administrative reason, disguising the real reason, cheapness.
You wouldn’t believe (or maybe you would!) the reader emails I get about this sort of thing. For example, this note of late from reader Sara M.:
I just received another annoying letter from my company Oxford about using less expensive medications. Oxford is a United Health Care Company and we’ll remember that their CEO recently got in trouble for backdating stock options, meaning he made a crap-load of money off the backs of us paying our premiums. Basically I read this letter as yet another attempt to control what it is I take and as punishing me for using the insulin I use (as if it were not the wisest consumer choice to make).
I’m advised that Humalog is a Tier 3 drug and that Novolog, which is a Tier 1 or Tier 2 alternative medication, would be cheaper for me to use. Of course the letter has all sorts of legally directed verbage in it like “the alternative medications treat the same conditions for a lower co-payment. You can save money by using medications that treat the same condition, but have different active ingredients, if your doctor decides that it is appropriate for you to do so. If you want to lower your costs for prescription mediations, talk to your doctor and about these less expensive alternatives. If an alternative medication is appropriate for your care….” blah, blah, blah. And of course, also “we realize that everyone reacts differently to medications and one may work better for you than another, so talk to your doctor…decisions about which medications you take remain between you and your doctor.”
Of course they say all that while they CLAIM they’e not telling you WHAT to take, but they really are driving the prescriptions we take because of cost. So, if Humalog really is my best insulin, I’ll get a little extra punishment. This is healthcare in this great country today. And what did Bush say about everyone being covered? The poor can just go to the emergency room (or something).
I hear you, Sara. You wouldn’t believe (or maybe you would!) the hoops I had to jump through to get certain prescriptions pre-authorized, and then pre-authorized again every time they run out — or to get my CDE sessions covered, using just the right HIPAA code to nail the provider so they can’t wiggle out of coverage based on some stupid semantics. I actually paid over $400 for the hour-long appointment in which my doctor diagnosed me with diabetes back in 2003; somehow the code was wrong, so this one got stamped “patient responsibility.”
Sure, healthcare reform is about getting everybody covered. But it’s also about making that coverage have some actual value when you really need it. Like when you get saddled with a medical issue for life.
According to the Partnership to Fight Chronic Diseases, a national advocacy coalition, “between the Iowa Caucus and election day, more than one million Americans will die from chronic diseases.” SHUDDER …