Tuesday, October 29, 2019

I Talk a Little About Healthcare

You may or may not be surprised to hear that I have a couple of issues with the healthcare system we have here in America. One of the biggest problems I have with it, though, is a philosophical one.

Our current healthcare system talks a little about outcomes, but its primary focus, at the end of the day, is to make a profit. Everything in America is transactional. The goal of a job or work will often define its outcomes. In other words, the success of an industry is often defined, in America, by how much money it makes. Healthcare is an industry that is inherently profitable because it is a false choice. I cannot choose to be unhealthy and still have a good life. Because of this false choice, there is also no such thing as a free market. People will pay whatever it takes to stay alive. Even if the choice is to go into debt or to maintain life, people will choose to go into debt. To not participate in health is to increase mortality. It is to die.

What does this have to do with diabetes? Good question.

For the purpose of this post, I'm going to focus on Type 1 Diabetes because that is the type that I have. There are two types (type 1 and type 2), and I can only write about that which I know. The challenges facing type 2 diabetics are similar but different.

Diabetes is a condition in which the body no longer produces a necessary enzyme called insulin.

The function of insulin is relatively simple: it unlocks cells to allow them to take in glucose (or sugar) so that they can metabolize and function. Without insulin, blood sugars rise, and raised blood sugars over a prolonged period of time cause nerve, kidney, vision, and blood vessel damage. The food we eat gets turned into glucose, so without insulin the body also begins to think that it is being starved and will break down fat and muscle in order to feed itself. Because type 1 diabetics no longer produce insulin on their own, they need to get it from somewhere. For many type 1 diabetics, their insulin delivery method is an insulin pump.

An insulin pump is a device that delivers insulin into the body through plastic tubing usually connected into the stomach or into other subcutaneous (somewhat fatty) tissue. There are only a few types of insulin that can be used in a pump. These insulins can also be used without a pump as they are the most effective therapy for type 1 diabetes (the insulin gets to work more quickly and doesn't hang around in the body for as long which makes them more predictable and useful for treating diabetes effectively). These insulins have also risen in cost despite there being 3 different manufacturers (more on this in a bit).

Yesterday, I went to pick a prescription of one of those fast acting, insulin pump compatible insulins and was told that the market price was $346.08 for a single vial. A single vial lasts about half a month for me, so the total cost without insurance would have been just over $692. This price is non-negotiable, and neither is my paying it.

Earlier, I talked about how the goal of American healthcare is to make money. My goal is to stay alive. In order to stay alive and deal with diabetes effectively, I must pay this money (or get insurance which will bring the cost down). To not pay this price is to choose to die as a diabetic. Some will say, "Why not pay less for the other insulin options?" To which I say, "There are no other effective insulin options." There are no other effective options. The choices for diabetics are limited. Specifically, they are limited to these insulins:

Each of these choices is essentially the same (there are slight differences in how they feel, but not enough to effect my choice as I have tried all three and haven't noticed any significant difference in their effectiveness). Each of these choices also costs about the same. About $346 a vial without insurance. Last year, they were about $270. When I first started taking Novolog more than 20 years ago, it was about $21 a vial. In Canada, they only cost about $34 a vial without insurance. Literally 1/10th the cost. The average cost to produce insulin is about $5 (link here). The profit margin on one vial of insulin is just above 6,900%. 

A picture of the receipt

The problem with American healthcare is that its goals are not aligned with its name. The goal of healthcare should be to keep people healthy rather than to make money off of peoples' illness, but that is exactly what America's healthcare industry's goal is: to make money. There is something very disgusting about existing in a system without choice and in which we are constantly told that it is THE BEST system in existence. Specifically, we are told that our privatized healthcare is leaps and bounds above other socialized systems.

Yesterday, though anecdotal, is one of the reasons I call BS on this claim.

When I had a private health insurance provided through work, I paid $50 for 1 month's supply of insulin. Yesterday, for the same supply, I paid 3 dollars under Colorado's Medicaid expansion program.

People are literally dying due to our healthcare system. There is article after article after article which has stories of people rationing insulin at the best and dying at the worst. These deaths are entirely preventable and entirely due to an industry whose goals are aligned with profit rather than health in addition to a political system which allows and even encourages this greed rather than fighting it.

Enough is enough. It's hard enough to be a diabetic and fighting that disease without also needing to fight a system that is designed around profit rather than health.

You may find yourself asking, "what can I do?"

Get involved. Contact your representatives. Vote in local elections. Hold politicians and those in power accountable. Spread the word. Injustices flourish in the dark, so consider this post to be a candle that I'm begging you to use to spread some light.

Thank you for reading.

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