August 28, 2008

Why This Election Matters to People With Diabetes

The media are touting the "good" news that the rate of uninsured in this country dropped to "only" 47.7 million people.

I don't know about you, but 47,700,000 people looks like a lot of folks to me. Especially when you realize that many of them are the people who most need health coverage--people in their 40s who have lost good professional jobs and may never find anything but part time work without benefits, people who because they have a preexisting condition, like cancer, or asthma cannot buy health insurance no matter how much money they have. And, of course, many, many people with diabetes.

There are heartrending stories all over the blogs of people with diabetes who have lost their jobs and with it not only their health insurance but their ability to buy health insurance on their own. I get mail from Type 1s who cannot afford test strips. I get mail from Type 1s who have to choose between insulin or being homeless.

There is a feeble so-called "safety net" in our system, but what most people don't realize until they lose a job is that if you own any assets--a college fund for your child, a home, the savings you have accumulated to tide you over until you find that next job, you won't qualify for that safety net. If you have any equity in your home or any savings, if you have a health crisis without insurance you are SOL.

The system we have in the U.S. today expects you to spend every dollar you have on your health expenses before it will offer you any help. Then, to add to the unfairness of the system, drug companies and hospitals charge FAR MORE to people without insurance for every prescription, treatment, hospitalization, and doctor's visit than they charge to those with insurance.

The insurers can bargain down the price of test strips. The day you lose your insurance, you will pay the full $103/100. Insurers have certain insulins they will pay for at a lower copay because they have negotiated discounts with the pharmaceutical companies. But if you are paying for that same insulin they pay $50 for, you will pay $83. It's the same for all the rest of your prescriptions.

Conditions are not all that much better for many people who technically HAVE insurance and don't show up in that 47.7 million "unemployed" figure. Over the past 8 years, insurance plans have cut back drastically on what they will cover while raising the copays for everything. Where I used to pay $5 for each prescription, I now pay a $50 for each vial of insulin I buy. Where a doctor appointment with my PCP used to be free and then rose to $5 it is now $20. Lab tests used to be fully covered. Now there is a $500 copay before my insurer will pay for a single lab test. And that is after I pay a monthly insurance premium that is a lot more than I used to pay for monthly rent when I was in my 30s.

Still, I am one of the very lucky ones. I can buy health insurance despite a diabetes diagnosis, because I live in the great state of Massachusetts where Liberals have made it against the law to refuse insurance to anyone because they have a pre-existing condition and where a liberal legislature, disgusted with our Federal government's refusal to do anything about health care, passed a landmark law two years ago (despite then-Governor Romney's opposition to it) that offered coverage to all and dramatically raised the number of insured in our state. We could all do with a bit more of that kind of liberalism. Texas, that bastion of conservatism,, now has the highest rate of people without health insurance of any state in the union.

And that is why this election matters.

The Republicans will tell you they are going to do something about health care. But they had complete control of congress, the White House and the courts for six year, and throughout that period they did nothing about changing the way our health care system works except to attempt to ban the import of cheaper pharmaceutical drugs from Canada and to set up a Medicare drug benefit for the elderly that explicitly banned Medicare from negotiating with drug companies for better prices. Their plan was a huge gift to the pharmaceutical companies and big insurers. It was a tragic rip off of America's older population.

The Republicans appointed people to the FDA who had contempt for science and used ideology to approve or disapprove drugs. FDA leaders with strong financial ties to the drug companies repeatedly approved dangerous drugs over the protests of the experts whose advice they are supposed to rely on. Throughout the years of Republican rule, drug company lobbyists have gotten everything they have asked for. The American people, well, they get what trickles down. [Supply your own barnyard image here.]

Wrapping themselves in the banner of "religions faith" the Republicans have done all they could to block the stem cell research that could lead to Type 1 diabetes cures. They have cut way back on all funding for the basic research that might heal all of us.

So they've had their chance. The Republicans will make the usual election year promises but over the past eight years they've shown you what their priorities are and whose bidding they will serve if they get back into power.

And because they can't point to their record, or offer you a real health plan solution, their current campaign relies not on ads that explain their positions to your or describe the policies they will follow. Instead they are trying to distract your from the real issues at stake in this election by bombarding you with smear ads, silly insult ads, and downright lie ads, intended to work on your emotions, frighten you, and to making sure nothing really changes.

The Democrats have tried. Sixteen years ago, they tried to do something about our health care system. But the Republicans came up with the Harry and Louise scare ads and we squandered that golden opportunity.

Well, the chances are good that Louise has Type 2 now, but can't afford test strips. Harry's probably working part time at Home Depot and has no health insurance. Neither has seen a doctor in two years because they can't afford to.

And how about you? Is your health care better now than it was in 1992? Could you have been worse off under "socialized medicine?" Health care in American now costs more than health care anywhere else in the world while the health of our population as a whole is far worse than that of people in other industrialized nations.

I'm ready for a change. I may not agree with all the policies the Democrats will put in place, but I know they are going to give it a hell of a try--which will be a lot easier to pull off if you also elect Democratic Senators and Representatives. And I know for a fact based on the last eight years that four more years of Republican rule is a huge "risk factor" for bad health consequences for all of us.


Anonymous said...

Nice post.

I'm personally voting Republican, but I can see your points.

Lee Ann Thill said...

I don't have anything to add because that was just perfect. Great post!

The Old Man and His Dog said...

From your mouth to America's ears and then to the polls in Nov.

Anonymous said...

I'm about fed up with those in power now....time for a change even if it is socialistic, we'll be the USSA (united socialist states of america)

Anonymous said...

If I might respectfully add, statistics presented in the midst of selling political agendas are always best viewed with extreme caution. Among those uninsured figures, for example, are illegal aliens who can accress free healthcare here but aren't members of insurance plans. It also doesn't count all of the native American peoples who do receive care via the Indian Health Services -- yet, they are included in the rosters of the uninsured.

Boz said...

Lack of affordable insurance was one of the causes leading to my complications due to neglected high glucose. There was just no money in the budget, and my employer, crying poverty, kept cutting wages. Luckily, my new wife has top line coverage and I can afford treatment.

Jenny said...

The Anonymous who doubts the statistics on the uninsured are real is probably young and employed.

I know far too many people in my age group--old enough to be the first to be laid off, but much too young for Medicare--to doubt that there are indeed many millions of people out there without insurance.

And even if the number were inflated, it should not be acceptable to any of us to have health care rationed in our society only to those with personal fortunes, excellent jobs, or a fortunate choice of home state.

It always astounds me how the same people who talk about Christian Values seem to forget what Jesus had to say about how you treat the least of your neighbors being how you are treating him.

A lot of folks in Texas must have been watching football when they read that lesson in church.

Anonymous said...

I wish some readers from Europe and Canada would post comments here. Tell us if Jenny is right to wish for a nationalized health care system.

Anonymous said...

I applaud you for a truly wonderful post! And I'm glad to see that you mentioned not only the uninsured, but the people who have insurance but still can't afford health care. A good friend of mine works well over 40 hours a week and even with insurance can't afford to go to the doctor when she's ill. Not only is the deductible crippling, as well as the cost of any medicines, but she can't afford to lose even one afternoon of work. I don't know how many times she's had to choose between paying for diabetes meds and groceries. I help her when I can, but it hurts her to accept "charity". And this is not a woman who splurges on excesses and therefore doesn't have money for necessities! She's as frugal as anyone I've ever seen, just stuck in a crappy situation. Her current job is about the best she can expect in this area, and since she has family here who need her care, she's unwilling to move.

Universal health care systems may not be perfect -- I'm sure there are disadvantages in the Canadian, British, French, etc., systems. But even imperfect care for all of us would be a tremendous improvement over our current cluster&#$@.

Anonymous said...

Love your blog, Jenny. I don't think there are any easy answers. I was just reading that in Britain the Government Health department is discouraging home testing for Type 2s.

I read another post where someone with that governmental health care is allowed to test 1 time a day.

It's crazy to assume that all the uninsured diabetics are going to get Cadillac health care as soon as the Dems are in power and get their way. It might start out good until they realize how expensive it is to take care of us.

It is really so sad about all the uninsured, but the last thing I need is for my husbands employer to assume that since we all have that all inclusive government health care they no longer need to help with our insurance.

Jenny, you live in Mass with the govt is it for diabetics? How many test strips? Are there limited choices for meds?

Jenny said...

Anonymous 6:07,

The Mass plan gives you a choice of insurers and plans. I have a PCP who has to refer me to specialists and they will cover 150 strips. If I used Humulog and Lantus the vials would be $25. They require special paperwork for pens, but the people I have spoken with at the insurer (a nonprofit associated with a hospital) have told me they will approve them if the endo writes a letter stating why I need them. For now I'm using samples as I use so little insulin I can get through a couple months on a couple pens.

I had both an ER visit and surgery this past year and they covered everything but my deductibles with no problem.

I read UK boards, so I know the limitations of their system, but everyone does get the drugs they need and people who are persistent can usually get strips.

They don't let drug companies market to the public and have much more stringent requirements to approve drugs. They have to show that they are more effective than current treatments.

It isn't ideal, but it's a lot better than nothing and nothing is what a lot of Americans have now.

I just today read a study that found that people without health insurance are twice as likely to have undiagnosed diabetes (diagnosed by fasting blood glucose) than those with. That translates into twice as likely to end up with amputations and kidney failure, too, I suspect.

Anonymous said...

I live in Sweden where we do have national health care funded via taxes. Very high taxes.

It costs roughly $20 to see a doctor, the price of medicine varies a bit. At most you pay $150 per year when you see a care giver and $300 per year for medicines. This means that the maximum medical cost is 450 per year, regardless of how much care you need or how expensive your medication is.

I don't love our high taxes, but I'm not sure there is a better alternative. Lower taxes with privatised health care just means you'll have to buy an expensive insurance, so the net effect is probably about the same.

And I do think it's incredibly important that everyone has equal access to healt care!

JD said...

I don't trust the government to anything right. It was the McGovern's committee in the 70's that told us that it was carbs we should be eating and that fat was bad. Do you really expect the government to be able to fix anything? Let's get real.

Anonymous said...

I'm one of the registered republicans, conservative Christians....and I'm voting Democrat this election for exactly these reasons!!!

I'm not thrilled about socialist style health care, but I like it better than allowing the uninsured or under-insured to suffer. I'd rather pay more in taxes than allow more of what I see around me, the misery, the despair, the lack of medical access.

Health care is my biggest issue this election. I am blessed to have great insurance, but I know others don't. If I lose my job, I will lose the insurance with it, so we are all 1 step away from joining the uninsured.

I just can't turn my back on the suffering, it really upsets me to see what is happening in America today.

I am very disappointed in the Republican Party. My husband feels the same way.

Anonymous said...

The Democrats have had control of Congress for the last two years. Are we better off than two years ago? I don't think so.
The Democrats have spent more time and money trying to bring indictments against the Republicans than help the so called "people" they are always talking about.
Even now there are doctors refusing to treat patients who don't follow the guidelines dictated to the doctor by insurance providers. The doctors have no choice if they want to get paid. Why don't you blog about this instead of your political beliefs?
If the majority of our representatives are liberal like you we can kiss many more of our personal freedoms goodbye.

Jenny said...

The Democrats had majorities in congress, but not the supermajority (60+ votes) needed to pass legislation over the president's veto.

So the Republicans in congress working with President Bush have blocked everything the Democrats have tried to do.

If we get a supermajority or a Democratic president, that will change and things will get done.

And perhaps, too, the meanspirited tone of hate that the right wing made popular over the last decade will go out of fashion as a new generation shows that government can achieve things for its people, not just for well connected cronies.

JD said...

Do you really think the Democrats are less beholden to special interests than Republicans? Special interest groups divide their largess equally among Democrats and Republicans. Things will not change one whit. Count on it. Both of these groups are so beholden to special interests it doesn't matter which of the two major parties are in office. I learned this lesson a long time ago. Surprised you haven't.

Jenny said...

Because I'm old enough to remember when Democrats did pass legislation that benefited more than special interests--Civil Rights, Medicare, Equal Opportunity employment laws, etc, I KNOW that it is possible for Congress to serve the people who elect them.

Change really can happen. Look at the difference between the '50s and the '60s. . ..

Jenny said...

Anonymous political tirades not related to the topic of this post have been and will be deleted.

Anonymous said...

I don't think government is the problem. I'm a hardcore democrat, but honestly, depending on a government is the worst thing you can possibly do for yourself, especially for something as important as your health. The problem is people keep pulling money out of the system and there's nothing left for those that need it. Pointing fingers at the government is just an excuse to not take care of your own health. I don't think this election will do anything for the healthcare system. I think people need be responsible for their own health.

For example, my grandmother had severe diabetes, type 2. I am at risk for it and am doing everything posisble to reverse the trend. I used to have a 34 inch waist when I was 12 years old, and now I'm training people.

My point is stop blaming others for your problems. Even if policies were set in motion today, nothings going to happen for a while. Take care of your health, and vote for those you feel supports your views.

Alan said...

Jenny, if this is too long or there are too many links, feel free to edit.

I won't take sides politically, but this info may may help Perkdoug and others, although I'm not from Europe or Canada. It's a copy of something I wrote on last month when a similar question arose.

In your election year you may want to compare some other countries to yours. I've noticed when the subject comes up the views in the US seem to be polarised and for some reason some see any government involvement in health provision or funding as socialist - a word that US voters seem to define differently to the rest of the world.

All governments have taxes; in democratic nations those governments usually spend the majority of those taxes on the services their constituents elected them to provide. Different countries choose different priorities for those politicians.

We are just one place you might compare to. Here, we choose to include basic Health provision as one of those priorities.

I'm covered by Medicare (absolutely nothing like the US system by the same name):

which also includes the PBS for subsidised medications:

The cost per taxpayer works out at about $3,500 per person.

That seems pretty cheap to me. It is paid for by a levy on taxpayer's taxable income of 1.5%.

Because I prefer to choose my own doctor and also to avoid the delays I mentioned earlier in public hospital ERs I choose to add Private Health Insurance:

I've paid taxes since I was 16yo; so I reckon I've paid my dues for Medicare. For the Private Health Insurance I pay top cover, which is about $200 per month for the two of us.

Between the two of them I don't get charged much for visits to the doc, medications, operations or hospital stays for myself or my wife. Additionally, for the leukemia or diabetes I'm covered by DVA so I pay even less for bills related to those such as test strips. I paid those dues by serving for 20 years.

Our system is not perfect and needs some major improvements. There are problems in some hospitals (which are usually administered by State Governments, but partly funded via Federal money) and shortages of medical staff in rural regions to mention just some of the shortcomings.

But when I look at the financial and medical tragedy of the US system for those who are underinsured or unemployed, and the other extreme of the unwieldy inertia, restriction of treatment and waste of the UK NHS I'm very glad that I live where I live.

Everything has a price. Provision of a government healthcare system has a price; so does the absence of one. The first is paid in dollars, the second may be paid in misery.

Anonymous said...

Anonymous #2 stated: It also doesn't count all of the native American peoples who do receive care via the Indian Health Services . . .

Has he/she actually checked out this "wonderful" health service system for Native Americans--it's appalling . . . but hey, when one has what HE needs, the conservative-Christian values can be seen through specious claims to support his "to hell with everyone else" attitude.


Anonymous said...

Nice words! As a Toronto life insurance broker I am naturally fan of private insurance, on the other hand I understand that if we use pure market driven system, some groups would be excluded from coverage. When talking about health care, we first have to think in terms of humanity first and then in terms of economy. I am glad to pay my taxes to be used for the less lucky, because I know some day I can be the less lucky one too.
Take care

Anonymous said...

"The Anonymous who doubts the statistics on the uninsured are real is probably young and employed."

Actually, Jenny, I have been a medical professional since 1970 and have worked at the largest health insurance company in the southwest, as well as as a case manager for patients throughout this region and am very familiar with medical care, both private and government funded/provided. Few would want their healthcare decisions made for them by the government if they knew what's going on behind the scenes.

Robert Rister said...

I'm a Texan unabashedly supporting the Democrats, but I will say the situation here is more complex than simply the availability of insurance.

Probably the one good thing George W. Bush did as governor of Texas was to support to the creation of a state health risk insurance pool. Any diabetic can get decent insurance, as can anyone turned down for health insurance at the "going rate" for any reason other than fraud. I'm in my 50's, and I pay $408 a month.

The problem in Texas is, there are entire families who live on $408 a month, some counties sinking to Third World levels. No running water. No sewage. And extremely high malpractice rates, the $250,000 the state allows in malpractice settlements still highly alluring in South Texas. The state does administer Medicaid, last time I checked, if you make under $154 a month and you're single.

So I'm with Jenny on the insurance issue. One still has to have the income to pay for it.

Arun.N.M. said...

It was interesting to read the post and all the comments.Indian health care system is extremely bad.Poor always suffers.May be only good thing here is medicines are really cheap compared to other countries.But with new patent laws it is changing. Let us hope Obama wins and bring some real changes to help the uninsured of USA