A Case Study In How Insurers Screw Insulin Patients
A friend and medical caretaker of mine recently had her insulin coverage denied. Let’s talk about it.
Hello, friends,
Last week, we talked about some sources that The Progressive Cafe recommends and relies on for information. It’s perhaps our first ‘living document’ in that it can and will be updated, both with new discoveries, sources I left out, and your contributions. Just go to the above article and leave a comment with those you’d recommend and I’ll consider adding them.
Now, we here at The Progressive Cafe have been talking about the costs of insulin for quite some time. It was one of our first articles, in fact! And we’ve done follow-ups about the Biden administration’s valiant efforts to lower the cost of it. And-and, as you know, we advocate for Medicare For All around these parts, which would solve most if not all of these problems for everyone.
Might I add that since I wrote that original article, my wife and mother in law were both diagnosed with Diabetes.
So when I say that we’ve worked on this issue, we’ve worked on this issue from multiple angles.
Unfortunately, one of the medical professionals responsible for my care - who, in fact, was one of the major inspirations for those original dives into the world of diabetes care - recently got told that her job’s health insurance was going to start denying the insulin it had been approving for her for years.
Let’s talk about it. No, we won’t be disclosing too many personal details, such as her name or exact job function. Respect, journalistic integrity, and all that.
A Case Study In Health Insurers Screwing Diabetics.
This person is both a medical professional and a peer. Like me, she has neck and back issues, among other health ailments. Hell, those issues are part of what inspired her to get into the medical field in the first place: She wanted to make changes for the better! Today, in clinic, we were talking about how she was doing and she informed me that she was told that her job’s insurance would no longer cover the type of insulin that she takes.
As we discussed in our previous articles, there are many different types of insulin. Some work faster, some work slower, and all of them are a little bit different than the rest. The type of insulin that works for one person might not work for another. That’s just the nature of this incredibly damaging beast called Diabetes.
She was informed that they would be happy to cover a different type of insulin, but she’s tried it before and it doesn’t help her. She was told that her doctor could, as she put it, “fight for her.” I guess this means that her doctor could file petitions with her insurance to demonstrate that hers’ is the only type of insulin that works for her. It’s a medical necessity thing.
I’ve been through similar with my physical therapy. I have degenerative disc disease, which I’ve talked about at length before, and I’ve had to fight to get various medical services, especially more physical therapy. Insurance is happy to deny patients care because it means they get to keep the premiums that the patients spend without doing their fucking jobs and paying for the healthcare that they’re paid to middle-person into existence.
In other words, denials are, in principle, nothing new.
Now, my care provider has some options. She’s a dual citizen, meaning she has citizenship in a country that will remain unnamed and, thus, has access to their healthcare system. All it takes it an $800 trans-Atlantic flight with a cooler in tow and she can pick up a years’ supply of insulin from that country for free. That’s right, she said free. Granted, it’s an $800 dollar trip plus the time and stress that traveling brings, but she has family there. She can basically go on her regularly scheduled family-visit vacation and come back with a years’ supply of medication that would, otherwise, cost her what we estimated to be a little less than $2,500.
But wait! There’s more!
You see, because her job - which, again, is a major fucking medical care company - isn’t willing to pay for her insulin, well…Maybe she can find a job that will. She’s informed her boss (her direct boss is not the one responsible for these decisions, mind you) she is now looking elsewhere for employment. She is also one of their best care providers, by the way, meaning at the very least this decision - if not overturned, and possibly even if it’s overturned - might cost this major medical company one of its best care providers.
And, yet, there’s another layer to this stinky, shit-covered onion!
You see, this problem stems from the hypercapitalist healthcare system that the United States uses, right? So you figure, “Okay, I have a disease that is guaranteed to be fatal if it’s left untreated.” And in the United States, there’s a specific age that becomes a major problem: Twenty Six years old, when children can no longer be on their parents’ health insurance plans.
The next thing a person in her situation might figure is, “You know, there are countries where this isn’t an issue. And I’m a citizen of one of them.”
You get where this is going, yet?
My care provider is strongly considering leaving this country in order to go where she can get better medical care, taking all of the skills she learned and provided her and doing her job in another country. After all, her disease is literally too expensive to live with for someone who works in the healthcare industry.
In other words, brain drain is a real problem.
So How Do We Fix This?
When we wrote our very first piece on Diabetes, the Inflation Reduction Act was still up in the air, but coming into form. And I wrote this particular set of paragraphs:
I reiterated my prediction in the follow-up article:
Sure enough, here we have the dreaded knock-on effects of the legitimately good things that the Inflation Reduction Act has achieved: Instead of lowering the price for everyone, insurers are finding ways to cut coverage in order to maintain as much of their profit margin as possible. That, or manufacturers are changing their prices which is in turn causing insurers to change policy. I couldn’t begin to guess which.
The truth is that systemic change on not just insulin pricing, but medical care as a whole is required. How we’ll get that change is beyond me, since the current administration doesn’t seem to have any intention of, say, passing medicare for all - and it ain’t exactly like we’ve got all the votes in place to make that happen, even if it was!
I guess what I’m saying is that we need to vote for change, but we lack the big banner of - say - the Bernie Sanders campaign of 2016, more’s the pity.
But regardless of how unlikely victory seems, we have to fight the fight.
In Other News…
It was not exactly a slow news week, even if most of the news in question wasn’t of newly-emergent dire importance and/or shock-and-outrage. That said, here are some things to note.
Tom Suozzi won the NY03 special election. While I wasn’t sold on him until someone (in this case, he himself) explained his stance on the environment, I did go out and cast my vote for him.
The so-called “Kids Online Safety Act” has been “revised” and is gaining more supporters. Since I don’t believe anything founded in such premeditated bigotry can be redeemed, let alone while still retaining Republican support, I still consider KOSA a red line until proven otherwise. You support that, don’t ask for my vote. For a refresher on what KOSA is, here’s our article about it.
In a tiny glimmer of hope for Palestinians living in the United States, the Biden Administration is doing its level best to protect them from deportation during what is, clearly, not a safe time to be deporting anyone. While this is a far, far cry away from ending the endless, pointless cycle of rocket attacks and refugee camp bombings, it’s something.
It seems like Texas is building a massive military base. We said weeks ago that Biden should Federalize the Texas National Guard to help defray that, but since he didn’t, well, now he’s got an ever-growing buildup of ‘technically not breaking the law yet’ force ready to be levied against defenseless migrants.
Amazon has joined SpaceX and Trader Joe’s in arguing that the National Labor Relations Board is unConstitutional, and they can just go fuck themselves.
In something along the lines of good news, the share of power generated by wind and solar power are starting to catch up to fossil fuels - in Europe, at any rate. It’s no LFTR, but it’s something.
Thank you for reading The Progressive Cafe. If this article has helped you, please consider signing up for our mailing list. This article is by Jesse Pohlman, a former hyperlocal journalist and sci-fi/fantasy author from Long Island, New York, whose website you can check out here.