Travelbetic.

Access to Health Care with Type 1 Diabetes in the U.S.

As a Global Advocate for T1International, (a charity organization working for access to insulin and health care for everyone with diabetes around the world) I was asked to write a bit about what health care is like with diabetes in my home country. While we as American citizens have access to some of the top health care minds and methods in the world, there is a lot that needs to be fixed in the US health industry. 

In the US we are very lucky to have access to some of the best health care methods and technology in the world. I never have to worry about where my next pen of insulin will come from and get to try out all the latest tech and choose what works best for me, for the most part. But unfortunately, like most things in the US, the health care industry is all about making money. It seems insurance and health care providers and pharmaceutical companies are more concerned with profits than providing affordable treatment to patients.

While insulin and diabetes supplies are abundantly accessible in the US, it is nearly required to have health insurance in order to afford prescriptions. The “Affordable” Care Act passed in 2012 by President Obama claims to have extended access to health insurance but it did little to actually make health care more affordable for diabetics.

Coverage for someone with a pre-existing condition such as type 1 diabetes is outrageously expensive. Many people with type 1 work jobs they hate just to receive corporate health care benefits to be able to afford insulin to live. A private health care plan for someone with diabetes can cost around $500-$1000 or more a month! Even with the best health insurance plan, many people still have to pay out of pocket for diabetes supplies each month on top of their monthly payment! (My insulin and supplies cost me over $200 a month out of pocket.) For those who don’t qualify for an affordable monthly payment (plenty of people with diabetes don’t) insulin and supplies must be purchased at ridiculously inflated prices (one manufacturer raised the price of their insulin 150% in five years). Here is a breakdown of costs for my monthly prescriptions if I were to pay for them without insurance:

Cost for 1 Month of Type 1 Diabetes Prescriptions Without Health Insurance

Toujeo (long acting insulin) – $337
Novolog (short acting insulin) – $916
Test Strips – $298
Pen Needles – $68
Glucagon Syringe – $238
Total = $1,857

Those who simply cannot afford health insurance face another issue. In order to purchase insulin and test strips they have to have a prescription, in order to receive a prescription they have to see a doctor, in order to see a doctor they have to have health insurance. It’s a sham that sucks patients into a vicious cycle, forcing them to cough up ridiculous amounts of money just to stay alive. Being sick is very expensive in the US.

Insurance premiums for those with pre-existing conditions such as diabetes can be flat out ridiculous and some providers simply will not cover a type 1 diabetic. The Affordable Care Act (ACA) attempts to solve this issue by offering no questions asked coverage, meaning a diabetic and non-diabetic could receive the same coverage for the same price. This may seem like a great solution but there’s a catch. In response to the ACA, many insurance providers have narrowed their networks, meaning they will only offer coverage for a limited number of doctors and hospitals. This simply will not do for someone with type 1 diabetes as we must see multiple specialists usually at different facilities including an endocrinologist, a diabetes coach, an ophthalmologist, etc. Doctors and health care professionals within these narrow networks are paid less, often causing a shortage in specialists. According to asweetlife.org, in 2013 there was one board certified endocrinologist in the US for every 33,000 people with diabetes.

The ACA isn’t all bad. It is the first successful US health care reform since Medicare was passed in 1965. One piece of reform in Obama’s health care bill benefits me and others my age greatly. The bill changed the required age at which an individual cannot remain under their parents’ policy and must purchase their own insurance from 23 to 26. Before the ACA, if you were 23 or older and not in college you had to apply for your own insurance as an independent, now you can remain under your parents’ coverage until 26 whether in school or not. As a 24 year old college graduate currently blogging and working odd jobs, this helps me tremendously as my father works for a large corporation and is able to provide me with excellent health insurance at no cost to me and little cost to him. This all changes come my 26th birthday. I will be on my own to find decent, affordable coverage, or start taking trips into Mexico to buy cheap generic insulin. The latter currently seems like a more realistic option.

Insurance companies make life difficult for diabetics in other ways too. Many companies will not cover insulin pumps or constant glucose monitors for adults or for anyone at all. Some providers will only cover certain health care manufacturers, evidence that our health is nothing but business to them. Many insurers limit the amount of supplies they will cover. I have completely run out of test strips on multiple occasions and was told by my insurance company to wait until a specific date to get more. When I asked them how to prevent this from happening again they told me to check my blood sugar less often. A “health” insurance company blatantly told me to sacrifice my health in order to save them a few dollars…

Those with type 1 in the US are very lucky compared to other countries. The issues discussed here pale in comparison to the difficulties faced by many. We have ample access to everything we need to live a healthy, abundant life but at a cost. Because the health care industry is profit centric, not patient centric we must pay a hefty price just to live. While the ACA attempted to reform health care in the US, it is a flawed system. The Act makes health care affordable for healthy individuals but leaves those of us with pre-existing conditions and in need of multiple specialists, to fend for ourselves.

In all fairness, the US is a capitalistic society and health insurance companies are for profit businesses with shareholders to please. But there has to be a happy medium between profit and patient. At some point a decision needs to be made to place the quality of a human’s life over the dollar. Insurance companies are to blame for the ridiculous cost of health care in this country. Imagine a world without them, all treatments and medications would cost less and be available to everyone. Health care should not be an industry, those who are sick should not be viewed as profit centers.

 

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