Wednesday, September 06, 2006

Is Good Heathcare a "Right"?

Let's face it. Having diabetes is expensive. If not for the individual, then for the individual's insurance company who foots the bill for test strips, insulin, syringes and/or pump supplies, quarterly doctor's visits, A1c tests, urine analysis, cholesterol screenings, annual eye exams, and if it should progress, treatment for complications such as retinopathy, neuropathy, heart disease, kidney problems, etc.


But I'll admit I'm split on the issue of the "right" to health care people tend to have. And, while I can argue either side very well, I wanted to focus on the more controversial side today, if only for the purpose of causing us to think. (I know, I know. Thinking makes my head hurt, too.)

There seems to be a lot of effort fighting for the "right" for everyone to have good health care. And, not surprisingly, most of the voices calling for such a fight are the very people either without health care, or with maladies that require it.

But I have to wonder just where the line is. At what point does the "right" end? The way many talk, you'd think we have a "right" to not be sick, that we have a "right" to not come down with colds, or the flu, or AIDS, or cancer...or diabetes.

The fact is, illness is a part of life. It is a part of this world. It isn't going away. Every time we make progress against some life-threatening disease, another one pops up. And treatment for existing diseases is growing more and more expensive.

So, where does my right to live as a healthy individual begin and end? And just what level of responsibility do I have in this?

Let's focus solely on diabetes. As the list above indicates, there is a lot of stuff that costs a lot of money to keep me healthy. And while it is all fine and well to say that my life is worth more than whatever the associated costs are, the fact is our country is bleeding, financially, when it comes to health care. Health insurance companies can't afford to treat everyone, nor can the government. So there must exist a give and take.

Unfortunately, everyone always wants to be on the taking side. But such mentality has to change.

I have a responsibility not only to my own life, and my own family, but also to my company which provides health insurance, as well as to the health insurance company itself (yes, I know...don't have a heart attack) to limit my health care expenses as much as possible.

There are many ways to do that. The first and foremost is taking care of myself. I've met many people who make no effort to take care of themselves, but then expect everyone to jump in and save their lives when their lack of responsibility for their own health catches up to them. I'm not suggesting any level of "enforcement" of this, of course. There is no effective means to judge who is taking advantage of the system in such a way. But the point is to encourage everyone to do everything possible to take care of themselves.

Of course, no matter how well I take care of myself, the fact is I'm still a diabetic. That isn't going away. (Sorry, but I'm not holding out much hope for a cure in my lifetime.) So, then, taking care of myself is confined to the hand I was dealt. As a diabetic, it means constant monitoring, for example.

But here is where things get tricky. If I want to stay healthy my whole life, just how much is reasonable for my health insurance to cover? Let's say they only pay for a box of 50 test strips a month. Am I willing to foot the bill to pay for more if I need them, knowing that it is my own life at stake, not the guy's writing checks at Blue Cross Blue Shield? And if not, why? Why would I expect BCBS to pay for something if I'm not? I've drawn a line in the sand, saying my own life isn't worth that much, so some insurance company should pay it instead.

Now, as I said, I'm being one-sided in this, because I realize many just can't afford the strips...or other care. But stay with me. I'm only trying to promote some discretion in how one determines their "rights".

Let's look at another expense. In my case, I have an insulin pump. Fact is, I don't need an insulin pump. I lived most of my life without one. Sure, I had to give myself four, five, sometimes six shots a day, and sure, I couldn't get quite as good of control as with the pump...but I was managing decent control. Staying under an A1c of 8, at least. The motive for getting the pump, aside from the fact that it is just cool and would help get a tad better control, was because I was having frequent lows on injections.

So, my insurance company foot the bill for a $6000 medical device, not to mention the additional cost of infusion sets and reservoirs. Now, in theory, the better control it offers should result in fewer complications and ultimately cost the insurance company far less money in the long run.

But today, I face a choice. My insulin pump just went out of warranty. It has been four years on the pump, and I'm happy to say I've kept my A1c levels at or below 7 for most of that time. I've had fewer lows. But my pump still works, and even though there are newer, better versions of the pump out there, and my insurance company would cover a replacement (being mine is out of warranty), the fact is I'm going to wait.

Why have the insurance company pay for something new when what I have today works just fine? And then, what about the fact that now I could get Minimed's Paradign REAL-time pump system with continuous glucose monitoring? Insurance companies won't pay for the CGMS part...and rightly so. Perhaps it would provide better control, and greater convenience. But do I have a "right" to that? Again, there is a line in the sand...and truth is, I don't think insurance companies should cover such an expense...not until it is cost effective for them.

So, here I am, living with an out of date pump. Boo hoo. Truth is, I'm so incredibly thankful and blessed to have it, I just can't see taking advantage of a "right" I have to a replacement pump unless something goes wrong with this one.

Anyhow, I suppose I'll stop now. I can imagine some of you rolling your eyes, going, "Yeah, easy for him to say. He's got health insurance." Or whatever. And I agree. It is easy for me to say. My tune would be very different if I didn't, I'm sure. Still, I think each of us can do anything we can to help out the health system in this country. And perhaps one day I'll write up why I think big business is good for health care, while at the same time it is bankrupting health care. But not today.


stay_c said...


This is an awesome, thought-provoking, post.

I hate our health insurance at work. It's weirdly complicated, but the PPO system is more "profitable" than HMOs or other systems. It's the only option for my family, so we use it. Because it is so complicated, however, the stepmother in my family (my 6yo's mom) (are you following this?) doesn't get how it works.

I've been placed into the situation, several times with my boys, where you think "What will this cost?" instead of "Do they really need to go?" I hate it. But that's just what needs to happen.

Some companies (and I really wish I had my sources here) tier their programs on health, not out of pocket. They pay more of the deductible for people who take care of themselves via gym memberships, low cholestoral, etc.

It is going to take some creative thinking to get over the health care issues this country has. Add education to that as well.

Scott K. Johnson said...

Hmmm. Yes, very thought provoking indeed.

I agree that we need to be as accountable for our health care expenses as we can.

My question is focused more on why these things cost so much? I can understand the cost of a pump - but what I can't quite figure is why the cost of a test strip is still near $1 per strip (for example)?

Maybe the burden of responsibility is not only on the consumer, but other organizations involved as well.

I was reading this post from Minnesota Nice, where at her hospital stay they would draw a single dose of insulin from the vial, then throw it away to avoid contamination or something. Rather than using the same vial for the same patient. How much insulin was simply "thrown away"?

That type of thing needs to change - and maybe the high expenses are not because of the consumer - but hospitals like this!?

It's a frustrating situation - and one that is spiraling out of control. And it scares the heck out of me because I could not afford to (try to) take care of myself without it - but it is quickly approaching the cost where it is prohibitive for me to continue to participate in it.

What is a person to do?

Great post Ryan - I'll be interested in what other comments you get on it.

Bernard said...


Thanks for the post. I agree that we have responsibilities to take good care of ourselves, and that includes trying to follow a diet with a reasonable amount of vegetables, not too much fat, etc., etc.

Don't get me wrong, there are plenty of days when I feel it's unfair that I can't eat whatever I want whenever I want. On the other hand, perhaps if I didn't have diabetes, I'd already have eaten myself to death by now. So from that point of view it's a blessing that provides me with an incentive for restraint.

Holding on to the pump beyond it's warranty is a good idea. I'd done that with my first pump, and I wish I'd held onto it even longer.

I have a suspicion (hope) that we're going to see substantial improvements in pump technology every other year from here on out. So if you don't have a reason to get the latest and greatest, wait for the next generation one.

As for the cure. I firmly believe it's possible - though I've no idea what form it would take. I'm excited about Denise Faustman's work at MGH, hence my bike ride this Sunday. What if everyone with diabetes gave a $1 to support this research? Don't tell me that wouldn't make a difference.