Skip to main content

Dolla-betes



Healthcare is such a tricky subject. Ironically, it seems the conversation has shifted away from health CARE in favor of divisive politics with a healthy side of cash. But I'm here to tell you there are real people dealing with real diseases behind all those numbers. And with a laser focus on the rising cost of insulin lately and advocacy groups like #insulin4all making waves, it prompted me to take a look at my own T1D cost breakdown.

**Please keep in mind I have (pretty good!) private insurance through my husband's employer and our income allows us to absorb these costs without pinching too many pennies. We have also been graced with good health (diabetes notwithstanding) and rarely order any prescriptions outside of those for my T1D. But its clear only a slight shift in this delicate equation can make for a dire situation.

Here's what my out-of-pocket looks like to cover type 1 diabetes annually:



The numbers above reflect simply the "baseline operating costs" of this disease - they don't include things like an insulin pump refresh (that will be on next year's bill since it is refreshed every four years), or extra backup supplies like insulin pens, needles or glucagon kits (I had enough saved from last year). It also doesn't include things like glucose tablets for raising low blood sugar, adhesive patches to keep sites on longer or special lotion to ease adhesive irritation after site removal.

Even with great insurance, this is not a trivial amount of money.    

And as an engineer who faces risk trades literally every single day, the trades involved with diabetes treatment at the insurance level are stunning. The treatment options that give me the most data and therefore allow for the most fine-tuned dosing decisions and control, staving off costly complications later in life, cost as much as rent in some parts of the country. The insurance plan we have financially encourages the use of standard blood glucose checks via finger prick - providing the meter and "unlimited test strips" at no charge. I use quotes there because the meter sends the blood sugar data to a central server via mobile network - it just so happens our house seems to be smack in the middle of a dead zone for whatever mobile carrier the service uses and therefore the readings never make it to said server. When I attempt to reorder test strips I am met with an error that I "still have plenty left" - a frustrating side effect of connected (or disconnected in this case) technology. This is all besides the fact that I can simply wear a sensor that will alleviate the need for finger pricks and provide blood sugar data every 5 minutes with trends instead of a random data point 4-5 times per day. 

The most stomach turning of all the price tags is insulin itself - the drug that sustains my life, a biologic of a naturally occurring human hormone. The exact insulin formula I use was approved by the FDA 23 years ago - so, not exactly a cutting edge magic potion. However, Bloomberg News recently reported that this brand of insulin, Humalog, increased it's list price 138% between 2009 and 2015, while the net price to the manufacturer increased by only 6%. That's a hard pill to swallow (or injection to take?) when so many middle men in the insulin supply chain are benefiting and forcing terms like "insulin rationing" to enter the patient lexicon.  

All of these confusing insurance terms and high deductibles and technology risk trades seem like a 180 from those early days of insulin discovery. Before Fredrick Banting discovered insulin in 1922, type 1 diabetes was a death sentence - and it was in this spirit, the spirit of providing life saving treatment to all those who needed it that Banting sold the patent for only $1.

As national diabetes awareness month comes to a close I think its important to shed light on these financial side effects of living with a chronic disease. Unlike a pregnancy or other "temporary" medical condition like a broken bone or corrective surgery - these costs come rain or shine, every single year. No chance to save up for a big procedure or bank on a recovery year after an unexpected medical bill. Diabetes is expensive, and tight management requires mental and financial agility. 

Comments

Post a Comment

Who has two thumbs and loves comments? Nerdy April!!! Type one out and hit publish!

Popular posts from this blog

The road to curing Type 1 Diabetes

From the moment of diagnosis, the road is rough, the learning curve is steep and the stakes are literally life or death. The map is less-than-helpful - paths originating from virtually every corner, coalescing at a center point (aka "diagnosis") and bursting back outwards - some paths cross and wrap around each other but others are isolated. And even with all of these roads, most of the territory is uncharted - how did we all get here and how will we all exit? Where are the obstacles we haven't found yet? Which passage holds the key to unlocking the solution? On any given day I feel pretty isolated with this disease - I'm the only T1D in my group at work, the only one in mission control, the only one in my family. I go through the logistics of calling insurance companies, ordering supplies, changing sites and troubleshooting malfunctions mostly on my own. Even those pesky carbs really only get counted in my brain, no group think for a meal bolus here. But there i

Hot OJT

Last week I had the chance to mentor a newly certified ADCO trainee - the NASA process is called "Hot On-The-Job-Training", or Hot OJT. What makes it "hot" you ask? Well, essentially I am hands off - he is sitting at the console, working all the plan reviews and updates, making calls to other flight controllers and to the flight director, reacting to anomalies and preparing material for the shift handover. My job is to act as the fault tolerance - a backup ADCO of sorts. Tuesday was his last official day and by Wednesday morning he was in the backroom sending commands to ISS in preparation for the docking of a three-person Soyuz. Controlling ISS during the 61S Soyuz docking! The beauty of this system is the gradual buildup in responsibility. There is a subtle shift from student, to subject matter expert, to fresh operations trainee to advanced trainee and finally to certification and real-time operations flight controller - the process takes two years

The Diabetes Transportation System DTS-T1

I was looking forward to the Space Shuttle launch on Monday, then it was pushed to Wednesday and now it is scheduled for Thursday due to several electrical issues from a main engine computer controller. Ironically, our little MH-47G (due to start testing on Monday originally) has been having it's own issues and it is still unclear exactly when we will start testing. And all of this uncertainty, schedule changes, and issue-working reminds me of my little friend Diabetes [come on, you knew that was coming :-)]. Even with hard work, super awesome bolusing skills [ check out Holly's blog today, the number crunching is very impressive] and constant blood sugar checks, Diabetes can still be unpredictable, necessitate schedule changes, and cause the carrier to work through the issues. I have been lucky today, even after a late-night cocktail last night, I woke up this morning at 112, and before lunch I was an amazing 113. I love being steady like that, cruising along with hardly an
01 09 10