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Government Health Care: We Are All Patients.

Last week I had the opportunity to attend a summit regarding government healthcare and the impact on patients and doctors in Washington, DC.  This event was put together by Dr. Val Jones of the Better Health network, and played host to some of the best of the medical blogosphere - including Kevin MD, Dr. Alan Dappen, Dr. Wes, Dr. Rich, Dr. Rob, Kim from Emergiblog, Mother Jones RN, Dr. Jim Herndon, Edwin Leap, Valerie Tinley, and Evan Falchuk.

Kerri, Val Jones, and Evan Falchuk
Me (Kerri), Val Jones, and Evan Falchuk

Some of the lady bloggers in attendance.
Me (Kerri), Mother Jones, Kim from Emergiblog, and Valerie Tinely

It was a lively discussion about government healthcare and how many of the people in the room were against it - including Congressman Ryan, who provided the keynote for this session.  Evan Falchuk, Mother Jones, and I were busy Twittering the session.  (For a full transcript, click here.)  But I'm not a doctor.  Or a nurse.  There are no initials after my name.  I'm a patient. 

However, being a "patient blogger" doesn't make me the only patient in the room.  Every doctor and nurse on that panel has been a patient at one time or another.  It's something we all are.  This makes healthcare something we all need to care about.  Hence, patients first. 

The doctors on the panel were discussing how primary care physicians are a dying breed, with fewer and fewer new PCPs joining the medical workforce every year.  Many doctors were also talking about how government healthcare could provoke a healthcare system of "rationing," where Americans don't receive the healthcare they need but instead the healthcare that is allocated to them.  And how a government healthcare system could cost the American public a bundle for inadequate care.

Then there were comments about the current healthcare system, how it's running the economy into the ground and people are underinsured.  I can attest to being a member of the working class, with insurance, yet spending plenty out of pocket for my medical needs.  What good is coverage when it doesn't cover? 

Kim made the comment that she called Blue Cross to "talk to someone," and asked, "What would make you outright deny an insurance policy?"  Blue Cross responded, "Insulin-dependent diabetes."  This comment came hot on the heels of a discussion about "good health habits" earning a lower insurance premium.  But as an insulin-dependent diabetic, would I be penalized regardless?  Even though I eat well, exercise regularly, and have a healthy BMI, could my need for insulin or my A1C level end up putting me in a different cost tier?

And I'm sitting there, a type 1 diabetic patient and a health blogger, completely unsure of what to think. 

I can't claim to be up on every last minute detail of the proposed healthcare system.  I mean, Congressman Ryan even admitted that no one has read the bill fully (which was an admission that blew my mind).  But I do know that I've been denied for a private health insurance policy for years (and life insurance as well), and that even with insurance, I've had to fight for coverage for test strips, insulin pumps, CGMs, etc.  I see my endocrinologist at least three times a year and my primary care physician at least every 180 days, in addition to any well-woman visits, dental appointments, and emergency situations.  I sometimes think that a system of universal coverage would be such a blessing for people with chronic illness because we'd have insurance, but now I fear that we still wouldn't have the coverage we need.

"Is healthcare a right or a privilege?"  One of the panelists asked during the session.  The response on Twitter was diverse and educated, but I'm still not sure.

I'm confused.  I've read a lot of lies, a lot of half-truths, and some of what may be the truth, but it's still tangled up in agendas.  I'm hoping that you guys can help set the record straight for me, or at least stop it from spinning for few minutes.  What is the truth about the proposed healthcare system?  How will it affect those of us with chronic illness? 

And what can I do, if anything, to change the outcome?

Comments

I have been following the health care debate at a distance. I can't claim to be up to date on what is being said/talked about.

Being Canadian, I come from "social" health care system. When we were living in Canada, my husband, whose is American, use to complain all the time about the amount of money that we were paying in taxes for health care.

Then we moved to FL...we had to pay taxes, health care premiums and copay. It was more expensive then when we were in Canada!

I think both systems have flaws. However, with a social health care, in my opinion, it's one less worry. Health care is never an issue. If you lose your job, you don't have to be concern about "what happens if I get sick"!

I don't think it's right that people have to choose between eating or buying the medicine that they need. I don't think that it's right for people with chronic disease to be denied coverage.

When I was having problems with Tristan's insurance, I found this information very useful. https://www.diabetes.org/advocacy-and-legalresources/healthcare/insurance.jsp

Depending on the state that you live, insurance company have to grant you insurance regardless of chronic disease and at the same cost as everybody else.... however, the cost for individual insurance runs around $900-$1000/month. Who can afford that?

i have a story rather than an answer. when i was a boy (that was not that long ago really) i remember home visits from the doctor, i also remember that a visit to his office was $5. that was the late 70's. he was a great old man, with a long white beard down to his belt, tall and thin. he retired when he had to start 'playing the game" as he called it. he had to pay malpractice insurance, he had to unionize ect ect. he could no longer afford to be the "country doctor" that he wanted to be... and i say country doctor, this was the boston suburbs... what causes such a high out of pocket cost with this stuff.. i think that it is the insurance.. the cure has become the problem. i don't know if it would work, there may be no going back, but if all of this was removed, and we had a buyer beware health care system... would the test strip companies charge a 900% markup as amy reported the other day?.... idealism hurts my head

yes my husband finally got a job and we just found out that his company uses bluc cross and blue shield and they refused to cover me so my husband is not taking the insurance as well . I would just love to see everyone in this country drop their health insurance and watch these insurance companys go broke !!! yeah I know perfect world aint gonna happen . great blog dear thanks again

Health care is not a privilege. I think that the only people who might say that are those who have never faced a significant medical challenge. And their time will (probably) come at some point.

Thanks Kerri, without even knowing you were going to this, I emailed you asking about healthcare! Hopefully the right decisions will be made for all of us. I'm looking forward to understanding this more and hopefully more helpful comments and links will follow.

One truth about the health care system in the US is that it is costing more per person than it should when individual costs are compared to those of other countries like France, Canada and Germany.

With the US spending 17% of its Gross Domestic Product GDP on health care as compared to approximately 10% in other countries, Americans are not getting good value for their money. For those with chronic illness, these inefficiencies are particularly damaging because of the ongoing costs of care that must come out of pocket in many cases.

Whether or not you like Obama plan, reform is absolutely needed and because it will hurt the profit of the insurance companies, they are going to fight it with a lot of dollars from the pockets of the very people they are insuring.

I'm more worried about it as the economy worsens and I loom closer to college graduation. No more dependence, I can't free load off my parent's health care anymore. As it stands, I can get 3 months of supplies for about 200 dollars, which is reasonable to me, but after their coverages no longer works for me, if I don't find a job WITH benifits within six months of graduating, I will be unable to recieve care and perscriptions...what will I do?

I want to like the idea of government healthcare, I really do. But, after looking at the success and failures of similar programs in other countries, I can't support the idea.

Rationing is a very real possibility, and one that will cost lives. In the U.K., people wait for months to have a simple procedure performed. The quality of care and facilities is often subpar, and people die waiting for the care they need.

My other concern is similar to yours, Kerri. What will happen if my A1c is higher than the government bureaucrats deem acceptable? What if I tumble into an unhealthy BMI? What if . . . ?

I am self-employed (a freelancer), so my health coverage is provided through my husband's employer. I went through a period of no insurance before we were married. It wasn't fun, and I don't wish that on anyone. As a type 1, I knew that living without insurance was a bad idea, but I just couldn't afford it myself. In the end, my husband and I married (in secret) six months before our actual wedding so that I could be added to his policy. Sad, but true.

What I think we need is a healthcare overhaul. We need a system that offers EVERYONE the opportunity to purchase insurance at a reasonable cost. One that is not employer-provided, but instead, is completely portable. One that can't deny anyone regardless of their medical conditions. I think it should still be a private industry, but one that is more regulated. If a person wants to purchase supplemental coverage, they can do so (at whatever price the insurance company wants to charge), but the basics (preventive care, prescriptions, emergency, maternity, medical supplies, etc.) should be covered by a low-cost health insurance policy.

The bottom line is that socialist healthcare systems don't work. They are costly, ineffective, and confusing. Can you imagine having to complete government-written healthcare forms?

I just don't think that decisions about my life and health should be made by a group of people whose primary objective is getting re-elected.

Our goal should be to cover all individuals through private health insurance. We are not prepared to turn our health system over to the government. Advocate for greater transparency in both quality and price information. Place both the decision making ability and healthcare dollars in the hands of the consumer. Support the Friends of the U.S. Chamber and sign the Health Care petition at http://www.friendsoftheuschamber.com/takeaction/index.cfm?ID=40 .

Government health care is never a good idea. I just watched a woman from Canada explain that she couldn't get the care she needed because the government claimed she was still young and "hadn't suffered for that long". The gov't decided there were people more deserving so she had to wait....THREE YEARS! Could you wait three years for your health care needs? I know my two young type 1's can't.

As a Canadian with a child with Type 1 I have to say I am relieved not to have to worry about healthcare insurance, not being able to afford insulin and supplies, or not getting excellent care. Our universal insurance coverage fee system and costs of prescription drugs/supplies are based on a sliding scale - if you make a good income you pay the maximum for your insurance - about $ 130 per month per family. If you earn less that average, you pay less. My daughter received top notch care from a team that is reachable 24 hours a day - a pediatric endocrinologist a diabetes nurse educator, a dietician and a phsychologist. She is seen by the team 4 times per year in addition to visits to her family doctor. These visits cost our family nothing out of pocket! In the fall my daughter will start on her insulin pump - at no cost to us for either the pump or supplies. Is my daughter waiting for her pump start - yes she is and I'm ok with that. I am not jumping the queue because I have more money than someone else. Did my daughter wait for primary care - absolutely not - she was diagnosed by our family doctor (in our rural community) and in the hospital within the hour. She was visited by a nurse educator that evening and we saw her whole team a few days after that. Of course the Canadian healthcare system has its drawbacks and shortcomings but I wouldn't trade it away for another.

Great post Kerri! Definitely a discussion that needs to happen. I'm also torn about which approach is best. My friends working in the medical field seem to be totally opposed to universal healthcare, however, my experience living in Europe and having friends living there makes me believe that the universal system works as well. The price that we in the U.S. pay for healthcare just doesn't seem to match up with the health indicies (infant mortality, life expectancy, etc.).

More than anything, I hate what appears to be the arbitrariness of the pricing for our medicine and supplies - insulin costs $10 under one plan and $75 under another when it's the same exact product. The system needs to be clear enough that we as patient/consumers can identify the best deal. There needs to be competition among suppliers that leads to more uniform prices for medicine, supplies and services. I just don't know how to make that happen??

I posted on this subject at Children With Diabetes, and it brought out some, let's call it lively, discussion. To me, it really boils down to two simple truths: with the CBO projecting the US debt/GDP ratio at 82% in 2019, we just cannot afford this, and I have yet to see one well-run, efficient, under-budget agency that remains within its intended scope.

http://forums.childrenwithdiabetes.com/showthread.php?t=41088

Thanks for writing about this Kerri! I think health care reform is a really important issue for anyone with a chronic disease. I know people are scared about "socialized medicine", but I have nothing but good experiences to share about living in a country with "socialized medicine". I lived in England for a little less than a year while on a study abroad program during college and received my diabetes care from the NHS. I was able to see a GP (general practitioner, i.e. family doctor) 3 times during the 10 months I was there. They did all my labs and everything right in the office, would send me reminder letters to set up appointments, and did pretty much everything my endocrinologist at home did. These appointments and the lab work cost me nothing. My prescriptions (insulin, test strips) were all free as well because diabetics do not have to pay for prescriptions (healthy adults pay around 14.00 USD per prescription). I ended up taking all my pump supplies with me and I expect I may have had to pay for those out of pocket, but when everything else is free, it seems like a much easier cost to bear. The English definitely do not have a prefect system and Brits complain about waiting times and higher taxes, but no one I talked to would give it up for the American system.

English is not my first language and I apologize in advance for any spelling or grammar mistakes.
As a French person with type 1 diabetes I can only hope that you too will get government health care.
I currently live in Canada. When I first arrived here I had a big shock… I had no idea how much my diabetes supplies cost! I never had to pay for it before that. (I currently pay upfront and then send my bills to France to be reimbursed)
Here is how it works in France: EVERYBODY is entitled to government health care (called la SECU and paid for by income tax). La SECU pays for 60% of ANY medical procedure and a variation of 30 to 65% when it comes to drugs.
To cover for the rest you have to buy a private insurance, which is relatively cheap (for me 210$ US/year).
But here is the sweet thing; some conditions such as diabetes, cancer or pregnancy (i-e conditions that require a lot of money) are covered 100%. Yes you read me well every single thing diabetes related is absolutely free and I never had to change test strip or meter or pump, I get to choose what works for me. No question asked.
Sure France is in debt because of this system...but as long as I don’t have to worry about money when it comes to my health, I really don’t care!

AWESOME feedback, guys. You are really helping me make sense of this, and I appreciate it.

I've spoken to many friends who are doctors and nurses. Most of the high cost of health care is attributable to one simple factor - the cost of insuring (to what extent you can) against being sued into the stone age. I don't see any solutions on the table to truly address this issue.

I don't want anyone to go without their medical supplies, or the care they need. But I also know that any government strong enough to give you anything you need is strong enough to take anything you have.

Hunh. This is some very interesting feedback. I'm up in the air on all this. Either way, private or g'ment healthcare, it has to be paid for somehow. How much are our taxes going to be raised in order to pay for this healthcare and is it really going to cover everything for me? It's a question we're all asking, I know. Right now, we have EXCELLENT health insurance coverage for my diabetes care from my husband's employer and really, it's been the only thing keeping him at this job. My pump supplies, doctor visits - everything, pretty much is covered 100%. It did take 2 near-death hypoglycemia experiences and one major DKA hospitalization for a pump to be approved, but it was a fast approval then.
Overall, I think American healthcare COSTS really need a major overhaul and our insurance companies need to face the fact that most of their expenses these days are going to go to CHRONIC care not CRISIS.

I agree completely with Anne Findlay's comments and am also delighted to read Marie's comments on the French system!

I am somewhere in between. I live in Australia where we have a government scheme Medicare which pays for a percentage of certain procedures, drugs (including insulin) and doctors visits. I then also pay private health insurance which pay for an insulin pump, cover me in the event I go to hospital, or have a procedure/drug/visit not covered by Medicare.

I still pay out of pocket but only on gaps - in a year I estimate I spend about AU$1700 (including my insurance). So while this is not a small amount it is still manageable and I never ration meds or visits for fear of costs.

I would hope that with chronic conditions such as Type 1 diabetes our government in the future considers moving our system towards that of the UK or France - my disease is costly but I am doing the best I can to maintain my good health, and I shouldn't be discouraged from doctors visits (or use of devices such as cgm) merely because of costs.

Kerri, I am not clear on what changes are being proposed by Obama (although I trust his judgment) but I think you should be keen for more government involvement and coverage - in Australia we always use the US as an example of a healthcare system no-one wants (other than right wing conservatives).

It is unfortunate that our health is a political issue. It should be a matter of what will benefit a person's health the most - and in my opinion that means the individual should not bear the whole burden.

I've come rather late to this, as I've been pondering how best to reply, especially as my experience of the NHS for a serious chronic illness is now 18 years old (my father died 18 years ago and was a type 1) and rather vague (I was young when he died). From what I know though, he didn't really have problems accessing the people and the things he needed to stay as healthy as he could, and for some time was on a pump. All his prescriptions and needles were free. I suspect that if he were around today he'd have even more choice than he did back in the day.

The most I can say for the NHS is that what I have experienced of it has been incredibly positive, and despite its faults I wouldn't want to swap it for any other healthcare system.

I wrote this on the 60th Anniversary of the NHS, which explains in more historical terms why I think the NHS is awesome (with a couple of paragraphs on why it's been good for my family specifically).

This is a good article I read today by a political journalist (Andrew Neil), which I think perhaps sums up best how the debate that you guys are currently having over there is seen by us (or at least the people I've talked to) over here.

Suffice to say, I don't think the NHS is nearly as bad as right wing commentators in the US are saying. But I am most definitely biased in my views :)

To sum up - I think the NHS is great, and have provided a couple of links I think sum things up from here well... but may as well not have posted cos I've not actually said very much. Sorry about that.

I'll start by saying I don't know what the answer is, but from my experience, the horror stories we're told about the programs in Europe and Canada don't seem to match up to what I've been told by people who actually live in those countries. Just as the sides opposing reform can pick horror stories to illustrate their point, we have plenty of stories from this country where people have been denied treatment because their insurers didn't deem it necessary. (You don't have to look far, just look at Kerri's CGM coverage struggle.)

A few things to think about--regarding rationed care, I'd argue we have that now. Insurers refusing to cover something is a form of rationing, whether we choose to call it that or not.

Second, insurance only works when you have a very large pool of contributors and a very small pool of people making claims (think car insurance--most everyone pays, but only a small number actually get into accidents and make claims). Health insurance is no longer working because we have a shrinking pool of contributors (declining through job loss and baby boomers retiring), soaring costs (a portion of which is cautionary care for med malpractice/lawsuit reasons, but mostly it's fee for service that encourages more tests because each stage has a fee), and to an extent, longer life expectancies. Add in there that many of these insurers are for-profit companies that are trying to make shareholders happy, and you have a problem.

The fact that nearly 60% of bankruptcies are caused by medical issues is atrocious. No one in this country should be worried about losing their home because they get sick. Coverage should also be decoupled from employment--COBRA is a joke.

Sorry for the marathon comment, but something really needs to be done about this issue, but it's so complex and affects such a large portion of the economy (20%, by some figures) that I'm not hopeful anything can be accomplished. It's a shame.

Health care coverage? I'm not at all sure if we EVER will be able to get BLANKET coverage for ALL of our health care, but I consider myself a very lucky person. I have recently gone on Medicare. At the same time, I am a disabled Army veteran, so I am well taken care of by the military establishment. For my wife's sake, I am also carrying MailHandler's medical, and they are EXCELLENT in picking up the extra. Oh, and by the way, did I mention I am also a purple-level VA patient, so I am covered there, too! So, between the base hospital here, and the VA hospital 40 miles away, I am VERY well taken care of. As a Type II diabetic, with my last A1C of 5.1%, I am doing fairly well, despite a very bad illness last year.
I don't know if government healthcare would affect me or not, but right now, I almost am afraid to rock the boat! All my testing supplies are supplied through the base hospital, with no out of pocket payments. Ditto my meds. I guess I'll have to read up on what this Obama special really will do to me...

Hi Kerri,

I'm a type 1 and scientist and although US would be a perfect place for my research, one of the main reasons I did not decided to go there is the (lack of) health care system. Ironicly, I was diagnosed when in US.

Now I'm living in Germany, I have a standard state Krankenkasse insurance and good diabetes care. My pump, stripes etc. are covered by the insurance, I've got also an excellent health care during my pregnancy. Of course, the system here is not perfect, but as for me, is better when more people have "good enough" health care, then when are people with excellent health care and other people without any health care. Besides, there are still private insurances or supplementary insurances and with that one can get additional things covered.

greetings,

Ania

I found your blog and found it interesting. I don't have diabetes, but I do have a chronic disease-Myasthenia Gravis.(muscle weakness) I'm very concerned about losing my effective ivIG (immunoglobulin)treatments that enable me to keep working from home and give me a quality of life that I would not otherwise have.I think ntl healthcare will cover diabetes costs-because it is so common. But what about those of us with expensive treatments and chronic disease? My insurance co is billed $6000 every 6-8 weeks when I receive an infusion.We gladly pay the $3500 deductible and insurance covers it all. I cost my ins company $100 day! There is no way the gov is going to do that! They will tell me to take a (prednisone) pill and "manage". I read that ivIG is not used much in the UK. Because they don't want to spend $ on chronic disease. I am on my husband's ins. I keep working and have access to ins at my job. But if my husband dies first, and I am unemployed I could not find coverage. Then I would have to resort to paying $100 mo. for the pills I take daily that are necessary but do not provide the quality of life I have without the ivIG also. Yet I am opposed to gov healthcare. There are ways to reform what we have without giving them total control. No one has mentioned Tort reform like we have here in Texas. Start with limiting medical lawsuits. Physicians have to pay over $100K year for malpractice insurance. Start there. Then provide $ for more medical schools and better pay for nursing instructors. The schools turn away 1000's of qualified students each year because of lack of instructors. It is a privilege and the freedom to choose our healthcare is a privilege I don't want to lose.
I wish you the best of care!

hi my name is gary i am type1 and use a pump i have no insurance and need help getting insulin

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