To be appalled at people dying in the USA because of the cost of insulin

[WeBuiltThisBuffetOnSausageRoll]

A 27yo man in Virginia, who had type 1 diabetes, died last month because he couldn't afford to pay for the insulin that he needed to keep him alive and healthy.

Up to the age of 25, he was covered on his step-father's medical insurance, but once he turned 26, he was on his own. He was in a low-paying job which didn't come with adequate health insurance, so he saw no alternative but to buy the much less effective (and much less suitable for his needs) cheap variant over-the-counter at Walmart and then ration it to eke it out as much as he could.

I saw a report today suggesting that this is far from the norm. One family has a child whose insulin costs them £1,200 a month. It's their biggest single family outgoing and they sometimes have to sit in the dark or the mother go without food herself to be able to afford it. Of course, as he grows, he will be needing to eat more food and therefore need more insulin. Whatever would the family do if they had another child who developed T1D?

At best, it seems that ordinary people can find themselves very limited in their job/career choices and will often have to take any job based on what insurance cover it comes with, rather than one based on their skills, abilities, qualifications, experience, interests etc. At worst, the poorest, most vulnerable and/or least educated will not be able to get into any job that comes with the cover they or their families need.

It's much, much cheaper in Canada, so Americans who live anywhere near the northern border travel over and stock up there whenever they're able to; but the USA is a huge country, so this will not be a feasible option for the vast majority.

We see and hear all of the heartbreaking reports and appeals from poor countries in Africa, Asia and eastern Europe, but THE USA?!?!

I know our NHS is far from perfect, but we have an immense amount to be grateful for.

How do American MNers manage to deal with this; or indeed, people from anywhere without an NHS or similar public set-up? Are these the full, true facts? Are people in the richest country on Earth really just tossed into the trash so easily and left to die for getting ill?

The only thing I would say about the USA was that where I lived (affluent, progressive west coast) the state covered my kids free of charge even though we are Brits because we earned under a certain wage and the mental health included was amazing, my dd has access to therapists for her autism that are simply not in the U.K.

@Purpleartichoke

“DH is a transplant recipient. His ongoing ability to cover his lifelong anti-rejection meds and follow up testing and exams was a factor in his authorization to receive an organ.”

This might possible be the most horrific thing I’ve read recently and I don’t know how it hasn’t been picked up elsewhere on the thread.

Are you really saying that in America a donated organ might not necessarily go to the person who needs it most but instead to the person who can pay for the aftercare?

How is that ok in a civilised society? How are any Americans ok with that?

The NHS has its faults but at least it doesn’t treat based on the size of the patients wallet.

Good ol' USA. Where if the illness doesn't kill you, the hospital bills will.

America really is a very backwards country in so many ways. Lack of free at point of access healthcare is one. Shame we seem to be importing their style of politics and lack of social cohesion to the UK

@BanjoStarz

This is less about having money and more about compliance with aftercare protocols. Someone on Medicaid or Medicare (safety net) would have the means to keep up with aftercare. But yes a person who did not have a way to keep up with the medication or a plan to find a way (including safety net) for maintenance is not a good candidate for a transplant.

If you had to choose who got a kidney, between 2 people, one who was able and willing to be compliant and one who is not, who would you choose?

Is your insurance premium higher if you have an existing illness?

Saltine is describing it well. There are programs available for people who don’t have insurance and have certain medical needs. Someone who won’t jump through the hoops to get enrolled in those programs would not be considered a good candidate

Wow, thanks for all your replies - many of them very unpleasant to read, though.

I asked my American friends the same question once and the overwhelming consensus was that there is an attitude in America of "why should I pay for you to have xxx? You should work harder and buy xxx for yourself".

the US is not the richest country on Earth

No, you're probably right there. I know it always used to be the case (may still be) that the US owed more money than any other country! But, as you say, the principle still holds very true. We're not talking about Somalia or Bangladesh here.

I really hope that this isn't the majority view. If talking about a bigger house, newer car, nicer clothes etc. then I can see the point completely; but how ignorant when it comes to basic healthcare. Do people with this attitude not realise that many people with serious health conditions cannot possibly work harder, a lot cannot work at all? Whilst insulin and loads of other medications cost a fortune, it's not even like they'd hold any interest or value to you if you're fortunate enough not to need them.

So when we lived in the States my son (he has a few lung issues from his premature birth) had to go to the ER. A 3000 dollar bill for a 6 hour ER visit and they did an X Ray and gave him a nebuliser. Our insurance said they would cover everything but the nebuliser because it wasn’t ‘necessary’! Huh? Who makes that judgement?

Have you seen these appalling threads on Twitter where people are billed 5-6K USD for the ‘possible resuscitation’ of stillborn babies (babies may have been born alive but were critically ill and died during labour) and insurance won’t cover it because the baby wasn’t technically born alive so didn’t fall under the mother’s insurance. A bunch of female doctors (so v well paid and could ultimately afford the bill) were tweeting about it.

Not sure what happened there - I quoted two separate comments and then responded with my thoughts the wrong way around!

Also if you haven’t seen any other system you accept it because that’s all you know. My son spent 90 days in the NICU. No one I knew in America could believe that I paid not a cent for this. I walked out of hospital and that was it. They can’t wrap their heads around the idea.

@saltinesandcoffeecups

Thanks for explaining a bit further.

I suppose on initial reaction i’d choose the person who needs it more.

But then, is it better to have the organ go to someone who can look after it (through paying for after care) or to someone who can’t and who will die sooner (and so waste the organ?!) because they can’t pay for the after care.

I suppose I’m grateful to live in a system where, all other things being equal, the ability of one patient to pay aftercare bills over another isn’t a consideration in transplant patients.

Also see Jen Gunter’s twitter handle.

I'm an American and agree with what's being said here. I will say I think a huge number of us do believe in socialized health care but are outvoted by the elderly Republicans every time (many of whom will be recipients of medicare). Obamacare was a step in the right direction but even parts of that are being rolled back.

For anyone that doesn't want to pay for other's health care, the US pays more per capita for health care (medicare, medicaid, etc) than many, many countries with a national health service type system.

My story of how much insurance sucks: I had to have my wisdom teeth removed quite urgently, along with several tumors in my mouth (which turned out to be benign but we didn't know this at the time), NOT a choice. My dental insurance approved the charge when the oral surgeon's office checked that it was okay, and then after the surgery dropped me. They didn't tell me that they dropped me, but they sent me a final notice letter for several thousand dollars to be repaid immediately over a year later. Luckily I was under 26 and my insurance was through my mother's job, so her union was able to fight for me. When I turned 26 luckily I was able to switch to my own work insurance, but I wasn't in a role where there was a union so I was very lucky it had happened when I was 24.

Cherish the NHS and do not let the US come anywhere near it in post Brexit trade deals.

@FATEdestiny

That can be a bit complicated to answer, but I’ll give it a shot. And please know that this will be a simplistic explanation as it is complicated. In general no.

Most health insurance is risk pool based and that pool is based on the employer in most cases. So it comes down to the law of averages. If your pool/employer is small then illness can increase the average cost of the pool more significantly. If you are in a larger pool then the individual high cost is mitigated by the numbers and amount of non sick people. This would be true for policies not tied to an employer as they are also grouped together into a pool.

I think the easiest way to explain this is that every person at my company pays the same premium, my employer pays the same amount for each employee. Theoretically next year if a high enough percentage of people in tha plan have high bills, then our group rate could be increased but the participants and employer will all share that increase.

If I get treated for cancer or have an expensive surgery, I will not pay more than my coworker who only had a routine checkup.

It is also important to note that if I am a person who can demonstrate a healthy lifestyle by not being overweight, not smoking, participating in designated programs, I may be offered a discount on my premium because my risk factors are lower.

This is very sad. I have always sympathised with American healthcare victims after a Brit friend shared a photo of their medical bill and it was almost 97 dollars for half a roll of bandage and microporous tape that he could bought from Walmart for 2 dollars and the nurse and dr charged 600 dollars for the consult and application of the bandage.

What worries me is that last week I saw proof that we are importing insulin FROM AMERICA by the lorry full. How do I know this? My brother in law is a temperature controlled haulage driver and knowing how vocal I've been about insulin and injections being produced in Europe (and the impact of Brexit) he showed me the documents and he and several other drivers moved several 40 ton lorries of insulin from import into chilled warehousing in the NW.

SO- why are we getting insulin from America when ours normally comes from Europe at a much cheaper rate? I think this is some sort of no deal stockpiling gift from the USA to get their hands on the NHS post Brexit. And if that happens ( or has it already happened with this import?) then all diabetics could find themselves in the same boat as that poor man.

One amazing fact I learned from another US-dominated forum is that it is often impossible to find out in advance what an operation will cost and to what extent it is covered by insurance. You can perform some checks, but you only really find out afterwards, at which point you discover the questions you didn't think to ask...

In billing terms, there isn't necessarily such a thing as the cost of an operation, it's something like the hospital charges, the surgeon charge, the anaesthetist charge, they all send separate bills. Many people don't think to check the anaesthetist, one guy who did (because his wife works in medical billing so he knew the questions to ask) found out there was a rota of anaesthetists, some would be covered by his insurance, others wouldn't, but he had no choice in which one was used, because, well it was a rota, The fact that it made several thousands of dollars difference to him who he got wasn't a reason to let him choose, apparently. (I'm not saying this is the way it's always done, just remembering one anecdote.)

When I say he had no choice, I meant he would get whoever was next on the list on the day, it was literally the case that no-one knew who he would get.

It's awful. I have type one diabetic twins am so lucky that we have the NHS and their insulin etc is free. If we lived in the USA we would be screwed

DS was diagnosed with type 1 diabetes when he was 4. I'm in Facebook groups with a majority of US members. It's weekly if not daily people saying they can't afford the £££ until they meet their deductible, or their insurance has decided to change their insulin brand without checking with them. It adds more stress to an already shit situation.

Every month DS gets a carrier bag of supplies from the chemist; two types of insulin, needles, lancets and glucose test strips. And he'll get this for free every month for the rest of his life and I am so grateful.

As a Canadian I am a bit annoyed that we may have shortages of insulin because Americans come here to buy it.

www.google.ca/amp/s/www.cbc.ca/amp/1.5232360

get your shit together, neighbour

“If I get treated for cancer or have an expensive surgery, I will not pay more than my coworker who only had a routine checkup. ”

Er, I doubt that. I have FEHB and anyone needing more than a routine checkup will pay more in out of pocket co-pays. No, their monthly premium will not go up, but there are extra co-pays for everything you end up needing.

I did a quick google, not an exact science I admit, but my basic maintenance meds would cost the equivalent of £540 per month if I were to buy them in the states.

That's without the extras which in the past 6 months include 2 MRI scans (average $2200 each) , 3x antibiotics ($15 total) 3x consultant appts ($750), 6x blood tests ($1000 each). It hasn't been a particularly difficult 6 months, just the ups and downs of a chronic health condition.

If I were uninsured that would have been an extra $6165/£4,943 £1305 monthly average.

If I didn't have access to the basic meds I need, working wouldn't be possible, and I could see a huge catch 22 developing. No meds=no work...no work=no meds. My quality of life would fall so dramatically if I had to pay even half of those costs. Shocking really.

Is your insurance premium higher if you have an existing illness?

It used to be and companies could even refuse to cover you at any price, but under ACA that is not allowed anymore. What is normal are different premiums for family size- usually it is self, self +1, and self + family (no limit to children). Also, some offer premium discounts if you have a healthy lifestyle.

There are also many types of insurance plans with different levels of coverage. So a plan that has lower co pays and lower deductibles, more provide choice and higher lifetime limits will be more expensive than a plan with higher co pays, higher deductibles, and lower lifetime limits.

The drug I'm on is something insanely pricey but apparently you can get on a register for it which makes it cheaper in America?
The stupid thing is, if we don't take it, we are higher risk for sepsis... which would cost more to treat

Ok just checked and one woman said the copay is $2400 and the medication is $9000