The June 18th DSMA Open Chat was the first one I had missed in a while. So when the Blog Carnival put forth a question from that chat, I jumped on it. The question is, “If you could change one thing about diabetes, (besides not having it), what would you change? Why?”
I will admit, I actually had to think long and hard about it. Diabetes has been a part of my life for so long, it just seems like that’s how life is just supposed to be. While most other people don’t understand what it is to have to inject a life-saving drug, I don’t really understand what it is to not. Since not having diabetes was off the table, I was a little stumped.
I was reacquainted this morning with a struggle I had last year with a diabetic supply company, and that serves as inspiration for the one thing I would change about diabetes: I would make it so that health insurance companies use medical decisions instead of profit margins to determine what they will cover and they allow me to decide how to go about treating the diabetes and what devices to use instead of telling me what I can and can’t have.
I was recently eligible for a pump upgrade, and I was really excited about the possibility of getting my hands on the Medtronic 530G. This pump works with CGMS to automatically suspend function and emit an obnoxious alarm whenever your blood glucose gets below a set level. I have had problems my entire life with the Dawn Phenomenon, and I thought that maybe this might be my answer. I was ready to have day after day of data so that I could use it to adjust my pump, stop my blood sugars from crashing in the middle of the night, and stop my liver from spilling its reserves and waking up with an astronomically high blood glucose reading. I was ready to get the next step towards artificial pancreas technology.
But, my insurance company rejected it. And why? Because they don’t cover the CGMS supplies. To them, testing your blood sugar manually is enough. To them, the cost of CGSM supplies are way too expensive, and that cost outweighs the benefits from it.
My thoughts are accurately summed up by the fearless leader, Captain Picard:
This is worse than dealing with the Borg
While I was disappointed, I wasn’t entirely surprised. Medical care in the United States is all about one thing: money. It’s not about healthcare, it’s not about keeping people healthy, it’s all about keeping shareholders happy and costs down for taxpayers. While I don’t necessarily object to the latter, I do object to it when it comes at the cost of helping people with chronic illnesses live long, healthy lives. Because the government hasn’t quite understood that when people live longer, they pay taxes longer.
In reality, two things need to happen here: drug companies and medical supply companies need to lower their prices, and insurance companies need to STFU and pony up for it. Now, as the child of someone who spent his working days writing grant proposals, I am well aware of the cost of the research that goes into these devices and medications, as well as the cost associated with producing them. I am very well aware that these companies need to turn a profit to keep their own investors happy. But things like CGMS have been around for ages now, why on earth do the sensors still cost something like $450 a box? Why have we not recouped the cost of the initial research, that was surely incredibly costly, years ago? Why are the prices still so high? You can’t begin to convince me that Medtronic had to put hundreds of millions into developing the Enlite sensors, they came off the prior Sof-sensor model (which you can now get for less than half the cost of the Enlites, but I digress) and looks like they only contained a few design tweaks as well as increased accuracy. I wouldn’t doubt that a couple million may have gone into the upgrade, but for what you’re charging people for these things ($473 for a box of FIVE without insurance), you should be able to get the price down here pretty quick.
I’ve taken an economics class, I know the laws of supply and demand – and these suckers are highly sought-after and people will pay anything to get their hands on them. The demand is relatively inelastic…but if they were to lower their price, they just might get a FLOOD of people buying them – insurance companies as well as the uninsured. Lower the cost of the Sof-sensor to $100 a box and I just might consider paying out-of-pocket for them (since that’s what’s compatible with my Revel). Or maybe if Dexcom lowered the cost of their products, I would be inclined to buy theirs and carry the two devices. The G4 will alarm me as well if my blood sugars are off, and since all the Revel is capable of is alarming me just the same just keeping it in one device, I would rather go with the more accurate CGMS system.
Either way, I would love to have one. I would love to have a continuous record of my blood sugars. I could keep a much better eye on the pump, and spot changes as I go through the ups and downs associated with the IVIG. But OH WAIT. The sensors cost an arm and a leg, the transmitters cost an arm and a leg, and my insurance won’t cover it. So here I am, wanting a piece of equipment that I can’t afford that I think would greatly improve my life, and I can’t get it because my insurance company won’t cover it, nor the supplies needed.
So here I am, having my medical decisions decided by the free-market system and a team of economists. Two things that have no expertise in the medical field, nor should have any sort of input into it. But these things dictate my medical decisions, they dictate how I manage my diabetes, and they dictate my life. These two things that shouldn’t have their fingers in my medical needs.
I’m starting to sound like a bit of a Republican here, but that’s not what I’m aiming for. I’m a bit of a fan of Obamacare, primarily that I now cannot be denied for insurance because of my pre-existing conditions, I cannot be dropped from an insurance because of my $20,000 a month IVIG treatments and there are no more lifetime caps on care. And to be honest, I wish that the legislation had a little more teeth. I wish that ALL medical devices, including CGMS, were considered durable medical equipment so that they MUST be covered. While I will agree that the insurance mandate is one thing I’m not sure I agree with, I’m required by law to carry car insurance despite never having filed a claim ever and I don’t have a problem with that. I suspect that we will get to the point where carrying health insurance is a known necessity just like car insurance.
Now that I’ve gone on for quite a while and have spent about an hour composing this blog entry (an hour that included a rather long bathroom break, to be honest..), I’m going to sum up my point: as a diabetic, I wish that health insurance companies didn’t suck. And I wish I had a Dexcom G4. In neon pink.
This post is my July entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetescaf.org/2014/07/july-dsma-blog-carnival-4/