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Thinking Too Small

© 2016 Scott Strange, Strangely Diabetic and

Sometimes I think we in the diabetes community, especially where technology and type 1 is involved, think way too goddamn small.

In particular, I am thinking of the response to the UHC/Medtronic announcement last wee.  Heather over at The Chronic Scholar has an excellent breakdown of the issue in her post UnitedHealthcare Policy Change: A Systemic IssueI’d really recommend reading it.  Go now, I’ll wait…

Before I go on with my tirade, we all need to realize and understand that there are things about insurance that most people simply don’t get

  1. Insurance companies do not consider patients to be customers.  They consider providers and facilities to be their customers.  This is something of a fallacy I’ll get to in a moment.
  2. Insurance companies do not exist so we can “afford” to pay for our healthcare.  They exist to provide a profit to their shareholders.  And while some maybe “non-profit” organziations, I seem to remember BC/BS losing their non-profit status in the State of California in the last few months.
  3. The trend to “contain” healthcare costs will be focused on those with the least say, the least power in the equation. Namely, patients. This approach is a fallacy, as we also have little-to-no power to affect costs.
  4. Notice how costs continue to increase for patients? Higher premiums, higher co-pays, higher deductibles, higher maximum out of pockets.  Notice also the narrowing of provider networks, closed formularies, pharmacy benefits managers directing drug availability and now only one type of insulin pump.

Now that we’ve caught up, look around the social media flack that this contract has spawned.  We’ve got pitchforks and torches alright, making a noticeable wave of discontent over this issue.  And rightly so.

But I have to ask, where was this wave of discontent when some plans only would carry a single type of test strip, or a single brand of insulin, or when providers are forced to jump through so many hoops they simply can’t provide the level of support they want to for their patients and their patients need.

Then the fog-of-war sinks in.  Providers sometimes simply can’t provide all the “required documentation” 2 or 3 times to get an approval, patients get told that the provider is the roadblock.  Providers now have patients, who are their customers, upset with them.

Payers, claiming that providers are their customers (the fallacy I mentioned in point 1 above),  actually hold most of the power in that relationship.  Without being accepted by that payer, patients will not come to that practice.  You may love your doctor to death, but if you can’t afford to go to them….

The narrowing of provider networks and the consolidation of practices into regional health care organization are limiting patient choice, the ability to choose our own care.

Now look at the Medtronic side of this, from a business perspective this is a coup. And simply a logical and a you-should-have-seen-this-shit-coming extension of a pharmacy benefits manager saying that this vial of insulin is $10, that one you can get for $75 and that one will cost you $300. They like to say this does not effect a patients care plan with their doctors and I’d like to know what the eff they are smoking because there is nothing marketing likes more than a product people will pay any price to obtain.

Look at insulin… no generics after more than 90 years on the market?  I seem to remember a certain President of the United States in 2009 or 2010 saying that we’d have generics by 2014.  I actually snorted when I heard that given the widespread practice of evergreening and the subsidies that the United States basically provides for drug costs for the rest of the world.

Anyone trying to tell you the market drives these costs is a liar or an idiot.  There is no market in healthcare.

Just to be clear, there is no market in healthcare.

Now all this aside, let’s circle back to where I think we tend to think just a tad too goddamn small.

Do you all seriously believe that diabetes is the only health condition this is true for?

Good lord people, look at all the patient communities out there.  If we can rally for ourselves for something that is a systemic issue, why can’t we rally with other communities when this happens to them? Why do we limit our community, and by extent other communities and all patients, by only raising hell when it affects us?

I remember the horror that was HMO insurance back in the day, being told that I only needed 27 days of insulin a month.  Being told that I had enough insulin if I got every drop from a vial, if I never ever needed any “extra”.  Those days are here again, disguised in new names and as modern “reforms” of healthcare.  These reforms have nothing to do with our health, but with how much money we will be allowed to drain from the profits of those contracted to pay for our care plan.

Oh, and speaking of contracts? I’d be amazed if this contract was “broken” between UHC and Medtronic, there is simply too much money involved. I suspect the best we could hope for would be out-of-network coverage for non-Medtronic pumps but there may even be contract provisions prohibiting that.  So, the contract would need to be mutually dropped or someone would be getting sued and loosing.  Maybe it could be deemed “unconscionable”?  Yea, about that stuff some folks were smoking earlier….

Yea, this is a battle worth fighting, no doubt.

But it is only a battle, a minor salvo in the bigger war that is hidden underneath the fear that we each have about loosing our insurance, the fear we have of not being able to afford the care a child, a wife, a parent, a sibling needs to have a quality life, not just hanging on because that is all they are “allotted” for their care.

We can point fingers at everyone in this and we’d always be pointing at someone who has a a role in this.

Even ourselves, yes us.  If we continue to fire salvo after salvo the war will be lost.

I’m pretty sure that it’s time to bring the Missouri to bear because the salvos from our little individual community patrol boats simply aren’t big enough to shatter the illusion that is healthcare in the United States.

PS: Does anyone know what Omar Ishrak and Hooman Hakami have to do with any of this Medtronic Diabetes hoohaw?

© 2016 Scott Strange, Strangely Diabetic and

  • krisguy

    I’m tired of this happening for my dad, who has several conditions. I’m tired of this happening for my transgendered friends. I’m tired of this happening to my friends with cancer, lupus, chronic arthritis, and so on. Insurance payers take the patient out of the equation because if they kept them in, there would be a emotional need to override the business need. HC companies work for their shareholders, but not for all their stakeholders.

  • tmana

    The real issue is that at current prices (negotiated or “market”), the requirement for “optimal” healthcare for each and every person in the United States amounts to more this nation’s Gross Domestic Product. Something has to give — and that “something” is the amount of reimbursement/coverage allotted to those of us whose health requires us to consume more than our “fair share” of healthcare.

    That said, the forced end-of-plan-year, year-at-a-time spending of FSA plans doesn’t help to keep costs down. Better is to have HSA plans, which rollover unused funds — so the costs of known high-ticket health items (think “insulin pumps” and “CGMs”) can be spread over the expected lifetime of the equipment, and end-of-plan-year binge spending becomes a thing of the past.