August 24, 2009

A Hyper Check

No no not the blog sugars. The 'bole.

As in Hyperbole.

I am sitting here checking my email and the news has someone in a full blown rant. I wish I had his coverage. He apparently has outstanding health coverage. He going on about “anything that comes between My Doctor and My Health is rationing. Anything the Government does that limits My Doctors options...”

Really? Is that what that is.

I didn’t know to call it that. But now that I know what to call it, I know that private insurance has been rationing continuous glucose monitoring since it was invented. Like many other people with type 1 diabetes we have been denied coverage.

I just figured that we, like a lot of other people, were applying for coverage with the hope of getting what we see as a quantum leap in treatment but with the real expectation that what we were doing was trying to storm at the castle gates. If enough of us banged on the door long enough the gates of our private insurance will open and CGMs will come tumbling. Or something like that.

Waiting is another issue with this guy on TV. Rationing is going to mean waiting for the health care we need now. Grandma may have complications or worse waiting.

We got a letter from our insurer telling us that the ‘formulary’ test strips under our plan were changing. We could get one free meter to switch.

Well we don’t like the formulary strips much. One meter doesn’t make the table ante at the T1 card game. IMHO the minimum to get in the game is four meters; a meter at home, backup at home, meter at school and a meter at the gym at school for potential PE issues. Not that it matters because we are going to use the strips and meters we think work best, not the ones our insurer is rationing

I wonder what the pundit on TV has to say. Nothing I suspect. It would be inconvenient to admit that the insurers do private deals with suppliers and negotiate special deals to make a particular brand of strips the formulary.

I doubt he would have an issue with that. There is practically spit flying in this dudes rant and the real point is he is getting his 15 minutes. If he puts on a really good show he may get picked up for another 15 in another broadcast.

Sadly people with type 1 don't live in 15 minutes of broadcast fame. But we do know our Hyper and Hypo.

At our house our turn for CGM, for at least one of the kids, is has come. We have waited long enough. I heard she was approved for a CGM. I am not sure but I think this is our third full court try for the thing. There have been countless Hypos and Hypers as in hyperglycemia not hyperbole in the intervening time. Some have been south of 40.

South of 40 is what most people who know what serious is would consider serious. There are potential long term issues with hypos, I hope we minimized them by acting fast. 100 to 1 Mr. TV guy has no idea what hyper or hypo mean and doesn't know a 38 from 102. I bet he lives red and blue.

Lows happen. (Feel free to insert an “s” word for lows there if you feel the need.) That is part of YDMV. It will be nice to have the tools to manage it (I am thinking the other the other word but mean lows.) It is nice that our time has come. I am particularly interested in using CGM to help manage basal setting.

I fully understand what the guy on TV is calling rationing. Like a lot of other people living with type 1 we have some first hand experience with it and the private sector. I don’t know what the end game in DC punditry is going to be. I suspect it will be more hyped up simplistic sound bites.

The conversion is kind of over stimulated and loosing cognitive abilities. Sound the media needs to check it collective blood sugar and take a correction bolus to get back into the sanity range.

What ever the outcome of all the 'debate' (hyper see above) is, we will still have two cases of type 1 in our house. We will still use strips and insulin. In the many homes across the world like ours, we know hyper, hypo, strips and insulin are the daily ante to be in the game.

We just are tired of playing. 24/7/365.

4 comments:

CALpumper aka Crystal said...

I be tired too.

I just want options, more options, to simply Have insurance.

Sigh.

Hope the CGMS comes soon and helps!

tmana said...

One of the issues involved is the possibility (more a probability, based on what I am hearing) that not only will all health care providers will be required to go through the government system but also all healthcare products. If the government says you have to uses Jiminy Cricket Meters and strips, all stores will stock Jiminy Cricket, will only allow you the number of strips the government says you can have, and it will be illegal for you to purchase JohnnyComeLately Meters and strips, or even extra Jiminy Cricket strips.

It gets worse when you start talking drugs. Already, my insurance keeps trying to get me to make my doctor switch me from my current blood pressure medicine to one to which I have a significant adverse reaction. That's just a blood pressure medication. My sister (who has pretty bad asthma) is allergic to all but one or two medications which are not covered by most insurance (so you know they will likely not be covered by any government-mandated option). Under the "most cost-effective" plan, she would not be able to get the medications she needs.

In short, the proposed system will shoehorn YDMV into One Size Fits None and then tell us all it's our fault.

Remember that in the end, it's cheapest to let people die.

Bennet said...

Good points tmana. Thanks for joining in.

"...my insurance keeps trying to get me to make my doctor switch me from my current blood pressure medicine to one to which I have a significant adverse reaction..."

And is this private insurance right? Seems like they are already shoehorning (BTW BadShoe loves the shoe pun in shoehorning) one size fits all. It seems to me the issue is the shoehorning not who the insurer is.

I am with you in feeling things are bad enough that they don’t need to get worse.

You conclude "Remember that in the end, it's cheapest to let people die." If that is the case, then isn't it the logical extension to say that for profits being profit driven and most likely to rigidly control costs and see dying as the cheapest option? Opps that is the exactly kind of hyperbole I am writing about.

I am not trying to say one system (one payer vs private carriers and some public support for those who need it vs all private payer) is better or worse. My bet is there is a middle ground there that is better than what happens now. To get there is going to take some clear calm thinking. Nobody thinks clearly when they are hypo.

My concern is the conversation has been taken over by hyper. When people say we will have rationing I just feel the need to say we have it now. Like you I am not wild about it. So how do we seriously talk about the rationing that is happening now, as you so clearly point out in you post?

That is what I one of the things I would love to hear proposals in the public conversation about.

Here is another:

How do we move primary care out of crowded ERs to more proactive primary care facilities that provide better long term health also cost less to run?

Or

How do we as a nation shrink the cost liability insurance while also protecting the public from real malpractice?

Or

How do we get to a one form for all insurance carriers so the over worked staff at the doctor’s office aren’t always playing paper work roulette trying to match the correct form to the patient and their insurer?

Alison said...

Great post Bennet, nice to read some sense amidst the scaremongering.

I live in the UK and use the NHS and they haven't yet determined that I'm too expensive to be worth treating (although if you believe some US press I should be fearing for my life in case I become economically unviable!).

Getting the NHS to fund CGMS was a real battle, but probably no more than the fights you guys have with insurance companies.

Re tmana's point on wanting drugs that aren't on the Govt mandated list - in the UK CGMS is not on the NICE approved list for NHS funding, but is considered on a case by case basis. Same goes for certain drugs.

A lot of what I read in the great US healthcare debate seems to be trying to use the exceptions to show that the rule is hopeless, rather than proper balanced debate. (If you want more I blogged about this ages ago - http://www.shootuporputup.co.uk/2009/05/18/why-im-a-fan-of-the-nhs/ )

Good luck with the CGMS - it has a few quirks that take some getting used to, but I've had mine for 2 years and wouldn't give it back for the world.