Pre-existing Conditions and For-Profit Healthcare

My story isn’t particularly dramatic but it is indicative of what’s happened with healthcare in this country over the past 50 years as it has moved from essentially part of the commons to a mostly profit driven enterprise.

In 1971 when I was ten years old I went several weeks not feeling too well. I was lethargic, nauseous, thirsty, constantly urinating, couldn’t get a good night sleep, couldn’t concentrate in school. One night I collapsed and lapsed into a coma. My parents drove me to a hospital where I was diagnosed as having Type 1 Juvenile diabetes.

My father was an attorney in private practice and my mother was his office manager. They had insurance for the family through Blue Cross and Blue Shield. In those days, BC/BS was a non-profit health insurance company that was easily affordable. In fact during those days, the Federal government subsidized non-profit health insurance. Also in those days, medical costs were nowhere near where they are today.

In the days before glucometers and insulin pumps my treatment for my diabetes was daily morning injections of U-80 Lente Insulin. Other than seeing the family doctor every year for a blood check, my parents’ out of pocket costs for the insulin and syringes wasn’t significant and insurance copays for supplies didn’t even exist. It was all out of pocket.

I had several jobs from the time I was 15 until I moved out of my parents’ home when I was 23. However, I did not have my own insurance until I was 25. What is interesting and forgotten by many is that when Ronald Reagan became President in 1980, he successfully eliminated Federal Grants and Loans to Non-Profit Health Insurance. As a result, many plans became “for profit”. Now although I was able to easily afford my insulin and syringes on my take-home pay, I didn’t have insurance to see a doctor for several years. In 1986 I got my first job that offered Health Insurance. I figured I would go ahead and make an appointment to see a doctor, only to find out that my plan wouldn’t cover that visit for six months because I had a “pre-existing condition.” I also found out that if I were to have gotten seriously ill during those first six months, my plan wouldn’t cover any of it. That plan was Blue Cross/Blue Shield.

Over the years, things changed slowly with healthcare and health insurance costs. Not only did the cost of medications and supplies increased, so did the cost of overall healthcare. The increases were incremental and almost unnoticeable.  As the years went by my payroll deduction for health insurance increased, the costs of getting my insulin and supplies increased and at some point insurance copays for pharmaceuticals entered into the equation. Big Pharma increased the costs of their medication to fund what they said was research. They failed to mention that the Federal Government, through research Grants, funded much of their research. In reality, they were increasing the costs of their products to increase their profit margins for their stockholders and CEO’s.

Now it is true that there have been major advances in medicine over the past 50 years. For diabetics like myself, we now have glucometers that better determine blood sugar levels, we have insulin pumps that mimic the how the pancreas delivers insulin throughout the day, we have insulins that work far better, but the costs have skyrocketed too. Without insurance, just buying a bottle of Novolog will cost you $538 a bottle, added to that a long lasting insulin like Lantus that costs $385 a bottle.

Type 1 diabetes isn’t caused by living a poor lifestyle, it is a genetic disorder from birth. For anyone with diabetes or any other chronic disease to survive in today’s world and be productive it’s very expensive, especially without insurance. I’m currently on a pump and see an endocrinologist every four months to monitor my health. At 56, I’m actually in fairly good health and my condition is under control. I cycle and run weekly, I recently retired from my job after 30 years and I’m now on my wife’s insurance plan. Thanks to the Obamacare insurance mandates, there was no six month waiting period before insurance would kick in. However, even with insurance, my out of pocket costs to treat my diabetes with insulin, testing and pump supplies is well over $400.00 a month, and that is low compared to many. If not for insurance and coverage for pre-existing conditions I wouldn’t be able to afford to live. That is a fact for me and most others suffering from diabetes, asthma, cancer, heart disease, etc.

In 1981, 88% of our nation’s HMOs were non-profit. In 1986 that number fell to 41%. By 2000, they were nearly non-existent. Because of this there was a push to improve the healthcare system. I honestly felt that Obamacare didn’t go far enough. It should have included a single-payer option like the rest of the world and even Candidate Donald Trump himself said single payer like they have in “Canada and Scotland” is the best kind of coverage. After the House approved “Trumpcare” (which if it becomes law, not only brings back exclusions or higher premiums for pre-existing conditions, it also brings back lifetime caps on coverage) he said Australia’s single payer system is better than our system.

So if you have a lifetime chronic health condition, insurance can end your coverage and life at the same time. Another problem with Obamacare was that it did nothing to reign in the cost of medical care in the first place, no price controls beyond requiring insurance companies to devote 80% of your premiums to actual healthcare instead of profit.

Now like 61% of the nation in recent polling, I’m with those who prefer fixes to Obamacare, not repeal and replace. Trumpcare has only 17% approval. Trumpcare is so unpopular, the House Republicans exempted themselves and their staff from Obamacare repeal. That says a lot.

Conservatively over 52 million Americans have a pre-existing condition. Most of those conditions are derived from issues they had no control over like genetic predisposition to diabetes, heart disease, cancer, asthma. Trumpcare actually lists rape as a pre-existing condition. This gives for profit insurance companies license to either deny service to these people or raise premium costs to offset the expense of care and thus, improve their profits. Money from Obamacare to subsidize coverage came in part from a $300 billion tax of the top 2% of Americans. Trumpcare eliminates that tax. Without insurance provided today by Obamacare, 50,000 Americans a year will die from not receiving proper care. Are the lives of 50,000 innocent Americans worth giving the wealthiest Americans another tax break?

The wealthiest Americans have no need for insurance because with the millions and billions they have, they can pay out of pocket rising healthcare costs. The rest of us in the lower 98% aren’t so lucky. Medical costs will continue to increase and those with pre-existing conditions will continue to exist because even if you die from lack of care, several more will take your place due to issues beyond their control.

If we are to be a humane and just nation that places a high value on life over the profits of a lucky few, we need to impose single payer coverage and we need to look at ways of cutting excessive profits to the healthcare industry. It is the only logical, fiscally responsible and moral thing to do.