Award and Medicare

Well, I’ve had a couple of good days. First was the email Thursday that Tourist Trap was a finalist in the Reader Views Literary Awards. Yes, that’s the same one Homecoming received last year.

Then I got a phone call from the clinic saying the box of replacement sets had arrived, and I picked them up Friday, thus ending a very nervous couple of weeks.

Replacement sets?

The other end of that plastic cord feeds into me.

I use an insulin pump. It’s about the size of a small stack of business cards, and it normally lives in my pocket. It contains a reservoir of insulin, which theoretically should be changed every three days. (I normally average about six, because that’s how long a full reservoir lasts me, and I have yet to see any drop in effectiveness after six days at body temperature.) The pump gradually pushes that insulin out very fine tubing a couple of feet long to a set, which is fastened to my body by a piece of adhesive and has a fine Teflon cannula piercing my skin and delivering insulin into the subcutaneous tissue. The set has a needle which is used to insert the cannula under the skin, and is then removed. The set has to be changed every three days – any longer than that in the skin, and scar tissue starts to build up and insulin no longer gets through. These sets are not reusable; in fact they become medical waste.

I’m lucky to have very good supplemental insurance as well as Medicare, and every 3 months I get shipped 30 sets. A couple of weeks ago the shipping company called me to check how many sets I had.

“Two. When are you going to ship them?”

“We did, a couple of weeks ago.”

I have them ship to my doctor’s office, because in my experience mail order pharmacies never adequately package temperature-sensitive medications being shipped to regions where 40-below temperatures are common, and in some shipments I get continuous glucose sensors which must not be frozen. So I called the clinic, which usually calls me when a package arrives for me.

They couldn’t find the box.

By that time the pharmacy was closed, so when I called back the next morning I got the details of the shipment. They insisted it had been signed for at the clinic and gave me the exact time and date of delivery.

I called the clinic back. I think it took about a day before they finally said that yes, they had received the box. The person who signed for it remembered it. So did several staff members. But they couldn’t find it, and they’d looked everywhere. They said they’d call the mail-order pharmacy back and pay for a replacement shipment. (This is stuff no local pharmacy carries.)

The mail order pharmacy said that Medicare rules did not allow them to send out a replacement shipment – never mind that it was the clinic, not me, that verified I had never received the sets that are essential to my life, or that the clinic was willing to pay for the replacement shipment.

The clinic combed the offices of the doctors that treat diabetes, and managed to come up with a few sets to tide me over. They also called the pump (and set) manufacturer. The manufacturer FedExed me a few more sets. Finally, Thursday, the clinic called and said they had the sets from the manufacturer, and I picked them up yesterday.

I realize that Medicare does have a huge fraud problem. But in this case the clinic was offering to pay for the lost shipment, so what kind of fraud did they think was involved? It’s not as if the sets were valuable to anyone else, but they are life or death to me.

Three Approaches to Health Care

There are three ways of approaching less than optimal health: prevention, treatment and cure. All have their strong and weak points; all are political hot cakes at the moment.

I think most individuals and societies would agree that the best solution is to stay in good health. It is also a solution that is not always possible. It is, however, the approach that is responsible for the dramatic drop in childhood death in developed countries.

Prevention measures are generally lumped as public health. Clean drinking water, proper sewage disposal, nutritious food, clean air and immunizations all fall into this category. So do measures intended to reduce accidental injury or death (such as seat belts) and those encouraging a healthier life style. Prevention would also include such highly controversial measures as not passing on genes known to have a deleterious effect on health.

In general prevention measures are good for the population, but affect individual choice. They may also affect the bottom line of corporations with a great influence on public policy, such as the food industry.

Some of what I need for treatment of diabetes. I want a cure!

By treatment I refer to ongoing treatment — the pill (or shot) for everything or treatments such as dialysis which must be repeated regularly for the life of the patient. Certainly it is better to have a treatment than not! I am alive today thanks to insulin. But treatment is generally expensive and is often lifelong. Further, treatment of this sort almost always has undesirable side effects. In my case, insulin can produce hypoglycemia which can kill. It should be noted that some “cures,” such as organ transplants, may then produce a condition in which lifelong treatment (anti-rejection drugs) is needed.

A cure implies a return to normal health. In some cases (such as the common cold) a cure is mainly a matter of time, with supporting treatment to prevent secondary infections or ease symptoms. Some cancers are curable with surgery, especially if caught early. Broken bones or other traumatic injuries can often be cured, especially in the young. A number of conditions, however, have no cure. Research on cures is ongoing, but the profit from a true cure is usually not as great as from lifelong treatment. Given that most health research today is profit-driven, research on cures tends to take a back seat to research on treatments.

I’ll probably return to this in the future, looking at one of the three approaches at a time. For right now, how would you order the importance of the three approaches?

Health

One of the things I blog about is health and health care. Here are links to posts on this topic. This post will be linked from the Index page, and I will add new posts as they go live.

General
A Pain in the Back 8/12/11
Pain Gel 10/1/11
The Cost of Health Care 10/8/22
Cranberry Recipes 11/24/11
Three Approaches to Health Care 1/21/12
Vitamin D 10/4/12

Cancer
Breast Cancer part 1 2/12/11
Breast Cancer Part 2 2/19/11
Breast Cancer 3: Mammograms 2/27/11
Radiation Therapy for Breast Cancer 3/12/11
Chemotherapy and Quilts 8/6/13
A Chemotherapy Fashion Show 8/15/13
Chemo, Hair Loss and Wig 8/22/13
Happy News: CT Scan 9/24/13
A to Z Reflections 5/8/14
Cancer Survivor 6/14/14
More cancer 10/6/14

Diabetes
Insulin Pumps 5/20/10
Cataract Surgery Complications 1/29/11
Diabetes and Blood Sugar 2/5/11
Complications of Diabetes 5/27/11
Diabetes: What’s in a Name 7/15/11
Conversation Piece (fiction) 10/20/11
Measuring Blood Sugar 11/12/11
Your Mileage May Vary 11/26/11
Continuous Glucose Monitors 12/3/11
Award and Medicare 3/3/12
Meals With Diabetes 5/19/12
Diet Sleuth: A Useful Meal Planning Tool 5/26/12

The Cost of Health Care

Why is health care growing steadily more expensive?

Well, there are quite a lot of reasons. But the most obvious to me, the elephant in the room (and I’d don’t mean the GOP elephant) is something never mentioned by politicians. What’s more, we all cheer it on.

I mean the advances in medical science.

Face it. One of the man reasons medicine is costing more and more is simply that doctors can do more and more.

Take my own case. A century ago, I would have died before getting my Ph.D., and the most a doctor could have done was tell me that I had diabetes and it would kill me, painfully, probably within a year if not a few weeks. Oh, my life could have been somewhat extended by a starvation diet, but I wouldn’t have lived long, and I probably would not have stacked up much medical cost.

42 years ago, when I was diagnosed as having diabetes, there was a treatment, insulin. It was cheap—a slaughterhouse byproduct. Hypodermics were glass, and my fingertips were often scalded because those glass syringes had to be taken apart and boiled before each use. Blood sugar tests? Those were carried out in a laboratory, and took several hours. Urine tests were available, but it didn’t take me long to realize that I could have urine sugar so high the tests would scarcely read it while I had every physical symptom of blood sugar so low I almost passed out. The medicine of the time kept me alive, but my diabetes was not exactly well controlled. Probably my eye problems today can be traced in part to this poor control.

Since then I have gladly discarded the glass syringes for disposable plastic, swapped beef-pork insulin for genetically engineered (and much more expensive) human insulin, learned to test my blood sugar with a finger prick, begun using artificial insulins genetically engineered to act faster and slower than human insulin, started using an insulin pump, and added a continuous blood sugar monitor. My diabetes is under far better control, and in fact my blood sugar is usually within the normal range. Thank goodness I have good insurance, because all of this is appallingly expensive.

Diabetes is by no means the only disease to see this kind of improvement in care at an increase in cost. Many cancers that were once fatal or “curable” only by gross mutilation can now be treated with far less invasive surgery, drugs and radiation. More and more conditions that were once a death sentence can be treated, even if few can be really cured.

And as one result, medical costs have skyrocketed. People for whom nothing could be done are now treatable.

Greater possibilities are not the only reason medical costs have climbed, and I’ll touch on some of the others later. But we have to recognize that at least part of the cost increase is simply because doctors can do something other than just tell a patient, “You’re going to die soon.”