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October 27, 2016
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(Lack of) Money Changes Everything

One of the themes I harp on with respect to type 2 diabetes is that it disproportionately strikes people in lower income brackets, and that people whose racial and ethnic profiles put them at higher risk for type 2 tend to be in those lower income brackets. It's a double-whammy that affects access to diabetes-friendly foods, medication, and even basic medical care.


The irony (or lack thereof) has not been lost on me that I've been through times where, excepting the racial background, this has been my reality. Perhaps more realistically, my periods of living this reality (or something close to it) have made me sensitive to this issue and accentuated my need to champion these voices the silent majority (or perhaps, significant minority) of people with diabetes, people who have been silenced by poverty and family rather than by indifference often to the point of indifference because, "Hey, why should I bother worrying about something I can't change?"


I honestly believe this indifference is distinct from clinical depression, although it can certainly become a factor in clinical depression (as can be the lack of resources to diagnose and treat it).


Now that I finally have some sort of medical insurance again (the past 14 months without being a combination of issues starting with lack of income and ending with a boss who didn't give me access to the tools to indicate I wanted medical insurance until it was too late to opt in), you'd think the first thing I'd do is head to the doctor's office to get my long-expired-and-depleted prescriptions for blood pressure medication and antibiotic (for dental procedures) written and refilled, my A1c checked, and all the appropriate care that I need.


Not so quickly.


First, the insurance plan limits me to four doctor visits a year. This means that quarterly visits must become a thing of the past, until I get a better job with better insurance. Second, there are a number of co-pays and lack of complete coverage, but I don't have a health savings account or flexible spending account to cover them. Third, I have a leftover bill from the doctor that I keep wanting to pay, but after I finish getting some groceries in the house and having to worry about making sure The Other Half has gas money and that the electricity doesn't get shut off, I don't have even the very small amount of money that is that doctor bill, to be able to pay it. And finally, the lab that did my last echocardiogram didn't submit a bill until more than a year had passed since I'd lost the job that had the insurance (and health savings account) to pay for it, so now they've been telling me I owe them more than a week's gross salary, and I know that a repeat diagnostic is in order.


Now, that is all assuming that the current insurance will cover, well, any of my current care. While technically, I've not been treated by a doctor for diabetes in over a year, and the last time I had my blood pressure medication filled was in February, the fact that I write about these issues publicly (on the Internet) can be sufficient for an insurance company to claim a "pre-existing condition" and refuse to cover me for a period ranging from six months to two years from my first claim. (This is all in the small print.) In this hyperconnected world, "due diligence" requires all employers and insurers to do complete Internet and social-media searches on all prospective employees and clients. In other words, once I go back to the doctor, I can still be financially liable for all my medical expenses beyond the basic visit and standard bloodwork for someone without my particular health issues for up to two years.


It is as much the fear of the large expenses as my inability to cover the small ones that keeps me from getting the medical care I need and I am not alone. People like me make up the silent majority of people living with chronic medical conditions, both known and undiagnosed. And regardless of how we tweak, overhaul, discard, or socialize the delivery of medical care, our numbers will continue to grow.


This is the healthcare crisis. This is the root of the costs of "complications of" chronic illnesses. And this is why I cannot remain silent.

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