Why Do We Tolerate Our Broken Health Care System?

January 31, 2022

Summary: A health care journalist describes in detail his fight to get insulin after changing jobs. The story underscores the absurdity and dangers of our healthcare system … and how we need universal and unified coverage, like in all other wealthy countries.

I Write About America’s Absurd Health Care System. Then I Got Caught Up in It.
Kaiser Health News
Jan 25, 2022
By Bram Sable-Smith

I had enough of the hormone that keeps me alive to last 17 days.

In my 10 years living with Type 1 diabetes, I’ve never really struggled to access insulin. But in my job reporting on the people left behind by our country’s absurdly complex health care system, I’ve written about how insulin’s steep cost leads to deadly rationing and about patients protesting to bring those prices down.

For the most part, though, I’ve been spared from the problems I cover. Maybe that’s why I waited over a week to call my new pharmacy in St. Louis, where I recently moved for this job with KHN.

I’d been waiting since September for an appointment with an endocrinologist in St. Louis; the doctor’s office couldn’t get me in until Dec. 23 and wouldn’t handle my prescriptions before then. When I finally called a pharmacy to sort this out, a pharmacist in St. Louis said my new employer-provided insurance wouldn’t cover insulin without something called a prior authorization. I’ve written about these, too. They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment.

Doctors hate them. The American Medical Association has a website outlining proposed changes to the practice, while the insurance industry defends it as protecting patient safety and saving money. It feels like a lot of paperwork to confirm something we already know: Without insulin, I will die.
…

It took 17 days and 20 phone calls. But I know I’m lucky. My insurance really is exceptional, recent events aside. My boss insisted that being alive was part of my job as I spent hours on the phone during the workday. And my job is to be persistent as I puzzle through the labyrinth of U.S. health care.

The time wasted by me, the pharmacists, the nurses and probably some insurance functionaries is astounding and likely both a cause and a symptom of the high cost of medical care. The problem is also much bigger than that.

Insulin is the single most important resource in my life, and this is what I had to do to get it. But I know not everyone has my good fortune. I’ve interviewed the loved ones of people with Type 1 diabetes who could not get insulin, and it’s not hard to imagine how my story could have ended just as tragically.

Comment by: Eagan Kemp

At first glance, this may seem like a simple story about the absurdity of prior authorization. But it is important to take a step back and see that it reflects so many perverse aspects of our health care system. Profit before patients, rising cost of drugs and abuses by pharmaceutical companies, undue burdens imposed on people with chronic conditions and disabilities, the time and mental strain of chasing down every avenue in hopes of staying alive another month, etc. Despite being familiar with the channels of power and influence within health care, this journalist came within hours of running out of life-sustaining insulin. 

While no health care system is perfect, no other comparably wealthy country has such an absurd and dystopian health care system as ours. And our system has amongst the worst health outcomes while also costing far more, per capita, than any other country. 

It is no coincidence that when you allow profit to stand between people and the care they need that many people will fall through the massive cracks, creating unnecessary suffering and death. And corporations are always looking for the next crack that they can profit from. The end of easy profit from surprise is sending private equity and hedge fund vultures after new sources of potential profits. Another glaring example is that hospitals are finding that medical debt to be quite profitable, and so it is no wonder that tens of millions of Americans now have medical debt. Until we end the profit motive in health care through enacting Medicare for All, we can expect the situation to remain dire for tens of millions of Americans. 

Sometimes a simple health care story can reveal so much, and that is what we see with Bram’s narrative above. We must remember that for every heartrending story told, there are millions of Americans silently struggling under the weight of a health care system that would rather bleed them dry than make them well.