Enablers

#1

I put this in the T2 category because that’s what I am, T2, but it could go anywhere.

I was thinking about the high cost of health care and it struck me that we, everyone, diabetic and non diabetic are unknowingly enablers. No one does it intentionally but we do it, we play a corrupt system to get what we must have.

Of course the system plays us back and they are much better at it. Let me give an example. Besides diabetes I also have sleep apnea, a condition that also requires on going supplies. One thing that must be replaced on a regular basis is the mask that is worn at night. I can buy this mask from my sleep clinic and pay out the deductible or I can go to Amazon and buy it straight out for the same cost as the deductible. If I buy from the clinic I enabled the clinic to overcharge my insurance. I don’t like the insurance monsters any more than the next person but I’m smart enough to realize that insurance does not absorb the overcharge, they pass it on. I buy online because I do not wish to enable.

How do you feel about this, do you sometimes feel like you are an enabler? Is the system stacked so we must enable them?

2 Likes
#2

The deductable and max out of pocket make it challenging to optimize what is lowest cost until you get to year end.
In this example, you could pay same price oop. But if at year end, you had met max oop with qualified costs, you end up paying more in total. (Max oop plus what you paid to AZ. )

And if you use a plan to use tax-advantaged funds, theres another difference in “true cost”. AZ paid with after tax $.

#3

Your only consideration should be in spending the least money overall. If adding to your deductible for the year helps, then do that. If it is cheaper online, and your deductible is not a factor, do that.

I think paying for your health insurance but not using it does not teach them a lesson!

If you are going to buy online frequently, get a policy that costs less and has a higher deductible.

Also, get a flex-spending account if you can with your job, so you are not paying taxes on that online prescription stuff. As long as you have a prescription, you can use flex money for anything like that.

#4

You can use flex account even without an rx can’t you? Used to be able to years ago anyway

#5

I don’t really use my insurance much, I think my total out of pocket including Medicare Premimiuns and drugs were around $2400.

This week we filed for my late ex wife for her finale year including cancer treatments, surgeries, chemo, rehab, a pretty rough year, her out of pocket was around $8000 undermedicare including gap coverage. /she had state college professor health insurance and gap insurance, plus extended care and hospice.

So I guess it is really interesting, it seems you pay a good amount for not much service,
For general stuff.

But a catastrophe seems to be covered.

I have had small business type coverage or individual policies most of my life.

My brother in law has never paid a dime out of pocket for any medical, drugs eyeglasses surgery etc, while work or retired from General Motors Nice if you can find it,

#6

I tried that last year and it was denied because I did not have a prescription, even though it was a qualified medical item.

So I had to “retro-fit” a prescription so I could apply flex funds for the item. The doctor simply wrote a script for me and back-dated it to the date of purchase.

But in my experience, if you don’t have a script, it becomes a hassle with flex accounts.

#7

We, as individual patients, are tiny players in a very large ecosystem. The big decisions that influence insurance coverage and the overall funding of health care are made by the big money players.

Our role, as rational actors in a system that someone else designed, contains a little wiggle room for us to maximize our economic interest. I think our actions have little to no influence on the medical funding infrastructure we live under.

No, I don’t think we are responsible for enabling the big money rip-off by the much larger players. They make the rules and pretty much control how the system works. It’s our job to do what’s best for us. Our system (US) cries out for reform but our puny roles don’t influence the overall system much.

Do you know how we are enabling the system? Our continued adherence to a diet rich in processed foods and simple carbohydrates. It’s the favored consumption of a high carb and high fat diet, the so-called Standard American Diet (SAD).

If people with diabetes all ate real foods (foods without an ingredient list) and avoided processed foods, we’d see an immediate and influential effect on the quantity of insulin and other pills used. But that’s a radical and pipe-dream idea. People just don’t like anyone messing with their diet – it’s a basic fact of human nature.

3 Likes
#8

I totally agree with your premise as a rule, although there are always exceptions. As a side note, the body has an absolutely amazing ability to adapt to most anything we put into it, within reason. I spend a lot of time in China, where a large part of the population considers McDonalds gourmet food, where the smog is so thick in the northern industrial towns that weeks go by you can barely see your hand in front of your face. Not only is the air totally polluted, but so is the water where they get their fish and the entire environment in general. As a rule, they smoke and drink and deal with poison in their foods daily from bad recycled oils to other toxins. They often get bad counterfeit medicine. All this junk is being poured into their body (and ours when we travel there) 24/7 and the life expectance in China is currently 76.4 years vs 78.6 in the US. Only about a 2 year difference – Simply amazing.

#9

I see this as a testament to the inherent resiliency of the human organism. Another factor that might apply here is the multi-generational role that genetics play. As the environment stimulates a human biological response, that’s described as epigenetics. That’s the expression of the genes in response to environmental cues.

I’ve seen some ideas posited that these environmental cues and the epigenetic response cause changes to the genes passed down from one generation to the next. In the US the current standard American diet has been in place for a few generations. I suspect that the explosion of T2D and obesity is likely caused by the accumulated gene expressions passed down from one generation to another.

What I’m trying to say is that these environmental insults can take some time to make their effect felt. The Chinese are a generation or two behind in their consumption of the standard American diet. Perhaps the longevity effects of this dietary change will lag for a generation or two.

2 Likes
#10

We may soon find out. 40 years ago you could not find an overweight individual in China. Today 35%+ students in elementary and middle schools are obese, especially in the cities due to rising incomes and middle class population.

#11

The export of the standard American diet is not one of our better ideas. Its legacy has more in common with a debilitating illicit drug. I can only hope that better thinking will prevail over the long-term. I don’t think I will live long enough to see that change but hope I’m wrong!

#12

I am always amazed by these kinds of statistics. Although very true, I am sometimes angered when I compare all we have to do to stay healthy. I feel the same anger when I see people live to 85 or 90 when they have broken every health rule everybody is supposed to follow. I am not angry at the individual, but the unfairness of it all. I definitely realize that life is not fair.

1 Like
#13

I planned to visit my 97 year old mother this week in the Boston area and she said visit needs to be postponed because she and her friends are putting together a large celebration, out of town, for Barbara, a chain smoker, who is turning 100 this week. Go figure.:roll_eyes:

#14

Yep, go figure!

#15

I’m not quite sure how this made its way into this topic. Maybe you misunderstand my premise. My rant, perhaps a poorly conceived one, is that we are being played in the worse kind of way. We must play these distasteful games, its just that every now and then I would like to beat the system.

The poor diet while it may be a sad affair is not the source of the problem. Even if everyone ate perfectly there would still be the big medical complex creating rules to serve themselves although with slightly fewer victims.

2 Likes
#16

I see thousands and maybe millions of people out there who are living longer and better lives, by the research and development of a new procedure, or medications. there are many out their (including T1’s) who are hoping to be included in the success story.
I don ‘t feel so used by the system.

1 Like
#17

Just my thoughts: I have three points to make.

  1. The diabetes community has a really bad or non existent marketing campaign. It takes marketing to get support.
    I have done a run supporting ALS for a couple of years. ALS to me is really awful and hopeless . No one really talked about it. But then came the ice bucket test. Now everyone is is talking about it. No one is talking about T1 or even knows what it is.
  2. Everyone is talking about T2. I was in Ohio last week on family matters. Let’s just say it I was difficult to wrap my mind around how obese and sedentary the population is. This is not politically correct., but a significant portion of the people shopping in the grocery store were as wide as their carts. I know not all are T2’s but that seems to be what people believe. Eventually smoking was considered bad, obesity is too.
  3. Type 1 and 2’s dont work jointly for any goal, common or not.
    As a t2 (I am thin enough to pass as a T1) i won’t go to any function with a lot of T1, it is not fun to be belittled.

Base line, my opinion. The “community”, if there is one, needs to step up and define itself.
My thoughts

3 Likes
#18

Agreed. And a lot of this goes back to the social stigma associated with type 2… which is unfortunate on many levels

#19

I like to shop outside the insurance racket every chance I get just for this reason. I buy 3 month supplies of test strips online for $45 instead of paying the $75 copay for my PBM’s “preferred” brand.

1 Like
#20

I buy US list price $8000 of Humalog and Lantus insulin at a time in Canada for USD $790 which is far lower than my Medicare Part D copays and has kept me out of the donut hole.

1 Like