American Healthcare: An Increasingly Worrisome Problem for Diabetics

 American Healthcare: An Increasingly Worrisome Problem for Diabetics

In 1923, Frederick Banting discovered insulin- a hormone that most bodies produce naturally to decrease blood sugar, but for diabetics, they rely on prescriptions and injections to maintain proper sugar levels. Banting didn’t want to profit from this life saving find, as he thought it would be unethical. He and his co-inventors decided to sell the insulin patent to the University of Toronto for $1 so everyone who needed it would have access. So why is it that just under 100 years later, people are suffering and dying because they cannot afford this treatment? 

In America, it is a widely known fact that most prescriptions, for diabetics or not, are astronomically expensive. Most rely on health insurance provided by their job to decrease the bill or cover medications or appointments they need, such as dental care or glasses. A health insurance company, Fidelis, provides their clients the ability to write off a new pair of exercise sneakers every year, but diabetics are still left with thousands of dollars in bills. For example, the insulin “Humalog” is about $300 a vial. Patients with type one diabetes usually average between 2-3 vials a month, and are left with a large sum. Even with insurance, patients and their families are usually left with a decent copay, not including other supplies such as needles, insulin pumps, sensors, excetera. Unfortunately, not known to many people outside the diabetic community, this substantial monthly cost leaves some to ration their insulin, skip doses, or not have any to use. The website “GoFundMe” is filled with thousands of posts of people begging for financial help with insulin and supplies, (Stanley, Ppar. 17). According to an article by NBC News, in 2019 there were at least 4 reported deaths due to insulin rationing, (Popken, Par. 3). While this number may seem small, it is important to note that those were just reported deaths, and there are likely many more that weren’t listed in relation to insulin or diabetes, and had another reported cause. Rationing insulin causes higher blood sugar numbers, and deteriorates your health, and it is important that people have access to these treatments. 

Health insurance coverage itself is an ongoing debate. In a class discussion, there was a point that really resonated with the topic- “Our healthcare system helps you when you’re sick, not to stay well.” The United States does not offer universal healthcare to all of their citizens, and 27.5 million people do not have health insurance, which is about 8.5% of the United States population, (ProCon, pPar. 1). While there are government programs such as Medicare and Medicaid, these often have poor coverage for their clients. Many countries, such as ones in Europe, offer healthcare to their citizens. If the United States were to follow suit, what would be the consequences? In an article by Britannica’s ProCon.org, they make a point that in European countries, the cost of coverage is covered by taxes. In the United Kingdom and some other countries, payroll taxes average 37%, which is more than double the United States’ 15.3% payroll tax, (ProCon, section 5). Theoretically, this could cause financial problems for many people, especially if they don’t have a great paying job. If taxes double, the amount of income people would have to pay other bills/expenses would decrease, which could cause suffering. Another important concept to note is resources, time, and providers. If the United States begins a universal system, the demand for tests, appointments, treatments, and healthcare workers will skyrocket. It is likely that people would begin to overuse the resources they’re provided, and the government could potentially ration those. More appointments means more medical professionals required which, according to ProCon.org, would result in a decrease in the annual salary of doctors, (ProCon, section 6-10).

In writer Joshua Cohen’s article on Forbes.com, “Insulin’s Out-Of-Pocket Cost Burden To Diabetic Patients Continues To Rise Despite Reduced Net Costs To PBMs.”, published in 2021, he addresses the topic of insulin costs and argues that costs continue to rise despite some efforts to lower prices. He supports this claim by discussing costs, and then looking at the issue from a business standpoint. He also touches on what changes have been made, such as small, ultimately not entirely successful, efforts by the Trump administration. Cohen’s purpose is to have you see the issue from both the businessperson and patient point of view in order to educate the reader and have them fully understand the situation. He also gives an informative tone, primarily sticking to facts and statistics as opposed to patient stories, for the audience of Forbes and others interested in the topic of the insulin crisis in order for them to create their own opinions. I think his article is very important in addressing the issue from an unbiased perspective. He discusses how even when net profits of insulin to PBM’s, or pharmacy benefit managers, have decreased over the years, many of these savings have not been passed through to the patients, (Cohen, Par 2). His article definitely makes the reader think, what reasonable changes need to be made? The Trump administration, besides former president Trump’s distasteful claims about insulin being “cheap like water”, made efforts to lower the out of pocket costs for some. He imposed a limit on what senior citizens pay at the counter, and also made an executive order for the 340B program to encourage lower costs on insulin and epinephrine products, but few hospitals and organizations are a part of this program so the outcome wasn’t as great as expected. Cohen stresses that this isn’t an easy fix, and will require a well thought out, multi-step approach. The consequences in the end may greatly outweigh the overall positive concept of universal healthcare.

In journalist Tiffany Stanley’s piece for The Washington Post, “Life, Death and Insulin.”, published in 2019, she addresses the severity of insulin costs and the effect it has on patients and their families. She argues that change needs to happen. She supports this claim by telling the story of Alec Raeshawn Smith; from his diagnosis to his unfortunate death, and what his family went through. Stanley’s purpose is to show how consequential not having enough, or any insulin can be, in order to encourage readers and society to change their opinions on reforming some of the healthcare system. She adopts a sympathetic tone for her audience, the readers of The Washington Post, and others interested in the topic of healthcare and issues occurring with insulin and diabetics nationwide. Stanley uses the concept of ethos to engage sympathy in readers, and highlights how serious this issue is, not only for diabetics, but for their families and support systems. When talking about Alec’s story, she also shares his family’s side after his death, and how he never let on that he was struggling because he didn’t want them to worry about the expense. While his death cannot be 100% determined as a result of his rationing, it is more than likely. He also vented to friends who tried to help, but in the end, it just wasn’t enough, which is heart wrenching. The toll that these expenses have on diabetics and loved ones alike is simply appalling. 

When it comes down to it, it’s easy to see the obvious pros and cons of the issue at hand. My stance on the issue is that change needs to be made, if not universally, than enough to help those that are suffering. People should not be dying or suffering because they do not have better access to a basic necessity for those with diabetes. While universal healthcare may be hard at first, I think that the long term benefits outweigh the problems we would need to get through as a country in order for this to be successful. This issue will only continue to worsen, which is why actions need to be taken as soon as possible.