Will My Type 1 Diabetic Son Ever Get Insurance Coverage When He Grows Up?

Beth McNamara Health Guide
  • As the healthcare reform debate rages on, we need to think carefully about how to solve the many problems that plague the system. The answers, as we are finding, are neither obvious nor simple.

    We all worry about our kids. My worry-meter kicked up several notches when my son was diagnosed with Type 1 diabetes.  First, I worried about getting him through the first weeks without ending up in the ICU DKA or calling 911 with low-low. Then I worried about his eyes, his kidneys, his feet, and his emotional well-being, amongst a million other things. I even went so far as to worry ahead a half-a-dozen years to college - would his diabetes affect his studies, even if he pulls an all-nighter to pass a final exam. Now one of the key things that keeps me up at night is if he'll ever be able to have access to affordable healthcare once he reaches adulthood.  

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    The renewed discussions regarding reform and the U.S. health care system have given me some hope that this actually may occur. It certainly is not true today. Given the nature of the current system, it can be tough for a Type 1 diabetic to receive health insurance coverage from the third-party insurance providers that currently dictate who gets what care, when, by whom and for how much.

    This was best exemplified at a panel I attended last Friday at the National Press Club hosted by Dr. Val Jones' Better Health Network entitled "Healthcare Reform: Putting Patients First." My stomach plummeted when one of the panelists, Kim McAllister of Emergiblog, told the story of how, as an emergency room RN trying to understand why she is seeing more people in her ER with less coverage, she came to talk to a representative at CareFirst BlueCross BlueShield. McAllister asked this representative if there was anyone that BlueCross would outright deny a policy to. The representative responded, "Insulin-dependent diabetics."  She went on to say that this was an unwritten rule, but followed none the less.

    After that insight, I knew that I wouldn't sleep that night, or probably for a week of nights.

    Shouldn't we consider the health of the American people as one of the key parts of our Nation's critical infrastructure? Shouldn't the insurance providers be prevented from pocketing millions (according to 2007 figures, Ronald A. Williams, Chairman and CEO of Aetna received over $23M in compensation for the year. All this while so many Americans, many with insurance, are devoting more and more of their income to healthcare to cover artificially inflated costs from procedures and medications. Still others must pay out-of-pocket for nearly all costs because they are either un- or underinsured, often denied for a previously existing condition like diabetes. Aren't the country and our GDP built on these very same people?

    As I mentioned above, it appears as if the tides are turning. Consider the latest healthcare reform proposal by the Obama Administration where the government offers a public option for healthcare insurance that ensures no one will be denied coverage due to a pre-existing condition.

  • However, I worry about such an option swinging too far and becoming a single payer government system. I don't think that an overarching solution such as this would be the answer either. Medicare, the system that potentially could serve as a model for a single-payer government system may have its good points, but bad points exist too. Notably, such a system could mean the death of primary care - a key part in a diabetic's medical team. Considering that there is a real shortage of pediatric endos, some diabetics must rely on primary care providers. Yet it is no secret that Medicare reimburses practitioners so poorly for its services that a practitioner could go broke if they accepted too many Medicare patients. Couple this with ongoing fear of being wrongly accused of fraud while trying to serve your patients and also the need to adhere to mountains of regulations, and some docs may just call it quits. If there is a shortage of endos, and a real shortage of primary care docs, where does that leave a diabetic? Or any of us for that matter?

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    Healthcare reform is a must, and soon. But I question if it is wise to rush reform in a weekend, considering the health of our citizens is one of the cornerstones upon which our country is built. Even Congressman Paul Ryan (R WI) who was the keynote speaker at the "Healthcare Reform: Putting Patients First" panel, admitted that he had not read the 1500+ page healthcare reform bill that he had deliberated until 2 am the previous morning. Frankly, who could have read it in such a short time?

    As Americans, we - each and every one of us -- deserve access to quality, affordable healthcare. And we also deserve a healthcare system that has been built on well-thought-out, sage reform and not a last-minute all-nighter.

Published On: July 23, 2009