Thursday, September 15, 2011

is it worth it?

Having money means having the ability to spend it. Having the ability to spend money means having the ability to acquire goods or services. Are we all together here? Within a closed system (that is, there is no more or less money), when an individual or collective has more money, that individual or collective is able to acquire more goods or services. To put it more simply and a way that is much easier to misconstrue, having more money means being able to buy more.

In the field of medicine, having more money means being able to do more research, produce more medication, and maintain and staff expensive equipment. Sports medicine is a perfect example. Because so many people are eager to see a player back in the game, most parties involved are willing to spend exorbitant amounts of money to make that happen. Kevin Everett may not be back on the football field, but he can walk.

Let’s not worry about whether prices are reasonable—money has gone into medicine to such a degree that people can *expect to* recover from severe injuries and illnesses. Many diseases that used to be as life altering as common, like polio, are considered third world. Most Americans who get influenza take some time off work, eat some soup, and move on with their lives as if nothing happened. Infant mortality is less than a third of what it was 50 years ago. As a society, we have shown with our dollars that medical technology is worth paying for.

We would not have these advancements if we didn’t have the money to put toward their development. You want lower premiums, lower copays, and more coverage—a bigger slice of every pie, as it were. The questions are who will pay for these miracles of modern medicine, and who gets to have them.

I’ll be your example, because in most respects I’m of a demographic that a lot of people like. I am a 28 year-old woman. I’m married, and we have a 10 month-old infant. I “work from home” as an artist. I don’t make a lot of money, but I love what I do. My husband has been employed in a skilled trade at the same employer for the past seven years. One of his benefits is health insurance. Like most families who are insured through an employer, we pay only a portion of our premium.

My husband and daughter are healthy enough that they only need regular check-ups. Our insurance plan covers all but $20 for these routine visits.

I have brain damage caused by a series of transient ischemic attacks and possibly a full stroke. These neurological events, as they are called, were caused by a lack of oxygen and possibly a blood clot. I had a 14mm hole in my heart (a patent foramen ovale) that we didn’t know about until significant damage had already been done. The diagnosis for the collection of symptoms I have, including a resting tremor and aphasia, is Parkinsonism.

The –ism is important; my condition is not degenerative. It is, however, chronic, and so it can’t be cured and won’t go away on its own.

Miracles of modern medicine have provided treatments that make people like me able to function almost normally. One medication is the reason I am able to function. Without it, the communication between my brain and body happens slowly enough that several minutes pass before I am able to react to things that I see or hear. I’ve been on it for several years except during my pregnancy and intermittently since February.

My insurance company won’t cover it any more.

UnitedHealth has a bright-line policy against the medication specifically, actually. It was the reason cited for not covering the drug in the first place and the only reason the appeal failed.

Over the course of a year, we pay about $1,000 more on our premium than this one pill per day costs. The retail value of all of my medications is close to $20,000 per year. That number does not include appointments, tests, and other treatments.

I’m young, too. It’s not unreasonable for a mother who had a child before she was thirty to hope to live long enough to see that child graduate from high school. Over the next 18 years, assuming no change in price or dose, my current medication cocktail will cost $355,762.80. Within a matter of a thousand dollars, that money could buy an apartment in the Chelsea neighborhood of New York City or a 2,560 square foot home near the intersection of Santa Monica Boulevard and Hollywood Freeway in Los Angeles-- and you can get a 30-year mortgage for those.

If the insurance company pays it, other people who are insured contribute. If the government pays, then really the taxpayers are the ones paying. If the responsibility is on me to pay, I will bankrupt myself and anyone else who would like to keep me on the anti-epileptic for one more month. So who pays?

Do I deserve it?

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