Our Conscience, Our Healthcare
I have multiple myeloma, an incurable cancer of the plasma cells in my blood. More and more, researchers are discovering ways to manage it as a chronic disease with drugs and stem cell transplants. But, staying alive does not come cheap.
On one of the myeloma blogs I read, there was an entry titled, “The High Cost of Staying Alive.” The subject was a drug commonly prescribed for patients with multiple myeloma, thalidomide. In the article, the writer questioned its exorbitant monthly cost. He alleged that the drug’s manufacturer discriminated against myeloma patients due to their limited options. Evidently, the cost accelerated over 800% between 2000-2005.
I don’t have enough information to judge whether the writer correctly exposed ethical shenanigans by the pharmaceutical company. I do know that my health insurance protected me from bankruptcy as well as cancer.
I used thalidomide for six months prior to a stem cell transplant. The list price was $4,800 for a 28-day supply. With my mail order prescription drug plan, I paid a nominal fee. It’s easy to scoff at enormous expenses when you’re using someone else’s money.
The extraordinary price of my healthcare only began with that drug therapy. Part of my consult with the cancer clinic about my transplant included a mandatory meeting with one of their financial representatives. Bluntly, the rep pegged the cost at $237,000. Patients must either have proof of coverage or pay up front. Without insurance, it’s time for a second mortgage or, perhaps, a lottery ticket.
I spent 3 1/2 months receiving care during the transplant phase. I underwent numerous preparatory procedures. I participated in a pre-transplant protocol requiring chemotherapy coupled with the harvest of my stem cells. During that period I contracted pneumonia requiring hospitalization for five days.
I scrutinized the hospital’s four pages of itemized billing. Just getting in the door costs $4,494.00 per day. Then each procedure and pharmaceutical added to the expense. For example, I paid as little as 0.87 cents for a daily multi-vitamin and as much as $965.34 for a shot of filgrastim, a stimulant to encourage stem cell proliferation. The total price of those five days: $41,916.25. You begin to see how that original quarter of a million dollar estimate plays out.
I’m not complaining or disputing the charges. My insurance covered nearly everything. My plan is a middle of the road Blue Cross/Blue Shield variety. It is one of several plans available to federal employees, including legislators. The plan works and, thanks to it, I am recovering from a complicated, lengthy treatment for blood cancer.
Having health insurance has not made me smug in a ‘have versus have not’ sort of way. As medical consumers, we must talk about the money. What others lack and I enjoy are not zero sum situations. Furthermore, social taboos about discussing what life costs lead to passive behavior. This enables sketchy ethics, arousing justifiable rage from the likes of the author I mentioned at the beginning of this diary.
So, what about the huge cost of healthcare; is it worth it? Certainly, the financial jeopardy can be as daunting as the disease, though that didn’t factor into my decisions. For me it was a bargain. Technically speaking, my insurance made me immune to the threat.
Still, my perspective matured as I trudged back and forth through the cancer clinic for those few months. I watched other families make agonizing choices, weighing the value of their lives against the risk of financial ruin. Would I have bought that prescription if I’d had to pay out of pocket? Would I have chanced bankrupting my family on a transplant with no guarantees? Seriously, at my age of 62, I doubt it.
Our country is about to engage in a discourse on universal health insurance. Among the questions to be answered is whether we consider empathy for one another a shared responsibility or a product to buy and sell. Ideology, lobbying, and serial skeptics discouraged us from conducting this conversation in year’s past. But the reluctance to change shrinks along with the underlying security of our economy. Suddenly, it’s not easy to obtain that second mortgage.
The juxtaposition of federal bailouts with newfound “Yes, we can,” idealism may motivate us, at last, to find a cure for the high cost of staying alive. I may even live long enough to see it.