I've turned into little more than a lurker on DailyKos over the past six months. As those of you who know me are aware, I have been coping with a chronic illness of my own for some time, and since my mother suffered a stroke in November, I have been caring for her as well. The experience has made me even more committed than before to guaranteed healthcare for all -- publicly funded and privately delivered -- and even more outraged by Republican talking points designed to mislead the public into believing that such a plan could possibly introduce more bureaucracy and less patient and physician choice into our healthcare system which is already typified by both.
In fact, such blatant propagandizing when lives and the country's wellbeing are at stake should be enough to induce nausea, or at least sicken the heart of thinking Americans. But, unsatisfied with provoking mere psychic malaise, a claims examiner at my insurance carrier made a decision that he knew was likely to cause me further illness and injury before his company would cough up the bucks for medication appropriately and thoughtfully prescribed by my physician.
For several years, I have been suffering from ideopathic osteoporosis -- rare in middle aged men, but less rare than commonly thought. It has reached the point where my spine is collapsing under its own weight, as my vertebrae, some of which are the consistency of chalk, spontaneously fracture. The result has been learning to live with chronic pain and reduced activity -- sacrificing many of the pursuits which had been most precious to me, and paying a heavy price to retain others. I am acutely aware that my suffering pales in comparison to others more seriously ill and disabled, but it has been a struggle at times nonetheless. I am also aware that I am luckier than many in this country, as I do have some medical insurance, albeit sufficiently inadequate to rank me among the underinsured. I cannot keep up with my medical expenses, given the high premiums, deductibles and co-pays, and without the resources of my family, I would have been forced into "medical bankruptcy" long ago.
But recently my primary care physician referred me to two specialists for evaluation of my case -- an endocrinologist and a physician board certified in physical medicine and rehabilitation. Although my x-rays and bone density tests were even more bleak than a year ago, they recommended a course of treatment which actually provides some hope for decreased pain levels and increased mobility. Hope. That's very important, since I have had to work at keeping a healthy attitude when each doctor's visit has resulted in more of the same -- increasing the pain meds.
My doctors concur that without agressive intervention I am facing life in a wheelchair in three to five years. They also agree on a two-fold regimen -- a surgical procedure to repair my broken vertebrae (balloon kyphoplasty), and an injectable medication to prevent further deterioration of my bones, and even rebuild some bone density.
The endocrinologist evaluated various medications available for osteoporosis based on my condition and past medical history and ruled out all of them but one for specific medical reasons. In fact, the particulars of my case included contraindications for most of them, some of them dangerous. In his best medical judgment he selected Forteo, an admittedly expensive regimen (about a thousand bucks a month for a course of two to three years), but one which is a near perfect fit to my condition. This opinion was backed up by that of the other medical professionals involved in my care, with whom he worked in close consultation, one of whom has been treating me for seven years, and is very fluent in my medical history.
But, despite these opinions and the medical documentation provided him, an employee of my insurance company disagreed. He declined benefits for the medication, and rejected a formal request for reconsideration. His decision trumped that of my doctors, and contradicted my documented contraindications. Even after two of my physicians explained exactly why it was a cheaper drug was not only unlikely to work as well, but could be dangerous for me to take in conjunction with other medications I'm on and other conditions I have, he dismissed these concerns as "speculative" and insisted no benefits would be available for the Forteo until I tried the other medication. Essentially, a low-level office clerk was prescribing a dangerous drug for me against the advice of my doctors.
I need my medicine. So, yesterday my doctor phoned in the prescription the insurance company demanded. Today, I took it, and spent over an hour throwing up. The good news is that the nausea is abating, I called my doctor, who in turn called the insurance company. Having jumped through their hoops, they are now authorizing the medication my doctors originally recommended and prescribed. I'll come up with the co-pays somehow.
This is after spending literally months fighting my mother's long-term care carrier for her needed benefits. That I am having such difficulties as a member of the underinsured class is unremarkable. But, my mother's circumstance is the precise opposite -- she has been paying steep premiums for the Cadillac of private insurance for decades. Now that she needs the protection that expense was to provide, it was revealed to be little more than an illusion.
Again, in each of our cases, we will ultimately get the care we need, unlike many Americans who need it just as badly or more, and who cannot afford even my meager coverage, and certainly not hers. Or who don't have the resources to fight for the coverage they've already paid for.
So, when I hear the likes of John Boehner touting Republican concerns for protecting our healthcare system from bureaucratic decisions... well, it's time to reach for an emesis basin again.
So, I risk appearing to be seeking sympathy by telling this story, as often as I can, so people can see that guaranteed healthcare for all Americans, publicly funded and privately delivered, doesn't threaten our healthcare system with bureaucracy. On the contrary, it's our best hope of freeing ourselves from the bureaucracy that is already in place to maximize profits of the insurance industry.
Obligatory "Wow!" Update: Yep, I've been here for what seems like forever (although I missed the fabled first primary season wars), and this is my first time on the Rec list. Heck, I was ecstatic when one of my diaries got rescued! But I am especially thankful for all of the caring and moral support expressed in the comments. I didn't realize how much that would mean to me, and as great as it is to see my nick on a Rec'd diary, that personal support means much more. As I mentioned in one of my own comments, my mother is exceeding expectations with her recovery. So much so, that I've returned home -- only a few blocks away -- and am now just spending a few hours with her in the morning, and again in the evening. Now that her longterm care policy has kicked in, an aide comes in daily to help her with much of what I was doing previously -- and she is able to do more for herself. As for me, my local Walgreens has ordered my medicine, and I hope to pick it up tomorrow or Monday, and I'll be seeing the doctor next week, at which time we'll be scheduling my procedure. It was a rough morning, but the day is looking brighter.
Update by request: It has been requested by a commenter that I mention the fact that the SEIU ad is a paid key-word advertisement. I did not place it there, nor have I yet clicked through to see what it is about.