My blood (sugar) is boiling

For those who do not know, I am – and have been since I was 10 years old – a type 1 insulin dependent diabetic.

Diabetes – very simply described – occurs when glucose in the blood becomes too high, as a result of the diabetic’s cells not consuming the glucose (for energy) at an adequate rate of speed. To consume glucose (remove it from the blood and use it for energy), cells need insulin. In essence, insulin is the key used to unlock the cell, which in turn allows the glucose to leave the blood, enter the cell, and be consumed for energy.

There exist two “types” of diabetes: Type 1 and Type 2. The only thing these two types of diabetes have in common are – as already described – an excess amount of glucose in the blood. The cause for this excess glucose, however, differs depending upon the type of diabetes involved.

Type 2 diabetes (once called “adult onset”), occurs when a person’s body cannot control the glucose (basic sugars) in their blood because either (or both) their pancreas is not producing enough insulin to control the glucose being consumed (reduced insulin production), or their cells are not utilizing the insulin effectively (reduced insulin sensitivity). Either or both of these conditions can lead to Type 2 diabetes. This is by far the more common, and better known, type of diabetes. It is the diabetes associated with pregnancy (gestational diabetes), weight, physical activity, diet, and age – though it can also be caused by many other less known catalysts – and there may also be genetic predispositions leading to some suffering it more easily than others. It is treated in many ways, from as little as a change in diet and exercise, to oral medication, to – in the more extreme cases – injecting additional insulin into the body through the use of syringes or a pump.

Type 1 diabetes (once called “juvenile”) tends to be less understood. We still don’t know what causes it, though the prevailing theory is that an illness (usually during childhood) will cause the body’s immune system to mistakenly “attack” the portion of the child’s pancreas that creates insulin, completely eliminating that child’s ability to produce insulin. As a result, no amount of diet or exercise will help reduce the amount of glucose in their blood – as they have absolutely no insulin in their body, with which their cells can consume the glucose.

For both types of diabetes, insulin is the key. In some instances, it is used to supplement the patient’s own insulin. In other instances – it is the only chance the patient (usually a child) – has for survival. Particularly as it relates to Type 1 diabetes, make no mistake – no amount of diet or exercise will allow a child to survive with Type 1 diabetes, if insulin is not available to them.

People generally understand this, even if they don’t understand the difference between Type 1 and Type 2 diabetes. As a result, there has been a clamoring in the media and politics to reduce the cost of insulin.

In an effort to satisfy the general public without actually reducing the total cost of insulin, politicians have yet again proposed shifting the cost away from the patient’s out-of-pocket liability, and reassigning it to their health plan or insurance – only to then claim that they have “saved money” for the patient by “reducing the cost” of the insulin. Specifically, various media outlets are reporting that policymakers in D.C. are trying to pass legislation that would “cap the price of insulin at $35/month.” Yet, in reality, they are not capping the “price” of insulin at all. Indeed, the bill that was passed by the House of Representatives only limits the patient cost-share (co-pays, deductibles, etc.), as opposed to limiting the actual price of the insulin.

The cost hasn’t been reduced; the division of who pays what has changed. For some, shifting the financial burden onto “the insurance companies” is commensurate to reducing the price of the insulin and thereby forcing the “pharmaceutical companies” to bear the loss. For many, there is no difference between the two outcomes, as long as a “large, wealthy corporation” is paying more (or losing more) and the patient is paying (losing) less.

Yet, we know there is a major difference between the manufacturer receiving less (a price reduction), and the plan or carrier paying a greater share of the price. Specifically, the money used by the health plan or insurance to pay the portion of the price that “once” belonged to the patient (and which – by law – was then shifted to the plan or carrier) comes from that very same patient’s insurance premiums or contributions.

For years I have complained about how every time someone “claims” to be addressing the cost of health care, all they are really doing is capping the patient out-of-pocket, shifting the burden onto the plan or insurance, and then – when premiums increase (so that the plan or carrier can pay that new, additional cost), the plan or carrier – and no one else – can be blamed for the “rising cost of health care.” Usually, this shell game goes unnoticed; but it seems this time, the public has figured it out. This time, the scheme has gone too far.

As Joshua Cohen writes on April 8, 2022, in his piece for Forbes, “Insulin Bill Would Help Diabetic Patients By Lowering Out-Of-Pocket Costs, But It Wouldn’t Bring Prices Down,”  “… the legislation would not bring list prices down. Contrary to what many in the media say, as well as several top Democrats who support the bill, this legislation is not an insulin price control bill. Also, conspicuously, the bill does nothing for the uninsured…” two-thirds of whom actually pay the highest price (retail list prices) for insulin.

Mr. Cohen goes on to say, “… insurers may increase premiums, as an offset in response to having to cover more of the cost of insulin. In turn, on balance, this shifting of cost could undercut savings to diabetic patients.” Mr. Cohen then explains how this shifting of the burden by insurance carriers onto their insureds is unacceptable as well, and I tend to agree. He readily admits that – when the cost is shifted by law from the consumer onto the carrier – the carrier has two choices. Either reduce profits and cover the added cost, or maintain their profits by shifting costs onto the insureds (in the form of higher premiums).

Yet, Mr. Cohen, the politicians, and everyone else are missing one key fact… Not every “insured” American is “insured” by “insurance.” Indeed, the majority of Americans receiving health benefits through their employer are NOT insured at all. It saddens and sickens me that people still do not understand what self-funding is, or the fact that – if they get health benefits through their employer – there is a very high likelihood that they are self-funded themselves! If you, like me and most people getting health benefits through your employer, are self-funded by a plan that is not generating profit. Self-funded health plans only collect from their members an amount necessary to cover their costs. So, when a bill like this proposes to shift the cost from the patient onto their self-funded plan, what that bill is really doing is shifting the cost from the patient onto the patient. It is leaving money in your right pocket, only to remove it from your left pocket.

This bill, like so many others, reveals the core issues with health care and health benefits education in our nation today. Specifically – a complete ignorance when it comes to self-funding and its difference from insurance, and confusion between the cost of health care versus the cost of health benefits.

The bottom line? Insurance is – once again – being treated like a tax. We are taking a cost only some people pay currently, and instead, spreading that cost across all insureds or plan members. Whether you use insulin or not, your cost (premiums or contributions) for coverage will increase a little, to save diabetics a lot. Just as the ACA hoped that – by forcing healthy people to buy insurance they won’t need, and using their premiums or contributions for the care of the less healthy (people with pre-existing conditions who, by the same law, would now be able to get coverage) – here too… we are asking the many to pay for the few. I’m not saying that’s a bad thing; indeed – I pay my taxes.

If you want to reduce the cost of insulin, reduce the cost of insulin. Do that, and everyone – insurance, self-funded plans, people with coverage, and the uninsured – will all pay less.

If you just want to spread the cost of insulin across more people – reducing what diabetics pay out of pocket at the point of sale, and spreading the cost of those savings across all plan members (or insureds) instead of just the diabetics, then admit that – by law – you are asking everyone to “chip in” and contribute towards the price of insulin.

All I ask, is that we be candid, and be honest. Sooner or later, these lies and misconceptions will result in a catastrophic failure; and that – unlike diabetes – is something for which we have no treatment.

Ron E. Peck, Esq., is chief legal officer with The Phia Group, LLC.