Robert Steinback

Matter of life, death

I am scheduled to begin dying on Feb. 1, 2010.

Although I have been an insulin-dependent Type 1 diabetic for 22 years, my health has always been very good. My condition has never impaired my enjoyment of life; I've never had a diabetic emergency.

Luck, of course, has played a part, as has educating myself about diabetes management. By far, though, the single most critical element of my vitality has been excellent health insurance coverage.

That will end on Jan. 31, the day my COBRA insurance benefits run out.

I worked for 24 years for the Miami Herald. We parted ways in July 2008 during a staff-reduction effort. I have been unable to find work since.

I continued my insurance coverage under COBRA, paying the entire $579 monthly premium.

Aetna has notified me that when my COBRA eligibility expires, it will not insure me for any price. Why not? The company didn't say, but the answer is obvious: my "pre-existing condition" isn't profitable. I wear a $5,000 insulin pump — the third one insurance has paid for since 1999. The pump's insulin-delivery kits, which must be changed every three days, cost $199 a month at market rates; insurance pays the full cost now. The insulin itself costs $338 a month (my current co-payment is $54). The test strips used in my blood-glucose testing monitor cost more than $200 a month over the counter (my current co-payment is $48).

I have had expensive laser eye treatments to stanch the blood leakage associated with diabetic retinopathy. The treatments have been successful; my eye health is stable and my vision perfect — but there is always a chance I will need further treatments.

Additionally, I'm sure Aetna has tables predicting my chances of organ deterioration or other complications and what that will cost. No matter how you examine it, I'm a bad bet for profit-based health care.

The health insurance industry, thus, has issued to me its solution for how it can maintain its profitability: Die, Mr. Steinback. You're too expensive to keep alive.

I am a beneficiary of the best medical science the world knows, much of it generated by the profit-based medical research industry. But I am also a victim of a system that resists covering the cost of those miraculous discoveries for the very people who need them.

It's hard not to notice the irony of the debate in Washington over health insurance reform. Some politicians and their supporters say they will work to defeat the bills because they cost too much and might raise taxes. Too bad I can't offer those people a choice: Would you rather have a higher tax burden, or Type 1 diabetes? I'd gladly trade, if I could.

Some who describe themselves as prolife say they will oppose the bills if there is even a hint of funding support for abortion rights. The American Journal of Public Health estimates that 45,000 people die in the United States each year for lack of health insurance coverage. Failure to pass health care reform is going to kill a lot of people like me — so how exactly does defeating health insurance reform qualify as prolife?

Some say they won't accept a so-called government-option health insurance plan. I don't understand people who fear government bureaucrats — who have no profit motive and ultimately must answer to the people — yet feel fully at ease with corporate bureaucrats whose sole interest is the bottom line and answer only to shareholders.

Thirty-nine U.S. senators voted to kill the reform bills without so much as a debate. All but one House Republican opposed the bills. Additionally, many provisions in the bills won't kick in for years, and the Obama administration insists that reform be revenue neutral. I'm scheduled to begin dying in two months. One of America's political parties doesn't want to talk about it, and the other fears taxes and is in no apparent hurry to solve the matter.

Without health insurance reform, what are my options? Working for a small company or for myself is ruled out because I could not get health coverage. I am limited to seeking work for a large corporation with a group health plan — and few are hiring these days.

I could try to get a government job, which would offer excellent health insurance — but an expanding public sector frightens so many people.

Maybe I could arrange a marriage of convenience to someone who has a good health plan. But then I really should look in France, Canada, Japan or any other developed nation, since, unlike in the United States, all of their citizens are covered.

It all seems a tad un-American to me. I believe a nation is best defined by what I call "shared destiny": the goals we collectively embrace, the burdens we collectively share. Is the cost of good health for every American a burden that should be shared by all Americans? Should it matter to all of us when any of us dies a preventable death?

If you have an answer, please let your elected officials know soon. I'm on the clock.

Robert Steinback is a freelance writer living in Miami. He can be reached at robert@robertsteinback.com.

Matter of life, death 12/08/09 [Last modified: Wednesday, December 9, 2009 7:17pm]

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