Every year I have to deal with patient anxiety caused by shrinking health insurance coverage. A lot of this anxiety involves biologic medications, since they all have one thing in common: They are very expensive.
Employers and insurers tote the heavy financial burden of health insurance, and they have gradually focused their ire on these drugs and the patients who have the temerity to need them. If these drugs are not covered at all, most patients are simply out of luck. It is becoming commonplace for patients to show up on our doorstep with these horror stories, expecting us to magically reform a very broken health care system.
By Dr. Larry Greenbaum
I saw a 49-year-old man with ankylosing spondylitis that was causing terrible pain in his back and hips. On his previous visit, his arthritis was imperfectly controlled with etanercept, but he was able to hold down a physically demanding factory job. His insurance took a turn for the worse, he could no longer get his medication, and he was drastically worse, reduced to the point of having to consider applying for disability.
While I was mentally trying to survey what treatment options might be open, I asked him about his new insurance. He painted a very ugly picture of his new coverage. He has a $6,000 deductible, and to make matters worse, most medical expenses don’t count towards meeting this high deductible. He was not even certain which expenses counted toward his deductible. Four months into his new insurance, no one had received a benefits booklet. One day he had severe pain at work and he asked if ambulance service counted toward his deductible, but no one was able to answer that question. His insurance covers catastrophic illness only, and anything else is likely just tough luck, or more accurately, tough insurance.
While I was mulling over this man’s dire insurance situation he told me his factory had made a $500 million profit last year. He claimed that his union’s negotiators had asked management why it was curtailing workers insurance benefits so severely in the face of high profits. According to my patient, management’s answer was: "We want it all."
Even if my patient embellished the details of this tale of unbridled avarice, his lack of insurance was the new reality I had to work with. I gave him a sample of another medication and a copay card, but I was not very optimistic that the other drug company would be able to help him. Copayment cards supplement patient drug insurance but do not pay the entire bill. I felt saddened and a little queasy in the face of this tale of corporate greed. Maybe it’s time for rheumatologists to occupy Wall Street.
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. You may reach him at rhnews@elsevier.com. This column, "Inside Rheum," appears regularly in Rheumatology News, a publication of Elsevier.