A Diabetic’s Two Cents on Healthcare

All the news and talk of healthcare recently has started me thinking; I have not read the healthcare bill, and I don’t have any answers for Congress, but there is one particularity of my experience that I think is worth sharing:

I have Type 1 diabetes, and I work for a start-up.

For those of you who aren’t intimately familiar each of these categories, that may not sound too impressive. For those of you who are, I think you’ll agree with me that I should thank my lucky stars.

You see, working at a start-up, like being self-employed or working for a very small business, implies I have no benefits– no HR, no 401k, and no healthcare. That is one of the trade-offs of working for a small company; I get to take advantage of the agility, personalization, and direct contact with great people that a small organization makes possible, but as a result I must give up some of the built-in economies of scale that I might get at a larger company.

But, the trick is, being a diabetic, life without healthcare is a nightmare. Good diabetes care requires seeing at least one specialist, preferably at least once per quarter; regular blood tests to monitor A1C; a blood glucose meter; zillions of pricey little test strips, not reusable; bottles of at least one type of insulin; and either a constant supply of disposable syringes or an expensive insulin pump and its requisite arsenal of infusion sets and insulin cartridges. And that’s just for the basics.

In other words, if you’re a diabetic, have healthcare or have a bottomless piggy bank, but don’t get stuck with neither.

I am not independently wealthy, and I do not have group healthcare. If I tried to get insured as a Type 1 diabetic, I would likely get laughed out of any insurer’s office. So how is it that I work at a start-up? What is the lucky star I can thank for the fact that I am insured, well-managed, and not destitute as a Type 1 diabetic?

Ah, yes. The foresight of my parents. Something in their genes likely gave me diabetes, but something in their parental anxiety caused them to enroll all four children at Kaiser when we were young and uncontaminated. So by the time I turned nine and was diagnosed with diabetes, I was already in the system.

The System. Kaiser Permanente. A behemoth, indeed– 8.6 million members, more than $30 billion in revenues, and a seemingly infinite network of departments and employees in charge of maintaining the massive bureaucratic infrastructure so key to my daily life as a diabetic.

Many people– myself included– complain about Kaiser and the myriad indignities that come with such a large HMO, from long wait-times to antagonistic pharmacists to doctors who don’t know patients’ names. But you know what? When I turned eighteen, I was able to roll over my dependent-care plan into an individual plan. I did not have to reapply. Crucially, that meant I inherited the no-preexisting-conditions status of my childhood. And that meant I could actually get coverage, and further that I could actually pay my monthly premiums.

Reactions to the fact that I slipped through the pre-existing net are varied, defining a spectrum from “You lucky b*,” through happy relief for my sake, through indifference, and all the way to, “You’re the one who makes healthcare expensive for the rest of us.”

Yes, I am. I’m sorry. But I’m also alive.

But the real trick, and the realization that started me on this train of thought, is that my healthcare luck doesn’t stop with my still being alive; because I am insured, I am able to participate in the job market and the larger economy in ways that I absolutely could not if I had to rely on personal savings or group healthcare for my diabetes care.

In other words, I work at a start-up, and I have Type 1 diabetes. Before working here, I co-owned a corporation that did web application development. I didn’t have healthcare there either.

Median tenure for employees these days is about 4 years. More and more, especially with the decay of pensions, workers are opting not to spend their lives with a single company, and instead are switching jobs, optimizing for better pay, more interesting labor, or even just novelty. I have taken part in this sea change in the American workforce, and I am surprised if anyone tells me they expect to work for their current employer for more than five years. Certainly among my peers this shifting is expected; as legend goes, the smart engineers gain experience for a few years on a project, then move to the next job for a bump in annual salary, then rinse, wash, and repeat.

Studies and opinions differ as to whether this is good for the GDP or good for America. I don’t have any verdict on the macroeconomic value of job mobility and instability, but I do have a verdict on the microeconomic value: I like it. Job mobility for me personally has meant freedom of choice, and that has been good for both my piggy bank and my peace of mind. The one job I’ve had that offered a group plan, I hated. After a few months, I came home crying every day. Luckily, I had not stopped paying for my Kaiser insurance, and so was able to leave that job without worrying about not getting the medical care I need, but if I didn’t have individual coverage, I would have been stuck until I could find a different position that also offered a group plan.

What does this all mean for the question of healthcare before Congress right now, and for the more long-term notion of single-payer coverage? I’m not sure exactly; my story is just one grain of sand on a crowded beach. But I know that if I didn’t have individual coverage that predated my diagnosis, my life would be a lot more complicated, and a lot more limited. And for all the pros and cons before Congress, I’d just like to add that I consider myself an active and able member of the workforce, but my capacity and output rely in large part on my access to healthcare.

But, hey, they know that, right? They’ve been talking about this for a century now; hopefully they’ve heard it all. For the me, then, the conclusions are simply these:

1. I love you, Mom and Dad. Thanks for worrying a few years ahead of time.
2. I love you, Kaiser. I hate you, but I love you. Please expand your national network, just in case I ever decide I want to move out of California.

Those are the two cents that I can spare (since I haven’t yet had to spend them on diabetes supplies)– what’s your story? What do you do if you don’t have individual coverage? Or if you don’t have healthcare?

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.