Nice guy I used to work with died today because his health insurance wouldn't cover treatment for..

[kpete]

A nice guy I used to work with died today because his health insurance wouldn't cover treatment for his diabetes. Our healthcare system is immoral beyond words. RIP Scott.



the rest:
http://readersupportednews.org/opinion2/277-75/45944-focus-the-most-important-legislation-of-my-lifetime

Link to tweet

[Not Ruth]

1. Sounds like he would have lived if he had single payer

[pnwmom]

7. NO! He was ELIGIBLE for Medicare but he didn't sign up for it. Transplants are one of the few

conditions that are covered by Medicare by people under 65.

What a shame he didn't apply during the enrollment period.

[Native]

11. People should not have to become healthcare experts simply to choose the proper plan.

And when all their energy should be devoted to recovering, they should not have to deal with the stress of getting their medical bills paid by the company that should be covering them. The whole system sucks, not just the lack of care/coverage.

[Not Ruth]

13. Deadline dates are for profit

Single payer by definition would minimize that.

[iluvtennis]

22. +++++++++++++++++++++++++++++++++++++++++ Agree, this is Shameful

[Sunlei]

27. That's why I love health care.gov- that website has consumer protections-they help me pick a plan &

even tell people when they're eligible for medicare/medicaid and help pick those plans as well.

Those consumer protections and consumer help is why Republicans and Insurance Corporations want to ruin Obamacare/ACA and try to harm the healthcare.gov website.

Republicans don't want Americans to have consumer protection & fiduciary help selecting health plans

[pnwmom]

36. This guy had DOCTORS who certainly would have told him about the importance

of signing up for Medicare in order to pay for the expensive transplant they were recommending.

This isn't something new. I knew a younger woman who had a transplant in the 80's that was paid for by Medicare. Every kidney doctor would know about this.

[Native]

42. Not necessarily.

You'd be surprised by what doctors do and don't tell their patients.

[pnwmom]

43. The guy didn't say that no one told him --which would have been a natural thing to say, if true.

Instead, he said he "didn't choose Medicare during the enrollment period."

[Native]

44. I hate it when people start saying crap like what you've just said...

you know, reading between the lines.

I hope when you get sick, people are more kind to you than you obviously are to others.

Bottom line - I know what I'm talking about. I worked for a major insurance company for years, and then I worked in hospital administration (the other side) for several more years (management, head of pensions and benefits). The bullshit and cruelty and ignorance and criminal actions I was witness to by the insurance companies would blow your baby mind.

And don't get me started on the doctors.

[pnwmom]

45. He "didn't choose Medicare during the enrollment period." He had the choice. n/t

[Native]

46. OMFG.

[LanternWaste]

59. Odd you focus on the failure of the deceased patient, and ignore the systemic failure

Odd you focus on the failure of the deceased patient, and ignore the systemic failure of the system itself.

No... thinking about, not odd at all.

But as you said, "you had the choice..."

[Hassin Bin Sober]

74. Victim blaming.

Absolutely disgusting.

[area51]

82. Agreed.

On some threads, this looks more like what I imagine freepertown looks like.

[Native]

90. I agree. It's stuff like this that makes me want to quit DU.

[moriah]

53. This guy is dead. And the friend of a DUer.

... Keep blaming him for making poor insurance choices in a bad situation. Makes you look really great, just saying.

And it's also possible that his condition escalated faster than his doctors predicted. Hence thinking he could stay on a plan that was covering his current needs at the deadline for enrollment in a Medicare plan.

[pnwmom]

57. He's not the friend of a DUer. A DUer reposted someone's tweet from Twitter. nt

[moriah]

60. And you're certain that "Kpete" isn't "Ken Klippenstein"?

The names were similar enough for me to at least think it was possible.

[mopinko]

84. pretty sure kpete is a she.

[crosinski]

62. I feel it too. Something's wrong here.

There seems to be a lot of You-Must-Follow-The-Rules-Or-Be-Eleminated vs human-beings-with-compassion type of talk going on. So what's up with that.

[moriah]

64. No, it's defense of the ACA. Which I get.

I do think, after enough GoogleFu, that I am correct kpete didn't just publish something he saw.

Sadly ESRD is handled uniquely under Medicare -- ESRD patients can't get on Advantage programs in most cases unless they were already on one prior to ESRD diagnosis. And ESRD was probably the qualifying condition for Medicare.

So you look at 80/20 for everything, not just your dialysis and transplant, and a separate Part D program, if you have ESRD.

If given misleading information about what was really going to be covered, one might look at a straight 80/20 with no max out of pocket as a worse deal than a Marketplace plan which all Google available documentation says does kidney transplants at that hospital at least on some of their plans and has a yearly MOOP.

[crosinski]

73. Ah, ok. Thanks for explaining.

I always think people are really taking about what they're talking about. sigh. I'm naive. I'll just be letting you all walk on down the road without me now.

[moriah]

79. I didn't say it was smart or even fully conscious defense of the ACA.

It's just that I do get people who instinctively want to defend every bit of it because it's under attack and is the best solution some people have -- and the only solution for others to get care.

So people disconnect from the idea that it could actually be a DUer's friend despite a similar username and the direct statement. That the person could have been misled into believing the Marketplace was the better option. That their doctor might have been just as confused as they were on which plan would best meet their needs. Etc.

It's gut-level stuff I sadly see enough to recognize.

[crosinski]

85. Moriah, you are kind. Yes, I see what you're talking about now. Live & learn. n/t

[sharedvalues]

88. What the heck?

I have a PhD. I am a climate scientist. I have no idea what you're talking about.

Advantage? Separate part D?


AMERICANS SHOULD NOT NEED TO BE HEALTHCARE AND INSURANCE EXPERTS TO GET CARE.



Insurance companies want to make it COMPLICATED for consumers. Because fewer people will spend time to figure it out to get paid.


We should demand simplicity. If you're sick, your healthcare is paid for. No incredible technical knowledge of insurance required.

[Ms. Toad]

80. More that this guy had resources available to him -

resources that the Republicans are threatening to take away from my daughter on a near-daily basis (she will ultimately need a transplant). He didn't take the steps necessary to take advantage of the resources, and was throwing gasoline on the Republican fire that will consume my daughter's access to care by blaming the system that made resources available to him (and my daughter) had he only taken advantage of them.

[moriah]

81. ... you can see, though, that not every patient is going to know...

... exactly what is going to be the better choice, especially if a Marketplace plan seems on the surface to cover the transplant as well as offer out-of-pocket protection?

I do have to admit I myself am confused on the whole thing myself, because there is an emergency qualifying period for ESRD that backdates coverage in the event of a hospitalization for a transplant, for up to two months back coverage from the date of the transplant. And the young lady I knew who had to have a liver transplant recently didn't have a closer choice than this guy did for a hospital -- but she's a dual Medicare-Medicaid eligible individual.

Still, by the time a patient has to be admitted it might be too late, and it looks like dialysis coverage starts the fourth month out if you're not able to do at-home dialysis. That's certainly faster than the 24 month waiting period for Medicare after another cause of disability, but...

I can see legitimate confusion for people who have other options *than* Medicare. Most ESRD patients don't have other options.

I also understand not wanting to let anything bad be said about things that are more than just "sacred cows" to people, but legitimately lifesaving programs that are under attack. Sadly, though, insurance companies suck. They screw with Advantage customers like myself, too.

[Ms. Toad]

86. I agree that insurance companies suck.

But if you live with a chronic illness, in the US, they are a necessary evil - as is the ACA. You're not going to live if you don't figure it out.

ALWAYS check the network and the formulary. We never choose a plan without ensuring that critical doctors (my daughter's transplant doc, her GI, my spouse's urologist, my cancer team, and our primary care. We never choose a plan without ensuring that it covers my daughter's meds (that cost $700 out of pocket if they are not on the formulary) - or her new medicine that costs $36,000/year.

That said, we've also gotten medical necessity exceptions for out-of-network coverage treated as in-network, forumulary exceptions for the new medicine, the state-wide software rewritten when it didn't match the policy we were given, and so on.

[moriah]

56. Also, looking at context of the post....

If he had done the "smart thing" and talked to doctors or researched on his own, probably they would have all found this:

http://www.aetna.com/docfind/cms/assets/pdf/ioe.pdf

Which lists the hospital in his area (Mercy in Des Moines) as an approved provider of adult kidney transplants as of 7/17.

It's pretty clear that whatever this plan is doing, it's doing wrong if it was listing in-network dialysis services as out of network, etc. And Aetna is exiting the Iowa marketplace.

I'm more willing to bet money that they were jacking him around about a lot.

[Hortensis]

28. Yes. There's going to be more here. People are denied transplants when

for instance, they have comorbid conditions that suggest a transplant would not have a good chance of extending life as long as if the organ was given to a healthier person. And those who have not taken the necessary steps to make themselves promising recipients, such as kicking alcohol or drugs, or becoming compliant with taking medications prescribed (some people just don't cooperate with care they really need and are given), are not eligible for transplant wait lists.

I am also wondering why he didn't sign up for Medicare also and, if he were really wrongly denied, why he didn't hire an attorney or get one of the transplant assistance organizations involved.

[LanternWaste]

58. Much more a shame a health insurance provider failed to provide insurance for his health.

Much more a shame a health insurance provider failed to provide insurance for his health.

[Texasgal]

68. That is not true.

You have to wait a minimum of 2 years.

[moriah]

83. ESRD has emergency eligibility protocols...

... that do backdate coverage for up to two months if hospitalization for a transplant is required, coverage the first month for in-home dialysis, and coverage at the fourth month for other types.

Just saying. It's still not perfect because not everyone can do in-home dialysis and by the time an admission is ruled medically necessary enough for the hospital to do it in expectation of the Medicare payments it's more likely the patient is going to be in worse shape, perhaps too late for an otherwise successful transplant.

But it's better than 24 months like for other disabling conditions.

[Texasgal]

89. My husband was placed on a liver/kidney

transplant list and we fought our asses off to get medicare for him. We were told two years or post transplant care before then. We finally got word after 18 months that he had been approved once he started dialysis... but then it was too late. He passed away.

I am currently being sued for 60,000 worth of medical bills that his OC did not cover. I've been through this. Medicare is not as EASY as everyone thinks it is to obtain. It was a complete battle.

[questionseverything]

70. what a shame we don't live in a country where medical

attention is a right not a privilege for the well connected

[aikoaiko]

2. The biggest massacre in US history. Private health insurance.

[Native]

49. Amen

[Bettie]

3. It is both sick and sad that this is

the country we live in.

People kept getting all up in arms about "the government between a patient and a doctor", but these same people are A-OK with an insurance company between a patient and doctor, killing people for the sake of "saving" some money.

[LonePirate]

4. A manslaughter charge should be filed against the officers of his insurance carrier.

If insurance companies want to kill Americans, then they should face legal ramifications for that behavior.

[Tanuki]

5. I wonder why he chose not to go on Medicare, which he said would have covered the transplant

in the hospital near him? He was without a doubt poorly (criminally, imho) served by his private Aetna plan. Meanwhile, Aetna's CEO got very, very rich off of his and others' premium payments, while skimming tens of millions of dollars that should have gone to healthcare:
https://en.m.wikipedia.org/wiki/Mark_Bertolini

..."Bertolini received a total compensation of $10.6 million in 2011 and $13.2 million in 2012 despite a cut of bonuses from $2 million to $892,000 for failing to meet financial performance goals.[5][not in citation given] In 2013, Bertolini received $30.7 million in compensation.[6]"

[WillowTree]

51. I don't know why he didn't, but I know why I haven't so far.

I'm still working and my HMO coverage (including Rx, vision and dental) is heavily subsidized by my employer and thus, so far at least, costs less than Medicare would and has pretty comprehensive coverage and low co-pays (only for office visits). Unless something changes, I plan not to enroll in Medicare until I get around to retiring.

[IADEMO2004]

6. And Planned Parenthood Navigators that were so great helping my wife find the best ACA plan

are gone thanks to GOP cuts. Nothing but contempt for the Iowa GOP elected to federal offices. Drain the gas slash the tires steal half the spark plug wires of the ACA then fill our mail boxes and airwaves that the ACA is a disaster.

[pnwmom]

8. The reality here is that MEDICARE would have paid for this if the guy's friend had signed up.

Medicare pays for these transplants because it was decided long ago that the costs were too much for regular insurance companies.

So I understand that the guy is grieving his friend, but his friend had the option for Medicare and for some reason chose not to exercise it.

[Not Ruth]

9. But with single payer, he probably could have signed up anytime

[pnwmom]

10. He had months to sign up for it. Yeah, with the single payer that doesn't exist, maybe he'd

have done better.

But this guy who needed a transplant isn't the poster child for single payer. Unlike most people under 65, he had the option to sign up for Medicare and chose not to.

[Bradshaw3]

20. This whole health care system is a labyrinth and hard for many people to navigate

I don't think blaming the victim is a good response. And yes people who don't always make the right choices or read the fine print (as I did recently in my health insurance plan) make mistakes. To minimize the screwed up system and the people suffering from it isn't helpful.

[pnwmom]

37. Who do you know who has complained about signing up for MEDICARE? It's not that hard to navigate.

And if he was having trouble, all he had to do was tell the doctors and nurses who were already treating his kidney condition.

[Bradshaw3]

50. You don't know him or his situation so it's wrong to be so judgmental

Again, if we had a health care system based on healthcare needs instead of the profit motive as they have in many other developed countries we would not have the coding, labryrinth of rules, etc. that make it hard for people to navigate. I blame greed for having the system we have, not the victims of our screwed up system. Obviously you place blame elsewhere.

[pnwmom]

52. He did have that healthcare system. It is called Medicare and he didn't sign up.

It's the system we want for everyone, so I don't see the point in trashing it.

[LanternWaste]

61. Of course, your priority is not health, but blame.

Of course, your priority is not health, but blame.

Good Christ, can't see the forest for the trees... or in our case, all the irresponsible, idiot patients who died for lack of pen stroke.

[Bradshaw3]

65. I didn't trash Medicare and neither did he.

So in addition to being wrong in blaming the victim it is wrong to mischaracterize what was written. If you read his post it is as I said a labyrinth of healthcare options that he had to navigate (and wrote about in detail), as many of us do. To make it "oh it's so easy, it's all his fault" is wrong on a moral and a factual level. It's strange to me that on a democratic/liberal site people have the very conservative view that if bad things happen to people it is their fault regardless of the circumstances. Clearly this is a case of someone not understanding a very complicated, Frankenstein of a healthcare system that values money over people. I fault those who created, and profit from this system. If the person had access to a Medicare type system from childhood on he wouldn't have been in this situation. But he didn't and was trying to transition to an option that would save his life. Laying blame at his feet totally ignores that he was a victim of a wrongheaded approach to health care.

[crosinski]

54. pnwmom, even if he chose the wrong insurance because he didn't think about it hard enough,

or even if he didn't ask the right people, I don't think that's a good enough reason to condemn him to death.

[pnwmom]

55. I'm saying he isn't a great poster child for the cause of single payer, because he didn't enroll

in Medicare, our government's single payer plan, when he had the opportunity.

[crosinski]

63. Are we looking for that perfect child who died too soon?

My husband's friend died of diabetes too. He just couldn't get the supplies he needed regularly. He died at the age of 32.

These men would both be alive if we had single payer earlier on, or any kind of heath care that people could really afford.

I guess neither one of them were perfect poster children.

[Native]

48. I agree. And blaming the victim based on limited information is even more heartless.

[pangaia]

17. Sounds to me like the insurance he had WOULD cover

a transplant. In fact it DID until AETNA got their hands on it.

So I wouldn't blame him.

[Raster]

23. It could be he did not know... I am 60, soon to be 61...

...I am a Type 2 Diabetic, with early Chronic Kidney Disease - Stage 2. I had no idea ANYONE could access ANYTHING with/from Medicare until you are 65. And I try to stay as aware as possible.

[pnwmom]

40. Don't you think that if you were on dialysis and needing a transplant

that your doctors would have told you about signing up for Medicare? If not, maybe you should think about switching doctors. This isn't something new. The transplant patient I knew was in the 80's.

[Raster]

41. I don't have ESKD and I am not on dialysis and, thank god, don't need a transplant...

...just stating that I did not know, and speculating that maybe he did not know. And yes, I would have hoped his doctors would have clued him in.

Now I know. Thanks.

[haele]

26. Here's the issue people have with early Medicare - it's presented as welfare.

A "choice of last resort", for people who can't otherwise get or afford insurance.

"Scott" used to be covered by his employer provided plan for at least his dialysis. The understandable assumption that people with employer provided plans is that the quality of the provided insurance won't drastically change over time, because those health benefits were part of the employment contract with their company.

If he was like most people - not being an insurance guru, or having someone able to take the time walk him through the ins and outs of the various plans and help him choose what's best for him - he picked his health insurance the most common way on the marketplace; balancing affordability and some vague notion that what is in the plan will cover what he needs. Maybe he picks the "plus" plan instead of the basic plan, or the HMO because he had diabetes and HMOs are supposed to "manage" that better than a PPO might.

I learned the hard way that I had to spend a good 10 - 12 hours every year dedicated to going over everything that is in the plans offered during the meager 2 week open enrollment at both my company and the ACA so my husband is able to continue to get the medication and specialist visits he requires to be functional. And during that time, I found myself calling the insurance company and wasting some of those hours tracking down the one plan manager who could give me the information I required to make my choices because our HR person didn't have information to that level of detail.

Things like "Are we able to pool therapy hours between types of therapy; if he needs more of this type that's allotted, can he pull hours off the type he won't use as they're the same cost?", or "Is XYZ type of therapy still included?", or "How many specialists can he see in a month?", or "If his condition changes during year, can he see this particular specialist more than once this year?" , or "If his condition changes, what other specialists is he allowed to see for this condition?", or "Is this type of critical medication he's been taking for the past 10 years still on the formulary I can't find on your web portal, and if not, what are the equivalent options?".

That's time I couldn't spend working or budgeting/planning for the holidays, or doing housework, or otherwise time with the family.
There were a few years I had to put him under a different plan than myself and the rest of the family just to be able to afford his coverage, because every year, our plan would change, or my company would get a different carrier, and we'd have to start all over again.

While we can all say "oh, he should have taken the Medicare expansion" - well, even if he studiously took time out of his life to try and understand what was offered, maybe he didn't think he could, depending on the rules of the state he lives in.
Even in California, my son in law can't get on the Medicare expansion - because he works under the table and doesn't have an official income history with the IRS - and I can't, because I make too much, and I'm not identified as disabled under HHS or the Social Security Administration.
I'm surprised from the article "Scott" wasn't eligible for the VA with his prior military service (back in the day, so long as you served over 180 days - as in, made it past boot camp and any additional training requirement - you're eligible with any discharge that wasn't dishonorable), but then again, the VA also has an income component to the eligibility if you're not a retired veteran, as well as a "do you have available affordable options nearby to the VA" component.

So, I'm not sure I'd make a point that not taking the option for Medicare somehow makes him responsible enough for his early demise that we should just ignore the fact that insurance companies were and still are yanking people around for profit with increasingly arcane rules that the layman typically doesn't understand.

Caveat Emptor is not a practice that should ever be acceptable for a critical public service like Health Insurance/Health Care, whether it's provided by public or private companies. Like basic food, water, or shelter, Health Care is not something anyone can "Just do without".
And that's the point I think this article was making.

Haele

[renate]

31. "Caveat Emptor is not acceptable for a critical service like health care"

EXACTLY. When it comes to life-and-death choices--especially when they're deliberately made complicated by for-profit companies, "too bad so sad" is simply not acceptable.

I'm furious on your behalf that you have to spend so many hours, and undergo so much stress, making the best decision for your husband every year. The stakes couldn't be higher, and yet you're basically left on your own to figure this labyrinthine system out.

[PoindexterOglethorpe]

34. I think you are conflating Medicare with Medicaid.

There has been no Medicare expansion, but some states have greatly expanded Medicaid under the ACA.

[haele]

39. Nope, my husband is eligible for Medicare. But it's more expensive than my current insurance.

On edit - I did make a mistake between Medicaid and Medicare in terms of the expansion. Sorry for that, I had fixated on Medicare, as we just finished our "open enrollment" (my employer's EOY was last month) and that was still one of the options I was considering, including the Covered California/ACA options.

In a pinch can set up "You take the Plus PPO plan and the rest of us go on the Basic PPO plan" and still come out close to $200 a month out of pocket cheaper (even considering co-pays and deductibles) than if he just went on Medicare and I covered myself and our dependent grandchildren on my employer provided plans. Because our household income is too much. Same with VA, which he is also eligible for.

On edit -
Even with the stress of trying to figure out which plan to pick for him, having him go on Medicare or the ACA plans are only "affordable" if our income is at the specified household income or below, or if my employer plan coverage changes so drastically that he won't get any of the services or medications to remain functional and not deteriorate further. We're currently 20% over on income.
Weighing the ~ $1K a month employer provided family coverage with reasonable co-pays, $3K individual deductible, and access to all formulary, to putting him on Medicare, leaving me with $820 a month plan as above (sans spouse but + grandkids), adding $200 a month supplemental to cover what he lost with pretty much the same co-pays - except for pharmacy, which has us dealing with a 2 - 3 month/$2500 donut hole for all his medicines within 3 months of the beginning of the year - no, for the time being, it's more affordable to roll him into our employer's plan.

The sad truth is that disabled people or people with chronic conditions that allow them to be eligible for Medicare - whether or not they receive SSDI - are systematically encouraged to use alternates like their spouse's insurance or the VA if they can rather than go on to Medicare until they hit retirement age.

And once he goes on Medicare, he can't just "get off Medicare" the next year if my plan changes that year, then return. Once he's on Medicare, he's on Medicare. Or he has to wait to get back on after he's 65.

So him going on Medicare is a "plan of last resort" for me.

Haele

[Native]

47. Not to mention that it is always a crap shoot when you have to get verification from a rep

at an insurance company. I found out a long time ago that you can't trust what you're told. If you don't get it in writing, you can easily be screwed.

[Towlie]

12. All of those great discoveries of medical scientists throughout the centuries were made so that...

rich people might be healthier and live longer.

That's the way the GOP sees it.

[Johonny]

14. My good friend, 46, died last month for the same reason

He had multiple strokes. The underlying cause was high blood pressure and diabetes. Both are treatable diseases but he went undiagnosed because his health insurance was iffy. I want universal health care. I will vote for universal health care from now on. That and gun control are non-negotiable. If Trump passes his tax plan, you can put wealth tax on the list too. I'm moving to the left.

[Ms. Toad]

15. While I agree that access to wealth should not be a barrier to health care,

People, especially people with chronic illnesses, need to learn the basics about how health insurance (what we currently have in place) works.

I'd have gone bankrupt a long time ago with my daughter's health care costing $60,000-$100,000/year every single year if I hadn't learned very early how insurance works.

You find out before choosing a plan whether your providers are in network or out of network
You review the formulary to make sure the meds you need are on it.
You pay close attention to deadlines, so you don't miss open enrollment periods
Before ACA, you NEVER created a gap in insurance - or you would neverget insurance again.
You find out how to appeal for in-network coverage for critical care that is out-of-network (done it many times, never been denied).

We should do a better job educating people, but this does not sound like insurance not paying - as much as it the person not learning how to use the insurance available to him.

[TrogL]

16. My wife (Craftygal) is on dialysis

She’s doing at home peritoneal dialysis using some sort of fancy $10,000 machine. Fluids are delivered by courier who bring them in the house and neatly stack them in the basement. She goes to the clinic every couple of months and has frequent blood tests.

Our biggest expense...

...the pop machine at the clinic.

Paperwork- present her health care card. Once.

[DK504]

18. Please tell me he has family to sue the hell out of them.

Insurance companies know they can kill people with zero repercussions. Once again Congress has shirked is responibilities.

[SCantiGOP]

19. Youre damn right its personal

My 20 year old daughter has been Type 1 diabetic since she was 5. The first thing W did when he got into Office was sign an EO limiting stem cell research, which is the only realistic avenue for a real cure for diabetes and many other horrible and life-threatening diseases.
Government health care policy could kill any of us at some point in the future.

[PoindexterOglethorpe]

21. What an incredibly misleading headline.

It's not that his insurance wouldn't cover treatment for his diabetes, it's that he didn't sign up for Medicare when he had the chance.

I suspect that Medicare covers kidney transplants simply because my brother got one after about four years of dialysis and being on Medicare. And yes, we shouldn't have to become experts in all the different companies out there, but we have to learn enough to know what we're doing.

Once again, he chose not to sign up for Medicare. And I find it hard to believe that his original insurance wouldn't pay for diabetes treatment. If nothing else, the treatment would have been covered once the ACA kicked in.

There's also a conflation between the original diabetes and the kidney failure that resulted from long-term un or inadequately treated diabetes.

[WillowTree]

25. He doesn't actually say that his insurance wouldn't pay for diabetes treatment.

"If I had grown up in a single-payer country, when I became diabetic it would have been covered and I would not have damaged my kidneys while having untreated diabetes."

He's unclear here. I've never heard of a health insurance plan that didn't cover treatment of diabetes, even before ACA. Did he not have insurance coverage when he first was diagnosed with diabetes?

There's some pertinent information missing here.

[PoindexterOglethorpe]

30. Yes, pertinent missing information.

I'm going to guess (based on no evidence at all) that the man ignored the clear-cut symptoms of diabetes for years. And I'm likewise under the impression that insurance plans have pretty much always covered diabetes treatment.

My brother ignored the very clear and obvious signs of diabetes until his vision started failing. It deteriorated rapidly and he wound up retiring on disability at age 50. Soon his kidneys went and he was on dialysis for a number of years. He eventually got a transplant (living donor) and at least he's not doing dialysis three or four days a week. But he's completely blind at this point.

If you were to ask him, he'd tell you had had absolutely no idea he had diabetes until the vision went. However, some ten years earlier, on a family vacation, we (his brothers and sisters) all told him, "You have diabetes," because the symptoms were so obvious. He did have good insurance through his job, and because he retired early, the dialysis was paid by Medicare. I don't think he even had a copay, but I could be wrong about that.

[renate]

32. I can sympathize with ignoring symptoms

The last thing you want in this country is to have a pre-existing condition.

I'm not saying it was smart of him to ignore the symptoms, but it's understandable to me. I'm really sorry about his blindness... that's awful.

[PoindexterOglethorpe]

35. He didn't ignore those symptoms because he was concerned about a pre-existing condition,

especially as he worked for the same employer for 30 years. No, he just did the idiot thing that too many people do of saying (in his case) "It's perfectly normal to have to pee every hour." "There's nothing bad about drinking a couple of liter bottles of a sugared soft drink every day."

And on that family vacation when we all very clearly told him that drinking two liters per day of a sugared soft drink was a truly stupid thing to be doing, and that no, it's not normal to pee every hour, he just waved us away. And then has the audacity to say he had NO idea he had diabetes until ten years later.

Nowadays he's very good about taking all of the many medications he needs to take.

It's also a bit frustrating that as his vision was fading he wasn't willing to learn to use a cane, and now at age 68 he's quite home bound. Fortunately he has good friends who do things like take him grocery shopping. He generally uses a senior van to go to his many doctor appointments. He lives some distance from any of us. It's a 6 or 7 hour drive for me to get there, and I'm the very closest. The other sister lives more like a plane ride away. Our oldest sister, who actually did a great deal of managing of various practical things for him, passed away earlier this year. She'd been in ill health herself, so it wasn't entirely unexpected. The two brothers are not able to step up and help him out, for various reason, mainly their own health issues.

For me the greatest takeaway here is that even if you have children or siblings, you really need to plan as best you can for end of life issues, or simply diminishing health and capability.

[Ms. Toad]

75. There are generally zero clear-cut symptoms of type 2 diabetes

prior to significant damage being done. It is generally silent (see the link below), and most doctors do not test for it at annual physicals.

Fuzzy vision, or slow-healing wounds are often the first signs - and that is typically around the same time (or later than) chronic kidney damage develops.

Every single person my age or older who descended from my grandfather has type 2 diabetes (and I grew up in a neighborhood with rampant Type 1 diabetes - in a school of fewer than a dozen children, 4 had type 1 diabetes), my spouse has type 2 diabetes (as do several of her siblings and ancestors. So I am intimately familiar with both types.

I have diabetes, as you might surmise from the description of who, in my family has diabetes. Mine was caught early because my doctor is among the few who test every year - so I was diagnosed within a year of first meeting the diagnostic criteria. My spouse, on the other hand, was not being tested regularly - and likely went a half dozen years before diagnosis.

My spouse had blurry vision. That was the only obvious symptom. I had no obvious symptoms. Neither of us experienced thirst or frequent urination, the only obvious symptom that type 2 diabetes patients notice - and even that is not common. Elevated blood sugar doesn't obviously feel different than normal blood sugar (unlike the low blood sugar associated with type 1 diabetes (or type 2 treated with insulin or a drug that increases insulin production))

In retrospect, my mental acuity was diminished. But it diminished gradually over time. My spouse's still is - she does not control her blood sugar. But the only reason I know this symptm now is that I immediately got my blood glucose under very tight control, so I went from mild diabetes back to normal blood glucose (unlike the gradual rise and gradual corresponding impact on blood glucose) so the change in mental acuity when I returned to normal was much more pronounced. In addition, after I got my blood glucose under control my boss (who is extraordinarily sensitive to mood) noticed a change in my affect, commented on it, and I tested my blood glucose (it was all of 140 - apparently around 130 is the level at which I begin to experience very subtle symptoms). Once that connection was made, I can tell when my blood glucose goes aboove 130. If I'm paying close attention. Had she not pointed it out, I might still not be aware of the subtle impact on mood.

Type 2 diabetes is largely a silent killer, destroying your internal organs significantly before you experience any overt symptoms.

Type 2 DM has previously been erroneously referred to as mild diabetes, because it is often asymptomatic in terms of the classical symptoms of diabetes such as thirst and polyuria.

http://onlinelibrary.wiley.com/doi/10.1002/pdi.230/pdf

If your brother had Type 2 diabetes, and truly had "clear and obvious" symptoms, before his diabetes was advanced enough to damage his kidneys he is among the lucky.

[PoindexterOglethorpe]

76. I likewise know people diagnosed with type 2 diabetes

that didn't show symptoms before it was caught. With my brother it was screamingly obvious. Only he did NOTHING about it until his vision and kidneys were both severely affected. Even now his diet leaves a great deal to be desired, and I'm not sure he ever really checks his blood sugar on a regular basis. He's blind and so reading anything is out of the question.

[Ms. Toad]

78. Since vision is associated with diabetes -

I'm sure there are meters that will talk to him and some mechanism to grab the drop of blood that doesn't require aiming at it. (Lancing can be done by feel.)

Even if he's following the ADA guidelines, his diet would not be good. They recommend far too many carbs for anyone with diabetes. (Their recommendations are an improvement - but since they are premised on never achieving truly normal blood glucose following diagnosis, if I ate what they recommend I would be as bad (or worse) than the day I was diagnosed.

[Old Vet]

24. I wonder if Kens friend was as confused as Iam with this story.....

[YOHABLO]

29. Whatever the case may be, the insurance co.s make it so damn stressful

I'm an HIV patient and I know from my experiences of the past 30 years. The system is immoral and people need to ditch their congressmen/women who don't support a "Medicare for All" system. The Republicans have made this country a hell hole for those in need.

[gopiscrap]

33. this is why we should have Universal Single Payer

fuck all insurance companies and greedy medical exec's

[pnwmom]

66. Except he didn't sign up for our governmental single payer (Medicare) when he had the chance. nt

[Persondem]

87. You are really coming across as a complete jerk ... fyi

The person thought he WAS covered and hence didn't need Medicare.

Now how about taking your "concern" elsewhere.

[ismnotwasm]

38. Holy shit

I work in Renal, Liver, pancreas and small-bowel transplant. This is despicable. Medicare covers 80% of dialysis, and covers renal transplant as well. How did his social worker not get his Medicare onboard?

Did this person go without insulin or diabetes education? This is a failure on several levels and is absolutely unacceptable, and one of the reasons the ACA denying refusal of pre-existing conditions was so crucial. Clearly too late for this person.

For a model of what single payer might look like, renal failure leading to kidney dialysis is the only chronic condition that is covered by the government in a bill dating back to 1973. . The how and why of that is kind of interesting, suffice it to say that prior to this legislation there were real death panels—a Group of individuals who judged just who would be “allowed” kidney dialysis when it was a new thing.

[pnwmom]

67. That is what I was wondering. How is it that none of his healthcare providers impressed upon him

the need to sign up for his Medicare coverage?

[ecstatic]

71. Maybe his doctors didn't accept medicare (and/or didn't know?),

which also further reinforced the guy's prejudice towards medicare? But based on him acknowledging that he didn't sign up for Medicare, I think he was told but somehow thought that private insurance would be better.

[ecstatic]

69. That's so awful, but I also agree with others that we have to be clear

when it comes to topics like this. If regular people are incorrectly led to believe that the ACA doesn't protect pre-existing conditions, then what good is it? Why fight for it? Still, I get the point about how confusing our system can be. He, like most people (myself included), probably assumed that private insurance would be superior to Medicare. However, it's still kind of weird because with his pre-existing conditions, I'd assume he would have been forced to become an expert and very discerning a long time ago. But I definitely get how a newbie with a newly discovered pre-existing condition could easily choose the wrong plan.

[taught_me_patience]

72. I'd guess there is a lot more to this story that is not being told

The line "If I had grown up in a single-payer country, when I became diabetic it would have been treated" makes no sense. All commercial insurances treat diabetes.

[InAbLuEsTaTe]

77. You said it... beyond words.