The Greatest Health Care System in the World

One might reasonably assume that diabetes testing supplies could be simply obtained. Continuous glucose monitoring (CGM) eliminates fingersticks and enables more precise knowledge of sugar levels. Recently insurance denied coverage of CGM supplies for a patient I see. My patient’s blood sugars were higher than last year. My patient was upset about their elevated blood sugars AND their lack of glucose monitoring supplies. I pressed the pharmacy to learn the reason for the denial. Insurance would not cover CGM because the patient’s diabetes control had worsened, which indicated that the CGM did not help lower their blood sugars.

Dumbstruck, I explained to the patient that CGM would only be covered if their blood sugars improved. But how could they manage their diabetes without the CGM?

One might also reasonably assume that medications to prevent suicidality and improve mental health would be accessible. A patient I see takes testosterone for gender-affirmation; he is transmasculine. Testosterone literally has saved his life, raising him from the depths of depression. Every month a snafu arises when he tries to pick up his medication. Due to supply chain issues, his medication is often out of stock. The pharmacy tells him to call other pharmacy branches to find it. Once the medication is located, the patient must request a new prescription to the new pharmacy. Sometimes the new pharmacy is far away and difficult to access. This takes time, results in missed doses, which causes his mood to plummet. Every Single Month.

It is hard enough to be trans in this country. Why must our medical system make it even harder?

Again, one might reasonably assume that people with asthma need their daily controller inhalers to prevent flares. Insurances frequently change which inhalers they cover based on cost factors. Patients and providers are deluged with warnings written in medical jibberish and capital letters: YOUR INHALER WILL NO LONGER BE COVERED. When the formulary changes, patients’ refills are denied.

Patients are understandably upset, and medical practices spend precious time sorting out paperwork, finding substitute medications that are utterly unfamiliar to patients. Why must insurance burden patients and providers in this manner?

As a physician, I strive to partner with my patients. To mitigate the medical trauma they have endured. And yet, when I explain the above to my dear patients, I feel ashamed and embarrassed to be part of this cold-hearted system.

Pamela Adelstein
Newton, Massachusetts