Insulin as a Right?

Healthcare is something I am passionate about. Healthcare coverage is extremely important but it is something that like many others was never very important to me until I needed it. Today as a type 1 diabetic, healthcare is a requirement to keep from terrible secondary disease and if left untreated, death. While it is a very broad and complex topic I want to focus on the effects to type 1 diabetics specifically.

USA today published an opinion article that provided some perspective. The short article discusses Shane Patrick Boyle who died after running out of insulin while caring for his dying mother out of state. A more comprehensive article about the situation can be found here. I know some will argue he could have acted differently and may not have died but we miss the central issue here. Victim blaming has increased in recent years which is why I only want to focus on type 1 diabetics here since they are not to “blame” for a preceding unhealthy lifestyle as often associated with type 2 diabetics. It is easy for Monday morning quarterbacks to talk about how the game should have gone on Sunday if the team would have just done this one OBVIOUS thing… Prevention is not a concept western medicine has adequately covered yet and Shane Patrick Boyle’s untimely death only helps to prove this.

When I first read the title of an opinion article I immediately disagreed: “Insulin is a human right for me, all diabetics. We need to make medications free to those who need it“. It wasn’t until later in the article when it made sense to me. As the author writes:

“If the “right to life” is a basic human right, then insulin is a human right for a diabetic.”

When stated in this manner it begs consideration. Without this medication, a type 1 diabetic will die within a very short period of time.  I can say I personally try staying active, eating right, and secure my own health insurance but what happens when I am between jobs? What happens if I move out of state? Is there any precedent for specific diseases being covered?


Kidney Disease as an Example

If we look at End Stage Renal Disease (ESRD) as an example we see that insurance coverage for a specific disease has already been established. In 1972 the Medicare Kidney Disease Entitlement bill was signed allowing coverage for ESRD. (Here is a link to an article discussing how and why congress enacted this game changing bill.) There are many instances that allow an individual to use Medicaid for different reasons including income status, kids, pregnant women, the medically needy, and specific disabilities but ESRD is also included. Patients with ESRD typically have two treatment options: 1) Dialysis or 2) Kidney transplant. Kidney-Transplant-Cost-Savings

The obvious third option is to do nothing and die but thanks to the 1972 legislation patient’s have an option to treat without worrying about cost. There are several ways to secure healthcare coverage but depending on the case’s circumstances, a patient with the diagnosis of ESRD can have coverage for treatment in 1-4 months which is very fast compared to normal waiting periods. According to a New England Journal of Medicine Article the majority of ESRD cases are associated with diabetes. (I understand there are far more cases associated with Type 2 vs Type 1 but stay with me…)nejmcp0906797_t2


What About Insulin?

With the increasing cost of insulin and the ramifications of these changes we have to look at this issue. There is clearly precedent to treat for the extremely high costs associated with ESRD and if the the majority of cases stem from diabetes complications, then why not work to prevent disease and complication progression? Managing diabetes is expensive (about $16,000 per patient every year according to American Diabetes Association) but the expenses of this single complication associated with poorly managed diabetes disease can cost from $75,000 to over $350,000 in just 5 years so why not promote the preventative approach? There are many possible answers to this question and it is up to each of us to make that decision. Diabetes is only one of many possible diseases we can discuss with this type of question but at the heart of it I think the answer is simple. In the USA for a type 1 diabetic, insulin is required to live. The Declaration of Independence states our unalienable rights are “Life, Liberty, and the Pursuit of Happiness” given to each human and as a responsibility of our government to protect. As such, I believe insulin treatment should be available to every single type 1 diabetic patient regardless of insurance status, monetary means, or social situation.

What do you think?