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Comment by colechristensen | Hacker News Reader

>So he made a rational decision: He’d go uninsured, save the cost of the premium, and just pay for his meds out of pocket, while racking up work experience that could serve as a springboard to a better position with health insurance.

He did not make a rational decision. This is the most upsetting part. I looked. You can buy an insurance plan in Minnesota with a $750 deductable $6000 out of pocket max for $350 per month.

It is not possible with that plan and a few more like it to spend more than 1000 per month. If you are planning to spend that much anyway it is irrational to pick anything else.

What seems to have happened is he was using expensive autoinjector pens while on good insurance and then didn't adapt when he lost it and didn't get the right advice for purchasing his own insurance or the right education to be able to pick an appropriate plan.

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At that point, he should just book a trip to Mexico or better yet China, and buy at less than 10% of the price.

As someone living in Mexico, I am always frustrated when reading horror stories from people in the USA about medicines. I have always been 100% willing to help getting any required medicines if needed.

And here I am today in the USA (visiting for 1 week of work), with what appears to be a stomach infection, and I'll have to just survive it maybe with Pepto, until I go back to Mexico, or otherwise pay a lot of money to see a GP to give me a receipt for a something that will cost me $6 USD back in Mexico ( https://www.angloinfo.com/blogs/mexico/mexico-city/more-adve... )

> He did not make a rational decision. This is the most upsetting part. I looked. You can buy an insurance plan in Minnesota with a $750 deductable $6000 out of pocket max for $350 per month.

What did you find exactly? Are you sure it’s something that was available to Alec? That price sounds surprisingly low, and sometimes there are cheaper plans for temporary work gap transitions that aren’t available to someone with a job permanently. The article said he was looking on the healthcare.gov marketplace, which doesn’t have plans anywhere near that low. I was using healthcare.gov for a few years while I ran a startup, and the prices went up so fast and so high I don’t know how normal or poor Americans can even afford them. We looked outside the marketplace and only found the same plans for the same price being offered privately.

I lived in Minnesota for a decade and bought individual insurance on the state exchange for a couple of years. I went on the same exchange today and searched for insurance plans available for 26 year old single men (the same situation I was in a few years ago) and found two $750/$6000 plans for $328 and $368 per month. There was also a $1000/$5000 plan for $375 and a few others in the neighborhood.

When I looked outside the exchange a few years ago I found a plan I liked more than my other options which I chose (didn't look today).

Quirks and or better management in MN gives it relatively favorable prices.

Thanks for the additional detail; you know more about Minnesota healthcare than I do. Looks like I'm wrong about the prices there. I guess maybe I'm reacting more to the idea that Alec's decision wasn't rational. I agree with you about how extra sad that decision was, if it was avoidable. But I might also give him some benefit of the doubt, especially since this exact same story isn't that uncommon, of people choosing against insurance because they don't feel like they can afford it, and then paying a much greater price.

Are you sure the base insurance price for a healthy person is going to be the same insurance price a diabetic would pay? I'm not so sure about that.

Yes, a significant part of the ACA was pre-existing condition protections.

You can only be charged rates based on location, age, and tobacco use.

Those pens allow for accurate dispensing.

Who wouldn't choose to learn how to use a syringe well instead of paying a third of their income for auto pens?

Looking at what a good friend of mine has to put up with, I'd say someone with severe diabetes. You have periods when you cannot think very straight and it is easy to fuck up with standard syringes. Auto injectors should not cost a third of your income, they are not complex devices.

They shouldn't.

But you also have a tiny mass produced machine that is life and death for people. Insuring quality is expensive and the cost of mistakes is extreme.

If you want cheaper medicine you have to also have cheaper mistakes and there aren't many people arguing equally loud for both. (Just one issue of many)

The mistakes are not cheaper. The result of mistakes is a high risk of death in both circumstances. And measuring insulin into standard syringes while not being able to think straight is dangerous as hell.

By mistakes I was referring to manufacturing defects of medical devises and the levels of financial liability coming from them.

I'm referring to which course of action is least likely to result in the death of a friend.

So how much do you want to limit and punish the accidental death of a friend?

Higher numbers for the previous two will increase cost and death to people who can no longer afford the treatment.

"Least likely" means infinite quality control and is not possible. Failure rate is not zero, you have to pick finite regulatory requirements and financial consequences for failure.

You have to assign a dollar amount to a human life. It is uncomfortable for many people to think big picture thoughts but you're contently using things made by people who have to.

Not sure if this is the same issue, but apparently the cheaper insulin syringes are thicker and cause more pain and bruising. From my understanding, these are shots that need to be administered several times a day in perpetuity. The savvy consumer's options are chronic physical pain or poverty. With that in mind, would you still suggest that people go with the cheaper option?

Most importantly, the consumer should decide what is the best option here. If you are poor and the only available option to stay alive is injection multiple times through the day using thicker needles, perhaps it is still better then die? Or maybe not. I do not want to decide that for anyone.

Life sucks, diabetes sucks, and poverty sucks. More than people who don't experience it can understand.

But you do the best with what you have, and that means picking your pain.

Most diabetics, not pumping take two kinds of insulin. One that provides a basal dose that covers the glucose your body produces. One to two injections a day for that. In addition, there is the bolus dosages that are taken with any carbohydrates. So most people on average, eat 3 meals a day, plus any snacking. We are up to about 6 a day here.

The cheaper insulin in the US is garbage and should not be used. period. The problem is the companies are have no pressure to reduce prices. the customers are captive and must pay or die. They make money in other countries that have price controls on the same product.

I've seen a friend with Type 1 diabetes quietly and quickly go from someone who practices law competently to someone who can barely manage to stab herself when she realizes she's having a blood sugar issue. Dosage is hard when you're crashing.

If you’re crashing (low blood glucose) you don’t take insulin, you drink juice or call an ambulance (My partner has had to do this, unfortunately). If you’re so high that you’re having trouble using a syringe you need to be in a hospital.

Source: Type 1 diabetic.

To help people understand low blood sugar episodes, I think it's good to watch these three videos.

https://www.youtube.com/watch?v=pC_0CI9jV6A https://www.youtube.com/watch?v=Bv4HIci1Qtc

https://www.youtube.com/watch?v=TidRyyrTz4k

One thing I forgot was a Glucagon injection to revive someone who has passed out.

Yes, but generally you're not going to be injecting yourself with glucagon, as if you're lucid enough to do that, you're lucid enough to eat/drink some carbs.

Personally I'd say there is no difference; I've stuck out on syringes in the uk for ages just because I found them lightweight and convenient; but recently moved to pre-filled pens. The cost to the NHS for prefilled pens vs syringes is pretty negligible.

Syringes were fine for me, pens might be less embarrassing to use in public maybe?

are we talking the same thing, I am thinking of the pens I used to use that you would dial the dosage in and then push the plunger. In Canada, those pen fills costed about 70 vs 36 for the vials, but they also had 15mL of insulin vs 10mL. So about 1/3 more with the syringes and needles being about the same price.

The problem isn't their choice of insulin delivery, it is that there are no price controls and an incentive to increase prices without any significant loss in sales. This is an area that government need to be all over.

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