Posted on October 9, 2007

David Lazarus gets personal


Nation’s healthcare crisis gets personal

By David Lazarus
Los Angeles Times
October 7, 2007

I write a lot about healthcare reform. Now it’s personal.

I was diagnosed this past week with diabetes. As of Friday, I was injecting myself with insulin, something I’ll be doing four or five times a day, every day, for the rest of my life. Without the injections, I’ll likely die.

Scared? You’re damn right I’m scared. What’s going to happen to me? What’s going to happen to my family?

I got past the shock pretty quickly and am now stuck somewhere between denial and anger. Depression will soon arrive, followed eventually by acceptance. Something to look forward to.

This is an uncertain time for me, but I know this much: I’m more convinced than ever that our medical system is a mess and that a single-payer insurance program is the only realistic way we can achieve universal coverage, promote preventive treatment and make healthcare affordable to all.

And if contracting diabetes is frightening for a relatively well-insured person like myself, what must it be like for any of the 47 million Americans who lack health insurance?

According to the American Diabetes Assn., nearly 21 million U.S. adults and kids have the disease — 7% of the population. About 15 million of this number have been diagnosed. The rest have no idea that they’re afflicted.

With obesity rates soaring, as many as 54 million others are strongly at risk of contracting diabetes in the future.

In my case, diabetes struck not because I stuff my face with Big Macs and fried chicken, which I don’t. I take good care of myself and am not overweight — considerably less so since unexpectedly dropping about 15 pounds over the past couple of months.

No, it’s almost certain I got nailed because a genetic time bomb finally exploded.

My father, Paul N. Lazarus III, who produced the movies “Westworld” and “Capricorn One,” has Type 1 diabetes and is now nearly blind. My younger brother has Type 1 and is doing well enough. My aunt had Type 1 before it blinded and then killed her.

The doctors say diabetes — almost certainly Type 1 — has been lurking in my DNA since I was a child, waiting for its time to strike.

But why now? I’ve lived 46 fairly healthy years, except for certain pharmaceutical pursuits during college. I don’t drink. I don’t smoke. I exercise as regularly as I can. What did I do wrong?

Probably nothing. The stress of my recent move to L.A. and starting a new job didn’t help, but it’s not to blame. This was going to happen no matter what.

I had a good idea something was wrong when I noticed that my weight kept going down no matter what I ate, and that I was consumed with a thirst of biblical proportions (accompanied by a commensurate increase in bathroom breaks).

I visited my doctor and had a blood test. The bad news came just days later. I was immediately referred to a specialist, whom I’ll call Dr. B.

Dr. B was great — knowledgeable, sensitive, empathetic. Problem was, Dr. B didn’t take insurance.

Excuse me? I said.

Dr. B explained that it just wasn’t cost-effective for him to seek reimbursement from insurance companies. It was too much hassle, he said, and he didn’t get paid enough for his efforts. Dr. B said an increasing number of doctors were cutting ties with insurers for the same reasons.

If I wanted to see him at his private practice, which was most convenient to my home, each visit could cost me hundreds of dollars — not the most appealing prospect when one’s facing a chronic disease.

Dr. B said I could try to deal with insurance reimbursements on my own, but that’s the last headache I wanted to inflict on myself at this point.

So I had to quickly find a doctor who would take insurance. My insurer’s website had a directory of possible choices, but you’re essentially pulling a name out of a hat — not the best way to make decisions when your blood-sugar level is three or four times normal.

This led me to Dr. W, who was equally knowledgeable if perhaps a bit lacking in the empathy department. He also had what seemed to me unconventional ideas about how diabetes can be treated with certain drugs and a rigidly monastic diet of his own devising.

This ultimately led me to Dr. D at UCLA’s Gonda (Goldschmied) Diabetes Center, whom I’m very fortunate to have found. Not only does he know what he’s doing, but he also has the resources of a world-class medical facility that focuses exclusively on what’s trying to put me under dirt.

It was Dr. D who finally made the call that I needed to start insulin injections, and it was he who made sure I knew how to handle that first, life-changing moment when needle touched skin.

Clearly I’m receiving the best available treatment, and I’d rather be here than anywhere in the world.

But the quirks and complexities of the insurance system border on madness. Through my employer, I have about as much insurance coverage as anyone. Yet that wasn’t good enough for Dr. B.

I have to wonder where else my private-sector insurance will fail me in years ahead.

And what happens if I get fired tomorrow? With a preexisting condition, I’m virtually uninsurable in the individual insurance market. Will diabetes leave my family destitute?

In the past, I always wrote about the uninsured in a largely abstract way — a faceless mass of millions of people confronted with a broadly defined medical challenge. I know better now.

The terrifying possibility of my own loss of coverage gives me an acute sense of what the uninsured must deal with, the dreadful awareness that you and your loved ones are only one medical misstep from catastrophe.

That’s unacceptable for any person who lives in the wealthiest, most advanced nation in the history of the world.

I’ll have a lot more to say about this in the future, especially as my own situation takes shape. But this much at least is evident:

  • Universal coverage must be our goal, and it must allow ready access to all aspects of the medical system at affordable prices.
  • The emphasis must be on treatment, not bureaucracy. As it stands, researchers at Harvard University estimate that about a third of the $2 trillion in annual healthcare spending is squandered on bureaucratic overhead.
  • Employer-based healthcare is obsolete. As costs continue climbing, businesses can no longer meet their historical obligation of being the primary provider of coverage to American families.
  • Quality medical treatment is a right, not a benefit.

Unfortunately, nearly all healthcare-reform proposals on the table center on expanding the existing system and pushing the uninsured into high-cost individual policies that will make private insurers even more profitable.

That can’t be the answer.

Single-payer isn’t perfect. Critics say it can involve long waits for treatment and can stifle innovation.

My belief is that Americans can get it right. We can learn from the examples of other nations and refine things so that our healthcare is second to none. It won’t be easy. Then again, how much worse could it be than the way things are now?

As of this moment, I’m completely dependent on the U.S. healthcare system to keep me alive. I, and you, shouldn’t have to settle for anything but the best.,1,7915141,full.column?coll=la-utilities-business&ctrack=2&cset=true


By Don McCanne, MD

David Lazarus now not only reports it; he lives it.