The Haves and Have-Nots

The Haves and Have-Nots


This content originally appeared on Beyond Type 1. Republished with permission.

By Alexi Melvin

In the United States, the complex healthcare system acts as a barrier for many people who require insulin to live. Without insurance, one vial of insulin can cost up to $350 – with most people requiring multiple vials of insulin each month. The high list price makes insurance coverage a matter of survival. It also sets up deep inequalities – depending on the status of each person’s health insurance coverage, people who need insulin are either able to get access to more insulin than we actually need, with multiple avenues to help facilitate that access (patient assistance lines, 24/7 nurse support, etc.) or we struggle to obtain enough insulin to keep ourselves alive, with little to no access to support resources. Given our current healthcare system, we are forced into one of two categories: the “Haves” or the “Have-Nots.”

This is not to say that the “Haves” do not also struggle with barriers – insulin access generally is often complicated, requiring an immense investment of time and energy to navigate insurance coverage, formularies, referrals, etc. But the situation for the “Have Nots” is often dire, with frequent and consistent roadblocks to adequate care just to stay alive.

Socioeconomic disparities are exaggerated in the healthcare system – those with lower socioeconomic status experience more frequent barriers to healthcare. This creates a situation in which those with less access to financial and social resources are also faced with fewer healthcare resources, compounding their unmet needs. People with diabetes who fall within a lower socioeconomic group struggle, in varied ways, to get a sufficient amount of insulin to efficiently manage their disease.

In 2019, the International Journal for Equity in Health conducted a study to gain more clarity on this issue. The journal conducted “in-depth face-to-face interviews” with 28 patients and the 6 healthcare professionals who cared for the patients. The framing of the study centered around access to healthcare for “vulnerable groups.”

The results showed that access to insulin and other management support was indeed difficult for those within a lower socioeconomic group, due to a number of factors including “non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication.” These factors were thought to also hinder the patients’ ability to obtain support and maintain communication with hospital staff that could vastly improve their diabetes management and knowledge, such as nurses, diabetes specialists and diabetes educators.

Let’s imagine, for example, a person who was raised by an upper-middle class family, in a nice neighborhood, and had the means to obtain a higher education from a well-respected institution. Statistically, that person would have had an upper hand when it comes to establishing a steady career path, when compared to someone who may have been born into a family that was less economically stable.

Reliable health insurance in the US is only afforded to us if we are able to do one of two things: secure a job with a stable company that recognizes the importance of comprehensive healthcare benefits – or be in a financial position to pay for it out of pocket. For those few, the “Haves” who were raised amidst or propelled into some element of privilege, they can wind up with an excess of insulin – even letting their backstock expire before they’ve had the chance to use it.

Those people living with diabetes who fall into the “Have Nots” may find themselves in a position where they ration insulin or are forced to obtain supplies from others. There are resources available for those who are in immediate need of insulin, but they require qualification and navigation, and many people may not know where to look for help because of lack of connections within the very system that has already excluded them. Our healthcare system is not easily accessible by design.

It is truly baffling how this situation is not reversed – how the healthcare system in the United States does not prioritize those who urgently need supplies due to financial and socioeconomic hardship. Reliable and consistent insulin access should not be a luxury reserved for the few. It should be the standard.

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Read more about advocacy, diabetes access, insulin, Intensive management.



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