When your Life is an Empty Donut Hole

I remember my mother worrying about going into the “Medicare donut hole.” I recall it had something to do with money, and the donut hole was a bad place to be, but I’ve always found Medicare far more confusing than should be necessary. I dismissed the donut hole as something I’d never have to deal with. After all, I’d never “been on medication” in my life. At age 64, healthy as a horse, a long-time cancer survivor and a recent total hip recipient now walking without pain, I saw Medicare as an annoyance, a necessary evil I’d now have to face. I dutifully researched my health insurance options prior to my sixty-fifth birthday. Lord knows, I never thought about the donut hole.

And then, last week, I woke up in the donut hole. It happened so fast, I was sure it was a mistake. Patient (and impatient) explanation by several insurance brokers finally helped me understand, and there it was – one of those rare epiphanies. Suddenly I understood the absolute insanity of a healthcare system that offers profit for a few based on the illness of others. The more sick people – and the sicker they are – the more profit for both the health insurance companies and the pharmaceuticals.

Now that it’s happening to me, it’s so clear, I think I can explain it in just a few lines. Try this:

Grandma is healthy. She takes no meds – never has.

At age 71, Grandma is wearing down. She is diagnosed with A-fib and is now at a high risk for stroke. The doctor prescribes Xarelto. No one mentions it is one of the most expensive medications on the market and cannot be sold as a generic drug.

Grandma is shocked at her $100 co-pay, equaling $1.11 per tiny pill, but she pays it. She has no idea that her insurance company is also paying for each pill she takes, to the tune of $17.60 per pill! The pharmaceutical company is well aware of that figure though, laughing all the way to the bank, rolling around in luxury, living it up, shoveling in the money.

The insurance company seems to be on Grandma’s side. And then, all at once, it’s not. “We’re not picking up this tab anymore, old lady. You’re going to have to pay more. Why, we have shareholders to satisfy! Health insurance is a money-making operation, after all. You think we’re in this for your health, old lady? We’re in business to make a profit.”

And now Grandma pays $4.68 every time she takes one of those fancy-shaped, tiny red pills. She is assured that, next year, the cost will go back to $1.11 (or thereabouts) for each pill – until the greedy insurance company gets fed up again, which is scheduled to happen the last quarter of the year, annually, until Grandma has the good sense to just die.

Big pharma makes money. Health insurance companies make money. Grandma loses money until she dies. America’s healthcare system defined: profit from the illness of others.

Do you understand the Medicare donut hole now? I think I do. In fact, I think I see the entire system a lot more clearly now that the life is being squeezed out of me through my bank account. I guess that “universal healthcare” concept might make some sense. Perhaps we should look into it.