Tag Archives: insurance

And the Costs Go Up

Its been a while since I posted a blog. I don’t write until something hits me as needing to be said. Found one. The rising cost of medical care. Congress and the president have talked about taking it to task to fix these issues for us. Still waiting. Why has the cost gone up so far so fast? I’ve been reading lots of posts on both Twitter and Facebook talking about rising cost and some not being able to afford the medication they need to live.  Why? I can’t afford to spend the $2,000  to $3,000 for a couple months supply of insulin and I’m just starting to make good money.

It’s not like these drug companies are not making a profit. Novo Nordisc made several billion dollars in 2015. I think that was the year I looked at a while ago. Sadly they made about a few million less from us than the rest of the world all together. I think profit has a lot to do with the price increases. A chart I read in a Wall Street Journal article says med prices went up 69% since 2000. The drug pricing process is so confusing and oblique, finding a source for the increase is very hard. Many states have started enacting laws that while not controlling the prices but open the doors to see why the increases are happening.

A few months ago there was a news blip about companies freezing prices instead of increasing them like normal. An article I read claimed the freeze was only for low market use drugs (more popular drugs still got the increases) and there was no indication it would last. In other words it sounded like to placate the people and get us off their case, they postponed the increase until we calmed down again.

Insulin is my drug of choice so I use it often to show the increases and the effects of them on my life. I started on NPH back in 1977 when I first became a diabetic. According to research I’ve done it was about $35 a bottle (10ml). Currently I’m taking Novolin N which is the same basic biosimilar formulation but different company. There has ben little to no improvement in over 40 years to this insulin. Even the regular Novolog I take now has not been extravagantly advanced in many years. Newer insulins are faster but the older ones don’t really change much. Its why I’m on them, they should be cheaper. So one would think. Reality is they are not much different. Last time I asked about it at pharmacy here was a difference of about $20 between older insulin and newer one I had been on.

I asked to switch years ago due to money issues to a cheaper fast acting insulin. My cost dropped from about $115 a bottle down to $60- $70 per bottle. Biosimilar (means the same formula really) products now-a-day are about $294 a bottle. How did it go up without a significant change? Still kicks in in about 30 to 90 minutes and last around 4 hours. Newer insulins kick in about 15 minutes and only last 3 hours. That is not a huge change but I’d give that a thumbs up for a price bump at least.

The long term insulins? Those are even worse in my book. Lantus is a long acting (24 hour) insulin that has been around for years. An article I read claimed that its patents was set to run out a year or two ago. I’ve never really checked into that. I got put on Toujeo a few years ago shortly after it came out. “It will be so much better for you.” I was told by my doctor. Well it was not. I read the information the company put out on it since it was supposed to be so new, only out for a few months when I was put on it. Come to find out Toujeo is actually a new formulation of Lantus. It will last in your body 36 hours according to the literature on it. 36 hours? Why? I still have to take it every 24 hours so I’m not gaining anything by switching other than a more costly insulin. The best part was I also read that since it was similar to Lantus the patent on Lantus was extended. No generic insulin then. It sure sounds like a profit boosting measure to me.

Another area that seems to be boosting prices is the lack of competition. Lack of competition? This is America were we can innovate out of anything. The corporations are really good at it. When people here started realizing that the same meds here are only a fraction the cost in other countries they began ordering them through the mail. A law was put on the books to stop that once it impacted the drug makers profits. Instead of opening up competition they capped the market to prevent having to compete and lower the prices here in the USA. The same insulin people get for $150 a bottle here are only about $9 in the UK and $2 in India. WTH? Same drugs made by the same company are so much cheaper there. Why? Those countries have a universal system that has the government as the health insurance provider. If you want to sell your drug there you have to negotiate a reasonable price for it or you don’t sell it at all. They would rather have a smaller profit than no profit. And yes they still show a profit in those countries even with such low prices. Huh.

The USA has an average price tag of over $8,000 per person in medical costs. The next one down the list was about $5,000. lol Even better that country had a longer life expectancy than we do. Less money and better care than we have. We should be paying more attention and less money.

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Are We Being Forced to Use New and Improved?

I responded to a tweet earlier that me think about my answer and a need to talk farther about it. A woman asked what was going to happen when diabetics started using the older  less improved insulins? It’s a solid question and I can give an answer at this point because of this exact thing happening to me.

As followers might know, I was asked to try a 670G pump and it did not work out as was hoped. When it was over, I wanted to go back to injecting insulin and my endocrinologist at the time stopped pushing to stay on it and accepted my decision to get off the pump. That’s were our worlds separated.

She talked about me going on to using a newer insulin, Tresiba, as my basal insulin. Now to those who do not know about it, Tresiba is a long acting insulin that by the makers information can last in the body for about 42 hours, about 1 3/4 days. My question is why does it need to last that long if you take it every day? Wouldn’t you slowly build it up, or stack it being the term for this, over time?

My biggest issue was not to be asked, but being placed on it again after its lack of benefit the LAST time I was on it. She had said try a new insulin but we had tried this one before I been placed on the pump to see if it could improve my A1C numbers. I had been given a sample to use to see if it made a change.

I had been on Toujeo for a while and since starting at 24 unit a day was down to 4 units a day as which was still making my levels drop while at work still. Yes I was taking 20 units less in the end as it was dropping my blood sugars too low while at work overnight. My morning levels however where very high. Some of that has to do with me eating to stop the lows and over compensating. The doctor did not understand why I was still dropping with such a small amount in my system. This was not supposed to happen.

When she brought up going to this “new” insulin she wanted to start at 22 units a day. If she had actually looked at my charts, it was in there that I had been down to 4 units of Toujeo and I’m hoping there was some note of using the Tresiba as well. Regardless, I pointed out we had already tried this and did not want to try another 24 hour insulin as it “locked” you into one dose all day. NPH seemed to be a better fit as it was only 12 hours and would let us switch from  lower dose at night to a higher dose in the morning when I needed more help. This made sense to me but apparently not to her.

All kinds of excuses were given, forgetting and going into ketoacidosis being the most pushed fear of hers. I could not help but feel a little uneasy as it seemed she was fighting too hard to stop me from using a much older and most likely less pharma pushed insulin. NPH has been out there for decades as Toujeo and Tresiba are very new, about one year at this point. Back hen I think Toujeo had only been out for a few months and Tresiba was not even through the FDA trials yet.

I found it very hard to ignore the voice in my mind telling me there was something not right with this. After arguing for over a week about it, I grabbed a 4 year old bottle of NPH I had in the fridge from a past prescription and started using it. She was so mad I had done that but immediately got on board and we started making changes to doses and working out how this was going to work.

My point is, why was it so hard for her to get on this new train that would let me follow the pump rates closer? The only thing my mind came up with was kickbacks from big pharma. Give out our insulin and we’ll give you something. Maybe there was nothing to fuel her determination to keep on the pump when it obviously was not working for me and then fight to go back to same insulin that I had such poor performance from that led her to press me for trying the pump, again. But that idea is hard to ignore with all the posts about on Twitter and in the news.

The rising cost of the newer insulins and people going back to older insulins because of this only lead me think this will end in one of two fashions. Either they will raise prices for these older insulins or they will stop producing them altogether to force people to buy the more expensive ones.

The first reason is actually already happening. The cost of the NPH was only about $200 when I started back then. I was forced to switch to Novolin N which is a biosimilar made by Novo Nordisk by my insurance company. It was only a $40 copay at first but became a $65 copay by the time I switched insurance by switching employers. Let’s do the math on that 20% copay. A $40 copay means a price of $200. A $65 copay means a price of about $320. A $120 jump in price in a little over a year. I heard of people on twitter and Facebook switching to keep cost down and look what is already happening to the pricing. There has been no improvement in this insulin in over 30 years. I used NPH in the late 1970s when I first became a diabetic.

Are there kickbacks for doctors to keep people on the newer meds and technology to control diabetes? I don’t know. I’m not a doctor. We will die without these meds and the technology will help us keep tighter controls to avoid later costly complications. I can only tell you what my opinion is, which comes from what I see, hear, and experience. The prices of even much older insulins is going higher fast. Research can’t be used as an excuse since it is so old the research cost has to have been recovered by now. Again, I don’t know but I have think it must have after that length of time. How could it not? It would be a poor business plan to run that cost out too far and risk loosing it due to newer meds that will replace it.

A co-worker once gave me a great piece of advice, the doctor works for you not you for them. If they give a treatment that does not work for you or you know you can’t afford it tell them and work with them to get to a more affordable treatment. I do pay them and quite well I must add. I will listen but they must listen as well. Another doctor once told me that would have to stay off my foot after an injury for about 2 weeks. I simply told him that I did not have any vacation to cover that and would loose my job and insurance if I had to be off that long. He did not look happy but agreed to let me go back to work as long as after work I wore a boot on the foot. I did and work went great. I had already been working on that foot at work for 3 weeks so its not going to make anything worse. lol

Paying More With Insurance?

Just made an observation at the pharmacy the other day. It was the first time it had to buy insulin without insurance after switching jobs. Back in January when I had the insurance discount it was $295 for one bottle. Thursday the same bottle minus the insurance “discount” was $272 for the same bottle. So the difference is $23 a bottle LESS without insurance before the copay kicked in. I’m actually a little relieved as I’ve been hearing from other diabetics online that they pay as much as $380 a bottle for Humolog, an Eli Lilly insulin. I was FORCED by the insurance to switch to Novlog which is a very similar substitute made by Novo Nordisk, a Danish company. It just struck me as odd that the “discounts” talked about by insurance companies actually cost me an EXTRA $46 back in Jan (2 bottles). Granted I’d much rather pay the 20% copay which ends up at $65 a bottle. New insurance copay is higher, It’s either going to be 25% or 40% depending on how they catagorize the insulin, formulary or non-formulary.
Why do I bring this up? I read last week or earlier this week Trump was trying to get Canada to raise the price it pays for meds to lower USA prices. Huh? I’ve looked at Novo Nordisk and a while ago at Eli Lilly financial staements (publicly traded companies so those are online). Novo made $17.4 Bilion last year. In their statement diabetic meds make up about 81% of their sales world wide and the USA makes up 52% of the sales worldwide.
What made me look twice at it was that they list 2 sales regions, North American and International. Its obvious that the USA, Mexico and Canada are the North American region unless they have a different map than mine. Total sales in those 3 countries was about $9.1 billion and the REST of the world was only $8.4 billion. 3 countries had more money in sales than the other 188 countries they serve (190 in all according to them). Trump wants the one of other countries in our region to raise the profits for a company that makes over a billion more from us already? It does not makes sense to me other than more of my money going to keeping me alive, hence calling us a captive audience in this story. The companies will not reveal how much it costs to make any of the meds but they are required to list sales and cost of goods. Sales last year was again $17.4 billion and cost of goods was only $2.8 billion. So making the goods cost them less than $3 billion but they charged more than $17 billion for them. That means that there was about $15 BILLION more made than spent on these meds.
An insulin that is sold for $150 here in the states is sold for only $9 in the UK and only $2 in India (going off memory here so not sure if I have the right price with right country). They are still making a profit off it.
The argument that it will cut into research money is also not completely true. It will reduce the amount but if it is focused into the right areas it would help. Why create an insulin that is touted to stay in your system for 36 hours but you are still made to take it every 24 or once a day just like the other insulins? What is the advantage? That same insulin is also a newer version of an older insulin that would have lost its patent protection, gone generic, if not for them changing the chemical makeup enough to keep both the new and old under a new 20 year patent. They only spent $2.2 billion, 12.5 % of their sales, on research. Those are their listed numbers.
We need to have the government step in and do something to stop the price gouging going on in our health care system. People wanted it when gas was so high but this does not affect everyone like gas prices do, just us with chronic life threatening conditions.Trying to make other countries pay more for the same meds is not the way. I’m not a business genius but if everyone started paying more the only outcome I can see is deeper pockets to throw money at congress to get more corporate control in there.
I know a lot of people hate to see more about universal healthcare but it works for other countries. Make it a universal tax like Medicare, which we will not have anymore. Why would we? If there was a universal system in place, everyone with an income would be putting into it and getting out of it. You would think corporations would be on board for this system as they wouldn’t have to split the cost anymore. The amount of money saved could go into pay raises for the CEO or board members. The last tax break didn’t increase my income much if any. The only reason I can say my wages went up is I switched employers. Last year my weekly take home was about $415 a week and in January without overtime it was about $423. In 8 months I’ll have an extra tank of gas at current prices. Welfare, disability, social security, unemployment, and any other income would have the tax on it. My current situation would not be happening. I lost my insurance when switching jobs. A universal system you wouldn’t lose it going from one job to another. You wouldn’t lose getting laid off. I have not heard of any annual restart dates where you end up going back to deductibles or having high out of pocket expenses. Being a working class guy, I would want this system just for the fact of having a security blanket that is with you anywhere at anytime. No out of network worries or coming up with a copay to see the doctor. I just had another MRI done to be sure the “nodule” in my lung had not grown or moved. Haven’t seen the bill from the hospital yet but it will be around $170 plus the $18 bill I just got since the radiologist who looks at the film is not in the network. $18 dollars for a few minutes work.  I’ll have another one coming in another 6 months. My new job is going to be shut down in about 2 weeks for a planned upgrade/refit. I will once again be without insurance. It makes me wonder at times if the universe really hates me or just doesn’t care whether I live or not. Most of the time I go for the former but there are times that it seems like the latter.

Fixing the Health System

I don’t have all the answers and I have never claimed to. I do have an opinion like everyone else on the subject. Facebook and Twitter have been on fire (at least in my world) with stories about diabetics going without insulin because they can’t afford the nearly $1,000 a month for insulin or their insurance company is constantly changing who and how much they must pay. Why isn’t aspirin spiraling out of hand like many other life saving drugs? Because it is not needed to stay alive. It can be not taken and not lose your life. If it gets too expensive, you stop taking it so they keep the prices low enough you will still want it.

Insulin and other drugs are not that easy to replace. Whoops, that was an incorrect statement. You can’t replace them. There are many drugs for seizures, heart problems, and the list goes on that people need to keep living. I’ve called us the “captive audience” before and will continue to do so until I am cured. I can’t just get up and leave the show (my life with insulin) because I will die.

Here’s my fix/opinion on how it can be improved. First, get rid of lobbyists. A person who is paid by a company to pander their policies and products to politicians should not be allowed to do so. If drug companies were not allowed to spend million of dollars to woo senators or representatives to pass laws that favor them over the common people maybe they would not need to charge so much to cover “research”. Laws that prevent us from ordering these life saving drugs from other countries where they are many times cheaper were lobbied for by these companies.

Second, repeal that anti-mail order law. If I could get drugs from Canada or Mexico (the reason they sought the law) they would either need to drop their prices to stay competitive or go out of business. One of the major reason touted for said law was to maintain high standards for these drugs. Recent tests have shown that the meds on pharmacies shelves today don’t always reach those standards anyway, despite having to pay nearly 6 times the price.

Third, start a national universal health care system like a huge chunk of the rest of the world has. There are always pro and cons for these systems and when set up here it will need to be tweaked and modified to work as well as it can. There is no perfect fix and there never will be. One of the biggest complaints of the system is “I don’t want to pay for someone else’s drugs or care”. I agree whole heartedly. What ever tax they set up to fund this system, make it apply to everyone. Rich or poor, young or old, and everywhere in-between. If you are on disability you get that tax taken out of your monthly check. If you are on welfare, social security, or get checks for your kids it would apply there as well. I said across the board and I meant it.

I know a lot of people may agree with some but not all these ideas/opinions but here’s my challenge to them. Come up with a better one. Like I said at the start, I don’t know all the answers but if enough people get together and work on it they can put one together that is fair and most certainly works better than our current system. I can hear the “Whiner!” and “Just shut up!” comment coming even before I post this. The problem is if you are telling me to shut up or call me a whiner then you must think the system works ok now. Does it?

The Fears of Being Diabetic

Why the fears of being diabetic? Why not? I didn’t call them phobias, they are not debilitating. A good diabetic will acknowledge the risks and prepare for them. Risks in my opinion are simply controlled fears. Will I run out of insulin today or drop the bottle and break it? Past incidents have led me to be very careful of where I set it when it is out of the case, aka been there done that. There are so many of them I can’t possibly bring up and talk about them all. The whole point to this post is letting people know that there are many risks to being a diabetic and not everyone knows them or wants to talk about them.

By knowing the risks you can either avoid them or minimize the chances of them happening. My big fear is having a low. Its not as bad with the CGM (that leads to another fear all diabetics have) since it lets me know where I’m at with my blood sugar and most of all which direction it is going. I can avoid the lows by knowing they are coming before they get too bad. I carry Skittles in my pocket so when I know I’m going somewhere I will not have easy access to snacks. Cutting back on exercise is never an option for me. I was not raised that way and can’t get past wanting to give 100% at whatever I do, at home or at work.

My 40+ years of dealing with diabetic issues have led me with a few near phobias with the lows being at the top of that list. I have been told what I am like when my sugar gets low and that scares the hell out of me more than anything else. I become a very combative, aggressive person. People who know me can tell you how calm and passive I am normally but lower my blood sugar and I become a different person. When I was 12 I threw a nurse across our living room, I’ve knocked orange juice out my mom’s hand so many times I lost count, and I woke up with 8 EMT/firefighters holding me down on my bed to get an IV started. At work I have told them to never try to force me to eat or drink anything. Just call the EMTs and let them handle it. The fear is hurting someone I care about. My old doctor hated the fact I run my sugars so high to avoid it.

Another fear that I alluded to earlier is how I am going to pay for all the meds and supplies I need to stay alive. It is sad to say insulin is not the only med with this issue but it is the one I am most familiar with. The cost of the bottles of insulin have gone from $115 about 10 years ago to $295 currently. That is also with the insurance company discount. Buying it without insurance I’ve heard is more like $380 a bottle. The CGM is also a big cost. Each month with insurance I pay about $120 for the sensors. Without insurance they are about $450 each month. They are only meant to stay on for one week but to save money I will leave them on as long as I can, 3 weeks at times if the adhesive stays put. The transmitters are another thing. I pay about $250 for one transmitter that last only 3 months, $1,000 a year with insurance. Without insurance, I would ben  paying $1000 each for them, $4,000. What happens if I loose my insurance? It keeps me up during the day, I work nights so that is my sleep time.

Up comes another fear/risk, loosing my job. I hate to break it to those who feel the ADA protects them but I have been in situations where employers have been, lets just say creative, in forcing me to leave. I don’t think I’m a bad employee. I show up for work on time 99% of the time, I don’t call in sick very often, I do what I am asked to do whether it is a part of my “job” or not, I get along with coworkers well, and am willing to work overtime when needed. I’m not going to get into the politics of it but “right to work” states also allow an employers to let you go without a reason. They will not use the word diabetic in any letter or phone call since that involves the ADA. They can just give any excuse and let you go, if they respond in the first place. As far as getting hired, that is another nightmare all together. The easiest form letter to use is “we have gone with another more qualified applicant” one. Have they? I have wondered how many times they hear about previous situations of low issues and decide to not hire over it. I’ve read the fine print at the tale end of the applications. You give permission for the company to run background checks on you which includes credit, criminal, and employment. You give them access to your employee files from former employers.

An everyday fear/risk is not calculating insulin does correctly. Did I count the carbs right? Did I get the right ratio? Did I do the math right? I’m not perfect. I’ve screwed this up more than just once in 40 years. Don’t panic and make the correction. Eat more if you go low. Take a bolus if you go high. This one is really easy to manage. Its more annoying than anything else.

Fear is a constant companion for a diabetic. One you need to become friends with instead of being paralyzed by it. I could  die by walking out of my house and down the street today, but I’m still going to do it. I could screw up any of the diabetic things I’ll do today but I’m still going to do them. As I said it in past blogs, I’m 9 years past my expiration date so in my mind I’m not loosing anything if I died today. I can hear the gasps from here. It’s life. I’m going to die, everyone will die. Its just when will I bite the big one. I realize the issues of being a diabetic each day and I work with those obstacles. I control them and move on. Enough said.

Oh the Game We Play

One day ago I decided I needed to get another set of sensors for my Dexcom, and so the game begins. Why do insurance companies try to play games with our life saving medicines? Well I guess the Decom isn’t really keeping me alive but it helps prevent me from succumbing to the lows that can lead to much worse problems. Car wreck, getting hand stuck in a machine at work, or even as simple as not figuring my insulin right because my sugar is low.

I called 2 days ago to se if I still had a refill left on old Endos prescription. I evidentially had.. Here’s where this gets very weird and made me ask questions. Earlier this year I was talked into trying a pump again and it put me over the yearly out of pocket for my insurance. Sad part is the pump still does not work for me. We spent 2 almost 3 months trying to work things around to get it to stop alarming out (low and high) but nothing worked very well. I gave up on it but didn’t get it returned. That is another story.

Anyhow, I have been getting all my meds and supplies for $0 since then. After I got off the pump I started using the Dexcom again and had to get a set of transmitters. Those thumb sized little marvels of medicine are $1000 a piece and I got 2 of them for free. Well I thought it was going to be free but I ended up paying about $150 for my share. The insurance company gets a discount so they are less than $1000, maybe $990. I don’t know or care really. All my insulins and test strips are being paid 100% since trying the pump.

I get a call yesterday morning from the place supplying me with my Dexcom supplies and they tell me my credit card was declined. Wait, why was it even being used in the first place? I asked the lady why it wasn’t covered 100% by the insurance company. She told me they claimed there was $260 left on my out of pocket to pay. Huh???

I told her that was not right as they had been paying for everything since roughly June or July. She looked closer at my account and at the transmitters I had received months ago. Low and behold, they had listed the same amount, $260 as left on my out of pocket back then. The $1100 I had to cough up for that pump pushed my out of pocket over for the year. Someone who deals with insurance companies all day could not come up with an explanation for this weirdness. She also told me I had a $150 credit on my account.

I asked where that had come from and she told me the money I had paid for the transmitters had been switched to credit as the insurance company had paid the cost in full, after I paid out the co-pay amount so they had given it back as credit. Fine by me but what the hell is going on with my out of pocket costs being out of whack? She looked even closer and found they had done the came thing back then as now. They had showed I still had money to pay for out of pocket yet were paying 100% already back then. Anyone confused because I sure am. The company I was dealing with was very nice and reasonable about all this. She said she would apply my credit to cover the sensor but if, better be when, they pay in full they would return my credit.

Thank you so Diabetic Supply of the Middlelands. You went above and beyond with this issue. As far as Coresource goes, I’m watching you now. Now that I’ve seen one of your tricks I can watch for it next time. I hate playing games but when they are pushed on me, I will figure out the rules and use them to ruffle your feathers. Pluck them straight out if need be. If you are going to waste my time with stupid issues then I feel it only right to follow your example.

P.S. To add to all this confusion, I saw another endo at my then current endocrinologist’s behest to see if she had missed something as to why I was always dropping so low while on the pump. I again, my mistake I guess, thought it would be covered 100% even if not in the “group”. I now own them/her $385 for that visit as the insurance company refused to cover it, at all. Was it not preapproved? I kind of thought they would have checked that out first. I’ve never gotten a good answer to that one looking at my stuff on line. Really need to call about that one. Just another nail in the coffin of trust I had with them.

Affordable Care Act Again

OK Here we go again with the Affordable Care Act. I still don’t see why this is such a hard decision for anyone and of course I’m biased. This act will help me out. According to the article I just read 77% of young people are agreeing that health care is important. I used to be a young just out of high school kid. I was indestructible. Well aside from being a type 1 diabetic. I believe that this plan will make things better for everyone from hospitals and doctors all the way to Billy Bob and his kids. I went through this once a while back but in case someone missed it here it is again. OK right now here in Nebraska if you don’t have insurance and you can’t afford to visit Doctor So and So, you have one choice left. You go to the Emergency room. If it is life threatening and/or your pregnant, they have to treat you regardless of your ability to pay. I was forced to go to the ER and ended with the bill. A simple stop in and check blood sugar and pulse was worth a little over $400. There was no adjusting the pump settings, no CAT scan, the second time I wasn’t even seen by a doctor, just a nurse practitioner. Nor was there any need for it. My endoconologist is all over this issue. She has been since I started this process. Was she notified of the incident? Yes she was. Was the data downloaded to her? Yes it was. Were changes made? Yes the were. Here’s were it gets weird. That $400 bill I paid wasn’t just for me but also for any one who stopped in because they didn’t have insurance to go to a regular doctor’s office. A long time ago I had just started a job and got into an accident with my own car in the garage. 4 1/2 hours and $275 later I was told everything was fine. Since I had just started my job (second week) I had no insurance and no money saved back to pay. The hospital worked with me and allowed me use what was back then called a slush fund to pay. How do you think that slush fund got there. This last weekend my mother had to go to the ER and there was a constant flow of people in and out. I just had to wonder how many had coverage and how many did not. The bottom line for me is that the people fighting the getting of insurance are the ones that for whatever reason don’t think they need any. That is until they end up in a car wreck that maybe will cover the injuries under the medical side of the auto insurance. There is no such thing as a planned accident and you never know when they will happen. Made they should look at changing the policy at the ER. If your not covered you don’t get treated. It would remove the last option for someone who feels they don’t need to get insurance because it is an unneeded expense. There you go no coverage no treatment. OK enough of hashing an old issue. Until next time.