On Matters of Healthcare, A Culture of Compassion

Last summer, I was diagnosed with Type 1 diabetes. What this means is that my pancreas does not produce insulin. Scientists are unsure why some people develop Type 1, but the why hardly matters for someone once they are diagnosed. Since my pancreas is for whatever reason not up for the job, I must give myself insulin injections to use the food I eat and make sure my body does not become a sack of sloshing, noxious sugar water, but I also much guard against blood sugar lows caused by using too much insulin or not eating enough.

In short, the life of a diabetic is one of constant vigilance, testing, moderation, and worry. Every day, I need to worry about whether or not I have eaten enough, taken enough medication, or done too much of either of those two things. Doesn’t this sound fun?

                The real kicker is that, in the United States, I often feel as if I am on my own. My doctors can tell me medically what is going on in my body and interpret my complex lab results, but ultimately the responsibility for treatment is with me – only I can moderate what I eat, how much I exercise, and how much I inject, striving for the right balance. Even with the emotional support of my partner, my parents, and my close friends, the anxiety takes its toll.

                The costs do not help matters. On matters of healthcare, the United States largely places the burden of paying for care on individuals and employers – while there is public assistance for needy people, for the most part our country relies on a system of private insurance, with adults paying monthly premiums to cover themselves and their families. Because of this self-reliance mentality, along with the insurance premiums and deductibles, I end up paying large sums of money to the pharmacy every time I need more diabetic supplies. To give some idea of my out of pocket costs, for about a month of testing supplies, I pay $40. For insulin, $160. That roughly $200 a month is after health insurance pays 85% of the bill – I don’t even want to think about how much I would be paying without insurance.

Compared to our American culture of self-reliance, the Australians take a different route, which I learned when I spoke to a pharmacist in Sydney. I came in to the pharmacy looking for more testing supplies. The pharmacist told me that the Australian government administers a grant, the National Diabetes Service Scheme, administered through the non-profit Diabetes Australia (website here: http://www.australiandiabetescouncil.com/ and here: http://www.diabetesaustralia.com.au/). This money, she said, subsidizes the price of supplies and medicine for all Australians, meaning that diabetics pay much less for the materials they need than I do in America. Even with Tony Abbott’s conservative government and their plan to cut back on healthcare payments in an attempt to reduce the deficit, my pharmacist friend told me, diabetic Australians could still depend on help from their government. “No one in this country,” she confidently declared, “believes that sick people should be left on their own with no help.”

                In addition to the much reduced medication cost, she told me, Diabetes Australia is a support network and education center. Instead of my panicked search for information last summer, the pharmacist showed me pamphlets and websites full of explanations and data I still cannot get my endocrinologist back home to share with me.

                When I told my pharmacist friend about my experiences as a diabetic in America, she was speechless. To my observation that there was nothing like Diabetes Australia in the US, without hesitation she exclaimed, “That’s appalling! Why should you a young, smart, hardworking, otherwise healthy person with so much to accomplish and give, be penalized for a disease which you did nothing to bring on? Why shouldn’t the community help you live your life to the best and fullest you can?”

                I could not answer her. All I could remember is the day I was diagnosed this past summer. After a gut-wrenching day at the doctor’s office, I went to my local CVS to fill my new prescription for the first time. When the tab came up, I was astonished – I would be paying almost $800, since I would have to pay for all my supplies plus my deductible. “Diabetes is expensive,” said the pharmacist behind the counter as she swiped my credit card.

                In their examination of culture, Fons Trompenaars and Charles Hamden-Turner observe that all human societies face basic problems, including the question of how to care for sick society members. Culture, they say, is the way which we answer those questions. Speaking to my Australian pharmacist, I could not help but wonder at how much different my life would be if I lived in Australia, a culture which places a premium on helping one another, instead of the United States, where independence and talk of bootstraps reign supreme. While I cannot generalize and say that Australians are a more compassionate people in all matters, their government, values, and culture seem more supportive towards those dealing with illness.