Insurance + Stigma = Fury!

Choosing to live a saner life shouldn’t be a luxury,

Posted Feb 10, 2019

I was forced to visit an insurance broker recently to try to reduce my astronomical health insurance costs—not something I'd ever volunteer to do unless my back was up against the wall.  I hate insurance and the games it plays with your sanity.  But there was no helping it, so there I was, filling out the dreaded forms that ask, "Are you taking any medications?" then leave you three spaces to fill in the names.

I needed a whole extra sheet.

The broker took one look at my addendum, and said, “Good lord!  Why are you taking all those drugs?"  A seemingly innocuous question, but I didn't hear it that way.  What I heard was a sneering, "Are you an addict, or are you a hypochondriac?"  He was a young fellow and probably didn't realize the sensitivity of the subject.  I'm giving him the benefit of the doubt now, but I didn't then.  I went straight into stigma alert.

In stigma alert, you're instantly wired, hyper-primed to the threat lurking behind the next look, the next question.  You reach back into the emergency zones of your brain to brush up on your defensive spiel:  This is what bipolar disorder is.  This is why I have to take medication.  This is what happens if I don't.  You've heard all of the questions before, and you're ready, able and armed—and the person sitting across from you has now become the enemy.

With as much patience as I could muster, I explained about bipolar disorder, and why I have to take “all those drugs.”  This one decreases mania, I told him; this one battles depression; these deal with the accompanying agitation and lethargy; these counteract the side effects I get from taking all the other ones.  And so forth, down the page.  I have other things that are wrong with me besides bipolar disorder, but they all somehow seem connected, tarred with the same dirty brush: my ulcer, for example, or my insomnia

The only condition I disclose without any embarrassment is my hypothyroidism (which is also a factor in my bipolar disorder, although few people know that).  I have yet to meet anyone who objects to the idea that you have to supplement a dysfunctional thyroid.  Which is amazing to me, because it's exactly the same notion that underlies psychiatric medication: correct a chemical imbalance.  But this wasn't the place to get into that discussion.  I simply took my shame and swallowed it.

The insurance broker shook his head.  "There's no way I can get you a lower priced policy, not with all those drugs."  He had an affinity for that phrase, it seems.  "You're lucky you have the coverage you have.”  I didn't feel lucky: My insurance premium and the co-pay for my drugs cost over half my income every month.  "You're just going to have to talk to your doctors and see if they can take you off some of these," he said.  

Okay, I wanted to ask him, what do you think I should live with?  Life-shattering mania?  Suicidal depression?  Mood-wrecking insomnia?  The problem is, the drugs that cost the most are the ones that most effectively keep me sane.  I actually credit them with saving my life.  Yet they’re the ones the insurance broker kept harping on—because, despite the fact that most of them are now generic, the prices are still exorbitant: one drug alone—a generic—is over a thousand dollars a month without insurance.  

"Why don't you just try something else?" he asked.  As if I hadn't already taken everything out on the market to try to reclaim my mind.  When you're lucky enough to find something that works, you stick with it, and to hell with the rent and the gas and the electric bills, and sometimes even food.

I slumped in the chair, sinking deeper and deeper inside myself.  Why did we have to make these barbaric choices?  Why did I have to defend my right to sanity against a weaselly insurance broker's ideas of how I ought to live my life?  I knew I couldn’t afford to keep on going as I was, but I also knew I couldn’t afford to change.  The chance of a stigma-free existence seemed very far away at that moment.  In a saner and more empathetic world, it wouldn’t be a luxury.

In the end, I sucked it up and kept my existing policy.  I could travel through Europe, I thought; I could buy a new car; I could shower myself with all sorts of culture... In short, I could have a more adventurous, far more glamorous life without “all those drugs.”  But would I be alive to enjoy it?