In a typically American gas station car park, there’s a man hunched over the steering wheel of his car. His cheeks are stained with tears and the needle in his hand doesn’t belong to him. The system has left him desperate, and he doesn’t see how he can go on. To his right sits the stranger who has just saved his life, Mindy Salango. Mindy is no doctor, but she has just given him a shot of insulin – extra from a pen she has left over – which has spared him from death.
Mindy tells me this story from the other side of my computer screen. She’s found time away from her receptionist job, looking after her children, and advocating for lower insulin costs to be interviewed via Zoom one Saturday afternoon.
She is one of the 37 million Americans living with diabetes, relying on insulin to survive as a Type one diabetic since her junior year of college. It was a time during which she didn’t know much about diabetes, she admits, and we agree that not many people do now, even 27 years later.
We’ve been discussing how the healthcare system operates across the pond and the lengths American diabetics go to in order to stay afloat.
“The one gentleman I was talking about was in between jobs and his insurance hadn’t kicked in yet for the new job” she says, describing a scene that’s not completely uncommon for diabetics living in the United States. “He’d already gone two days without insulin, so he was bordering death.”
Diabetes is a chronic condition affecting the body’s ability to produce insulin, a vital hormone that regulates sugar levels in the blood. Having Type one diabetes means the body cannot make insulin at all, and a complete day without it can cause fatal complications such as ketoacidosis which can lead to comatose and even death.
The ongoing nature of the condition means many describe the emotional burden that comes with a diabetes diagnosis, but for those in America, the added financial strain of the healthcare system only contributes to everyday stress and anxiety.
Mindy admits the huge sum of money healthcare has cost her in her life, it’s a sum she has right on the tip of her tongue, “$350 a month… I’m lucky” she says, nervously laughing off the figure before adding, “financially living with diabetes in the United States is incredibly difficult.
“I’ve been asked six times if I have extra insulin to spare because people either can’t afford their next prescription or they [haven’t been] paid yet and they’re out of insulin,” she recalls, describing the snakes and ladders of trying to access the life-saving drug.
The biggest problem, she notes, is employment-tied insurance, which stirs fear for those who are unemployed or between jobs. These types of insurance plans aim to cover some of the costs of pharmaceutical company services, private endocrinologist appointments and medical supply fees, but leave a large portion of Americans unaccounted for.
In fact, even with health insurance plans, vulnerable people in chronically ill communities are still required to pay up to $9,000 each year for their healthcare.
It’s an eye-watering figure, one that’s unavoidable for diabetics and others living with chronic illness. The American Diabetes Association estimates that diabetics have 2.3 times greater healthcare costs than the average American. Without this insurance to cover a portion of these fees, people are forced to ration their insulin supply or, in more desperate scenarios, go without it completely.
Mindy knows this to be true all too well.
“After I got divorced [I] found myself as a single mother and my former husband’s insurance was really good,” Mindy explains, “so I didn’t really understand how expensive it could be until I got out on my own.
“I was paying over $500 a month as a single mother for insulin and supplies just to be able to survive. To keep a roof over our heads, food on the table and our utilities going I either had to ration or go without,” she says with a tone not completely detached – the recollection of this event clearly upsetting her – but in a matter-of-fact way that makes me realise this is not so unusual to those living in America. It was only last year that the Alec Smith Insulin Affordability Act passed in Minnesota after insulin rationing led to Alec’s death at the age of 26.
With just three pharmaceutical companies dominating over 90% of the global insulin market, Novo Nordisk, Sanofi and Eli Lilly hold a monopoly over insulin prices which they can increase at any time. Add that to the threat of unemployment caused by COVID-19, it’s no surprise that people are now taking matters into their own hands. Illegal prescription sharing across states is just one of the dangerous methods to access vital, life-saving medicine.
Chloe Chance, a 23-year-old teacher from Cambridge was diagnosed with Type one diabetes when she was 4 years old. She has experienced diabetes healthcare under both U.S and U.K systems having lived in Mississippi and Maine for a year in 2010.
She notes that the American healthcare system is significantly more advanced than the UK’s but recognises the dangers of not having insurance as a chronically ill citizen.
“Because we had insurance, we never had any issues with getting the equipment and supplies and insulin,” she says, “I think the only reason for that was because we were on insurance that covered everything, had we have not had that I think it would’ve been a totally different story.”
The issues with employment-tied insurance continue to plague America. While Mindy’s involvement in her community has helped to save countless lives and elevated the voices of the underrepresented in their times of need, her efforts are more than an inspirational tale. In reality, they are a reflection of a system that’s failing America’s most vulnerable citizens.