The Expense of Chronic Pain (Or can I afford my groceries and my prescriptions this month?)

Chronic pain, like any chronic illness, is expensive.  In addition to the time spent in doctors appointments, medical tests, procedures, and everything else healthcare related, the amount of money that individuals spend on healthcare is huge.

Individuals with chronic pain spend, on average, $1000 per month on their healthcare. According to Johns Hopkins University, the annual cost of chronic pain in America is upwards of $635 billion a year.  This includes costs such as lost time from work and disability claims in addition to the costs to the healthcare system.  So, let's have a real conversation about the costs and factors here.

"Affordable" Healthcare

Before I jump into this, I want to state that I have absolutely no interest in getting into a political debate and my writing on current legislation is based on my professional experience in healthcare administration and my personal experience as a healthcare consumer in addition to the legislation and reported consequences of the rates of reimbursements.
The Affordable Care Act has been met with a lot of criticism, but the intent behind a plan for national healthcare was to address a few major problems facing the healthcare system:

1. Overcrowding and inappropriate utilization of Emergency Resources.  Emergency Departments across the country have been dealing with overcrowding and long waits for years, and the problem is only getting worse.  This leads to really long wait times for care and using resources that had been allocated for emergency services for reasons that are not emergency related. (And frankly, emergency room visits are expensive!)
2. Individuals who are not insured are unlikely to seek out preventative care and will frequently wait until it's an emergency situation (or close to it) to seek out care...and they visit the ER/ED to do so.  The lack of preventative care leads to a worsening of conditions that are treatable and preventable, leading to either needing (more expensive) treatment or, unfortunately, an untimely death that could have been prevented.  (And did I mention that emergency room visits are expensive?)
3. With the increase in ER/ED usage, high cost of usage, and lack of insurance coverage (or reimbursement rates), who pays for the services rendered and resources utilized? Unfortunately, the costs have to be covered somewhere, and so the price of healthcare gets jacked up elsewhere to cover the costs. 
4. And an issue not directly related to the challenges of the emergency resources, there was a lack of coverage for anything that was considered a "pre-existing condition", which is particularly problematic for individuals with chronic illness.

So, the intent behind it was to get everyone covered with some sort of healthcare coverage (which was supposed to be affordable--I'll get to that in a moment) which included preventative care, so people could have better overall health leading to better long term health outcomes.  Of course, the ER/EDs are still available to emergency treatment, but the hope was to decrease the need for people to go to the ER/ED rather than primary care.  It sounds like a win-win.  Except...

Has anyone checked out the cost of health insurance?

There is a larger section of the population who now qualifies for fully subsidized healthcare coverage under Medicaid.  Medicaid covers quite a bit of healthcare costs without a cost to the patient, and Medicaid is publicly funded.  Many people are covered under their employer or spouse's/domestic partner's insurance coverage, which can range from great coverage with little cost to the employee to not-so-great coverage with a great cost to the employee. And then there are millions of people who are in the gap between the two, and have utilized sites such as HealthCare.gov or, in California, Covered California to find insurance coverage.  There are different levels of coverage that are available and recommended based on how often someone may access care vs. how much they want to pay out of pocket for deductibles and doctor visits vs. how much one wants to pay for premiums.

So for people in the unsubsidized groups, it can get really pricey.

Up until recently, I was enrolled in a High Deductible Plan where I had to pay for services (including all tests, doctor's visits, prescriptions, etc) out of pocket until I reached the deductible of $5000, but my employer covered all premiums, and after I paid the deductible, I had no co pays for anything. Using the Health Savings Account, it actually worked out fairly well...I could divert the money I would've spent on premiums to the HSA and ended up saving money in the long run.  This was actually a good plan.
But some High Deductible Plans still have co pays, so the insured ends up paying the high deductible and then starts paying the co pays for each office visit, prescription, and whatever co pays are required.
So, healthcare is expensive.  Having spent time on High Deductible Plans, I have had the opportunity to see how much my doctors' visits are, how expensive my blood tests are, and (in particular) how expensive my prescriptions are.  It's been eye opening, and I'd like to share that with you.

Where are the expenses?
(I am using myself as an example; some individuals with chronic illness will have more expenses, some less.  And since chronic illness and chronic pain can go in waves, there are some months where there are very few-relatively speaking-healthcare expenses and some months where the expenses are high.)

In the past year, I've had:

25 doctors' visits (at about $150 per visit)
5 ED visits (at about $800 per visit)
30 or so lab tests (cost depends on the specific test)
5 medical tests (ultrasounds, scans, etc.) (Again, the cost depends on the specific test)
1 invasive medical procedure (REALLY expensive)
1 major surgery (REALLY, REALLY expensive)

Regarding prescriptions, I regularly take 5 prescription medications daily (in addition to the supplements I have to take).  (Side note:  I joke when I say I take a handful of pills on a daily basis, but in truth, I take massive amounts of pills on a daily basis just to keep me going.)  And these do not count the high amount of prescriptions I have that are designated "prn" (or "as needed").  My nightstand is a pharmacy.  Our medicine cabinet is filled with bottles.  We have a space in the kitchen for medications that need to be taken with food and supplements to be taken in the morning.

Fortunately, all of my prescriptions are now generic, however due to a shortage in one of the medications, the cost suddenly jumped from less than $20 for a month prescription to $180 for a month for a generic medication!  At one point, I was paying close to $300 a month for all of my prescriptions, and this is on top of the other healthcare costs.

And then there are the costs of healthcare which insurance (or at least my insurance) doesn't cover. My acupuncturist is $75 and I see him once every three weeks.  My massage therapist is a monthly visit at $100.  My supplements to help me sleep?  Add another $50/month to the bill.  My gym membership--which I use for the pool and the weight training portion of my treatment plan--is $55 per month.  The essential oils and other topicals I use on a regular basis to manage my symptoms? Add another $100 to the monthly budget.

These aren't "incidental" costs.  These aren't optional costs.  If I want to stay healthy (or as healthy as I can get), I have to stick to my treatment plan.  Health shouldn't be optional.

Final Note:  And there are programs to help offset some costs, such as prescription medication. (Unfortunately, I don't qualify for any of them.)  But many pharmacies can assist you in working with those patient assistance programs if you have difficulty paying for your medications.


Definitions of Medical Conditions list in my Medical Chart