Thursday, January 1, 2009

Thinking About Simple Health Insurance

By Joe L
(Originally published in 2006 at

After simplifying my life a few years ago and leaving a regular job with “benefits” behind my largest single monthly expense, outside of housing, is health insurance. But thanks to general good health and the fact that I don’t yet have any chronic medical issues I’ve felt safe in carrying only a high deductible catastrophic health insurance policy. In my case, at age 54, the savings have been large since a comprehensive low deductible health insurance plan is more than double what I’m currently paying. But of course there are some risks. Beyond the obvious risk of the higher deductible my insurance never covers outpatient prescription drugs and drug expenses don’t count toward either the high deductible or the policy’s stop loss limit. So recently I decided to try and learn about the size of the risk in having such a large hole in my health insurance coverage.

What I’ve learned is that three quarters of the population over the age of 45, and five of six over the age of 65, are taking at least one prescription drug. The prescription drugs that I’m most interested in though are those drugs that might be prescribed for a long term chronic condition. After a little research on the internet I discovered that the most common chronic conditions requiring use of prescription drugs, as reported by the Center for Disease Control, are high cholesterol, hypertension, arthritis and muscle pain, and type 2 diabetes.

During a recent physical exam I learned that my cholesterol was bordering on the high range. Now a year later after losing some weight, making a number of dietary changes, and adding some dietary supplements my cholesterol is way below its levels of a year ago. Had my efforts failed it’s likely that I would soon be a candidate for one of the cholesterol lowering statin drugs, like Lipitor, which is now the number one most prescribed prescription drug on the market.

Statin drugs help us to lower our bad LDL cholesterol levels and increase our level of good HDL cholesterol as well as helping to reduce the risk of heart attacks and strokes in people who already have coronary artery disease or diabetes. Of eight common statin drugs I found listed there is only one that is available in a generic form-- Lovastatin. Prices for generic Lovastatin range from $30 to $60 for a thirty day supply where as Lipitor, a drug still covered by patents, costs from $66 to $121 for a thirty day supply. The good news by most reports is that all of the statin drugs have about the same effectiveness so the lower cost generic Lovastatin will work for many people.

According to recently revised guidelines nearly half of the population of the planet is now considered either hypertensive, and in need of treatment for high blood pressure, or pre-hypertensive and on the verge of needing treatment. But there’s a lot of controversy around the change of what constitutes high blood pressure. Before May of 2003 the threshold for hypertension was considered to be blood pressure over 160/100. With the newly established guidelines for hypertension treatment is now recommended for blood pressures of 140/90 and above with blood pressures between 120/80 and 140/90 being labeled as “pre-hypertensive”. Critics have claimed that the newer guidelines were adopted in response to studies by doctors with strong connections to drug companies. Critics also claim that some of the newer drugs used to treat hypertension are more expensive, less safe, and not as effective as older treatments.

I also learned during my last physical that my blood pressure was in what is now called the “pre-hypertensive” range. Luckily many of the same changes made to lower cholesterol levels have the double effect of also lowering blood pressure. My blood pressure in fact came down along with the lower cholesterol levels but for those not able to control their blood pressure through exercise and diet there are a number of drugs available to help. Thiazide diuretics, sometimes called water pills, have been used for decades to help lower blood pressure and can cost less than $5 a month. Another group of drugs called beta blockers, in use for over 40 years, are also effective in many cases and can cost from $5 to $30 dollars a month. Four other newer drugs are also available with monthly costs ranging from about $30 to $60 per month.

NSAID’s or, non-steroidal anti-inflammatory drugs, are another one of the most commonly prescribed types of drugs. Two NSAID drugs, ibuprofen and naproxen, are often prescribed to relieve pain and inflammation resulting from arthritis and muscle and joint pain. There are a number of cost saving choices for generic NSAID drugs with monthly costs ranging from about $20 to $45 per month while patented NSAID drug prices commonly costing from $100 to $150 per month.

Type 2 diabetes is the last common health condition that I considered in my survey of chronic conditions requiring ongoing use of prescription drugs. Type 2 Diabetes can often be treated with oral hypoglycemic drugs that lower the blood sugar level. Orally administered hypoglycemic drugs are usually preferred in people with Type 2 Diabetes over insulin because of their decreased side effects. At least half of the commonly prescribed hypoglycemic drugs are available in generic form with the cost of a one month supply ranging from $20 to $50 with drugs still under patent costing from $30 to $167 for a months supply.

The general conclusion I’ve drawn from looking at the four most common chronic conditions requiring prescription drugs is that they can usually be treated with prescription drugs costing less than $50 a month. Of course everyone also needs to consider their own health history to determine what health conditions, beyond the four common conditions discussed here, may affect the prescription drugs that could be in their future. And so with that in mind I’ve decided that for now I’ll continue to roll the dice with my high deductible health insurance plan and its lack of prescription drug coverage.

Joe Leeak is a part-time engineer, writer, bicyclist and guitarist who lives simply in Seattle, Washington.