Lungs O' Doom

“Can Primatene Mist contribute to airway remodeling?” I asked the nurse.

She looked horrified by my question. “You’re not using Primatene are you?” she asked.

I shook my head. There’s no need for me to use Primatene. I have pretty good health insurance through my employer, and I happen to live in California, where it is illegal for employer-provided health insurance to refrain from covering pre-existing conditions. And since I’ve had asthma since birth, it definitely counts as a pre-existing condition. So fortunately, my insurance will pay for me to use Proventil, an albuterol-based inhaler which is considered the front-line medication for asthma patients having serious attacks (though recently my co-pay increased from $10 to $20, a result of a new remix using more ozone-friendly propellant, meaning the drug no longer qualifies as a “generic”).

Primatene Mist, by contrast, is an over-the-counter inhaler meant to treat mild asthma attacks in patients whose asthma is pretty well under control without medical intervention. It is NOT recommended for people with diagnosed asthma, because in patients with moderate to severe asthma, it can just do much more harm than good. And while it doesn’t contribute to airway remodeling (a phenomenon where the airways in the lungs change permanently due to chronic asthma-induced inflammation, leading to decreased airflow and lung capacity, and often alarming physicians who take X-rays of my chest), Primatene can cause long-term damage in asthma patients. This is why the nurse told me in response to my question.

Years ago, though, there was a time when I relied on Primatene Mist. I’ve had asthma since birth, as I’ve mentioned, and when my student insurance ran out after I graduated from college, I had no way of treating myself. I couldn’t afford to go to a doctor. I went deep into debt for the occasional hospital visit due to severe attacks; at such visits, I’d get a prescription for an albuterol inhaler, but I wouldn’t get them filled because I simply couldn’t afford it. (Of course, because I was unable to pay for my ER visits, the costs simply carried over to other patients). So I used Primatene. It was available without a prescription, I could afford it, and it worked for short-term relief. It caused damage to my lungs, worsening my asthma in the long-term, but it’s all that was available to me at the time.

MediCal was recommended to me as a way to get medical coverage during this time. Unfortunately, I was earning too much money at the time to qualify for MediCal; I was working two part-time jobs, neither of which provided any insurance, but I needed the income to pay rent (even though I had two housemates to help cover the cost of rent and utilities). It was  a choice for me between MediCal and shelter. I suppose there would have been resources to help me keep a roof over my head while I sacrificed part of my income so that I could get proper treatment for my asthma, but I wasn’t too keen on going on welfare. And, of course, I could not afford private health insurance, since my asthma counted as a pre-existing condition that would have made my premiums prohibitively expensive (and yes, I did look into it).

Fortunately, after a life-endangering episode, I finally got in touch with Dr. G., a local allergist and pulmonologist, who agreed to see me for a minimal cost. Dr. G. gave me the sample medications that drug reps gave him when they came to visit, including an albuterol inhaler so that I no longer had to use Primatene. And because he knew my financial situation, he agreed to see me monthly for the absolute minimal cost that he could — $10 per visit. This meant he wasn’t charging me for any of the tests that he performed, the spirometry and blood pressure and other tests that he performed regularly to keep tabs on my asthma. It was, as I understood it, at least partially dodgy for him to do so since he had to account for all of these tests, but believe me, I appreciated it. Of course, my asthma was aggravated by severe allergies, and, of course, he couldn’t give me the immunotherapy (allergy shots) that I really required to keep my asthma under control; and the drugs he gave me were barely adequate. In short, my asthma was under control, but just barely, and any irritation was liable to cause a serious flare-up which might require a hospital visit.

When I finally got a full-time job that offered health insurance benefits (after years of working part-time for a newspaper where I was regularly exposed to particulate matter in the form of paper dust and ink mist), Dr. G. was thrilled because now I could get the top-of-the-line medications he wanted me to have, and start on immunotherapy. I was thrilled to, although with my employee contribution to health insurance and all of the co-pays I was now paying for office visits and prescriptions, I was earning just under what I’d been earning before with my two part-time jobs. Still, six years after I graduated from college, I finally had adequate health coverage.

All of which is just to point out that the health care system in our nation is a joke. It’s full of pitfalls and traps. You might be able to qualify for state-run health care, but you have to go on welfare to do so because the job you need to pay your rent simply pays too much, putting you at just above the poverty level. If you have children, you have a better chance of getting assistance from the state, though if your child has a major condition — such as asthma — then you’re in trouble (my mom was still paying off my childhood medical bills even when I was in high school). God forbid you have to go on private health insurance, especially if you have a pre-existing condition, which pretty much rules out any notion of self employment. And me, I’m pretty sure that I’ll be working all my life instead of retiring, since I’m sure my asthma and other conditions will simply be too expensive to treat under MediCare or Social Security, without supplemental income. That is, if these conditions don’t kill me before retirement age anyway.

And from what I can tell, I’ve been lucky. I’ve known people with worse medical conditions than mine who can’t get any coverage at all. 68% of bankruptcies in our nation are caused by astronomical health care costs. Of those, 70% of the people filing for bankruptcy have health insurance. 50 million Americans have no form of health care coverage at all, and the majority of those people are children. And children who are sick pose health threats to other children, to say nothing of people in low-wage jobs who have no insurance (or inadequate insurance), who must stay on their job anyway because they can’t afford to take any time off.

The health care debate in our country isn’t just an issue of poor people not having access to adequate health care, it’s a public health issue as well. Diseases spread. Untreated diseases spread further and more aggressively. Even if you have adequate coverage, exposure to someone who is uninsured and sick and still preparing your food or driving your bus will make you sick as well.

That’s why I am totally in favor of health care reform in our country, and why I favor a public option as well. Vague threats about “socialized medicine” don’t scare me at all (and, to be honest, I’m convinced that most people throwing around the boogeyman of “socialized medicine” don’t even know what the term means). I don’t give a tinker’s cuss about insurance companies that link health care to profit and deny previously-guaranteed coverage when an illness becomes too severe. Our “system” is not any sort of system; it’s a convoluted mess of half-assed measures, cracks, and loopholes for executives.

Thus, I support President Obama’s goal of reforming the US health insurance industry to provide affordable health care coverage for all Americans. I’m not a Communist or a Socialist (and again, I think most people who use these terms as perjoratives have no idea what they really mean), though neither am I a Libertarian or a hard-core capitalist. I’m simply an American who believes that when all other Americans have access to adequate health care coverage, the entire nation will benefit.