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01/29/2005

And they say there's no health care crisis in America

RSV — respiratory syncitial virus — is the most common respiratory virus in babies and young children. It's highly contagious; virtually all children get it before age 2. Most of the time, it causes an illness no more serious than the garden variety cold, but in premature babies, it can be life-threatening. 125,000 kids are hospitalized yearly with RSV, put on ventilators, returned to an ICU. And about 2500 infants die yearly from it.

There's no vaccine for RSV, but there is a drug that can keep the illness from becoming so severe if a baby contracts it. It's called Synagis, and it's given every 28 days during RSV season to babies who meet certain criteria — premature birth, chronic lung disease, or both.

It also costs the motherfucking earth.

The dose is calculated by weight, so the cost increases monthly. The total cost of Synagis during a single RSV season can exceed $6000 per child.

Charlie getting SynagisCharlie's first dose was administered in the hospital in Connecticut. His second was delivered to our house to be given by a visiting nurse. The dispensing pharmacy called a few days before shipping to let us know the package was on its way, and to alert us that our insurance company was agreeing to pay only 40% of the cost for the injection.

There must be some mistake, I thought. It's a prescription drug, just like any other, covered with a reasonable co-pay. Someone's made a mistake.

Ah, but after several phone calls we have determined that there was no mistake at all. Charlie's Synagis — a drug so effective that his doctor said, "I can't tell you how many lives it's saved" — is covered on the same schedule as drugs that enhance erection.

Imagine my delight.

It turns out that there's a bit of controversy surrounding Synagis. While it's been proven to be remarkably potent against RSV, it's not thought to be cost-effective as a prophylaxis.

Follow me? It is cheaper to hospitalize a kid when he's sick than it is to prevent the illness to begin with. So the insurance company's taking its chances. Taking its chances with my kid's health.

I know this is what insurance companies do. I know they're a business. I know each company must minimize its own risk to maximize its profit. And I think it's fucking unconscionable.

Look, we're lucky. I know that. No matter what, Charlie will get his shots. We can afford to make up the difference in cost. And even if we couldn't, we'd have to find a way. We're parents who love a child, a flesh and blood being, after all, not a corporation that answers only to its shareholders.

And to think I was miffed when the company wouldn't pay for fertility treatment.

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