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Peginterferon-Ribavirin, Failed it twice. Incivek, Failed it. Sovaldi Olysio, failed it. Harvoni, failed it... Hopefully we can find a new treatment, Otherwise i'll be transplant bound.

Tuesday, March 14, 2017

Zero


Not the ghost dog from Tim Burton's The Nightmare Before Christmas.
Although that is one of my favorite Disney movies.

The reason why it is one of my favorite movies is because Jack Skellington (the main character) struggles with not only his own identity, but that of the town's. He was trapped in Halloween Town until he followed Zero out into the woods.

He needed Zero to nudge him in the right direction.


Zero, helped him overcome the fog, even though it would ultimately crush him, he rose from the wrecked attempt to revitalize himself and his town.

He rose to ultimately find a new identity, separate from the darkness he found within himself. It was his failures that gave rise to his success and it all happened because of a Zero.

To understand why this antihero means so much to me, isn't so hard.

Monday, March 13th, 2017 I found out I have an undetectable viral load, in other words, a Zero.

I've followed my Zero before, and I've crashed, but now that I've risen from the graveyard so to speak (Shit, I left that part out, this is why I'd be a terrible narrator, anyway so Jack gets shot from the sky and ends up in a graveyard where he reflects on his failures and saves Christmas. Even though he kinda wrecked it in the first place, the point is that the graveyard is where he did it. Okay, back to the emotionally charged story of rebirth and all that.)

My Transplant gave me time to reflect, (Yea, I had one of those, I'll tell you about it sometime... It's a long story) it gave me a renewed energy to take on what I want from life.

Like Jack I'd resigned much of myself to the darkness, hope is always there but my last few months felt more like acceptance than hope.

My transplant changed that, but it didn't shake the underlying problem. I still had HCV. A little over six weeks prior to my Zero, I began a combination treatment of Sovaldi, Zepatier, and Ribavirin.

Now I'm here again, following my Zero into the night. I know you've probably been waiting for the happy ending but I'm sorry about how long this movie is, 86 minutes just isn't enough time.

I've put on thirty five pounds since December, It only took me a month after the transplant to start dating again, and for the most part I assume this is what normal feels like.

But this is where the rebirth thing changes.

Because I need your help.

You.
Specifically.


I wrote a lil bit about how the ACA saved my life, but it's more than that.


The proposed replacement will create brackets of insolvency. If you are sick, you will eventually find yourself facing exponential cost increases as time goes by.

Unless you happen to make over 250k per year.

If you find yourself in delinquent medical debt, the biggest benefit of the AHCA(the ACA replacement;) the Health Savings Account increases, suddenly become useless.

Last year my medical costs consumed ~35% of my income. This year, because of Medicare I'm looking at ~20%, next year I will no longer be on Medicare.


If the AHCA(the ACA replacement) passes I will see my healthcare costs rise to 50-60% of my annual income.

The reason for its variability is because with no mandate, insurance premiums will rise and the proposed tax credit doesn't even touch me because I barely make enough income to be taxed as it is.

It drops Medicaid eligibility to 100% of the poverty rate, its static tax credit doesn't lower premium costs for anyone who actively uses insurance. The 30% continuation fee creates no incentive to buy insurance because its threshold is too variable to have any form of consistent applicability.

If you make 18,400 and pay $59 per month for a bronze plan, that plan increases in price to $270. If you are 29, you can receive a $2,000 tax credit, at that income you'll max it out, assuming you have no other deductions or credits. The cost is comparatively $708(under the ACA) vs. $1240(under the AHCA) annually.

This also doesn't assume out of pockets that can max out under deductibles, which historically speaking increase when there are less payers and more risk per payer, nor the increases in premium pricing, nor the unusual requirements for maternity and abortion exclusion policies, ad nauseam.

(Why did I go with 18,400? Because that was my annual income whilst attending college, most articles focus on how this affects the elderly and the sick. And while it affects them absurdly more I wanted to show how it affects an average college kid as well. I didn't bother with gender because of a weird disparity: women use medical services more often than men although men tend to need more services than women over their lifetime. With that I'm going to assume that minimal bronze level care is all that's needed.)

Why average? Because healthy is rarer than having an illness or ailment.

The bill falls short of what it is"replacing" at its most effective point for the average young American.


As someone grows older it doesn't scale with any actuarial reality and instead uses ten year age brackets to increase that credit by $500 each time.


To make this more penalizing for being sick, the 30% continuation fee is based on your past level of care. So if someone had bronze care at $270, and another person had platinum care at $460 they would pay $81 or $131 respectively.

The bill also suggests that this amount is to be charged on a monthly basis transforming a penalty of a few hundred dollars to nearly a thousand dollars annually on the low end. That money no longer goes to pay for the system but rather instead to insurers for what I can only describe as faith-based economics. the only principle that could possibly support this is that we should trust an insurance company to lower prices now that they're making more profit. Certainly it's easy to see why I call this faith-based economics.

But here's where it gets really weird.



So how does that work when you fall at 101-136% of poverty. Because Medicaid will no longer be covered for the near poor under the AHCA. Will the states arbitrarily determine how that continuation fee is levied? Will they use their MCO(managed care organization) to determine that rate?

Because the bill fails to correctly qualify this there will be countless legal disputes attempting to resolve it.

As the bill stands now, there is an incentive to avoid the fee entirely if a person does not have insurance. Because the incentive of the continuation fee does not apply to them until they obtain coverage.

This means that it actually disincentivizes health insurance for those who are currently uninsured.



We can do better. Remind our representatives that we must do better.


Contact your Representative


Contact your Senator

8 comments:

  1. Congrats on finding ZERO Rick! Now you just need to stay at zero and move forward with your new lease on life (your L/T). How's that going? How are you feeling? Is that extra 35# a result of the rejection drugs? Please comment on how it's going with the transplant, I'm facing one and value your oppinion. Thanks. RC

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  2. Thanks, it's going well, it's hard avoiding the sun whilst hiking again but ample amounts of sunscreen helps.
    I'm feeling pretty fantastic health-wise. I haven't felt this way in years, i think. It's hard to remember when i felt like this TBH.

    actually the 35% was last year because I wasn't on Medicare, while on Medicare my healthcare costs have dropped about 15% due to lower out of pocket costs.

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    Replies
    1. He meant 35 pounds. He wanted to know if the weight gain was because of the rejection drugs.

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    2. Oh lol. No, it's because I was grossly underweight post transplant. I went down to around 160lbs, when my normal weight is around 180lbs, I'm presently 195. I've been working out since December, slowly increasing the difficulty.

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  3. Hi Rick. I was referring to weight gain on rejection drugs. I have so many questions about the L/T. How long after the operation was it before they pulled the breathing tube? Do you remember the first few days after the L/T? How mush pain was involved just post operation?and how is the pain today? Are you feeling really good? Your a true warrior Rick, all you have been through! RC

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  4. Hi Rick
    My thoughts are with you on this journey.
    I too have been waiting for another treatment that hopfully will be succesful.
    I did a trial with dac and failed a number of years ago and was left with a nasty Ns5a resistance profile.
    I was wondering if you know what resistance RAVs you were left with after harvoni and could share them here
    Thanks and best of luck
    Rod

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  5. I have been on two trials, the first in 2013 was the new wonder drug SOF. I did 16 weeks Sof-RIBA and it took 9.5 weeks to see zero. That was my first warning, one week post treatment my count was back in the millions. The second trial was 12 weeks Sof-RIBA-Peg. I went to zero in 3 weeks and stayed there throughout treatment, but 1 week post I was back in the millions!! So it's onward to the third trial. I screened for the Polaris (4) trial and made it on paper!! However with my history and a liver bounce test of 38 (fibroscan) they asked for a MRI And that's where they found the 3 spots in my liver that looked like HCC. The HCC diagnosis was confirmed with another MRI showed it to be mixed HCC/CC. (Bile duct cancer) mixed in with the HCC. So I was pulled off that trial, I know in my heart that that one would have cured me!! My Dr wants to wait until after L/T to treat me for the Hep-c. I'm a 3-a. Compensating well. I'm seeing him the first of next week and will ask about rags. He has mentioned Y-93 and wants to treat with Sof- Vel- vox it should be out on the market this fall. Thanks guys. RC

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  6. Hi Rc
    My thoughts are with you also as they are for all of us dealing with this.
    My question was actually for Rick about what Ns5a resistance mutations he has(if known) after being exposed to harvoni.

    Rc....good luck .As you were never exposed to an Ns5a drug by the looks of what you say you will not have to worry about those treatment -emergant resistance mutations moving forward and the sof/vel /vox should work very well for you
    Good luck
    Rod

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