This isn't an interview: Me to me.

My name is Rick Nash, as I write this, I am thirty years of age and soon I'll be one year older.

This birthday is special to me.

Because it is one I didn't expect to necessarily have.

When I was in summer of my seventh grade year, I was diagnosed with Hepatitis C ( HCV.) One of the key elements I took from that doctor's appointment was that I would need a transplant around 30, or die. And given the knowledge he had and the virility of my, to be later understood as, variant strain, a transplant would only extend my life a short period of time.

It was a prediction that I have fought against my entire life. Two months ago, I received a liver transplant. And presently I am on treatment for HCV, my viral load fell from 100 million to 33,000 at present following four days of treatment.

I am not yet out of the woods, but I'm better off than he predicted. Because he also believed that my state would be far more impacted by the virus.

I stay healthy otherwise, and a life of keeping myself that way has helped me survive. But by no means could I be writing this now without the support of others near and far.

So this isn't an interview, it's just a format to help isolate certain issues, but what are we talking about?

Presently we are in dire straits politically, and many don't understand just what the stakes are.

I'm talking about the ACA aka Obamacare.

First off, I want you to know that I am biased. After all without the ACA, I wouldn't be here. To make this more complicated I'm going to state that I'm a registered Republican, always have been. In fact, I come from a line of Republicans, my family has been here since Coolidge and I take pride in this.

So we're essentially talking about how the ACA/Obamacare saved my life.

You've had a preexisting condition your entire life, one that insurance companies actively prefer to deny treatment for, how has that impacted your life?

I've been aware of healthcare policies and health insurance since high school. I learned how to understand benefits from my mom, who has worked in HR for as long as I've been alive. My senior year in college I began looking for a job that would give me the benefits I needed. I focused more on benefits packages than compensation, because of the high costs I would pay otherwise.

My first failed treatment in 2008 showed me the price to lose insurance. That treatment would have cost me over $60,000 even having failed and stopped halfway through. I graduated in 2008, and like many others at the start of the recession, finding any decent paying job was a challenge.

When I graduated I realized that I would need to stay in school full-time until I could get a job to so as to not lose health insurance. So I enrolled in classes and worked 25-39 hours per week. When I found an available promotion, I seized it. I took a chance and began a second treatment, and while I was working 39 hours a week and making a living wage, in order to have benefits, I still went to school full-time.

I was lucky in that four months before I turned 25( my parents' insurance had a policy that allows students under 25 to be on their parents' plan) I managed to find a job with benefits.

That next year in 2011, I planned on starting treatment. With a solid job I could try the one that would eventually cure my mom. But a week before an esophageal bleeding episode would send me into the hospital, I was pink slipped. To make this more confusing, it would be recalled, and sent again twice.

After receiving my MELD Score of 14, I began to look for a new job. Thankfully my friends knew of an opening and I started later that year.

There was one problem. The company used a temp service to hire its own employees allowing them to bypass benefits. Using a temp agency like this is common, and lives in a legal gray zone. The temp agency can't exclusively cater to one company and/or be owned by the company.

Thankfully the ACA stepped in twofold: it extended my coverage until 26, and my preexisting condition was no longer a coverage concern.

That being said, the ACA was new and still very shaky, and insurance companies can retroactively deny coverage.

So I prepared myself for a potential situation wherein the ACA is repealed and my insurance retroactively kicks me off of it, using my preexisting condition as a reason.

What this meant for me is that I would need to use COBRA to extend coverage until I would start my new insurance in April. So for two months I would see nine hundred dollars a month fade away into nothing to insure my insurance would still carry me.

What would have happened without the ACA?

Without the ACA I would presently still be in debt from a six month coverage gap. Because as I would begin my new job, my left femur was injured in a car accident. While her insurance covered the losses, it was reimbursed months after the collision. I would not have been able to cover my medical bills, or any other incidentals. My HCV treatment without insurance was over $100,000 and the medical care otherwise meant I hit max out of pocket on a yearly basis.

Meaning I would have no choice but accumulate unpayable amounts of debt with the hope that bankruptcy could possibly save me. Thus limit my housing options, my ability to cover future medical costs, and any potential use of my economics degree. Essentially a recipe for homelessness.

Thankfully, the ACA does exist, so that didn't happen.

Those two parts of the ACA/Obamacare legislation were vital in your life, how else has it affected you?

After the third treatment failed at the end of 2012, my symptoms began to worsen.

Ascities, an extreme form of water retention, became an issue of vigilance. While I was prescribed a solution in the form of diuretics, I would only take them occasionally. Because if I took them regularly, my electrolyte imbalance was such that my legs would randomly spasm out of control.

I would find a method that would keep me moving and alleviate the issue: Balancing my electrolytes. While I couldn't control how my liver used them, I could make sure I was always consuming a specific amount.

The ACA required restaurants of a certain size to post nutritional information, and increased requirements on packaged foods. Without that, it would have been incredibly challenging to navigate.

The amount of magnesium, sodium, potassium, sugar, and water would change, and I learned how to understand each different pain and what it associated with. It took months to find that balance. Unfortunately, I was terminated at the end of 2013. While the termination was unlawful and discriminatory, fighting it wasn't an option. While I was legally disabled, disability would take time and would not be enough to cover the cost of health insurance. While it did allow MediCal/Medicaid, my treatment wouldn't have been covered under it at that time. So I worked as much as I could, enough to obtain insurance.

Wait, you were legally disabled, why didn't you have disability Medicare?

When you become disabled, it can take between two and three years until you can have access to Disability Medicare. I guess they hope that you die before you need it. Because, of all the laws and decisions I've read, I can't figure what their rationale is.

Without a job I was frantically familiarizing myself with Covered California.

Covered California is the California specific version of Healthcare.Gov, the ACA marketplace, there are a lot of mixed feelings about its pricing, where do you stand?

First off, the marketplace prices are set by private insurance companies. And because of this marketplace, smaller locally based hospital-insurance hybrids have been growing. The prices are still primarily controlled by two elements: the top four insurers, and the banks that are invested in these insurance companies.

Sounds like you're into conspiracy theories.

Technically, that's what this is, they're conspiring to control prices. We have no way to correct this market inequality besides government action.

The ACA allowed me access to insurance, and because my income was eligible for the credit I was able to purchase an affordable plan and keep my doctor.

It allowed me to postpone my death by a year as I zeroed out on my fourth treatment. The victory was short lived as I hit my out of pocket maximum, a four thousand dollar deductible and a week in the hospital after a run in with C.Diff at a diner. The treatment had failed and the virus was back in the millions.

Thankfully, I soon began a fifth treatment. The year ended and new insurance plans came up, the one I was on previously was shuffled a bit so they could legally increase the price.

The plan increased in price by about forty dollars per month, a 13% increase with few noticeable changes in benefits. While irritating and burdensome, it was still far better than the alternative. Each of these treatments combined cost me out of pocket only about $12,000. Which may sound absurd for an effective income of $18,000 per year but remember that without it, if I could even get the treatment, I would be out over $300,000 on treatments alone.
To date my cumulative bill to insurance total is approaching six million dollars.
TIL: I'm not a cheap date.

It was worth it though, you were cured, right?

No, the fifth treatment failed, and within a year my liver went from an average MELD of 20 to 30. I was steadily dying, and it was visible. To hide the jaundice I maintained a tan; however, by June the jaundice made me look more orange than anything else.

My treatment was postponed as I was no longer allowed treatment due to my high MELD score, and so I waited by my phone. I had been on the transplant list nearly three years by this point and only received two calls before September of last year.


Before I would be between hospitalizations near the end of the year, my Disability Medicare finally came in. While it is more expensive per month than my previous plan, I was able to have three weeks of hospital stays, a week of at-home nursing, and dozens of RXs taken care of for very manageable copays... Oh, also a liver transplant and subsequent medication.

It sounds like the ACA was the bridge before Medicare for you, was that always the plan?

No, no one means to be sick, I did everything in my power to live and utilize the tools I had access to. I didn't want to get to the point where I needed Medicare. But I can say this comparatively, having it is one of the most relieving insurance plans I've had.

So you're alive today because of the ACA and Medicare, how do you feel about the repeal and replace?

I'm interested to watch as the GOP replaces The ACA/Obamacare with The ACA/Obamacare or Ryancare.

Don't you mean Trumpcare?

No, Trump has nothing to do with helping anyone but himself, while I disagree with Paul D Ryan on most things, he is the congressman who will craft a replacement. He has been at the head of this opposition since the ACA came into being.

Like the Sanders v Cruz debate, the GOP wants to keep things vague, they don't stand for anything until the day they vote. Unless they author/co-author legislation. It's their M.O. because if you haven't taken a stance, citizens are less likely to be angry with your decision.

The new Right to Try legislation will most likely fuse into an Obamacare replacement.

We can change this, we can make sure we have a good healthcare system. Just call your local Congressperson and/or Senator and tell them what you like or don't like about the ACA/Obamacare.

A legal document must be read through and through, to understand it's gravity. I say gravity because it doesn't just affect its intended target, it affects everything around it. The ACA aka Obamacare is one of the most powerful pieces of legislation I have seen in my lifetime. It saves lives, improved lives, expanded Medicaid to millions and expanded potential millions of dollars in productivity while decreasing the reliance on (medical bill related) bankruptcy.

 After all, a healthy workforce earns more, spends more, and lives longer.

Deviated September

Yesterday was my fourth blood test, in the last month. My bilirubin and INR have been at a levels worry some enough to postpone treatment.
(The cost of a treatment is more than the meds alone, this month I spent over $350 out-of-pocket costs and that's with insurance!)

With the help of my family and advocates I was able to negotiate better terms on the price I can bear. But all of this is contingent on my having my present insurance and that I'd ordered and received it before I switch insurance September first.

In one day I switch insurance plans, the present Gilead plan offers mysupportpath to be used twice.
This is my third Gilead treatment, so it's hard trying to lobby for support.

While I'm pushing to get the hold/stop order from my doc removed, I'm also moving. (Which when you have health concerns requires certain things.)

If the stop order isn't removed I will have to go through the hoops I just went through before getting access to treatment.

It's about time.

That's what I'm losing. I'm at a point where each week that my liver continues to degrade I get worse off.
The weeks I lose waiting for treatment aren't just the time now, it's less time later.



To savor every day that I have, that is all i can do.

Berning Up

Bernie Sanders is an amazing candidate trying to uphold his ideals against the establishment. He doesn't play political games and he talks only about the issues.

Wait, sorry I messed that up.

Oh wait, no I didn't, he messed that up.

This is why I found him appealing as a candidate. That his idealistic solutions had tangible form which will usher in an era of liberalism within government.
This is what I felt walking away from rallies.

But more recently, Bernie released details of his healthcare plan. Which sounds like a wonderful plan.

But let's really start to give a shit for a second and think about how actually impossible everything he wants to do is.

Of all the candidates Bernie will face the most opposition. Why? Because without the Millennial vote in tow his political power is moot.

"That's not true! Older people vote for Bernie!"
Sure, but by worse margins than the numbers of millennials who support Clinton.

Democrats: 77%-12% Bernie doesn't exactly hold the torch of millennial voting. As for Clinton among Democrats: 65%-30% isn't that far away.

While Independents and unaffiliated can vote in the Democratic primary, the purpose of super-delegates serves as a political counterweight to those votes. Which basically affords us a lovely moral for the whole family: Rigging a political game is only "cheating" when you're not winning.

If the political opposition is so terrible to work with that their own speaker resigns, Sanders will be handcuffed politically. But I haven't said anything we all already didn't know.

Before I flew up to Sacramento, to speak in favor of an item on the budget proposal allocating funding for HCV testing statewide, I read something i couldn't believe. 

In talking with other advocates for HIV/AIDs and Viral Hepatitis, I was disappointed to find not a Bernie supporter among them.
When I returned home I took a closer look at his healthcare plan. And I realized why. Bernie Sanders is ever the idealist, and as such he doesn't consider the communities affected by his decisions. His plan requires multiple radical changes that if done would result in years of healthcare chaos, and if no one de-funds it, it still will be incredibly inflexible and result in patients dying waiting for treatment.

Sanders espouses Medicare for all, a single payer plan. The type of plan that Sanders would likely install would be reminiscent of Canada.

His plan calls for a replacement of our existing insurance system to a single payer government insurance. But...Insurance companies no longer resemble the behemoths they did before the Affordable Care Act (ACA). Because of the ACA, many new insurers have grown out of medical groups and Managed Care Organizations (MCOs). Local medical groups can offer better rates with a better focus on care and since the insurance companies are built into the hospital the overhead feeds the hospital as well. It's not ideal, but it's more responsive, compassionate an patient centered than ANY insurance system we have ever had public access to. It is an adaptation of Kaiser's model, and it works (better than it did previously).

Not understanding the transitional needs of patients between insurance agencies means sidelining prescription drugs, and medical appointments. Making for additional hurdles to the often kafka-esque nightmare that is transitioning between MediCal/Medicaid and any other insurance.

The politicking insanity of Sanders after Clinton's Nancy Reagan comment:

Girl, look at The Body
It works out.
Sexy, I know it. 

Keep in mind that Sanders' position on HIV/AIDS was not revealed until that gaffe, and it was done so intentionally alongside his own personal comments against Clinton. As previously mentioned, his/his staff's disrespect towards the HIV/AIDS coalition orgs shows his true colors, but regardless I held my breath waiting for May 25th to see what he would do.

The plan he presented in March (in conjunction with politically attacking Clinton after she tried to play to legitimizing her political experience as a FLOTUS by making some very embellished statements regarding Nancy Reagan's role in HIV/AIDS History ) remained the same after Sanders rescheduled meeting on the 25th.

And then he decided to re-package it...

He presents the same stances over and over again, and has demonstrated a general disrespect for the HIV/AIDS community.

Having Hepatitis C, with the liver damage I do...if I have one day without my prescription medications there is a high likelihood I will end up in a hospital. I know of many others with Hep C who are stuck waiting to get sick enough for treatment who would find themselves in even worse situations due to paperwork backlogs.

Millions of Americans have Viral Hepatitis, and thousands of them will die every year regardless of race, creed, political affiliation or income.

JK!

It's absurd how much it resembles a microcosm of the systemic problems within each community it affects.
Which is why it's so important to understand every perspective on these matters. The solutions in San Diego, or Compton, or Los Gatos will all be different.
Because fighting these diseases needs social and emotional support tools as much as it does medical, insurance and pharma reform.

The bottom-line is that saying he stands for people with Hepatitis and HIV/AIDs when he ignores our needs and listens to what he wants to hear is disrespectful, and to do so with such a nonchalant attitude... he doesn't stand for me and he doesn't understand that.

In a millennial homage to a questionable DNC nominee:

Outta matches, maybe I'd be better of with a tinder date
heart dropped, shame no profile for this candidate.
Are all he has group photos? It's so hard to pick him out.
He'd appeal to our grizzly population posing with a trout.
What is this insane lack of respect?
I'm off balance, out of checks.
Am i missing something, out of conned text.
No. Just really about the gender, the sex.
I thought he was supposed to be the last of the Silent Generation.
And there's hard turns up ahead but less for the white Caucasian.
I had the privilege of privilege but it is one voice within a crowd.
and we all deserve equal time on the mic, so quiet down.
not to be silent but to listen to others,
because that's what sets us apart, besides our mothers.
When it comes up not down to these perspectives
He should understand the model: Respect, Give.


I can no longer endorse Bernie Sanders.

#Berntout


You can follow some of the more absurd web antics of the clash between Bernie's newest conspiracy theories and HIV/AIDs activist Peter Staley 

Sanders is a weak idealistic candidate who has little consideration for the communities he represents.

His narrative is the big picture: (Democratic socialist) Idealistic structures that he has mentally concocted over his decades in government can be applied to fix real world issues.

He presents his narrative to communities he meets with and then tells them how it applies to them. He does not consider the perspectives of the communities he is engaging.

That's why I'm not voting for Ron Pau...I mean Bernie Sanders.

Caveat Emptor

It's almost as American as it is Roman. "Let the buyer beware."

In the US we advocate this a strange notion of preparation. So when it comes to healthcare, we've put ourselves in an awkward position.

I came across some inspiration from imgur 



Roamin' Phrases.
Welcome to the United States of America, land of the free, home of the brave.

Laws pay me no mind, I'm a freelancer in the cracks and crags, live with the hacks and hags of society.

The idea and principle that I navigate the labyrinth under the legalities means that I am temporarily live on the outskirts of the law.

I'd love to be protected, but the shield costs money I don't have. Tickets as if I'm going somewhere from different states, different counties.

Last notice! Papers pile high, on the table, gladly pay it all if I were able.

What's the law to those in the labyrinth? Here we chase freedom in hopes of scraps that fall from societies favor and become available to us.

In here, you watch your step, there's emergency care but you'd better have insurance. Make all checks payable to the feet that blot out the sun.

Insurance agencies at every corner down here, the world knows the labyrinth exists. Tens of millions live in it, they'd be blind to ignore it. Each agency employs us, telling us what to do and how to live if we want their pittance.

Money is free speech, money can travel the world to exotic accounts in the Caribbean, or the Alps.

Money holds thousands of insurance employees hostage as it demands more vacation hours.

Bills, from sneezes, lawsuits from companies claiming ownership of the breeze down here.

They already own all the hot air.
So we run after false profits, don't run in the labyrinth, you'll trip. A broken ankle will cost you an arm and a leg. "But I've got insurance" I told them. Apparently my network only extends to one doctor 30 miles away, my cell phone has better coverage.

But it needs to, it's got ads to sell me, and apps to sell me. Already paid for the hospital when it was built, that was for the pre-release, who knew there'd be hundreds of day one DLC?*

It's dark here, I wish we were outsiders, I wish we're the outliers.

Lines of string litter the floor, looking for the exit, ridiculous you can climb out anytime. These walls aren't that high.

Climb over the bodies that make up the surface, these walls are made by those before us.

The last of someone's sweat, blood, straw build the bricks of tomorrow.

Up there, the sun shines on monuments dedicated to the austerity of the posterior. A history that never was, made of legends men told to justify their lordship.

The labyrinth is the foundation of their pomp society. Seeds of knowledge drop from trees too large to cut down. The library's branches spread ever outward. Knowledge of my nudity does not protect me from the cold.

Awakened from my slumber by a solitary beep.
The IV is out of fluid, it's the second time this week.
More concerned about coverage of my cell network
Litigiously inspected every goddamn perk.
No mind, insurance, nine to five times as much.
Didn't realize my car would cost less than a crutch.
Didn't know it's Kaiser's face on the hundred thousand bill.
But when I first saw the thing, I passed out from the thrill.
Labyrinth obscure me as a number on a sheet.
Thirtieth time, in debt, someone will die this week.
Worked hard all my life, to move up someday.
The maze; a debtor's prison, as there's hell to pay.
This is my last straw, they'll be bricks no more.
It's time to be unburdened by Caveat Emptor.




*Pre-release or pre-purchasing in the video games industry refers to paying for the game before it comes out. Day One DLC refers to Downloadable Content which is available at an extra cost when the game is released. Day One DLC can consist of expansions to game-play, or can be what was prior-to-release assumed to be part of the content of the program itself. It's basically a really complicated Bait and Switch.

Inertia and Inhibitors

In the last year a great deal has changed for patients with Hep C. Multiple treatment options with minimal symptoms which take half as long or even less, a renewed focus on testing, and a healthcare overhaul have all been at the forefront.

We're also seeing a trend of high cost medication, with a round of treatment costing twice as much as the poverty rate for a family of four.

Medicaid clamped down to only approve the sickest of patients, many states requiring permanent liver damage before treatment can be an option.
States will begin to get better pricing when election season is done, but depending upon how the TPP goes, it could be better or worse.

Private insurers have similar policies, taking advantage of the discounts offered to patients and often denying coverage.

Cure rates for most treatments remain 90+% and more treatments which use Protease and Polymerase inhibitors are on their way. (Protease and Polymerase are two different approaches in destroying the virus, they combine to be far more effective than alone/with Ribavirin)
So what happens when you're not part of the 90+%?

When you've spent years of your life becoming familiar with health insurance, FDA studies, and in hospitals/clinics. When you grow up memorizing hallways, bizarre wallpaper, medical pamphlets and illustrated guides, all of this seems pretty normal.

I've pressed on past each failure, and usually each time they've found a more specific reason why it didn't work.

I have failed five different treatments, and recently I found out why.

I have three mutations which combine to prevent protease inhibitors from working properly.

Originally I was under the impression that I had the q80k polymorphism (it's a weird mutation that can prevent protease inhibitors from working without a combo of meds) which was an accurate assumption until better tests were able to pinpoint why Harvoni did not work.

While failing one protease inhibitor does not mean another may fail, it does reduce the chance of success significantly.

The combination of mutations I have prevents Ledipasvir (the protease part of Harvoni) and most NS3/4a inhibitors from working as intended.

NS3/4a inhibitors = protease inhibitors= Olysio/Simeprevir, Daclatasvir, Ledipasvir, etc...

So what happens now?

Nothing. Now that I know which drugs I cannot take, it means searching the web for any potential studies which are for Treatment experienced, f4 decompensated patients who cannot take protease inhibitors.

Why I say nothing, is because that's presently what I've found. I'm certain that at some point they'll find a new way to attack the virus but until then my life waits.

I'm uncertain how long I'll live. Depending on my luck, I could have a few years still until transplant.

Transplant is an extension, the likelihood that my liver will decompensate within a year is about 50%, as I will re-infect it. I could push a few more years past that, but it's hard to say.

To say that this isn't depressing would be absurd.

When a chilling reality like this hits i accept it, i embrace it, i understand it, and i forget it.

I accept that my health outlook is grim and will ultimately defeat me.

I embrace the problem and refuse to define myself by it.

I understand the precautions and limitations I face are guidelines, not rules (but seriously though, some are still rules).

I forget it, because the focus isn't on it, my focus is on me.

To move forward i must turn inward and find small bits of motivation to get me moving.

An object in motion will stay in motion.

#care

Why King V Burwell matters for people with Hep C.

First some context,

The ACA has done many things, from preexisting conditions, extension of benefits for young people (under 26), required labeling at restaurants of a certain size, a healthcare marketplace with an exchange that's consistent, and properly taxing what was before sheltered income for those making over 200,000 per year/have Cadillac plans.

There is one more, and this was the lynch-pin in the court case. it was whether or not the subsidies would be issued to states who did not create their own exchanges.

An interesting problem is that the many of the largest groups of subsidy recipients happen to be in states without exchanges. A problem if King V Burwell went the other way.

with King v Burwell a 6-3 it means that more cases which bare similarity will be less likely come up to the supreme court. 

The Majority Opinion of the court helps millions maintain health insurance. Every year thousands more Americans find out they have Hep C, a disease which needs medical attention, care and insurance. 

The other day I wrote about barriers. one of the big barriers when a person knows they have it, is paying for the care/treatment. 

Insurance helps reduce the cost dramatically, and those with insurance are more likely not only to get treated, but to better manage their health than someone without insurance.

My testing and treatment, using Covered California cost to date around ten thousand dollars.

That is because it hot max out of pocket of $ 4,000 last year, and I'm on track to do it again.

If I did not have Covered California I would likely be on Medicare due to my meager income, and without the ACA's expansion, I'd still be waiting another 20 months, because I'm disabled it takes 24 months of being permanently disabled to receive Medicare. wait...WHAT? 24 MONTHS?

So..because they're permanently disabled, and more than likely require health services, the government has to wait two years, to give them healthcare.
The exchanges prevent issues like this by reducing the cost of insurance, and subsidizing those who are having trouble paying for insurance.


For those of you Nay sayers against the ACA: the ACA will reduce medical costs overall by increasing buying competition through insurers. Since you don't directly pay (only co-pay) most hospitals, you're not he consumer of healthcare, you are the end-user.
This means that more money is spent in other sectors, money that would have mostly gone into overhead and left circulation.
It will reduce the number of bankruptcies as I talked about last blog. medical bills are getting paid, preventative care is more common, both of which reduce the overall medical debt which leads to medical bankruptcies.
Over one million Americans filed for medical-bill related personal bankruptcy in 2013.While bankruptcy numbers won't be in for three or four years which show the early effects of the ACA/Obamacare, bills are down and cost reduction is improving.
Bankruptcy costs society millions of dollars every year, sick workers are less productive, and more money is removed from circulation. For the Nay sayers, here's the financial cents.


The ACA has room for improvement but as it stands it expands healthcare to those who need it. It helps protect individuals and society by lowering costs. and it keeps more people productive, happy, and healthier.

The walls we build.

There are a lot of barriers to Hepatitis C (HCV) treatment.

Let's break 'em down, so we can break through 'em.

1. The biggest is awareness of the virus. Most of those infected with HCV don't know they have it.


2. The second is non-adherence. Basically patients don't meet up with specialists, cut corners and avoid tests. Typically it's only two or three tests at any given time, but it can be as high as seven if there is enough liver degradation.


3. Financial hurdles: this is a lot more complicated, in 2013  medical debt was the number one source of bankruptcy in the US. 2013 also saw the major roll outs of the ACA aka Obamacare. since then medical debt has fallen and medical costs have also gone down on average. In 2015 we can see the benefits of having most of the country insured.

New players: With the rise of the insured, drug companies and insurance companies are fighting to hold on to patients. finical support is becoming a regular part of both sector's products.

The scary part about this, is how realistic they are: services being rendered to 200-500% of poverty level. They're well aware of high medical costs, and a poverty level that is absolutely absurd.


Despite its decline, medical costs will be a large hurdle.


4. There is also something to be said for the combination of non-adherence and financial hurdles:

In 2008-2013 i had over 90 sick days used for medical related absences. most of which were planned for tests, treatments or appointments. I was nearly let go twice due to my excessive absences. I was saved by a law called FMLA.

About spring 2011 I ran out of paid sick days, which meant that every sick day was on my own dime. Which meant smaller pay checks to pay bigger bills.

To this day half my medical costs equal about half of my income.



5. Stigma: People don't like getting treatment because it means they probably need to tell someone about the problem. I've always been of the notion that a few coworkers of mine should know, just in case something happens. But many others i know, tell no one they work with. And often fear being shamed and judged by their coworkers. Or worse being targeted and being pressured to quit, or being fired for some other reason.

6. Psychiatric illness:

Yes, there's something wrong and while many with HCV suffer from irritability to severe depression. There is assistance in the form of all manner of therapy and counseling. This has its own hurdles.



7. Aegrescit Medendo:

"The cure is often worse than the illness itself." HCV has had a really weird last decade.

HCV is known as a silent killer, because often those who have it, aren't aware until it's already causing cirrhosis. Which means that for the bulk of people with HCV, they're going to have minimal side effects for the first few decades of its infection (oh, it's still destroying your liver, it's just being a ninja about it).

And up until 2013, side effects from treatment were horrible! So why would someone be inclined to make that switch until it rear's its ugly head. I mean besides their kids, loved ones, friends, and naturally their own life.

This hurdle is no longer the case.

From 2013 onward the (DAAs especially) treatments are relatively asymptomatic, and often only either emphasize or improve the patient's own symptoms.