Friday, April 8, 2011

Phoenix From The Fire. I Hope.

I had a reverie this morning, in which I changed my living will to state that I am to be kept on the Cadillac of life support, forever. My legal directive came to pass, so beautifully according-to-plan that health insurance executives flew their jets right into our little town and threw themselves, weeping, at my family members’ feet. Please! Please! We’ll do anything! Just agree to cut her off! They offered their souls in exchange for a signed DNR. To which my family said, “ew.”

Because this blog is public, let me be clear: It was just a reverie. I do not want under any circumstances to be kept in a permanent vegetative state. It scares me to no end, to think that certain members of my Catholic fundamentalist family would take that paragraph all the way to the Supreme Court.

But oh how I relish the vision of those execs writhing in agony.

All of this was because last night, I was told that my health insurance would not devote one nickel of its astonishing profit to help me pay for the $250 nicotine inhaler my doctor prescribed for me. Our regular pharmacy doesn’t even keep one in stock. “I’d have to order it for you,” the pharmacist told me. “It’s been years since anyone has bought one.”

Well no shit. Let me look into a loan first. A credit card, maybe. Let’s bring one more for-profit industry into this gathering of vultures. If you’re a reader whose mind rushes to a cost-benefit analysis, smoking vs. smoking cessation, kindly think for one second about blaming the victim first. Tobacco addiction is expensive, but the cost is borne in dribs and drabs, one pack or one carton at time. If your average Joe The Plumber is going to trade the cost of one for the other, he has to quit smoking first.

In the interest of full disclosure, later today a different pharmacy sold me the inhaler at a huge discount. I don't know why  --  I suspect it's because we pay an optional, additional monthly premium for upgraded health insurance  --  but I'm not asking any questions for fear it was a mistake. On behalf of so many others, I still bear lots of ill will against a host of profiteering demons in this mess. Remember the original pharmacist's words? Most nicotine replacement therapies are sold over the counter in this country, where insurance is not even a remote possibility. And when was the last time you heard of an in- or out-patient nicotine drug rehab facility?

Nobody my age who is still smoking wants to. Nobody wants to strangle to death slowly, nobody wants in on the health care nightmare, nobody wants a piece of their face cut off or a voice box sliced up or to have a crippling stroke. Plenty of my very close genetic relations have died torturous deaths because of cigarettes, smoking to the last, ashamed and so sorry for what they “had done” by making their families endure their horrible ends. Extraordinarily intelligent, beautiful, artistic people. Every one of my genetic siblings has smoked heavily, beginning in their teen years. Note that I am adopted, did not “imprint” on smoking behavior, and am the only smoker in the entire extended, adoptive family that raised me. I didn’t know my “genetic” family, or of our extremely similar, powerful cravings—for dairy products and tobacco, for example—until I was 16 years old. (And already a pack-a-day smoker…) My bio-mother said repeatedly that our drive to drink milk was the pure Norwegian in us. It was always a bit of a joke to me until I read the book Why Some Like It Hot by Gary Nabhan, and readjusted my big-britches attitude and understanding of genetic propensity.

Whatever the biological reality, nicotine addiction is hurting you, whether or not anyone in your family lights up.

Almost six years after Peter Jennings’ death, his mea culpa for having smoked makes me sad and angry. “I was weak,” he said when he announced his lung cancer diagnosis, so visibly full of shame for smoking after a lifetime of doing so much else. I wish instead he was furious, and got numbers like these into the discussion:

—In 2008, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. (

—The same year, Philip Morris International boasted a profit of $16.3 billion on sales outside the United States.  (

—In 2009, the top five earning health insurance companies averaged profits of $12.2 billion. (

Obviously, I spent about 10 minutes of internet “research” here. It appears that it would take quite a bit more for some reason, to get a figure for US profit on tobacco sales. Somebody else find the primary sources, and argue all the statistics and numbers that could be pulled into this debate. I already know, from long personal experience, that it’s not in the tobacco, health insurance, or health care industries’ general financial interests to help people quit. I can't even dream of health insurance industry executives begging my family for mercy in the end — Medicare is picking up the tab in the cost-of-dying matrix, what doesn’t bankrupt us as individuals, anyway. We will pay and pay, coming and going.

Here’s how serious I am about this. If I die a smoking-related death tomorrow, or next year, or anytime at which I look remotely like the photograph used for this blog, use the same photograph for my obituary, and don't crop out the cigarette. Tell the world I fought to quit my whole life, and tell the world I did not want to go this way. But also tell the world I do not apologize. Until we all quit blaming the victims, until we fully accept this for a devastating, heartbreaking disease with genetic origins, and fight like hell for research and against such insane profitability, we’re going to lose loved ones this way. Until everybody stops clucking at people like me and starts demanding holistic answers, we the “little people,” smoking and non-smoking taxpayers, are going to foot the bill—in advance with our Medicare contributions, and after death with the sales of our estates. Bend over, friends.

Yet, I am not Joe the Plumber; I can afford the $250. I am one of the lucky ones who could make the decision to ante up the bucks, whatever my insurance decided. I slept on it and then called around until I found a pharmacy that had a nicotine inhaler in stock, just in time for my quit date of April 9, 2011. I asked how much it would be at this particular establishment.

“Will your insurance help pay for it?” the pharmacist asked first.

“No,” I answered. “Assholes.”

One second of shocked silence and she burst into bitter laughter. I guess not too many people just say it. A few hours later she rang up the sale for me, at just $25. Maybe she forgot a zero. Maybe something else more hopeful, from an insurance perspective, happened.

Undoubtedly, at some point, someone else less lucky than I am right now will be standing in line at the same pharmacy, terrified that it's far too late for quitting. And that someone else will not be so lucky. The pharmacist will hand over the drugs that help a human being endure chemo, or will collect someone's last dollar for the month. I'd be willing to bet you a $250 nicotine inhaler that the word "assholes" pops into her mind.