I wrote this two weeks ago. You know what’s weird about having a baby? How your life becomes really fragmented. You get to do things in ten-minute increments, constantly on high alert in case somebody starts complaining loudly. So the measurements are out of date – we took H. for another doctor’s appointment more recently, and he was eight pounds, nine ounces. He probably weighs FORTY-TWO POUNDS by now or something. You should see his jowls. Sometimes I like to kind of tuck his chin into his chest, because I’m a jerk and it makes him look exactly like Winston Churchill.
But anyway. Here’s a somewhat-out-of-date tale of some stuff relating to our kid, Captain Jowly Gruntles of the RAF:
Henry is seven pounds, 11 ounces today. And he’s 20 inches long. And his head circumference is – I forget, but it’s some number that gets his head ON THE HEAD GROWTH CURVE. In fact, he’s now on the curve for everything: in the bottom 1% for weight and length for baby boys who are 1.6 months old, but in the 4th percentile for head circumference. So if he were in a room with 99 other babies, he could beat up three of them USING ONLY HIS HEAD.
We were at the pediatrician’s office yesterday morning. In addition to getting a set of measurements, we got our kid a shot of antibodies that will theoretically help him fight off Respiratory Syncytial Virus (RSV).
We had a hard time deciding to do this, deciding to agree with his doctor’s recommendation that he get these shots once a month for the duration of cold and flu season. And not because we’re Opposed To Vaccines. (For some stupid reason it is very important to me that everyone understand that I LOVE SCIENCE and do not believe that the MMR vaccine causes ASTHMAUTISM… parenthood is kind of a trip in terms of how it smashes your face into a whole bunch of your less-ignorable character flaws.) And not even because watching your seven pound, 11 ounce baby get a shot is kind of a horrifying experience. Although I freely admit that I am morally weak and it is a horrifying experience.
But because this shot is insanely expensive (and because the experience of being convinced to get it made me feel really bad about a lot of things relating to the American health care system, ahem.)
How expensive, you ask?
Well, of course nobody in the US can actually just say “This is how much Shot X costs”, because it depends on if you’re a sucker who’s paying cash, or if you have an insurance company (partially) footing the bill, and if so which insurance company – the cost of everything DEPENDS. So I couldn’t nail down exactly how much this shot costs. But it’s expensive, somewhere between $1000 and $3300 (the highest number for a cash-paying patient I saw On The Internet) per shot. And your baby gets one shot a month. For up to six months. So you can see how this could add up to quite a lot of money.
Henry’s pediatrician – who is so cool Seth and I wish we could hang out with him on a social basis… you know, maybe go see a movie or something – said of this drug that he recommended it for premature babies, but that it was crazy expensive and that most insurance companies refused to pay for it. And if ours, as he expected they would, refused to pay for it, he wouldn’t advise us to pay cash for it or anything. It wasn’t a disaster if we couldn’t get it, it was just some extra protection for a developing immune system during cold season.
So it was pretty clear that Dr. S- didn’t expect our insurance company to approve the drug. And Seth and I felt fine about that. Even before we got in the car and talked it over, I knew we felt fine about it. Guess how I knew! It was because when Dr. S- first said “This drug costs about a thousand dollars per shot”, Seth and I looked at each other and shared The Gaze Of Cheap/Bad Parents, where both of us were clearly going “HAHAHAHAHAHA” in our heads.
But then Dr. S-‘s biller started calling us. “I’m still working on getting that approval!” she’d say. And we’d go “…oh.” because we had expected our sensible military insurance company to immediately shut this nonsense down, possibly by sending our kid a letter reading “TOUGHEN UP, BUTTERCUP”.
In the meantime, we started Googling this drug and this disease (I know! You should never do this. Who among us hasn’t decided that he or she has a terminal case of TOE CANCER after some late-night Googling?), and discovered the following:
- Different medical groups have different ways of deciding if this drug is appropriate, but generally, it’s recommended for premature babies during cold and flu season, but only if the babies have one or more added risk factors in addition to being premature. Such as “lungs are not so great” and “lives with a bunch of other babies who bring home illnesses a lot”.
- RSV is not that big of a deal for the vast majority of people, something akin to a cold. But it can be bad for little babies and end up giving them permanent lung issues. Like wheeziness.
- The drug doesn’t actually keep your baby from getting RSV. It just tends to make the course of the illness less awful.
- Bearing in mind our layperson’s ability to read study extracts, it seemed to be the case that this drug did not actually reduce mortality – reduce the number of babies dying from this virus – it just reduced the number of hospitalizations.
- The drug is super-expensive. HAD I MENTIONED THAT?
- Most parents of babies, premature or otherwise at elevated risk for this disease, were desperate to get their hands on this drug. They lobbied their doctors, they lobbied their insurance companies, they lobbied their state legislators to make it available, they paid outrageous co-pays gladly, they went into debt to pay for the whole course of shots themselves. Cash. Because their insurance companies said no dice. But apparently, the drug company was sometimes willing to help desperate parents arrange financing. How nice of them.
After some debate, we pretty much decided that this drug wasn’t for us. Henry was premature, but he’s really healthy (yes, I knock wood, typing this) and he doesn’t have any lung issues. And it’s not like he hangs out with a bunch of other babies at baby nightclubs snorting lines of baby coke and compromising the integrity of his airways. It was hard to see how you could justify the cost in his case. We were pretty sure that our insurance company was going to deny the request, which was PERFECT, because then we wouldn’t have to seem like bad, unfeeling parents and actually reject the drug ourselves.
AND THEN THE PEDIACTRICIAN’S BILLER CALLED AND SAID WE HAD BEEN APPROVED, dangit.
And then, when we didn’t immediately schedule the appointment to get the shot, the company that makes the drug started calling us. Was I Henry’s mother? Was I aware that this wonderful drug had been approved for his use? DID I WANT TO SCHEDULE THE APPOINTMENT IMMEDIATELY? I DID, RIGHT?
It was a hard sell in the vein of talking to a car salesman. It was really bizarre.
Also the company sent us a “starter kit” in the mail. Which was a sales flyer talking about how terrible it would be to HAVE YOUR BABY DIE BECAUSE YOU DIDN’T GIVE IT THIS MIRACLE DRUG.
Finally, cementing my “this is so totally creepy” feeling, the car/drug salesman, when attempting to lock me into a six-shot course for the rest of the winter, told me: “And your co-pay is zero dollars! So it’s free!”
Now, okay, getting really outraged in a moral-high-horse way over that probably means I need to take a meditation class.
But even so, it’s kind of weird. There not being a co-pay doesn’t mean that it’s free. It’s just free to me, the end user. But you know who pays for it? Everyone else in the risk pool. That’s how insurance works. And in the case of our insurance, although we pay into a pot for it, it’s also underwritten by you, THE AMERICAN TAXPAYER. So no. It’s not “free”.
And also, just to get this out of the way, it makes me have COMMUNIST EMOTIONS to think about how this super-expensive drug is available to only some babies, basically at the whim of their parents’ insurer, and it’s available at vastly differing prices, and some parents can get it and some parents can’t, and some parents go into debt for it and some parents don’t have to because it’s “free”.
All of that strikes me as basically not okay.
But. In the end, we got him the shots. Seth got on the phone with Dr. S, who proved his awesomeness by understanding our ambivalence and saying “Would it be better to use this money to get 800 kids a polio vaccine? I don’t know. Maybe.”
Also, Seth pointed out that at this point H. has cost our sensible military insurance company quite a bit of money, so they probably would rather pay for ridiculous shots now than risk a hospital stay later.
Also, Seth’s sensible doctor sister said we should probably do it.
So we did, but I still don’t know if that was the best choice or not: Making medical decisions for someone else is much harder than I would have guessed. And I feel much less qualified to do it than my know-it-all personality might lead you to believe. I keep wanting the answers to be starkly black and white, and I guess they never are, they’re always going to be vague and best-guess-y and sometimes they will involve someone sticking a needle in your baby’s thigh when he’s not paying attention, leading to a serious case of the UNGH GAHs.