As Insurance Runs Out, A Diabetic Journalist Fears for His Life

Robert Steinback is a Pulitzer Prize-winning journalist and former Miami Herald columnist who was laid off in 2008. His COBRA health insurance ends in January, and, because he has diabetes, no insurer will offer him an individual policy. Other alternatives, such as a HIPAA policy, are prohibitively expensive.

Frustrated by his lack of options, Steinback published a heartfelt column in the St. Petersburg Times. Here's how it began:

I am scheduled to begin dying on Feb. 1, 2010.

Although I have been an insulin-dependent Type 1 diabetic for 22 years, my health has always been very good. My condition has never impaired my enjoyment of life; I've never had a diabetic emergency. Luck, of course, has played a part, as has educating myself about diabetes management. By far, though, the single most critical element of my vitality has been excellent health insurance coverage.

That will end on Jan. 31, the day my COBRA insurance benefits run out.

I talked with Steinback this week about his perspective as both patient and journalist on the health reform debate. Our conversation has been edited for length and clarity.

Q: What kind of reaction have you gotten to your column?

A: There's a lot of frustration out there, there's a lot of fear. I heard from people who either are in bad situations or fear they will be in a bad situation. There was a lot of advice also. Before I wrote the column, I didn't know that Florida does have a guaranteed conversion insurance plan, HIPAA. It's probably not something I can use; the price is off the charts.

Q: Why did you write this column now?

A: In some ways, my column was an emotional outburst. I was in line for what looked like a good job and got a conditional offer that was later withdrawn. All of a sudden, it's just a couple of months from end of COBRA, and as I sit here, I don't know exactly what I'm going to do. I am scared, I am frustrated. What frustrates me more is the tenor of the debate in this issue. I actually heard a radio interview in which a woman said, "I love my Medicare, and I don't want to see anything threaten it, and I don't want to have government involved in my insurance." I find it hard to believe a nation like the United States, with 47 million uninsured, can't even come up with a consensus that we need to solve this problem.

Q: Did you consider taking any kind of job just to get health insurance? Starbucks comes to mind.

A. I have considered that. There's something that Americans need to understand about that calculation. America suffers when it doesn't use its citizens' productive capabilities to the fullest. I don't want to sound elitist, but if a person has two college degrees and has to go pour coffee in order to get health care, America has to look at that and say there's something wrong with America. We put ourselves at a competitive disadvantage when we do that.

Right now, my health is very good. If because I don't have health insurance starting next year, my health starts to deteriorate, that's going to limit the number of jobs I can take. If I had continuing health care, my life would go on without interruption. As long as you treat diabetes properly, your health is secure, if you don't manage it, you can deteriorate very quickly. That should not be something anyone should worry about.

Q: You were laid off in 2008. What kind of work have you been doing since then?

A: I haven't been doing a lot. I had kind of invested in job I'd told you about. It took months to qualify for this job, then the rug was pulled out. I know I can't make a lot of money freelancing. I'd never make enough to pay for the health care plans that might be available to me. I feel like I can't work for myself or a small company that has no health insurance. I really feel like I'm limited to finding a job with a large company that has a health care plan.

Q: As you read about health care reform, what do you wish reporters would cover?

A: We always have to remember that there's a human being at the end of these stories. We talk about 47 million uninsured, but who are these people? How is health reform going to affect Sue Smith living on Main Street. Politicians are so used to dealing with billion dollar numbers that they forget there's an individual on the other end of that line. I also wonder how easy the new insurance "marketplace" is going to be for an individual to (navigate). And it makes no sense to me that we have 50 different patchworks of state laws about insurance.

These stories are all human stories. We've gotten a little too bureaucratic in our coverage. You need to sit in a living room with someone, with a cockroach crawling up the wall, and if you can't relate to that person, you are not doing your job.  

I think reporters also have to go beyond the idea that if both sides have a chance to comment, I've done my job. We need to challenge people. A perfect example was the "death panels." That was an issue that should not have survived 24 hours. Every reporter knew within 24 hours that it was a crock. It was weeks before it finally died out. We had prominent politicians talking about something that didn't exist.

Q: How has having diabetes changed you as a journalist?

A:  I'm not sure that it did. I got an insulin pump 10 years ago, and that does free you a lot. When I'm managing my diabetes well, I'm not thinking about it. What (good treatment) did was allow me to be whatever journalist I could be.

Q: How has being a journalist changed your outlook as a person living with diabetes?

A: As a journalist, you're always in an inquiring mode, but I think that helps, when it's your own diabetes you're researching. You always feel like there's something out there you need to know, and somebody out there knows what I'm trying to find out

Q: As a columnist, you were able to weigh in on the moral questions of the day with passion. How can reporters deal with the moral issues relating to healthcare without compromising their objectivity?

A: That was the great aspect of being a columnist. The editor who gave me my column in 1990 said, "your role is to say what the reporter can't say." There's a limit to what a reporter can do in an individual story but I think there are ways journalist can illustrate a moral issue, and one way is to find a person who will express it. The thing I'd try to do is to stay tuned into the moral debate on whatever it is you're covering. Watching some of the veteran reporters around me – before they wrote the story – they would say to people they might not quote, "what am I missing?" Once you understand the moral issues from people who are willing to whisper in your ear, you can make sure all those issues are addressed even if you never say it in your voice.

Q: If you were still writing your column for the Miami Herald, what would you be saying about health reform now?

A: We're not conveying the urgency (of health reform) enough. Some of the people who wrote to me were managing, but they were on the edge. One guy told me he's paying more for health care coverage than he's paying for his mortgage. It's an outrage that in America you can have almost one of every six people without health care coverage. In a country that's supposed to be rich and innovative, we can't come up with an answer for this? One of the things I wrote about a lot was what makes America? I still think to this day it's an outrage. I just never thought it's an outrage I'd come face to face with.