The Human Cost

CW: Death

Alec Raeshawn Smith was 26 when he died. Smith died of complications from diabetes. Diabetic ketoacidosis (DKA) is a life-threatening condition that affects diabetics. It occurs when the body begins breaking down fat at an unusually rapid rate. The fat is converted by the liver into a fuel called ketones, which causes the blood to become acidic.

In February 2017, Alec was three months shy of his 26th birthday. A pharmacist informed Smith that without insurance, his supplies would cost more than $1,000 a month. The options with insurance weren’t much different.

Smith was the manager of a restaurant in Minnesota. His salary was too high to qualify for Medicaid. He earned about $35,000 annually. Health insurance was unaffordable for Smith. The plan he qualified for had an annual deductible of more than $7,000 and a monthly premium of more than $400.

He decided to forgo insurance due to the cost. Tragically this decision would have fatal consequences. He died less than a month after aging out of his mother’s health insurance plan. Smith’s family thought that he might have been rationing his supply of insulin to save money.

Unfortunately, this is far too common. According to an October 2022 report published in the journal Annals of Internal Medicine, an estimated 1.3 million adults with diabetes in the United States have rationed their insulin within the past year. This equates to approximately 16.5% of insulin-dependent diabetics in the U.S.

Smith’s story is heartbreaking but not unusual. According to a 2009 study done by Harvard Medical School, a lack of health insurance is responsible for around 45,000 deaths in the United States each year. More people die each year from a lack of health insurance than from renal disease.

Susan Finley returned to work at a Walmart retail store in Grand Junction, Colorado, after missing work due to pneumonia. According to her family, the day she returned, the 53-year-old received her ten-year associate award and was laid off. Finley struggled to find employment after leaving her job in May 2016. She also lost her health insurance. Finley was discovered dead in her apartment three months later after delaying medical care for flu-like symptoms.

Losing healthcare coverage often means that people remain uninsured. For some people losing insurance is a matter of life or death. The United States needs affordable healthcare for all before this crisis worsens.


American Diabetes Association Professional Practice Committee. “2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022.” Diabetes care vol. 45,Suppl 1 (2022): S17-S38. doi:10.2337/dc22-S002

Abelson, Reed. “Harvard Medical Study Links Lack of Insurance to 45,000 U.S. Deaths a Year.” The New York Times, The New York Times, 17 Sept. 2009,

Sable-Smith, Bram. “Insulin’s High Cost Leads to Lethal Rationing.” NPR, NPR, 1 Sept. 2018,

Sainato, Michael. “The Americans Dying Because They Can’t Afford Medical Care.” The Guardian, Guardian News and Media, 7 Jan. 2020,

Searing, Linda. “Over 1 Million Americans with Diabetes Rationed Insulin in Past Year.” The Washington Post, WP Company, 17 Nov. 2022,


  1. Grace, I am curious as to whether you have seen much recent information about the high cost of insulin. Wonder how much it is in the news these days? What a crime/shame to have to resort to rationing it.

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