Horror Story

Excerpts from the Wall Street Journal Review and Outlook Section for Today, March 18. If you want to read the whole story (I really didn’t take out very much) you have to be a member of WSJ.

The Pro-Diabetes Board
Washington state targets modern medicine. Coming soon to D.C.

The future tragedies of government health care will include today’s
many warnings about how it operates in practice. The
subsidize-mandate-overregulate insurance model is imploding in
Massachusetts. Then there’s Washington state, where a government
board may decide that modern medicine is too expensive for kids with

Seriously. In 2006, Washington created a board to scrutinize the
cost-effectiveness of various surgeries and treatments, known as the
Health Technology Assessment program. At a hearing today, the panel
will debate glucose monitoring for diabetic children under 18. In
other words, the board is targeting the fundamental standard of
diabetes care that has been the established medical consensus for at
least three decades.

This state issue deserves far more scrutiny, if only because
ObamaCare and the stimulus devoted billions of dollars to comparative
effectiveness research… In theory, it sounds great. But the Health
Technology Assessment is an example of how comparative effectiveness
will work in the real world, as the political system tries to find
ways to restrict or limit treatment to control entitlement spending.

(Diabetes) Patients
do so either with finger sticks that are read by an electronic meter
or continuous glucose monitors that track blood sugar levels
virtually in real time.

The Health Technology Assessment has homed in on both technologies,
claiming that the “effectiveness and optimal frequency of
self-monitoring of blood glucose in patients is controversial.” Not
among physicians. But in a recent report, the panel suggests that
there isn’t enough “evidence” to support monitoring among childhood
and adolescent diabetics, and that the randomized controlled trials
that have been conducted aren’t high quality.

Such a trial would violate medical ethics: A group of children would
essentially be required to not monitor glucose putting them at risk
for long-run complications from too high or low blood sugar,
including seizures and even death. Following a landmark 1993 trial on
tight glycemic control, and the vastly improved outcomes since, the
clinical benefits of intensive management are irrefutable.

Except, apparently, to a government board looking to scrimp.
Washington’s Health Technology Assessment makes decisions for
state-subsidized health care, including Medicaid beneficiaries,
public employees and prisoners about 750,000 people. If it bans
continuous monitors or limits finger sticks to a certain daily number
at today’s hearing, pediatric patients and their parents will lose
the tools and the more and better information they need to manage
their disease.

More to the point, as shown by the arbitrary Washington state method,
political comparative effectiveness isn’t about informing choices.
It’s really about taking away options.

Which brings us from Washington state to Washington, D.C. The Health
Technology Assessment program’s director, Leah Hole-Curry, was
appointed last year as a governor of the comparative effectiveness
board established by ObamaCare. The national board is known as the
Patient-Centered Outcomes Research Institute, yet at an early meeting
in November, Ms. Hole-Curry and the other 14 governors debated
whether or not patients were the institute’s “primary constituents.”

Now this agenda is on autopilot. The institute is built on
self-executing funding that is, not subject to annual appropriations
like other federal programs and dedicated taxes on insurers. At the
very least Americans deserve some honesty about who these people are
and what they favor.

Am shaking my head so hard that I may give myself whiplash. Horror story–indeed. Have other choice words I’d like to add if this wasn’t a PG-13 community. Reading articles like this convinces me we’re doomed as a culture. Layer upon layer of corruption & unconscionable profit driven greed. Hopeless. Bring back the guillotine.

A kid from wall street told me five years ago on a plane back from some very expensive salmon fishing : " that America needed another revolution". I didn’t believe my ears. Should have paid attention and sold all our shares.

You shouldn’t have to subscribe to read the whole article. If you access it though a Google search result it will give you the whole article. It did me for me at least.

The problem with this “story” is that it’s not a story. If you actually go to the WSJ website and read the small print above the article you’ll see it’s an opinion piece. This sounds like more anti-Obama fear mongering to me.

I’ve found information on what they’re talking about. I’ve only been able to read a little bit of it so far, but I can tell you right now it doesn’t sound arbitrary. There was a period of time where they were taking the public’s suggestions on the topic. Here’s the site if you want to check it out:


I remember one of those petition things going around Facebook a couple months ago about a state doing this - I am guessing WA was that state. With the stuff they are doing with Medicare now and this kind of stuff, anyone that has a health problem really has their right to life taken away from them.

There is no such thing as “ObamaCare”.

Using that term in any article is a red flag to me of a biased opinion piece, not objective reporting.

For what it’s worth, my diabetologist – a professor at U.W. – is skeptical about CGM. He says that testing interstitial fluid is delayed (20 minutes or so after BG changes) and that the accuracy just isn’t there yet. He thinks that CGM would be of limited usefulness for me – that any hypo alarms would come too late to be of much use, given my erratic and rare drops.

On the other hand, he’s all in favor of me testing my BG’s 6 to 8 plus times per day if that’s what we need to do to get a handle on my BG’s and get me under good control.

I think intelligent, well-intentioned people can disagree about the effectiveness of treatment and management options.

And I would venture to guess 99% of the folks that use CGMS on this site would beg to differ with your diabetologist’s opinion. Fingerstick glucose monitoring can’t even hold a candle to the level of info you get from a CGMS. I think PWD should be the only group that should be making these “decisions”.

I am in the state of Washington. They are buying “Obamacare” hook line and sinker. Regardless of what this new line of thinking should be called or not the above is what we will see, sadly. As great as some of the provisions are, I believe this new way of doing healthcare will, in the end, be a detriment to PWD. If you are going to cover a bunch more people you have to try to save a buck where you can, particullarly in these troubled times.

I’ve lived in the state of Washington, off and on, since 1983. Again, there is no such thing as “ObamaCare” here or anywhere else in the U.S. “ObamaCare” is just a biased talking point being promulgated by people who take large political donations from the private health insurance companies – the people who are REALLY rationing healthcare already in this country and have been for decades via rescission, refusing to cover pre-existing conditions, limiting access to medications via limited formularies, huge premiums for individual and small-business plans, cherry-picking, etc.

If someone who is uninsured can’t get ANY insulin or test strips or A1C tests or appointments with an Endo or eye checks for retinopathy or dental care, isn’t that the real rationing of healthcare?

Forty million Americans can’t get so much as a fasting glucose test because they have no health coverage at all. Any article on the subject which doesn’t mention this horrific fact is biased in the extreme – truly dishonest.

The bucks we pay for health insurance coverage are currently being shunted into things like the $350 million annual salary of a private health insurance company’s CEO. How many A1C tests or test strips could one buy for $350 million dollars? What if he was payed a million per month? Couldn’t he live on $12 million a year and fold the other $338 million back in to providing actual healthcare? Why not?

Our healthcare system wastes many more hundreds of millions each year on shuffling paperwork for all the different insurance companies, jumping through ridiculous hoops designed to delay payment, fighting to get legitimate bills reimbursed, writing off millions for care for the uninsured who show up in ER’s across the nation 24/7. Just moving to a single-payer system for reimbursement would free up billions.

I worked at a hospital-based clinic that had two administrative staff (paperwork shufflers) for every nurse. Why? Because that’s what it took to get reimbursed by health insurance companies. Waste, profiteering and greed are eating up our healthcare dollars – migrating to a single-payer system would allow us to shift over to having perhaps one administrative person for every seven or ten nurses.

Our system has become totally skewed.

Howling about “ObamaCare” and pitting the insured against the uninsured isn’t going to fix anything. Having everyone covered, a lot more medical staff and a lot less profiteering and senseless paper shuffling will go a long way towards ending the healthcare rationing that we now accept as “normal” – normal, that is, unless we’re the people who can’t get any health coverage.

I think there are so many people that are afraid of the Health Care Reform bill that everything that happens related to health care is getting blamed on that. I was asked to be an advocate for a group fighting the Medicare DME changes after I wrote about it on my blog so have been doing a lot of reading up on that stuff. I have seen numerous people blame it on “ObamaCare” – I know you don’t like that term, but that is the term they are using when they are writing about it. The Medicare rule was passed several years ago, long before the world even heard the name Obama, but because they went in effect after the Health Care bill was passed, people that don’t know better are pointing the finger at that bill as being responsible when it is not.

Unfortunately, the people coming up with these ridiculous ideas about how to save some money are not looking at the big picture. Medicare is now saving some money on DME, but now people have to spend more time in the hospital or nursing home type centers because of it. They have to spend far more money in other categories than what they saved on DME.

The same is going to happen with test strips. They might save some bucks on test strips but are going to spend a lot more on ER trips because of lows and all the complications caused by uncontrolled BS.

I agree that there is a lot of waste and also greed and the system needs fixed. Some of the things that could save money, they aren’t doing anything about and they are changing stuff that is going to cost them more money in the long run.

How exactly is a comment from a report written in Washington STATE somehow Obama’s fault? How can we fix a problem if we won’t even pay attention to the actual source of the problem?

All this flailing around and honking, “ObamaCare! ObamaCare! Aaaak!” may be good for FOX news ratings and Mr. Murdoch’s other enterprises (i.e. the Wall Street Journal and the Republican Party) but it is doing nothing to improve healthcare for diabetics, or anyone else.

I agree that any rationing of test strips or CGM is short-sighted and counterproductive, but if the money is not there due to waste, fraud, greedy profit-taking and forcing the indigent to swamp our Emergency Rooms (at ten or more times the cost of preventative care) which gets passed on to all of us, then what are we going to do? What’s the plan?

More of the same old, same old isn’t going to fix anything.

:Howling about “ObamaCare” and pitting the insured against the uninsured isn’t going to fix anything. Having everyone covered, a lot more medical staff and a lot less profiteering and senseless paper shuffling will go a long way towards ending the healthcare rationing that we now accept as “normal” – normal, that is, unless we’re the people who can’t get any health coverage.I agree, Jean V

We are in the midst of very divisive perioid in our nation’s political culture:There are multiple states facing cuts in funding to schools, hopspitals,m prisons libraries and legislations peniding that change how pulbic sector workers ( teachers, firefighters, helalthcare workers, govenrment workers ,firefighter, police officers, etc) negotiate for and recieve insurance benfits and conditions . Many people, legislators and governors included, beleive that public workers are 'too spoiled" by their unions and their pension and sick leaver] policies… So again those who are in the public sector are pited against those who work private sector jobs… And the public sector workers are made the scapegoats for the unbalanced budgets

I do not bleive that the health-are initiative is what wimit saccess to proper diabetes care. tTe profit-0based health insurance congolomerates,funders of are at the source of this, I beleieve. I have excellent insurance, Now, as a current employee of a schol district. I am reiring in June, and I am researching whether I will be able to keep my current level of type one care ( CGM, Insulin oump)while under the group insurance funded by my state"s reitirerment board. They are facing cuts too I am hoping and praying that I will not be forced to go back to 6 shots a day , no CGMS;and a limiit on my test strips, , upon reitrement, due to a change in what the onlky insurance I can get offers… I know some peple who are literally sick and tired but keep working to get insurance coverage… What will they do if insurance coverages change whether they continue to work or not?

I am not worried, but concerned… Even if I cannot gert my pump supplies funded through post-retirement insurance, God will make a way for me :He always has and always will,

God Blerss

I don’t think there is an easy answer but cutting back on a lot of the waste would make a big difference. I have seen it here & other message boards with people saying “my supply company keeps sending me …” If they were paying for those supplies, they would put a stop to it but because it is the insurance paying, they don’t worry about it. After all, it was free! They don’t seem to get the fact that someone is paying for it.

The auto-ship setup is nice, but I also think it helps create some of the waste and I would put an end to that. If people had to pick up the phone and call to get strips when they were running out, they probably would not call until they actually needed to call. They would not be ordering lancets when they already have 10 boxes in their closet. Because I ordered lancets in the past, every time I call to order my test strips, they ask me if I need them and I say no. I change my lancet about once a month now (if that) and that box of 17 cartridges with 6 lancets each will last me for awhile and I am not having them ship me a new box every 90 days.

There was a member here that posted on another board complaining because his doctor gave him a script for the free diabetic shoes and that was wasting Medicare’s money. He blamed the doctor for doing that but took no personal responsibility for the fact that he accepted the “free” shoes. I have had foot reconstruction and I never accepted the “free” shoes. To be clear here, I realize that they are not free!

Last year, Medicare did put some new rules into place that I think were good. They have requirements to qualify for a pump but if someone had a pump that did not meet the qualifications, they were still able to have Medicare pay for the supplies. I don’t agree with their requirements, but if you are not going to pay for a product, then you should not be paying for the supplies to use it either. If I switch supply companies, the new supply company now needs a copy of my c-peptide test before they can ship me supplies. Because insulin for a pump gets billed differently under Medicare than insulin for MDI, even the pharmacy had to have a copy of the c-peptide.

Medicare will only pay for orthotics if you are diabetic but no one ever had to prove they were diabetic before. When I went for new orthotics last year, the orthotics company I use had to get proof from my doctor that I was diabetic,.

Gee, right on!! Totally agree. I am a nurse in the northeast and see all of the above that you are talking about.


WHAT THE *^$#. This is NOT right!!! OK got to pick my mouth up out of the floor. WOW! I can’t belive that one! SHEZ!!!

After just reading “Deadly Spin” by Wendell Potter, I am inclined to support JeanV’s position that this is a well placed piece of concocted public relations spin. I skimmed the state report, it is a reasonable look at the question and by no means suggests reducing glucose testing. Most alarming is the assignment of the effectiveness approaches to “Obamacare.” These are Bush era approaches to managed health care. And the use of “Obamacare,” “death panels” and other terms are “classic” hallmarks of spin.