Horror Story

I agree that waste is a HUGE problem. Do you honestly believe the government trying to “fix” healthcare is really going to solve this problem?

I am NOT trying to pit the uninsured against the insured AT ALL. If the government is going to get involved I would be much more apt to feel like this is going to work out if there was a single payor source and everyone get’s the same insurance including all the slimeballs that wrote the current bill (amazing how they and their friends get a special exemption that they do not have to be involved in this new brand of healthcare).

As far as I can see with the new health care bill, every concern you have in regards to paper shuffling and waste just got amplified by about 30 million people. Do you think they will try to get rid of the waste? Nope that is too difficult. They are going to start saying- boy those PWD sure are expensive we should not cover these expensive strips, insulin , and CGMS machine’s.

Healthcare reform needs to deal with fraud and waste. Can you point me to where this is a prominent in the new bill?

And don’t get me started about the lack of funds allocated to prevention.

The indigent will continue to swamp our ER’s even with the new bill. How does this new bill prevent that? I predict it will actually only make it worse!

We obviously know that glucose testing is essential. People who don’t know needed another study to prove that to them. This study tested that and concluded that YES, testing is important! It was more inconclusive about the use of CGMS in kids, but cited extensively the JDRF study providing evidence that it is effective. The WSJ article quotes that testing is “controversial”, which is stated in the introduction of the report as a justification for doing it, but NOT in the results or findings. Those are clearly in favor of testing.

I think this is an example of how easy it is to use ANY information to support your own aims. This article had an agenda and quoted this report without summarizing the findings. It sounds really scary until you read the report :slight_smile:

Here is a summary of the results from the report:
“Overall, participants 13-17 years old (N=195) at baseline (N = 195, mean age 15 years) in the
intensive treatment group (across both cohorts over the entire study period) experienced:
• Significantly lower mean A1C levels by 6-12 months that remained lower for the remainder of the 7.4 year
trial, (8.06% intensive treatment versus 9.76% conventional treatment; (P value for test of medians was <
0.0001, loss to follow-up unclear).
• Lower average daily blood glucose concentrations (P< 0.0001)
• A higher rate of hypoglycemia resulting in coma or seizures (RR 2.93; 95% CI, 1.75, 4.90; P < 0.001).
• A 61% risk reduction in sustained ≥ three-step retinopathy (95% CI 30% to 78%; p=0.02) after adjusting for
baseline retinopathy
• No statistical difference in rate of ketoacidosis (18% for intensively treated, 20% for conventionally
• No significant differences in nephropathy in the primary prevention cohort or the combined cohorts.
(Participants in the secondary prevention cohort who were intensively treated experienced a statistically
significant reduction in risk (55%) of having microalbuminuria (95% CI 3, 79%, P = 0.042) compared with
those in this cohort who were conservatively treated.)
• Significantly higher peripheral motor and sensory nerve conduction velocities compared with the
conventionally treated group at 5 years. No statistically significant difference in neuropathy between
treatment groups were seen in the combined cohort.”

On a more personal note, I used to test 15-20 times per day. I started with a new (wonderful) endo who persuaded me that I could get the same results from 7-8 tests per day if I added more routine into my life.

I decided to give it a try. My lifestyle is much less flexible, more regimented, but indeed my results are a lot better at a lower cost.

The national health care system here only subsidizes 5 test strips per day. The rest I buy out of pocket (at a cost MUCH lower than in the USA – works out to about $35 per month that I need to pay). I was able to reduce my costs a lot by reducing the amount that I test and only testing at times that will truly give me information about how to act.

I know this is controversial, but I just wanted to add my experience that sometimes the same control can be achieved with less testing, but more regimented lifestyle (which is a price to pay! I don’t deny that!!). In my case, it’s worth it.

I could give you a twenty-paragraph answer, but here is the shorter form:

The cost of TWO uninsured women with no prenatal care showing up in the ER in labor with a high-risk pregnancy that ends up with a stay for the baby in the neonatal intensive care costs the same as providing preventative, comprehensive prenatal care AND labor and delivery for TWELVE HUNDRED mothers.

I know this for a fact from working for 3-1/2 years as the assistant to the medical director of a hospital-based perinatal clinic for low-income women. I maintained their databases and tracked their numbers.

Two receiving late-stage, emergency care vs 1,200 receiving months of prenatal care, visits with the doctor, ultrasounds, meeting with a nutritionist, visits with a social worker if they have family or financial problems, labor in a safe, planned process, post-delivery hospital stay, visits with the ob/gyn and pediatrician after delivery, etc. etc. costs the same.

Which is a better deal for rate payers and/or tax payers? Which is a better use of our healthcare dollars?

No one can fool me with all this anti-“ObamaCare” smoke and mirrors.

I know the numbers; I know the facts. Prevention is ALWAYS tremendously more cost-effective over-all.

Great summary. And the report said “nothing” suggesting testing or CGMS was inappropriate for < 18 years, the biggest thing they noted was a lack of evidence. And the reason we don’t do studies? It is not really ethical to experiment on children, especially when there is evidence that failure to test has negative consequences.

I would like to try CGMS, but as a type 2, I’m not sure I would like wearing a device all the time if I don’t really need it.

I also left out of my earlier post that I am allergic to most adhesives and would probably be dealing with a red, itchy, bumpy rash at each site, which figured in to my discussion with my doctor.

I agree that we should be the final decision-makers about our care. My point was that every time a researcher or doctor has a different opinion, it is not necessarily due to some big, scary conspiracy to hurt diabetics in order to make money/save money.

Good-hearted, intelligent people can legitimately disagree.

I just say no to unnecessary supplies for my sleep apnea set-up (CPAP) all the time, and have done so for years. What a racket. I have been on CPAP for eighteen years. I have used TWO hoses in that period of time. They are sturdy plastic and last a very long time. If my CPAP supply company had their way, they’d be auto-sending me a new hose every six months. Ridiculous.

I told them absolutely not.

The salesman kept saying, “It’s free to you. It’s covered by your insurance.”

I said, “Yeah, and waste raises the cost of my premiums. No.”

If they charged even a $5 co-pay for those hoses, a lot more people would say no.

I think reasonable, small co-pays are an example of a strategy that prevents waste, along with regular audits to catch sales practices like the one I described. Salespeople who run up our healthcare costs via waste and fraud should be canned and banned.

I believe in making Medicare universal – I want everyone from the President, Vice President, Senators and Cabinet members to the local homeless meth addict and teen mother to be on the exact, same, universal, single-payer health system.

That is the only way we’ll ever get true value for our dollar and true quality in healthcare. If Mrs. Trump, Mrs. Murdoch, Mrs. Obama, my niece and the gal living under the viaduct in her van all have the exact same coverage for their contraceptives, their pregnancies, their preventative care, their infant’s care, then we’d get the waste and fraud out pronto and have a vastly better system for everyone.

Would we pay hundreds of millions in salaries to three-martini-lunch suits who add nothing to the process of providing healthcare? Not it if meant a cut in services to Mrs. Trump.

Would we turn a blind eye to waste and fraud? Not if it meant less quality care for Mrs. Murdoch.

Would we negotiate drug prices? You BET we would.

Level the darn playing field and watch all the clamoring for more medical school slots, more nursing schools, fewer paper shufflers and less of the current, obscene profiteering.

I don’t think that less testing necessarily requires a lot more routine, although I think it can be helpful for a lot of people. I generally think the following is true:

  1. If you consistently get the same results when you do the same thing under the same conditions, you probably can afford to test less. If you’re doing something new or experimenting, you probably need to test more.
  2. Don’t test unless you can and will take action to alter an unfavorable test result (this is a principle from medicine). For instance, testing at 1 hour after eating probably isn’t helpful, not because it won’t give you information, but because you can’t correct it without the risk of stacking insulin. Doesn’t mean that you should never test at 1 hour, but if you’re looking to test less often that’s the first thing I’d cut out.

I personally value my ability to skip meals, vary what I eat, exercise when I feel like exercising, and work/sleep irregular (but adequate) hours more than I value slightly less testing or slightly tighter control. If I were to have problems I’d start keeping better data and looking to pinpoint the source of those problems, but routine is not necessarily the right answer for everyone.

I agree. Discussion leads to a better level of care.

Don’t get me wrong Jean I want the same thing as you! I got kicked off my parents insurance in college and am now working 2 jobs to pay off the credit card debt I accumulated to pay for my healthcare during that time. The high risk pregnant women in your example SHOULD have healthcare and I agree 100% that it will save us all a whole bundle of money.

However prevention was woefully underfunded in this bill. Look it up- you will be dismayed. Without it all we have done is spent a bundle of money to help people after the fact. Just because you mandate people have to enroll into a system that is already failing us does not mean we are going to improve much and sounds to me like we won’t be getting much bang for our buck. Where are the programs educating these women on the importance of prenatal care?

I am not trying to fool you Jean and it is quite telling you would jump on me about throwing up “smoke and mirrors” but propose in a previous post that intelligent people having a healthy debate improves the process . I think we all need to be covered and be provided preventitive care. I just disagree with the way it is mandated to be done.


I didn’t mean you, personally, when I objected to anti-“ObamaCare” smoke and mirrors.

I think my earlier posts made it clear (I’m sorry if it wasn’t) that I blame the politicians (Republican, mostly, but also some Dems) who accept HUGE campaign donations from the for-profit health insurance, drug and HMO industries.

They’re the ones trying to scare everyone with “death panels” and “rationing” and “no money for you because it’s all going to go to illegal aliens” and “be afraid, be afraid, insuring the poor means you’ll have to sit around with a broken leg for six months waiting to get surgery” and all the other lies and nonsense.

They’re the ones who have been fighting for decades to prevent any improvement in our healthcare system that might cut into the private profiteers’ bottom lines.

I don’t think any individual, regular citizen has anything close to resembling the evil intent of the Healthcare Robber Barons and their political mouthpieces.

Research the German system and you’ll see what I mean. Their doctors still make HOUSECALLS, especially to the disabled and the elderly. All of their health measures are better than ours. Many of them are way better. The idea that we’ll all suffer if we have universal coverage is bunk. But I certainly don’t blame you for the bunk, unless you’re working full-time for Mr. Murdoch, the brothers Koch or someone else in the propaganda business? ;0)

That said, the most recently passed healthcare reform act was not my favorite flavor of reform. I am absolutely sold on a single-payer system, essentially rolling out Medicare to all Americans over a period of years, bringing the young and relatively healthy into the same big “pool” as the elderly and, in effect, getting the profit OUT of health coverage, unless the rich want to buy boutique supplemental coverage for silly things like tanning, avocado facials and weekends at the spa in the event that they get cancer and want to be pampered.

Basic healthcare is, in my opinion, a human right that we could best afford if we had one, big “pool” of all Americans. This bill is better than nothing, but it doesn’t go nearly far enough. But to blame that on Obama is silly – the people who fought it tooth and nail are, for the most part, on the other side of the political fence.

My doctor is a professor at U.W. but I see him through Group Health, Dr. David McCulloch (author, by the way, of “The Diabetes Answer Book”.)

There may be a difference because I’m a T2, but Dr. McCulloch was kind of enthused about some of the new CGM’s coming out in the next year or two if clinical trials go well. He liked the results so far on one that is implanted under your (?) collarbone that monitors whole blood, not interstitial fluid. I didn’t get all the details but he said it was “more like a pacemaker” in that it was inside your body and not just “plugged in” to your body fat.

I said, “If it’s accurate and you don’t have to use adhesive on your skin then sign me up!” (I’m allergic to most adhesives.)

I’m a database geek and I firmly believe that I can never have too many diabetes data points. ;0) As soon as I get my next job, I’m going to start saving for one of these new CGM’s, whether Group Health likes it or not. I think he said they’re scheduled to come out in 2013?

Shirley Wang’s Wall Street Journal news article is not an opinion piece but facts as to where cuts in health care in the state of Washington are headed. As usual the illustrious decisions made by our legislators impose cuts to the budget in the wrong areas; cuts need to be made in legislative and bureaucratic payrolls if not eliminate some offices and their expensive ineffective teams—including Leah Hole-Curry, the program director. Being a diabetic I know that one treatment may not be effective for one patient but, maybe effective for another patient and therefore should not be cut. As for the BG test strips they are donated at a discount from TRUE meters—I personally take advantage of this savings and purchase my test strips at an area clinic for 13 dollars for a box of 50.
Wang, S.S. (March 19, 2011) State Wrestles With Health Coverage. The Wall Street Journal U.S. Copyright ©2011 Dow Jones & Company, Inc. All Rights Reserved. Retrieved March 19, 2011 from http://online.wsj.com/article/SB10001424052748703512404576209152520603470.html?mod=WSJ_WSJ_US_News_5

I think this is a dumb proposal based on the available data, but I see no problem in principle with making evidence-based decisions about what sort of treatment to pay for. From the perspective of a diabetic, this is obviously unfortunate news, but that’s not the right perspective to make healthcare decisions from; the only coherent way to make these decisions is to assume the position of a person who doesn’t know whether they are healthy or sick and to make decisions based on weighing the aggregate costs against the aggregate benefits of treatment. I don’t even see a problem with Hole-Curry’s statement that patients might not be the primary constituency to consider; after all, they are not the only people who pay into Medicare, and their interests may not adequately represent society’s interest in delivering cost-effective health outcomes.

As far as waste goes, it’s unfortunate, but given the massive economies of scale that Medicare and many private insurers enjoy, the cost of eliminating waste at the margins may very well exceed the cost of the waste itself.

Thanks for the link. I’m glad to hear that they will, at least, continue to cover test strips!

Yes, thank you so much for the link. I am always worried about test strips being covered because my 5 year old daughter is a type 1 and she is covered under Medicaid. We’re in Ohio not Washington, but they’ve been looking for ways to cut costs recently so I’m sure she would have been affected.

Anyone who is worried about where this is headed needs to keep an eye on the Health Technology Assessment website. During each assessment for a short period of time they actually allow the public, literally anyone, to email them and offer their opinion. Those opinions are reviewed and included in their reports. Want to know how many people commented on the glucose monitoring assessment? Ten. Only ten people. Where was the Wall Street Journal when that was going on? We could have flooded them with opinions!

My doctor told me to test 2 times per week. Since I have to buy my own strips I test 3-4 times per day. I have regained excellent control by doing this. I wonder if people had to buy their own strips whether they would still test as much. I would but I feel some others would not. My 91 year old dad is also a D with neuropathy and only tests 2 times per week, none of them after meals.