This Would Never Happen In The US!

Diabetes patients in Hungary are punished if their A1c's are too high!!

http://www.diabetes24-7.com/?p=1174

"Never" is a very long time!

Europe is broke !!! The Dutch Government resigned yesterday : NO support for austerity ...very sad but true .

The resignment of the Dutch Government is not welcome in Germany. Combined with the victory of Hollande in France this is not good. But broke is not the right word. Europe could resolve its current problems just by taxing its assets. Broke is when the debts are greater than the assets. Let us take a look at per head numbers in different countries:

Greece: 30000€ debts VS 56000€ assets => not broke!
Ireland: 23000€ debts VS 74000€ assets => not broke!
Portugal: 12000€ debts VS 48000€ assets => not broke!
Italy: 29000€ debts VS 130000€ assets => not broke!
Germany: 24000€ debts VS 104000€ assets => not broke!
Austria: 22000€ debts VS 101000€ assets => not broke!

DRUM ROLE

USA: 32000€ debts VS 22000€ assets => well?

I actually think something like this is inevitable, here in the US, as health care costs continue growing faster than inflation. At some point the pressure to trim the cost of insurance will become too much. Instead of tackling the insurance companies, who have the Congress bought and sold, this will be the line of least resistance.

The first target will be the overweight. The line of reasoning will be that your weight is costing the normal weight folks money, and to solve this problem you will have to pay more for your medical care, or perhaps your care will be inferior, as in the example of Hungary. The line of reasoning will be, this will give you an incentive to loose those extra pounds. Diabetics of all stripes will not be far behind with an A1C standard being imposed. Appropriate penalties will be imposed for non compliance.

The problem with this line of reasoning is that it assumes we are all perfectible, and that a utopian future is just over the horizon. In this brave new world everyone will be slim and everyone's A1c will be indistinguishable from a non diabetics. Everyone's kids will also be above average:)

In my experience we are all flawed to one degree or another, and most of us are only perfectible around the edges. I hope I'm wrong, but something will have to be done about health care costs, the question is what.

Regardless of the financial situation, punishing people for bad A1Cs is just nuts. First of all, there are frequently issues with lab results (be it A1Cs or anything else you have measured) due to equipment calibration issues, preservation of samples, etc. Labs are meant to be a guidepost, not an absolute. I have had doctors run labs multiple times in the past because something came back abnormal (and was then normal in subsequent samples).

With regard to the A1C - it's just ONE thing that can be looked at when assessing diabetes care. HOWEVER, A1C values can vary for any number of reasons. For example, if I get sick (cold, flu, infection), my BGs are going to go up and my A1C will too, no matter what I do. That's just part of being diabetic. If my A1C is drawn during the week when I notoriously run high because I'm PMSing...yep, gonna be a bit higher then too and not reflective of all the work I've done throughout the month. If I get a bad batch of insulin or multiple failed infusion sets or my pump dies, well, all these things that are somewhat out of my control are also going to throw off my A1C.

What scares me about this approach is that it is likely going to result in people finding ways to just game the system OR running dangerously low to avoid punishment. Also, what is a "good" A1C seems to change all the time. There was a period of time where every endo I met said, "You need to have an A1C in the 6s." Now, that tide has turned a bit; my endo says that I should focus less on the A1C and more on the standard deviation and my overall trends. She felt that aiming for an A1C in the low or mid 6 range was, for me, unrealistic and putting me in danger because of severe hypos.

My doctor told me that she wanted me under 7%. I was 7.2%. She didn't lecture me, but indicated that I could do better. I go for my next one in mid-May. I fully expect a similar number. If I lived in Hungary, I guess I'd be hooped!

This situation reminds me of the new thing Louisiana education is going through. They are implementing a system that will pay teachers based on how well their kids score. To a suit in an office, this seems very logical. If a teacher sucks, his students will likewise. On the surface it seems great, if a diabetic isn’t taking good care of themselves, why should tax payers money go more to them. Kind of like insurances that used to deny CGM’s because they were in “too good of control.” Yeah on the surface it seems like a great way to do it, but there are so many intangibles that you can’t see. Like someone said earlier, what if you are fighting an illness for over a month. What if you are in a very stressful time in your life. It’s hard to look at a number and determine how well someone is controlling their diabetes. So many variables work together to get those numbers, some we can’t fix. Just like a school teacher. I can’t affect if a student of mine didn’t get any sleep at all the night before the BIG test. He may be my best student, but problems at home, having a bad day, not eating breakfast, you fill in the blank for reasons why a kid might show up and do worse than he normally would on a test.

Bottom line is, it’s so hard having people that aren’t diabetics make decisions based on statistics. I wish that there was a way for the government to find out who was taking good care of themselves verses who wasn’t. The people who are blatantly crapping their lives away SHOULD have to pay more, but there is no way in the world that anyone can use one, or even multiple tests to do that. You will always have “good” diabetics for whatever reason fall on the “bad” side, and therefore be punished. I am a teacher, I feel I am a good one. I wish there could be a nice easy way to evaluate teachers to weed out the bad ones. But do not look at a single, or even a few test scores and judge me on that. True I can affect their scores based on what I do, but there are just so many variables that go into that that I cannot control. There’s no easy answer to any of these types of problems. The governments head is in the right place, but there is no plausible way of actually implementing strategies like that.

And please don’t misunderstand my “blatantly crapping away” comment. I am talking about those who know they have diabetes bu do not care, not those who are struggling with control. I have learned, even in this “easy” honeymoon period, that control can be a beast. I am just talking about those with diabetes who don’t try to control it at all, not the ones who are trying, even if they are struggling.

"Pat" the diabetic starch queen dietician:)

This whole scenario could certainly generate some Orwellian paranoid fantasy's if one were so inclined!


There have been many recent reforms to health care and more to come. Soon, medicare will begin paying providers by outcomes as opposed to service provided. I think providers will start scrambling for external partnerships to help patients do better.

"punishment" can come in many forms. When I asked to be a new patient of my current endo, she asked for labs and her staff did a short phone interview. It took several days to learn I was accepted. Not sure her exact reasoning...but wondered at the time if she could see what was coming.

I have to agree w/ BadMoon that the handwriting is on the wall. The US is competing with China/ Europe/ India but has hamstrung the ability of the government to do, well, just about anything because politicians are not allowed to raise funds the government needs to operate. Health care costs are going to continue to rise without any "supervision" and there's not really a significant "will" to do so in Washington. Plans are "bad" and "tools of big government" and the suggestion that private healthcare insurance will solve things favorably, particularly with our longstanding tradition of cutting seriously ill people loose and tossing them on the scrapheap of Medicare/ SSDI. I suspect that we may end up there someday, with R/N and 4x strips/ day.

Hmmm, can we start taxing the ADA & CDA & the Pats to hold them responsible:)

Unfortunately this is what happens when the government gets involved just about anything. When they get their claws into the health care industry you better just watch out. You hear so many people asking for universal health care. All I can say is be careful what you wish.

I am all for everyone's health needs being cared for. There are members here that sure can use the help and deserve it but government run health care is not the answer. I think that a better idea for caring for the masses is not universal government run health care but rather universal government supplied insurance coverage. In my utopian world the government would supply each person regardless of wealth or lack of with a voucher for the cost of a basic insurance policy. A voucher that could be redeemed with the insurance carrier of their choice. The gov would set the coverage and price on a basic policy thru negotiations with the insurance industry and then get out of the way and let the free market take over and only get involved to settle disputes.

That's my suggestion for health care, now if I can only get a bunch of politicians to agree.

Gary S

The "Pat the diabetic starch queen dieticians" of the world are adamant in their belief that they are in sole possession of dietetic truth.

Here's an article about "The North Carolina Board of Dietetics/Nutrition" (The Ministry of Dietetic Truth?) who "is threatening to send a blogger to jail for recounting publicly his battle against diabetes and encouraging others to follow his lifestyle." The blogger in question, Steve Cooksey, follows a low carb/paleo diet and has had success using it to control his diabetes. He makes no bones about his disdane for the standard dietetic advice and apparently those who have been the target of his attacks have taken notice. If he doesn't take down his site he faces up to 120 days in jail!

Although they claim to be following science the "ADA Minions" as Cooksey calls them:) are defending a paradigm that is decades out of date. In science all paradigms/theories are open to reexamination in the spirit of advancing our understanding. I think it's bad form to threaten the questioners with jail.

"In Oceania at the present day, Science, in the old sense, has almost ceased to exist. In Newspeak there is no word for 'Science.' The empirical method of thought, on which all the scientific achievements of the past were founded, is opposed to the most fundamental principles of Ingsoc." George Orwell 1984.

Although I think it's an interesting idea, i don't necessarily agree that it's a good one. I think perhaps repeat offenders that show no effort of improvement should be warned, but it fails to take into account all the other life factors, that may influence one's ability to have perfect blood sugars.

Interesting link and story, on the frontier of free speech and the internet? I read the rest of the link to the edits done by the board and I have to agree that he ought not to be selling his services, however useful, without a license? That perhaps crosses the frontier although it's also interesting that he's seemed to have helped a number of people too?

I poked around his site and could not find that he is selling anything beyond some videos by 3rd parties. Perhaps the threats by the The North Carolina Board of Dietetics/Nutrition had an effect on him. He does have a rather all encompassing disclaimer page in which he freely admits he has no credentials and no education beyond self education and his own experience. He says "Personal advice will not be given on this site. This site is ONLY intended for educational purposes ONLY. Providing people with the information on a “real” diabetes diet is my goal. Creating other Diabetes Warriors…is my desire!" With a disclaimer like that one has to at least raise free speech concerns.

It certainly didn't alter his opinion of the "ADA Minions". He is a bit on the strident side, but that sometimes is what happens when you are given disastrous advice by experts. I follow a similar diet and have achieved some success, although I am not able to do it without the assistance of drugs, as he has been able to do, so I am probably predisposed to be sympathetic.

The link I found was here: http://www.diabetes-warrior.net/wp-content/uploads/2012/01/Website_Review_Cooksey_Jan._2012.pdf, in their review. It seems sort of "grey area" to me but I could see it crossing a regulatory line? Like about 1/2 of what I post here.

How sad! Reminds me of that movie 1984. Reading the world news in recent years helps me to remember that movie with Lew Ayers and how his character had to ration his insulin.