Why I harp on my clients about control, control, control

Life Insurance underwriters are more in touch with medical issues than they ever have in the history of the profession. But we still need to give them something to work with. Underwriting is a two side coin, one side with good control and the other side, well not so much. Diabetes is considered a chronic disease. Here are some statistics that we have to overcome when we apply for life insurance.

Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.

Complications

Heart disease and stroke

• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
• In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
• The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

• In 2003–2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 mmHg, or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.
• In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.
• In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous system disease (Neuropathy)

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

• More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
• In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Cost of Diabetes

$174 billion: Total costs of diagnosed diabetes in the United States in 2007

$116 billion for direct medical costs
$58 billion for indirect costs (disability, work loss, premature mortality)
After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

Factoring in the additional costs of undiagnosed diabetes, pre-diabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion.

• $18 billion for the 6.3 million people with undiagnosed diabetes
• $25 billion for the 57 million American adults with pre-diabetes
• $623 million for the 180,000 pregnancies where gestational diabetes is diagnosed

For Additional Information

These stastics and additional information can be found in the National Diabetes Fact Sheet, 2007, the most recent comprehensive assessment of the impact of diabetes in the United States, jointly produced by the CDC, NIH, ADA, and other organizations.

I understand what you’re saying and why you’re sharing this info.

But … sigh … the stats don’t help people with diabetes learn how to achieve tighter control. They’re just scary numbers.

I’m one of the few in the office who hasn’t needed to use a sick day yet this winter. I like to attribute that to the care I take of my health and the fact I wash my hands a lot (to get valid bg readings, ya know). Yet all I am to life insurance underwriters (or health insurance underwriters, for that matter) is an expensive burden. 'Cause they don’t look at my A1C and my stellar blood pressure and kidney tests. They just stamp “no” on the application because I’ve ticked the diabetes box.

I suppose percentage wise Canada is comparable . This proofs to me( I think I knew ) we need to have made available: ongoing Education ,incl visits with our Health Team , tools to use , such as glucose strips, Insulin pumps , medications to help prevent kidney disease and high blood pressure , regular eye tests , awereness about how important exercise is and to quite smoking , proper food labelling …forgive me, if I have forgotten anything …am a bit stressed : a HI glucose reading after having a LOW .

Why don’t those in the medical field turn things around and not tell us the negative things that can happen to someone with Diabetes. Why not tell patients the positive things that will help prevent the negatives that we always hear. Emphasis the positive.
I’ve lived with this disease for 50 years and am tired of hearing about the negatives. I hate hearing about the commercials for Diabetes products…I also hate the word DIABETIC, enough is enough stop and concentrate on educating people who live with Diabetes but do it in a positive way.

It concerns me that the insurance companies are basing their underwriting statistics on a healthcare system that has not been able to provide for the uninsured or underinsured. If a PWD is unable to afford the Meds or items that they need to “control” there Diabetes due to a “underwriting calculation” they will be a statistic. I choose not to be a statistic. I control my diabetes.

One day insurance companies will figured it out. If they provide affordable insurance to all, less people will place a burden on system and not be a statistic. You did a wonderful presentation of insurance underwriting statistic, but we need look at it look differently. Just think if the underwriters were able to approve a person with a chronic disease affordable insurance, 75,000 people would not have to die. They will be able to get the care they need to control the diabetes. And PWD will no longer be considered a statistic. Also they will not be counted on the grand total ticker for Heart Disease, Amputations, Blindness, High blood pressure, and kidney disease.

Sounds like we are getting blamed for having a chronic disease.

The National Diabetes Fact Sheet you cite as the source, jointly produced by the CDC, NIH, ADA, and other organizations (derived largely from the NHANES studies), cannot even identify TYPE of diabetes by disease etiology, thus the ability to measure co-morbidities is also severely impaired. As for the costs of diabetes, that is irrelevant to a life insurance underwriter because it does not impact the time in which a life insurance claim will be made. In addition, as Dr. Steven Edelman noted in his letter to the FDA on behalf of amylin’s NDA several years ago, well-controlled diabetes is the leading cause of NOTHING, but you cannot determine whether the disease is well-controlled from the National Diabetes Fact Sheet. Instead, the mere having the disease is used as an excuse to exclude all patients with diabetes from being able to attain life insurance policies, or the actuaries price the policies in a manner that renders them unaffordable to most people, and not worth the cost even for those who can afford them. Why is it that the banking industry gets all sorts of criticism for its practices, and new laws (such as the CARD Act are passed increasing regulation on that industry) yet no one is calling for the same type of restrictions on the insurance industry? Its worth noting that the single biggest bailout in U.S. history and one of the few TARP recipients that has not repaid its TARP funds is AIG, an insurance underwriter!

Scott,

Great points, but in response to your question re: restrictions on the insurance industry it has a lot to do with, IMO, the fact that the insurance industry is the single largest loaner of money to the federal reserve (at least I think they still are, they were 5 or 6 years ago, I’d have to check) and they contribute on hell of a lot to politicians. Banking bubbled to the top last year, but insurance stays behind the scenes. Notice that we are talking healthCARE reform with the pending legislation, when it is really health INSURANCE reform that really needs to be addressed

I love you guys,

Just to make sure you are getting which insurance I am talking about, this is from the perspective of life insurance not health insurance. And Scott Strumello you hit the nail on the head when I said control. The life insurance industry had their ability to contest insurance policies reduced to 2 years in all states and 1 year in several. Since then, they have had to focus on the science of life insurance and this year we got our first cases of Preferred diabetic clients.

But Scott brought something up that I think we all need to keep our elected representatives held to task over, and that is Health insurance providers need to be held accountable to the science of insurance and not the economics. And I personally feel that their are certain industries that don’t need to have profit as their primary goal. The Health industry needs to have HEALTH as its focus. Dargirl and Nel, I would go as far as to say that certain chronic diseases should be exempt from statistical observation. That would put the burden on the health insurance industry to get them as healthy as possible as quick as possible. Boy that sounded foreign to the US health insurance system.

Kathyann their not blaming, but this is the 300 pound gorilla in the room. If we can show good control, he doesn’t affect the underwriting. But private pilots have to do the same thing. They have different levels of proficiency that result in different levels of risk. Student pilot, then visual flight rating, then instrument rating on up. All I meant to illustrate was the 300 pound gorilla. Now let’s show him the door.

In my experience, most primary care physicians give a similar answer when treating diabetes, diet, exercise and take these meds. On rare occasions I’ve had one that was exceptional and really dialed the type of program Kelly Rawlins discussed up for their patient. But for the diabetics that ask my advice I really recommend a good endocrinologist who can take the time to differentiate between lifestyle and metabolism. Who follows up with prescriptions to make sure they are as good as he was hoping. If not then body chemistry suggests something else. And to set realistic interim goals, but lofty lifetime goals.

Because Betty J, your not a diabetic. Your a wonderful person who lives an exceptional life. And I’m sure I’m not the first, but keep doing what you are doing. Fifty years as a healthy person, I’m glad you’re here.

Thanks everybody,
Tom

Thank you Tom, not often do I vent but I have my moments. I agree insurance companies do need to have health as it’s focus but that’s not their focus because there is no profit there. Education is the biggest key to living with Diabetes and some other chronic diseases.