DR. PONDER: Economy, health policy impact diabetics
Diabetes is the No. 7 killer of Americans today. It drains more than $200 billion dollars from our economy each year. And if we make no lasting changes in our lifestyles, one in three Americans will be diabetic by 2050. But before that ever happens there are going to be many painful choices to make, not just individually, but as a society too. So where is this going?
The crushing national debt, struggling or bankrupt state budgets and high unemployment are already pushing many Americans over the edge. The “buy now, pay later” approach to life has caught up with us and threatens our economic future. Meanwhile new drugs and technologies are constantly in development to save, extend or comfort those of us with diabetes (and other equally serious diseases). None of these are cheap. Hopefully, the ultimate benefit of any new drugs and technologies would be a longer, fuller life.
The 2010 mid-term elections highlighted a growing frustration with government spending. There will be more public attention paid to finding ways to better balance state and federal budgets and pay down the national debt. But in the 21st century, more and more Americans will be touched by “chronic” diseases like diabetes, heart disease, high blood pressure, AIDS and even cancer. As government spending declines to balance budgets or pay off debt, medical costs for our aging population will continue to accelerate.
As medical costs grow, the financial burden of treating these conditions is going to be shifted more and more to the patient or family. It’s happening already.
Arizona recently decided not to pay for insulin pumps for diabetic Medicaid recipients over 21 years of age. This poses a challenge for thousands of diabetic children as they grow up there. Over the years, the costs of medicine have been shifting more and more to patients, even with insurance, in the form of higher co-pays, larger deductibles, lifetime coverage limits and non-coverage for pre-existing medical conditions. These last two were eliminated by health care reform, right? Maybe.
The states are in a difficult bind. They’re often handed down so-called unfunded mandates from the federal government that shifts cost burdens to the states to implement federal governmental directives. Second, less income is flowing into most state treasuries due to the depressed economy. And third, more states have mandates to keep their budgets balanced. This all translates into drastic cuts to high cost medicines and treatments. So medical cost shifting becomes an attractive alternative to states. The problem, of course, is that these costs are being shifted to those least prepared to absorb the burden.
Lawmakers need to understand that as costs of medical care are shifted to patients, interesting things start to happen. For example, as out-of-pocket co-pay costs for prescriptions rise, there is a clear association with prescription abandonment. Insulin is one of the most commonly abandoned prescription medicines due to rising co-pays. It was hard enough to keep insulin-requiring diabetics on insulin before co-pays went up. Add one more reason why two out of three diabetics are not adequately controlling their disease. Not taking your heart pill or blood pressure pill raises the chances of a major complication such as heart attack or stroke.
If we ask patients to dole out more co-pay for a doctor visit, many simply will avoid seeing the doctor. That allows a minor manageable problem to often fester into a medical catastrophe. Visits to emergency rooms increase and the costs actually go up over the long term. We may be replacing our “buy now, pay later” philosophy with something far more dangerous: “save now, pay (dearly) later”.
Saving dollars is logical and understandable. What we need to appreciate is that the short term savings gained by not paying for insulin pumps at all, cutting back on diabetes education programs, or underpaying for new diabetes therapies will only translate into a sicker work force with even higher medical costs in the next decade or two due to the earlier onset of more devastating complications with incredible price tags, such a crippling heart disease, kidney dialysis, blindness and amputations. And these complications, while manageable in some cases, are not reversible. There are no “do-overs” when it comes to a diabetic complication like blindness. Few of these complications are “immediate” killers, and we do have expensive therapies available already to manage them. Ironically, these cost more than the treatments to prevent them!
And this is my point, that the cost of avoidance or providing the necessary diabetes tools to all in need now only magnifies costs in a few short years. State and private insurers seem to be gambling that most of this cost burden won’t occur on their watch until after the federal government starts to pick up the health care tab in the form of Medicare. Of course, by then these costs will be paid for by our federal government, right? Maybe.
Dr. Stephen Ponder has had type 1 diabetes since 1966. He has been a pediatric endocrinologist for 24 years. He is located at Lone Star Diabetes and Endocrinology. Email lonestarendocrine@gmail.com and phone 432-582-2414 or follow him at twitter.com/dr_steve_ponder.
