Friday, March 18, 2011

"The Pro-Diabetes Board" -- a reminder of the ultimate cost of shortsighted penny-wise, pound-foolish approaches to health spending

A powerful editorial in The Wall Street Journal this morning, "The Pro-Diabetes Board," detailing efforts by Washington State to use comparative effectiveness review (CER) methods to crimp down on Medicaid and other state spending by de-funding glucose self-monitoring tools, such as finger sticks.   As the Journal edit notes, self-monitoring is long established as the best way to deal with diabetes, but now, in this new Obamacare era, rationers--motivated in part by saving money and in part also, we can say, by an ideological desire to shrink the healthcare sector, just as the President says we must.  And in their zeal to "bend the curve," they are ignoring established medical best-practice.  

As the Journal notes, this "Scarcitarian" approach to diabetes is likely to travel from Washington State to Washington DC: 

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.

Former Arkansas governor Mike Huckabee has been attacked for questioning CER in his recent book, but here we see the way the rationing process works out in practice, just as Huckabee said.   We might pause to note that the idea of CER is a perfectly valid, because more information is always better than less information.

CER is valid, that is, with two caveats: First, it has to make room for personalized medicine (and personalized medicine will not flourish till the trial lawyers are pushed out of the way, as discussed here many times) and second, CER has to be managed by experts that people trust.   The "death panel" allegation struck a nerve because there's just too much evidence, here and around the world, that nationalized health systems end up pushing toward euthanasia.  And so the public simply will not have trust if they get the feeling that those running the healthcare system do not have their best interests at heart.  

We might further note, by the way, the ultimate futility of this Scarcitarian approach to cost-saving.  Washington State is not going to save money, long term, with this CER-ish method, and neither is Washington DC.  Why?  Because people are still sick, whether or not they are being properly treated.  Indeed, if they aren't treated, they will get sicker faster.  It is shortsighted, penny-wise and pound foolish, because diabetes needs to be treated properly from the beginning, and good treatment includes good monitoring.

The cynical "best" that can be said about such an approach is that it saves money for the incumbent regime.   If Washington State, or Washington DC spend less money on healthcare this year or next, that's good news for whoever's in charge.  That is, he or she can say, "Hey, I saved money on my watch!"

Never mind, of course, that ass diabetes worsens, it gets more expensive--nerve damage and intense pain, limbs have to be amputated, and, of course, kidney failure resulting in dialysis, costing an average of $77,000 a  year per patient.  Of course, from Washington State's point of view, there might be a kind of sneaky fiscal logic, because the dialysis program is a federal program.  So if patients get sick enough, they become a federal burden.   That's a federal entitlement, in place since 1972, and no sign of it going away, even if we wanted it to.  

And thus a key Serious Medicine Point: We have had universal coverage, long before the enactment of Obamacare.   It's just that the way we provide that coverage, at present, is fundamentally incompetent, because we mostly focus on healthcare finance, as opposed to actual health itself.  Sick people are more expensive than healthy people.  So by managing national health badly, we spend more.  It's almost as if our healthcare system were designed by the nursing home industry.

Gary Puckrein, president of the National Minority Quality Forum, makes the further point that four in ten diabetics are admitted to a hospital every year--that's expensive, and inevitably costs localities and states money, as well as the feds.    Indeed, overall, diabetes costs the US some $174 billion a year, according to the American Diabetes Association.

So if we really want to save money on diabetes, we would make the hardheaded calculation that it's time to do something preemptive about diabetes--like cure it.  But that's not a thought that the Obama administration, locked into to its retroactive fiscal model, seems to be contemplating.  


  1. Diabetes can victimize a person who is not genetically or family disposed to the disease. That is why we have a country whose citizens are overweight, eat bad food and are sedentary in their easy chairs watching fit reality show actors who have healthy lifestyles. One thing this country can do is to set up a seminar network similar to Defensive Driving classes. Healthy lifestyle would be the subject, healthy food and everyday exercising.incentives like coupons or movie passes could be distributed or give everybody a low cost camera for attending. The patients in Jim's outstanding article are too far gone for prevention because they already have diabetes. Sara Palin spoke about death panels and I agree that taking away their treatment methods qualifies fo her description.

  2. Diabetic is generally visible as genetic. So called it is genetic disease. This is wonderful information and author explained wonderfully about the topic.

  3. I like the information you shared here. I am really happy to know about this. Thanks for giving acknowledgement.

  4. I've been 'pro-diabetes' from day one! We can really, really trust articles that begin with this phrase...

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