Universal Health Care: Is It Good for Us?

The push for universal health care is mostly about covering uninsured citizens, but what I wanted to know was: What would it mean for us diabetics and others with chronic diseases who depend so acutely on the system?

Background: In California, Sen. Sheila Kuehl (D- Los Angeles) just announced the California Health Insurance Reliability Act, her third stab at pushing a universal-care bill through the Legislature. This calls for a single-payer system like in Canada, in which government pays for health care but keeps the delivery of health care under mostly private control. Supporters say the system would be more fair, cheaper and more efficient than the current patchwork system in the US. But opponents say quality will suffer, bringing with it long waits for health care services, a slowness to adopt new technologies and maintain facilities, and big bureaucracy that will rob patients and doctors of authority over clinical decision-making.

I found a neat sheet on myths and facts about universal health care from the American medical student association. But like most materials on the topic, there seems to be a strong underlying agenda/bias.

What seems clear is that healthcare spending is now concentrated on curative care, while it ought to be focused on preventative care. When patients with cancer, heart disease and diabetes wait too long to get treatment, you end up with high incidence of ultra-expensive chronic conditions. (Duh!)

Clincher: Opponents claim “the American people do not want to stifle the innovation and quality that the private sector enables” in the healthcare sphere. Hmm, why can’t I picture sick people with minimal or no health insurance cheerleading for capitalism?

Take Janice Ramsey, of Deltona, Florida, the 60-year-old small business owner who was dropped by her individual policy when she was diagnosed with diabetes. This woman was left with $22,000 in debt by a fraudulent association health plan, and turned down by numerous other carriers. Now she remains uninsured and worried she and her husband could lose everything if she gets seriously ill before she becomes eligible for Medicare.

Mrs. Ramsey is one of the cases highlighted in a new study by American Diabetes Association and the Georgetown University Health Policy Institute, called “Falling Through the Cracks, Stories of How Health Insurance can Fail People with Diabetes.” This study publicly substantiates many of the dirty little secrets about being chronically ill: diabetics tend to lose insurance coverage more frequently and are uninsured longer than healthy beneficiaries.

Conclusions are nothing new, really, but now have the punch of being official ADA research results:

- “the impact on the entire health system due to uncontrolled diabetes are enormous.”

- “In 2002, one in ten healthcare dollars and one in four Medicare dollars went towards diabetes care. The cost of diabetes in America in 2002 was at least $132 billion.

- “We can reverse these trends, but to do so, we need a health care system that allows diabetes patients to manage their care and that provides the tools to help reduce the number of Americans who will be diagnosed with the disease.

- “Given that as many as one in 10 Americans live with diabetes today … and one in three Americans will have the disease by 2050, it is time for policymakers to seriously rethink the flawed health insurance solutions up for debate that harm as opposed to benefit people with diabetes.”

Neither the ADA nor the JDRF take an official stance in the universal health care debate. This seems to be as close as they get –- calling for a “serious rethink” of today’s flawed system. If a major overhaul is in order, then sounds to me like “going Canadian” might be an excellent option. Ostensibly, fewer people fall through the cracks, and preventative care takes a front seat –- not least because a more holistic system will work together to prevent the mushrooming costs that result when diabetics and other “sick folk” are left untreated for too long.


3 Responses

  1. Diabetes not mine
    Diabetes not mine March 1, 2005 at 5:13 pm | | Reply

    First, full disclosure: I’m Canadian living in the US (how many of us do you know, Amy?)
    Second, my opinion (for what it is worth): I REALLY miss the Canadian system. Don’t get me wrong, it is far far from perfect and some (not all) of the horror stories you’ve heard about long waiting lines are true. The system does need some fixing. But in terms of expense it is cheaper (I’m not sure how much of taxes goes to healthcare, but it can’t equal what I’m paying now a month for my HMO. In terms of chronic care, my understanding is the system does work quite well. My aunt had cancer and we feel the treatment she got was the best we could expect anywhere (although she did end up dying).
    Here’s a question…. why are the incidents of diabetes on the rise in the US?

  2. Amy Tenderich
    Amy Tenderich March 2, 2005 at 8:32 am | | Reply

    Thanks for your feedback. I am glad to get to know some Canadian diabetics (did you say you have diabetes?) In any case, I lived in Germany for several years, and the US health care system is shockingly expensive and piecemeal in comparison. In terms of increasing Type 2 diabetes in the US, it clearly has to do with our generally poor eating habits. What stumps me is the increasing incidents of Type 1 in adults, like myself, who are not overwieght and live healthfully. Why us??

  3. Violet
    Violet March 2, 2005 at 10:29 am | | Reply

    From what I’ve read, it may not be that Type 1 in adults is on the rise, but that it’s being correctly diagnosed more often than before. In adults, Type 1 has historically been misdiagnosed as Type 2 with alarming frequency. Still happens. (Indeed, when I was told I was diabetic a few months ago, my primary care doc didn’t want to bother with testing me for ketones because my age indicated I had type 2, and type 2s, she said, don’t go high enough to develop ketones. Wrong on both points!)

    My experience notwithstanding, in general I think there’s wider understanding about adults with type 1, as reflected in diabetes literature, which commonly does acknowledge our existence. Also, tests that weren’t available a few years help docs make the distinction between 1 and 2 in some adults. So maybe that’s why the numbers are up?

    W/r/t causes of type 2: sedentary lifestyle, which is certainly championed by many facets of U.S. culture, is another culprit. This lifestyle, along with nutritional problems, is believed to be causing a new epidemic of type 2 in KIDS. And since there’s a genetic predisposition to getting type 2 as well, we can posit that as the population grows the number of type 2s will grow with it.

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