Posted by Bill Sandweg on 08 May 2019.
“How the U.S. health-care system puts people with diabetes in danger” is the title of an article which appeared today in the Washington Post. The author is an ICU physician who sees and treats diabetics when they become critically ill with ketoacidosis. He describes his encounters with this condition as “frequent.” When blood sugars get out of control for a diabetic due to lack of insulin, ketoacidosis can develop. It is a deadly condition. The body needs insulin to turn blood glucose into energy and, when there is not enough insulin, the body begins to burn fats for energy. This process causes acids, called ketones, to form and the blood becomes acidotic. Nausea, vomiting, confusion and death may follow. The condition can come on quickly and is often brought on by an illness which interferes with the body’s processing of insulin. It is more common and more severe among Type 1 diabetics than it is among those with Type 2.
Dr. Adam Gaffney is the pulmonary and critical care physician who wrote the Post article. In addition to his clinical duties, he is on the faculty at the Harvard Medical School. Dr. Gaffney wanted to know whether our health-care system with its spotty insurance coverage and high deductibles was responsible for some of the cases of diabetic ketoacidosis he sees in the ICU. Since ketoacidosis is more likely to occur if a patient does not take his or her insulin, Dr. Gaffney wondered if there were fewer cases in countries in which insulin was easily available. As any reader of this blog knows, insulin prices in the United States have skyrocketed in the last 10 years and we pay many times more for insulin than anyone else in the world. For a Type 1 diabetic, insulin is life and without it the diabetic will die.
I have written about people not able to afford their insulin. Some try to ration it by taking smaller doses than they should. They allow their blood sugars to regularly run high. While this may get them by in the short term, over the long term it leads to irreversible damage to nerves, to the eyes and kidneys. Blindness, amputation of parts of the legs and feet and kidney failure may result. Diabetics trying to ration their insulin may also guess wrong about how high their blood sugars are and they may develop ketoacidosis.
The high cost of insulin is a huge problem for those without insurance. However, as Dr. Gaffney points out, it is also a problem for many people with insurance coverage. Those who receive their coverage through work are at the mercy of their employer, who may buy skimpy coverage in order to save a few dollars. This is not a criticism as the increasing costs of so much of our medical care cause premiums to go up and up. An employer may have only a choice between bad coverage and no coverage. With bad coverage, insured diabetics must pay large deductibles or large co-pays. Either way, even with insurance, insulin may be an unaffordable expense for those who also want to eat.
Dr. Gaffney and his colleagues looked at rates of ketoacidosis in Canada and other countries with universal health care. There were significantly fewer cases in these countries, especially among young adults who, in the United States, often find themselves losing the coverage they had as children.
Why do we allow this? We are the richest nation on the face of the earth? We pride ourselves at being the best. No one in the United States should ever die because they could not afford health care. We are the only developed nation without universal health care. I don’t know the best way to get to universal health care but I do know that the present system is immoral and a disgrace.