Diabetes complications soar in US, but not Canada, as teens become young adults

https://medicalxpress.com/news/2019-05-diabetes-complications-soar-canada-teenagers.html

by howard941 • 7 years ago

71 78 7 years ago

xenospn4• 7 years ago

Reminds me of the height differences between South and North Koreans.

kevin_b_er• 7 years ago

This really is a study on the political consequences of an underregulated free-market economy and the result of political demands for more libertarian ideals as applied. The consequence is the poor cannot afford to live.

minikites4• 7 years ago

Lots of people affirmatively believe that the uninsured should die:

https://slate.com/news-and-politics/2011/09/let-him-die-a-de...

What should happen, the moderator asked hypothetically, if a healthy 30-year-old man who can afford insurance chooses not to buy it—and then becomes catastrophically ill and needs intensive care for six months? When Dr. Paul ducked, fondly recalling the good old days before Medicare and saying that we should all take responsibility for ourselves, Blitzer pressed the point. “But, Congressman, are you saying the society should just let him die?” At that point, the rabble erupted in cheers and whoops of “Yeah!”

ksdale4• 7 years ago

I feel like these are two vastly different questions though, whether, on the one hand, society should let people who cannot afford healthcare die, and on the other hand, whether society should allow people to choose how their dollars are spent in a way that may lead to bad healthcare outcomes (like dying from something that's preventable given enough dollars). In your quote, they seem to explicity mention that the person can afford insurance but chooses not to buy it.

I mean, we don't make it illegal for people to do a ton of extreme sports where they might die. I don't see much of a difference between, say, climbing Mount Everest and a healthy, wealthy person deciding to spend thousands of dollars on something other than health insurance, knowing that they might not be able to pay the piper. Both are instances of someone choosing current enjoyment and weighing it against the chance of a life-threatening outcome.

The real problem seems to be when people have no choice. Of course everyone wants to not die, and of course no one wants to pay for healthcare, but we can't have both, so we have to find a middle ground that involves preventing deaths and paying for healthcare, and it doesn't seem horribly immoral to me to allow people to make the choice to trade their future health for money now (or enjoyment, in the case of mountain climbing or sky diving or whatever). Once again, the problem lies in the lack of choice from the get go.

ecpottinger2• 7 years ago

You don't even need to be poor, just not have a lot of money saved or expensive insurance and then have a major health problem.

mrguyorama• 7 years ago

You can be genuinely well off, making over $120k a year, and still get medically bankrupted because of an unforeseeable condition and some capricious bullshit by your expensive health plan

Prophasi2• 7 years ago

This perception of the US as having a free-market economy, particularly in the area of healthcare, is curiously persistent.

Vast sums of money are spent lobbying to distort the market in favor of particular companies and industries. The FDA has long been accused of preventing key drugs from coming to market that are available in other countries. The patent system alone perpetuates medication monopolies over decades for fabricated reasons, keeping cheap generics out of people's hands. The tax system heavily favors employer-run plans (for reasons rooted in the WWII era) that encourage overspending, tie coverage to your employer, and distort the market in multiple, deep ways.

Medicare and Medicaid are huge. The chart in the FEE link below puts US gov per capita expenditures at 4th in the world.

The below Vox article, which is otherwise anti-free-market, concedes that generic insulin providers seem too daunted by secondary patents and "extreme regulatory complexity," both of which obviously run counter to a free market.

This isn't to say a free-market system would be a panacea of all complaints (systems dealing in scarce resources will never be perfect to all participants), but those complaints would be much different than those about the layers of bureaucracy, high government spending, low competition, high time-to-market for drugs, breathtaking lobbying efforts, and overwhelming tax complexity we have now.

Maybe you think you'd prefer single-payer to the present regime, but to characterize the latter as "free-market" sets up a false dichotomy. (Note that it could logically still be "underregulated," as you say, despite not being free - not that I would agree.)

Drug patents: https://www.statnews.com/2019/02/11/drug-patent-protection-o...

Tax distortion: https://www.forbes.com/sites/theapothecary/2017/07/30/why-ta...

Insulin prices: https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expe...

Free market? https://fee.org/articles/the-idea-that-the-us-has-a-free-mar...

howard941• 7 years ago

We had a free market for drugs. So free and freely abused that it gave birth to modern journalism (muckraking) and the Pure Food and Drug Act of 1906. For good reasons few yearn to return to those truly free times.

https://en.wikipedia.org/wiki/Pure_Food_and_Drug_Act

https://www.u-s-history.com/pages/h917.html

kjdndisneinj2• 7 years ago

The free market will always distort regulation to suit the elites that profit from those distortions. Either through government or monopolistic corporations.

As long as private property is enforced through the threat of violence these problems are not tractable. The only solution to regulatory distortion is the complete abolition of capital.

In the case of healthcare, nationalized single-payer system gets far enough for something so critical to our existence without requiring a complete restructuring of the economy.

jimrandomh• 7 years ago

The article talks about people being uninsured, but this is a misunderstanding of the problem. I'm type 1 diabetic, and the reasons for this are pretty straightforward.

In thus US, insulin (of the types people actually use) is very expensive (~$300/vial), and requires a prescription which expires after one year. In Canada, the exact same insulins from the exact same manufacturers are literally 10x cheaper, and are OTC. Being without insulin takes about two hours to turn into a life-threatening emergency.

The prescription requirement creates ample opportunities for logistical errors that turn into life-threatening emergencies. And there's no legitimate reason for prescriptions to expire. And the cost is such that, if travel were free, you'd often be better off paying the full price in another country than just the co-pay in the US; the price is so insanely inflated that insurance is just compensating for the dysfunction, it isn't better than a sane uninsured baseline would be.

Insulin is cheap in every country in the world except for the United States. This is completely insane. It needs to be OTC in the US, and the import restrictions need to be removed so that US diabetics can have it at the international price instead of the gouging price.

albuterol• 7 years ago

Same goes for asthma medication. Epinephrine got removed from OTC options a few years ago, and now it's impossible to treat asthma without getting pushed into steroid treatments with whopping price tags.

mikecsh• 7 years ago

Do you not have access to beta2 agonists such as salbutamol?

ASalazarMX• 7 years ago

As a fellow asthmatic, great username.

bluejellybean• 7 years ago

It's actually back as an OTC, I only learned it was made available again after a scary ER visit. Check your local Walgreens!

nickles4• 7 years ago

Although I agree with you that the article misunderstands the problem, I'm not sure it's the cost of insulin that's the issue. Of all diabetics in the United States, ~3% have type 1 diabetes. It looks like 90-95% have type 2 [0], which is highly correlated with obesity.

While obesity rates in Canada appear to have stagnated [1], they are steadily increasing in the United States [2]. Additionally, the United States has roughly double the rate of obesity as Canada. Given the relative increase in obesity in the USA versus Canada, it's quite possible the increase in diabetic complications can be attributed to this.

[0] http://diabetes.org/diabetes-basics/statistics/

[1] https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article...

[2] https://www.stateofobesity.org/obesity-rates-trends-overview...

qntty3• 7 years ago

For young people, the numbers are very different. See my other comment.

ng12• 7 years ago

Obesity and Type 2 diabetes have very little to do with this issue. Not all Type 2 diabetics take insulin and not all Type 2 diabetics who take insulin are at risk of DKA. Furthermore, the vast majority of Type 2 diabetics are adults. The article is very clearly referring to Type 1 diabetics.

ordu• 7 years ago

there's no legitimate reason for prescriptions to expire.

It reminds me a bureaucracy of USSR, where there was a developed system helping to people with disabilities -- medical and social measures, -- but to be a subject of that help you need to prove your disabilities on regular basis. System was not bothered by the fact, that if someone miss a limb, than it will last forever. So a person with a missing limb was forced to "prove" his/her limb is missing every few years.

pjc503• 7 years ago

Ah, the current UK system.

It's been condemned by the UN, but the government would far rather lose lawsuits than admit that disabled people aren't lying about being disabled.

vkou2• 7 years ago

The prescription requirement creates ample opportunities for logistical errors that turn into life-threatening emergencies.

And logistical errors with prescription medications in the United States happen all the time. My wife has two simple, common prescriptions, and when she comes in for refills, it's a complete crap-shoot of whether they are in.

You'd figure that the free market would find some way to optimize this sort of thing - but apparently, it's incapable of anything but gouging patients.

BRAlNlAC• 7 years ago

The prescription drug market is hardly free.

pjc503• 7 years ago

insulin (of the types people actually use)

Is this perhaps the key - people being steered off the old patent free insulin and onto more expensive treatments, without really being given the choice?

cperciva• 7 years ago

Modern insulin is vastly superior. The difference between Novolog and Fiasp is small, but the difference between Novolog and Humulin is huge.

throwing838383• 7 years ago

the problem with medical service in the US is the prices. We really need cost controls here. The medical industry should be highly regulated in terms of the prices they can charge.

coldpie2• 7 years ago

In other words, stop voting for Republicans.

genzoman• 7 years ago

Big Pharma knows no party.

minikites4• 7 years ago

Then why are only Democrats pushing for Medicare For All and other comprehensive public health plans while Republicans want to dismantle the ACA (Obamacare)?

coldpie2• 7 years ago

Nah, this is dumb. There's a clear distinction between parties in terms of how they feel about the current healthcare system and where it should go. To imply they're the same is utter nonsense.

snarf21• 7 years ago

Big Pharma knows both parties. They own them both, they really don't care much who wins. Welcome to life in a plutocracy.

maxxxxx3• 7 years ago

Like the banks. They own both parties.

drak0n1c• 7 years ago

The President and other Republicans are currently making regulations requiring drug companies to charge US customers the same low rates they charge international customers. The price difference is entirely in the price charged, this isn't a case of single payers offsetting the cost.

The US public has been subsidizing pharmaceutical research for the entire world with these inflated prices and hopefully that changes soon.

rossenberg793• 7 years ago

The US public has been subsidizing pharmaceutical research for the entire world with these inflated prices and hopefully that changes soon.

This is what some people refuse to acknowledge when they mock the US for having such high prices. If US prices drop over night to match RoW pharma companies are not just going to go quietly into that good night, there will be consequences. Most likely, a lowering of US prices will result in a rise everywhere else, so enjoy your low prices while they last. It’s time for Americans to put America first.

maxxxxx3• 7 years ago

Let’s hope that something really comes out of this. From previous Republican healthcare attempts I have my doubts but maybe they will do the right thing this time.

sctb• 7 years ago

We detached this subthread from https://news.ycombinator.com/item?id=19870180.

GeekyBear• 7 years ago

Obama certainly campaigned on putting a stop to drug company price gouging inside the US by finally allowing Americans to purchase prescription drugs from Canada where price gouging is not allowed.

However, a back room deal was quickly cut.

WASHINGTON — After weeks of talks, drug industry lobbyists were growing nervous. To cut a deal with the White House on overhauling health care, they needed to be sure that President Obama would stop a proposal intended to bring down medicine prices.

On June 3, 2009, one of the lobbyists e-mailed Nancy-Ann DeParle, the president’s health care adviser. Ms. DeParle reassured the lobbyist. Although Mr. Obama was overseas, she wrote, she and other top officials had “made decision, based on how constructive you guys have been, to oppose importation” on a different proposal.

Just like that, Mr. Obama’s staff signaled a willingness to put aside support for the reimportation of prescription medicines at lower prices and by doing so solidified a compact with an industry the president had vilified on the campaign trail.

https://www.nytimes.com/2012/06/09/us/politics/e-mails-revea...

Supposedly, the industry promised to control costs themselves in exchange for the deal, but looking at the data on drug prices, we know they never followed through.

ecpottinger2• 7 years ago

I am type 2, but here in Canada my cost to buy Insulin is way lower, I have no medical plan and buy OTC about 4 months supply for $60 CDN.

Also since I am diabetic I have to have a yearly eye examination but it is free.

So also for my visits to the Diabetic Clinic every three months where they monitor me.

All my doctor visits are free, I have a general (family) doctor, heart doctor, urologist, kidney doctor all free to make appointments with.

I do not know how I could afford medical help if I had to pay directly for it all. Yes, I have higher taxes, but I am 62. I have been paying taxes for decades. However, I have relatives in the US with low taxes but are now near bankrupt or are running out of health insurance.

UnFleshedOne• 7 years ago

The funny thing is, you probably are not paying that much more in taxes [0]:

"The OECD analyzes the tax burdens of 35 countries, including the United States and Canada. According to its data, in terms of total tax revenue as a percentage of GDP, in 2010, the U.S. collected a slightly lower than average amount of taxes from its citizens ($11,365 USD per capita). Canada collected a slightly higher than average amount ($14,693 USD)."

This is taxes per GDP, but marginal taxes are not that different either.

[0] https://www.cnbc.com/2017/08/07/canadians-may-pay-more-taxes...

gamblor956• 7 years ago

A $3300 difference is a huge difference on a per capita basis. It's literally a 30% increase in tax burden on a per capita basis.

xenospn4• 7 years ago

When I lived in Israel, I used to pay about $100/month in health tax in one of the highest tax brackets, and after that, the only expensive is hospital parking, which is usually reimbursed.

cmurf• 7 years ago

And even that's misleading because of the high deductibles of all U.S. plans let alone if you happen to get a so-called high deductible plan (that qualifies for a Health Savings Account). To see a paid for benefit, other than those PPACA requires they be provided at no addition cost from the get go, you pay the annual "tax" in the form of a premium and then you pay the deductible, and then depending on the insurance and provider it will pay 50% to 90%. I estimate I'd have to spend ~$10,000 out of pocket before the first dollar "insurance" would pay. Per year, as the deductible resets.

Americans are consistently paying obscene amounts of money for no better results and in some cases, like the up thread type 1 diabetes example, vastly inferior.

docker_up3• 7 years ago

Having employer-sponsored medical insurance is generally better than Canadian health care. I'm Canadian living in the US. Of course, having Canadian public health care is better when you don't have much money.

I needed an MRI. I got one the next day through Kaiser. My friend had a suspected gallstone. It took her 4 months to get an MRI scheduled. She had to live with pain during those 4 months.

Her children are both diagnosed with autism. It took 2.5 years to get therapy paid for by the government. The only other option besides waiting was to pay for therapy herself which was $80,000/year. She couldn't afford it so her children had to wait without therapy during the most crucial times for therapy. Recently, the Ford government decided upon spending cuts that will limit her youngest son with severe autism to 2 more years of care and then they get nothing.

With Kaiser, they have a top standard autism program where children get instantly put into. My friend is a medical doctor specializing in this and he said the Kaiser program was great. When I told him that my friend had to wait 2.5 years in Canada, he was shocked and saddened for the children.

Before the younger son could get diagnosed with autism, he had to undergo an MRI to ensure there wasn't anything specifically wrong with his brain. They waited 3.5 months, and then when they got to the MRI appointment, they were told their appointment was cancelled, and they had to wait another month.

My aunt was scheduled for gall stone surgery in Toronto but it was also months in advance. One weekend she went to emergency because was vomiting from pain. They put her in a bed and scheduled her for surgery at the hospital. If she left, she would have to wait for the scheduled surgery but if she took an emergency room spot, she could get surgery sooner. She had occupy that bed for 1.5 weeks until they finally scheduled her for surgery, taking the place of other patients. We asked if we could move her to another hospital that didn't have the wait and they said no, she had to stay in that hospital otherwise she would lose her place.

These are experiences just with people I know. I've lived much of my life with Canadian health care and I trust it. But what you don't pay with money you pay with time.

I've found that most people in the US want government health care, but they also want a private option, which is untenable for such a large country, and illegal in Canada. They have a 2 party health care system in Australia but the quality difference is vast. With public and private, you can criticism that only rich people get the best health care but with a single public system, everyone waits. So there's no great way.

lotsofpulp• 7 years ago

Having employer-sponsored medical insurance is generally better than Canadian health care.

Some lucky employees in the US have generous health insurance benefits. But the majority, by far, do not. Kaiser itself is a uniquely high performing organization, that serves a very small portion of the US population.

The employer has nothing to do with the quality of the healthcare the patient receives, other than being in a sufficiently lucrative business to be able to pay for nice health insurance. Health insurance and healthcare would be much better for everyone if employers were left out of the whole equation so that more healthy, lower cost lives get mixed in with higher cost lives in order to create a viable marketplace for multiple health insurance companies to be able to compete for business on healthcare.gov.

vkou2• 7 years ago

Kaiser doesn't treat many people over the age of 65, because the overwhelming majority of them aren't working, and those that are, aren't working somewhere they can get Kaiser healthcare.

Any healthcare system can be made 'cheap' and 'good', if it mostly cuts out old people.

If Canada just kicked old people off the healthcare bus to die alone, I'm sure both the waitlists, and the tax bills would be a lot smaller.

refurb• 7 years ago

As a Canada-US transplant that's been my experience as well. If you have good coverage through work, you'll get better care in the US than in the public Canadian system.

Of course, not everyone in the US has good coverage through work...

xenospn4• 7 years ago

We have that in Israel and it works fine. There are a lot of things i disagree with Israel about, but the way they do healthcare is one of the best in the world.

cgh• 7 years ago

In Canada, you can pay for a whole variety of things, from imaging (to reference your MRI examples) to day surgeries. I've done both. In fact, I paid for a shoulder MRI just last year and only had to wait a few days.

qntty3• 7 years ago

At these ages, it's mostly type 1 diabetes we're talking about.

Rates for 19 and under:

22 per 100,000 for type 1

13 per 100,000 for type 2

http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-re...

nickles4• 7 years ago

The referenced article studied individuals aged 12 to 30. Additionally, while type 1 and type 2 diabetes rates among youths are rising, type 2 diabetes is becoming more common in that group.

[0] https://link.springer.com/article/10.1007/s11606-019-05006-6

[1] https://www.nih.gov/news-events/news-releases/rates-new-diag...

qntty3• 7 years ago

The results from the study linked in the second article (https://www.nejm.org/doi/full/10.1056/NEJMoa1610187) seems to be identical to the ones that I cited for 2011-12.

lolc• 7 years ago

Wow this is sad. To me, insulin is like food. If I don't get it I die. I will literally starve without it. It's also like food in that my fridge is stocked and it's just part of regular expenses.

When I was diagnosed I thought about how a hundred years ago it was a death sentence. And how far we'd come short of a cure. Then I read this and think how far we are spread along the path.

Diabetes complications soar in US, but not Canada, as teens become young adults

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