With the US election less than two weeks away you may already have made up your mind about the candidate that will get your vote. (And you arevoting, right?)
If you have a chronic illness like diabetes, one important consideration is how the future president might impact health care in the US. If you're like me, you've probably got a lot of questions about this. To help you make up your mind about this, here's some assigned reading! Today's Wall Street Journal talks about A Blizzard of Numbers and how these are obscuring the details of the health plans for the two major candidates. Their main point is that some experts have produced the numbers for each health plan option, but these are estimates, not exact figures. The WSJ article also refers to an article from yesterday's New York Times On Health Plans, the Numbers Fly that calls these figures "the roughest of estimates".
The US Chamber of Commerce and Business Roundtable, two highly conservative business lobbying groups, have both stated that they believe McCain's health plan to be deeply flawed (my emphasis and likely to increase the number of the uninsured, not lower it.
Finally the National Federation of Independent Business has a nice side-by-side comparison of where McCain and Obama stand on health care.
Remember, your vote does count. If you need more information about voting where you live use this handy site provided by Google.
Update: The New England Journal of medicine published a somewhat related (short) article Three "Inconvenient" Truths about Healthcare. The summary is that our current approach to healthcare needs to be changed for the reasons covered in the article.
Update 2: The Wall Street Journal has an editorial page article on health care choices between the two candidates. According to this, Mr. Obama "would impose new nationwide rules on insurance companies to prohibit "cherry picking," where companies sometimes reject applicants on the basis of pre-existing conditions" while Mr. McCain "believes such regulations are one reason health coverage is so expensive".
My take is that many of us with chronic illnesses would be served extremely badly if we were excluded for coverage of our 'pre-existing' conditions.
While not directly related to diabetes, the New York Times posted an article Doctors and Patients Start Talking that points to a new series being written by an oncology doctor, Dr. Pauline Chen. She is the author of Final Exam: A Surgeon's Reflection on Mortality. I have not read the book, but there's a huge amount of discussion on her article at the NYT site.
Those of us with chronic illnesses understand the importance of good, honest communication with our healthcare team. Some doctors and nurses aren't good at that, others don't have time to really explain things or answer questions. So we turn to help from folks on TuDiabetes.com and other supportive sites. I think this is part of how healthcare is evolving in the US. What do you think? Maybe you can leave a comment on the NYT site.
While I'm talking about reading, here's a free book that may be really useful if you're dealing with the US healthcare system. I just started reading My Healthcare is Killing Me! earlier today and I've already got some ideas for better handling myself within our (sometimes challenging) system.
Finally, if you're one of many of us who'd like to see insurance coverage for CGM devices, please go and sign Gina Capone's petition. If you'd like to know more about Gina and the petition, read Amy's interview with her.
I was reading Forbes magazine this evening and noticed a full right-page advertisement that started with this statement.
3rd Law of Healthonomics Soaring healthcare costs are only the symptoms. You've got to start treating the disease.
The remainder of the advertisement reads.
Most employers are rethinking their responses to escalating healthcare costs. Why? They recognize chronic diseases are the root problem. Example: An employee managing his diabetes might cost $5,000 per year. An employee not managing his diabetes could cost up to $45,000. The win-win here is that by providing employees incentives to lead healthier lives an helping them to manage their chronic diseases, you reduce your healthcare costs. And you'll have healthier employees. Sure beaths the alternative.
The DTCC FAQ page includes the following summary of how the DTCC works:
The Diabetes Ten City Challenge establishes a voluntary health benefit for employees, dependents and retirees with diabetes, provides incentives through waived co-pays for diabetes medications and supplies, and helps people manage their diabetes with help from a pharmacist coach in collaboration with their physicians and diabetes educators.
I like the idea of waiving co-pays for meds and supplies to help with better diabetes management. I just wonder whether this program is aimed at people with all forms of diabetes, or just those with type 2? Given that one of the sponsors is GlaxoSmithKline, I'll bet I'm right. Will is lead to better benefits for insulin pumps and continuous glucose monitors, or will the focus on cost reduction mean these important technologies are less covered?
This program is being tried by a number of employers in the following cities: Charleston/Spartanburg; Cumberland; Chicago; Colorado Springs; Dalton; Honolulu; Los Angeles; Milwaukee; Pittsburgh; and Tampa Bay.
Have you been enrolled in this program and can you give any feedback on how it works for you? I'm interested in seeing if this is the start of a new approach to diabetes care across the country. And I'd love to know whether or not it includes all types of diabetes.
The New York Times has a really useful tool that lets you watch and read the recent Republican presidential debate. This was brought to my attention thanks to a recent blog post by Jon Udell.
There are two tabs, the Video Transcript which comes up by default, and the Transcript Analyzer.
In the first tab you can watch the debate and see a scrolling text transcript at the same time. Or you can scroll down through the text and click on a section to get taken to that part of the debate. That alone is pretty cool.
But the Transcript Analyzer is even more useful. You can see the number of words spoken by each candidate, the moderator, and by the You Tube videos. And if you click on a name in the list on the left, you'll see where in the overall debate they actually spoke. Those sections are highlighted in dark blue. By moving your mouse over any section, you'll see the text.
You can also enter a word in the Search box at the top of the page. And if the word appears in the text you'll a little black mark showing its location and a word count for each of the speakers. I tried the word health and found that it was mentioned a grand total of five times in the entire debate. That's pretty shocking to me.
The NYT also has an election guide section where you can see a lot of information about the various candidates and a summary of where they stand on various issues, including health care.
Personally I think health care is going to be very important in the near future for the United States and I'll be watching closely to see what the various candidates say about it.
All of us - insurance companies, legislators, health care providers, and health care users - need to figure out a way to ensure more of the population is covered for at least basic health care. Otherwise I think we're going to see some really big cost problems in the next decade or so.
And guess who'll be footing the bill unless we can figure out a compromise? The American taxpayer. Which would be you and me.
It's a short read that outlines the ways in which healthcare may change in the future.
What's interesting to me is that a lot of the things mentioned in the Empowerment through Internet Technologies part of the article are already available.
For social networking look at the success of the excellent TuDiabetes.com site. I see a lot of members that are thrilled to find others with diabetes and that are actually learning about better ways to treat the disease and are getting lots of support from others.
For Twitter and updates via e-mail, you can look at the wonderful SugarStats.com site that lets you track blood sugars and other things related to diabetes care by sending messages via e-mail, SMS or Twitter.
From my perspective there are many ways to improve care for chronic illnesses. But thanks to the internet and the work of some great people the future is looking a lot better for many of us who work hard to have normal lives despite our imperfect bodies.
Today's New York Times has an article about Google and Microsoft and their planned move into the health care arena.
And no, they're not going to do this by paying for our doctor visits. Their approach is really all about empowering us to take more control over our own health. They'll do this with a combination of better search tools (like my own Diabetes Search Engine that's built with Google technology) and enabling us to maintain personal health records (PHR).
Now Electronic Health Records (EHR) or Medical records (EMR) are nothing new. There are several versions of these around provided by different companies. I believe the question will be whether Microsoft and Google can work together to develop a standard for PHRs. That would be a trick worth watching.
Right now the Google version has only been shown to a small number of people. The Google Blogoscoped site has shots of some of the screens from the Google system.
From the NYT article is sounds like Google is trying to do the 'right thing'
At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.
I'm just wondering when they actually start working with real patients as they evolve this system.
Between Diabetes, Asthma and general coughs and colds, I'd say that I'm in a doctor's office at least 10 times each year. And one thing that's always bothered me is when I visit a doctor that I don't see visibly wash their hands before starting to talk with me.
Now they may have washed their hands before coming into the room. But what are the chances?
Today on the editorial page of the Wall Street Journal, I saw an advertisement placed by RID, the Committee to Reduce Infectious Deaths. And guess what they have listed as the first of 15 steps you can take to reduce your risk of getting a hospital infection?
That's right Ask that hospital staff clean their hands before treating you.
I'm going to clip the advert and give a copy to all my doctors at my next visit.
I know you're going to think that I've lost my mind. Because what I'm complaining about may not seem that important to you. But it is probably a lot more important than you think. So bear with me.
On Tuesday, I went for an eye doctor appointment to see what was going on with my right eye. I've had some blurriness in the central part of my vision for a while. So the doctor decided to take some pictures while injecting a fluorescent dye into me. That way if there are any issues, they'll show up clearly in the camera.
Now being a geek, I thought this was way cool. I asked the man doing the pictures whether I could get copies of them. I figured the kids would be interested in them, and I might post one to the Diabetes Made Visible photo group on Flickr.
Well he mentioned that I'd need to fill out some paperwork and then he could print me some copies. But I didn't want paper copies. I wanted the high resolution photos that I saw on the screen in front of me. So I said, "well I just want to take them home on a Flash drive". His immediate response is "no, you can't take the files".
Now it's not like I'm removing them. I only want a copy. When I pushed him on this, he said they're "scared what you might do with them". Now can you think of something terrible I might do? Print big posters and e-mail to folks causing heart failure? What's possible bad thing could I do with close up pictures of the back of my eyes?
So that's bad data day item #1. Oh, and by the way, there's no significant damage to my eye. So we're just going to keep watch on it (pun intended).
After I got home, I spent some time talking with someone in Dexcom. I'm trying to get one of the new Dexcom SEVEN systems with software, so I can review it.
The response is that right now they're trying to get training ready for the systems. So there are none available for review.
While I was talking with this woman, I asked why Dexcom is making it so hard for us to get to our data. Her response is that it's due to FDA restrictions.
This is bad data item #2.
I'm checking now to see if the FDA remark is actually true. I can't find anything in various advisory committee transcripts about this. I've fired off notes to some contacts within the FDA. I'll let you know what I find out.
Did you read my post about Google and health issues? Now how can we get access to our data if you have 'the' diabetes hospital (Joslin Clinic) saying "you can't have your files". And if the FDA or a device maker is saying "you can't have your data".
I'm just steamed about this!!
How can we improve things with a shrinking supply of endocrinologists, and without access to the facts we need to improve our control?
Grrr!!
Update: I currently use four pieces of diabetes-related software. All of them have the data locked down in some way.
Dexcom: Data encrypted or in binary form (unable to crack -- so far)
OneTouch: Data password protected (easy to crack)
MiniMed: Data password protected (easy to crack)
AgaMatrix: Data password protected (easy to crack)
So I think this is a widespread practice. But I can't figure out why.
I was talking with someone in support at Dexcom last week. We were discussing some fluctuations in my numbers and how to control these. And he offered to send me this guide that might help.
It arrived in the mail yesterday, and it's 38-pages about how to use CGM effectively to control your blood sugars. It's written by Dr. Steven Edelman (from TCOYD) and Dr. Timothy Bailey (co-author of Using Insulin). Dexcom supported this book by providing a grant, and there are graphs taken from the Dexcom STS system throughout the book.
From reading it, I think that anyone using any CGM system will benefit from reading this short book.
After the Introduction, there are three main sections:
Blood Glucose Levels on the Rise
Blood Glucose Levels on the Way Down
Blood Glucose Levels During the Night
The book has a total of ten scenarios. Each one describes a situation that happened with details about insulin dosage, food eaten, etc., and then shows a graph of what happened to BG levels. You then get to answer a question choosing from 3-4 answers per question.
The book helped me think about how to best interpret what was happening and decide what alternate actions I could take to improve a given situation.
Now here's the best news. You don't have to be a Dexcom customer to get this book. You can get a PDF version here courtesy of the Taking Control of your Diabetes site.
I was just thinking about how my Dexcom CGM is more than just something that buzzes annoyingly when my blood sugar is going high or dropping low.
To me it's a bit more like a time machine.
Ever since I first got diabetes I would hear or read about how "you have to control your blood sugar levels or..." something terrible will happen.
But here's the problem. The something terrible doesn't happen immediately.
Let's say I go to a church potluck (always causes eating problems for me) and overeat. My blood sugars go high and stay high for a few hours. It's not like I see this or there's any immediate issues. And no-one, including me, can really tell anything happened. Not by looking at me.
The only immediate problem is some level of drowsiness. Unless the numbers run high for some time, I really won't be able to see any immediate issues. And then, by the time I do see issues with my eyes, or kidneys, or heart, or something else it's almost too late.
But this is where my time machine comes in. When I'm wearing the Dexcom, I can see those highs. And knowing what they're doing to me, I really can see the future.
If I have a day where my blood glucose goes to, say, 230, and it takes me a few hours to get it down, I feel those highs in a very different way. I almost imagine the possible future problems and (for me) it's an encouragement to get things more under control.
Don't get me wrong. Seeing the future is more of a pain than a benefit. When I have days where my numbers don't get above 180, that feels good. But the swings and the long highs are hard to take.
I'm still learning how to use this information for better control. And I'm still learning to accept the (WAY TOO LOUD) alarms the Dexcom gives. (Can you hear me, Dexcom folks).
But I'm also starting to get somewhat better control. My total daily dosage has gone down a little, and there are less profound swings.
I thank God for this small blessing, and I'm looking forward to the next generation of devices that will keep me healthy until something better comes along. (Hint: it's a four letter word, C**e).
On Tuesday the Wall Street Journal had a very interesting article on cutting copays(preview only). It's worth looking for it in your local library.
Apparently some employers and health care companies are trying to reduce the long-term costs for those with chronic diseases. And now they believe that if they provide the necessary drugs for maintenance of those diseases with zero copay amounts, then folks might actually take the medicine.
Well duh. I guess that's why the executives of these companies get the big bucks.
According to the Journal "employers and health plans have targeted conditions like diabetes and heart disease in part because chronic illnesses are major drivers of the over rise in health-care costs". The emphasis on diabetes is mine.
Now my guess is that they're really talking about Type 2 diabetes. Of course I still hold out hope that they'll do the same for Type 1 diabetes and actually cover the technology that we need to maintain our blood glucose levels and reduce long-term complications.
Let's call this article a glimmer of light at the end of the tunnel.
The Diabetes Technology Blog is focused on using technology to live life to the full with diabetes. I review new diabetes technology including: blood glucose monitors; continuous glucose monitors; blood sugar meters; diabetes software and living with diabetes.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN Plus CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
