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What It’s Like To Be Diagnosed With Type 1 Diabetes

July 8th, 2009 by KerriSparling in Better Health Network, Patient Interviews, True Stories

Tags: Diabetes, Diagnosis, Endocrinology, Family Medicine, Fear Of Needles, insulin, Internal Medicine, Pancreas, Type 1 Diabetes

After a hectic week with the conference in Philly and then Chris’s great news, I need to spend some time today catching up on everything.  Thankfully, Jessica Phillips has offered to guest post today, writing about marking 500 days with type 1 diabetes.  She’s come a long way, and I’m proud to host her words here on SUM.

Heeeeeeere’s Jessica!

As I was injecting myself with insulin on a lunch break at work, a co-worker walked by and exclaimed, “I could never do that! EW! I hate needles!” Less than two years ago I might have agreed. I never had a strong phobia of needles, but that is not to say that I particularly liked them either. I was known in my childhood to run out of doctor’s offices into the parking lot at the first mention of “shot”. Now when I hear such a strong and callous remark to my now normal routine of insulin injections, I struggle with trying not to angrily reply, “Well you would have to give yourself shots if you had to in order to live!” or, “How do you think I feel? You think I want to do this?” I’ve learned as of late to simply smile and say, “It’s not easy.”

Reactions like this are commonplace for those of you who have experienced Type One Diabetes for many years, and even some for the majority of your life. For me, June 9th, 2009 marked my 500th day with type 1 diabetes. I was diagnosed in my hometown of San Diego, California on January 25th, 2008 at 26 years-old. For a couple months prior to diagnosis I had been experiencing the typical signs of hyperglycemia and a failing pancreas as I was constantly dehydrated, urinating, and tired. Being a college student and in a constant state of stress, I quickly attributed the majority of my symptoms, from dizziness to infections, to be solely related to my immune system’s battle with my constant stress. After many weeks of procrastinating, I finally urged my doctor to order a blood test. I went in to the lab on January 23rd and was called by my doctor 24 hours later while I was driving to school. The tone in her voice immediately caught my attention and set me in a state of alarm. She informed me that my blood sugar the day before was above 300 mg/dL and I was to avoid sugar and be referred to an endocrinologist immediately.

Luckily I was able to see an experienced endocrinologist the next day, and he diagnosed me with type 1 within minutes of being seated in the exam room. I was in complete shock, and felt confused, angry, and overwhelmingly sad all at the same time. I felt a struggle between trying to remain alert to the bombardment of information he was feeding me, and trying desperately not to cry. The doctor left the room to retrieve my new meter and insulin pens, and I lost it. Luckily I had some moral support with me, but I have never felt so alone and lost. I kept thinking, “how did this happen?” and, “what did I do wrong?” To have gone many years without having anything major occur medically, not even a broken bone, it was a major shock to hear I had something irreversibly wrong with me. I not only had something wrong, but I could not do anything to change it.

The next few days were extremely challenging to say the least. I was unable to give myself insulin and had to have someone else do it for me for the first couple days. I would sit and look at the needle and could not conceive of how this tiny piece of metal was going to go through my skin. I just kept thinking it was so wrong, and foreign. I also cried. A lot. And I researched online and in books so much that I felt as though I could speak at a lecture on the biology of diabetes. I found the knowledge empowering, and the more I grasped what my body was actually doing, and not doing, I became more confident in my ability to control my state.

Now, 500 days later, this diabetic routine is normal to me. I can hardly even remember a time when diabetes wasn’t on my mind. The memories have faded of when my blood sugar was not a concern, and when I was able to look at food as just food. The last year and a half has been a giant emotional roller coaster, full of ups and downs, but they have changed me. Sometimes I get the look of sympathy from others when I detail my hardships with this disease, anywhere from medical costs to just the simple annoyance of pricking myself all the time, and I have found myself realizing that although I would not choose to have this disease, I consider myself lucky. I am lucky of course to not have something worse, but having gone through this change has made me look at my life through a new and clearer lens. My bottom-line now is a cliché idea, but it is so true … life is short, and you only get one shot, so make it worth it, no matter what.

*     *     *

Thanks for sharing your story, Jessica.  (And for the record, Jessica is the one with the fantastic hair on the right in that photo.  Also for the record, I just realized that today is my 8,209th day with diabetes.  Holy crap, my pancreas is lazy.)

*This blog post was originally published at Six Until Me.*

Political Victory On Healthcare Reform Trumps Careful Analysis

July 7th, 2009 by EvanFalchukJD in Better Health Network, Health Policy

Tags: Dartmouth Atlas, Healthcare reform, healthreform.gov, Politics, Propaganda

At healthreform.gov, the Department of Health and Human Services publishes data on the “Health Care Status Quo.”

It reads a bit like what would happen if you took the Dartmouth Atlas of Healthcare and buried it in Stephen King’s Pet Sematary.

The front page of healthreform.gov now has a map of the 50 states where you can click and read about the “current status of health care and the need for reform.”

(I should add that DC is included in the map, too.  But as of the time of posting the link doesn’t seem to work).

It lists a grab-bag of categories of information on each state.  But no matter what the data shows in a state, the HHS report always concludes the same thing.   Fifty times out of fifty:

[Insert state name here] families simply can’t afford the status quo and deserve better. President Obama is committed to working with Congress to pass health reform this year that reduces costs for families, businesses and government; protects people’s choice of doctors, hospitals and health plans; and assures affordable, quality health care for all Americans.

A good example are the reports for Massachusetts and Texas- two very different states with very different data.

• 25% of Texans are uninsured, while only 2.6% of “Massachusettsans” are.

• Overall “quality of care” in Texas is “Weak,” while in Massachusetts it is “Strong.”

• The percentage of people with employer-based coverage in Texas dropped from 57% to 50% from 2000 to 2007, but held steady at 72% in Massachusetts

• 20% of Texans reported not visiting a doctor due to high costs, but only 7% of Massachusetts residents did, and “this has significantly improved since 2007.”

• Average premiums for health insurance are about 5% cheaper in Texas, even though the market is described as being less competitive than Massachusetts

• 27% of middle income Massachusetts families spend more than 10% of their earnings on health care, compared to 17% in Texas

What’s going on?  The HHS doesn’t seem terribly interested in exploring it.  It just says it wants some kind of unspecified health care reform, this year.

I suppose this is the way the political process works.  Make the case there is a serious problem, and seek support to do something – anything – about it, now.  As Secretary Sebelius put it:  “we cannot wait to pass reform that protects what’s good about health care and fixes what’s broken.“  I don’t think anyone really knows what this means, but maybe that’s the point.

It’s a strategy for a political victory, but not for real, needed reform of our system.

*This blog post was originally published at See First Blog*

Healthcare Should Be Free – I’m Entitled To It

July 7th, 2009 by Emergiblog in Better Health Network, True Stories

Tags: copays, Emergency Medicine, entitlement, Free, Health Insurance, healthcare, Nursing, premiums

Why shouldn’t we have to pay for our health care?

Why….we don’t have that sort of money!!!  How dare you even suggest that we should pay!!!!

We manage to buy cigarettes. We manage to buy fast food.  Often. We manage to get all the channels we want via cable or satellite television. Some of us even have satellite radio in our cars. And GPS.  Our cell phones are really nice, but all that texting costs a pretty penny.   We drop a few bucks at Starbucks every week without thinking twice.

And then we roll our eyes when we have to pay for….god forbid…..health care!

*****

Think I’m heartless?  Think I’m an elitist?

Think I’m talking about the Medicare patients in my ER who bring in a super-sized number 8 from McDonalds for the entire family and hold out their right arm for a BP while they text rapidly with their left hand?

I could be.

But I’m not.

The patient rolling their eyes at having to pay was me.

*****

Yeah.

Me.

Showed up for a colonoscopy yesterday and the receptionist went over what would and would not be covered by my insurance.

My out-of-pocket payment would be $216.

And my first thought was “why the hell am I paying anything out of pocket for this? I have insurance!”

I was ticked.

*****

But why was I ticked?

Why shouldn’t I have to incur out-of-pocket expenses?

I have insurance.  Good insurance. Insurance I don’t pay a single penny for. It’s a benefit I get from my employer for working 24 hours a week.

Did I think I was entitled to full coverage because I was insured?

Entitled?

Me?

*****

Isn’t that term used to describe some patients who get their health care for “free” through a public plan?

Well, I get my coverage for “free”, too, and god help me, the emotion I felt in that office yesterday was “entitlement”.

Now I understand.

And I won’t use that term again.

Ever.

*This blog post was originally published at Emergiblog*

Is High Fructose Corn Syrup Worse Than Sugar?

July 6th, 2009 by admin in Better Health Network

Tags: Diet and Nutrition, Food and Nutrition, HFCS, High Fructose Corn Syrup, Obesity, Sugar

Have you noticed that many products on grocery shelves are bragging that they do not have high fructose corn syrup (HFCS)? HFCS has been demonized by many people in the public as well as the medical community in recent years. But how much different is it from just plain old sugar? The answer is up for debate, but I will do my best to present the facts.

HFCS has been used for many years, but the use really became much more common in the 1980’s. Food companies use it because it makes a desirable end product and is fairly cheap. HFCS comes from corn and is refined to get the sweet taste into a syrup. But is it worse than sugar?

Many experts believe it is no different than sugar. Both are high in calories and are considered “empty” calories, meaning they don’t have vitamins, minerals, or other healthy nutrients in significant quantities.

The American Medical Association and other scientists have agreed that both sugar and HFCS both contribute to risks of obesity, diabetes, heart disease, and other illnesses if eaten in large quantities. In other words, there is no proof to date that HFCS is more harmful than sugar.

So why are so many companies eliminating HFCS? It is all consumer perception. Consumers have heard that HFCS bad so companies are spending time and money eliminating it from it’s products? What are they using instead? Sugar.

Is HFCS natural? The Corn Refiners Association says that HFCS is natural. The FDA does not define the term “natural” so we really have no way of seeing whether something is natural on a food label. Food companies can use this word without repercussion from the FDA since they have not defined it.

For more information on HFCS, check out www.sweetsurprise.com

This post, Is High Fructose Corn Syrup Worse Than Sugar?, was originally published on Healthine.com by Brian Westphal.

Ezra Klein Recommends Cutting Medicare Payments To Inner City Hospitals?!

July 6th, 2009 by Shadowfax in Better Health Network, Health Policy

Tags: CMS, Costs, Dumb Idea, Ezra Klein, Finance, Hospitals, Ignorant, Medicare, Wrong

Oh, man, I picked a fight with Ezra and he got all wonky on me, even with a chart.  Oh Noes!  Not a chart!  And … it’s actually a pretty interesting chart.  Here it is:

First of all, just for the record, let it be noted that my previous post was entirely about Medicare’s under-reimbursement of physicians, and Ezra’s clearly going all Willie Sutton and going where the real dollars are: facility reimbursement.  Fair enough, though I’ll disclaim that I’m not nearly as well-versed in hospital reimbursement as I am in the professional side of the Medicare fee schedule.

The above graph would seem to disprove Ezra’s original thesis, that hospitals continue to participate in Medicare because it is profitable for them to continue to do so.  As you can see, there’s rampant cost shifting, as Medicare pays only 92% of the actual costs of inpatient care whereas the commercial payers are in the high 120s%.  Right?

Well, yes and no.  The lifeline in this case is some very interesting testimony by the head of MedPac regarding a small subset of hospitals (about 12% of all hospitals) who were actually able to eke out a positive margin (0.5%) on Medicare payments in 2004-2006.  The contention is that since these hospitals were able to do so, and with higher quality than the other 88% of hospitals, that the hospital industry in general is inefficient and if they were only able to get their act together Medicare payments would be sufficient to support a viable hospital industry.

The key factor which Ezra glides over is that these hospitals are in the “financially pressured” category.  There doesn’t seem to be a definition or cross-tabs on what exactly “financially pressured” means, but these hospitals actually have a worse operating margin on their non-medicare business (-2.4%).  Given that, it’s fairly safe to conclude that this means hospitals with crummy payer mixes — high medicaid and uninsured, low numbers of commercially insured patients.  This occurs most commonly in rural and inner-city markets — underserved areas in which there is usually one hospital at best.  These undesirable markets do not encourage other providers to enter and compete for customers and so the hospitals there tend to undercapitalize, willfully or no, and offer bare-bones services.  That some fraction of “financially pressured” over-perform on outcomes is not explained in the testimony.   It could be a statistical aberration, or cherry-picked data; giving credit to the integrity of MedPac, it might be due to the exceptional leadership that some of these financially stressed hospitals have developed.  The testimony does not reveal what fraction of “financially pressured” hospitals outperform on quality measures — if less than 50% of “financially pressured” hospitals outperform on quality, it would imply that the under-funding of these facilities harms quality of care more than it helps.  Note that those that outperform have substantially worse margins (0.5% vs 4.2) on Medicare payments, implying that there is some linkage between higher expenditures and better outcomes.

I am gallant, however, and I will concede the key point here: hospitals which are well-funded do tend to be inefficient.  Specifically, areas with enviable payer mixes are generally served by multiple hospitals and those hospitals compete for patients and revenue by over-capitalizing and improving amenities and customer service.  This is just another example of the perversion of the market in which patients do not directly bear the costs of their health care decisions.

Coming back to the original point: if Medicare were such a lousy payer, hospitals would opt out, yet this never occurs.  Interestingly, the well-heeled suburban hospitals who lose the most money on Medicare patients are the least likely to opt out of Medicare.  They have such high margins on their commercial patients that they can view Medicare as their charity contribution to the community.  On the other hand, the financially pressured hospitals do better on Medicare than the rest of their payers, so Medicare is their economic lifeline.  Or, more formally, the value of Medicare patients to a hospital varies inversely with the number of commercial patients in their payer mix.

Ezra’s conclusion here is that we need to cut costs, hospitals are in many cases inefficient, and so we should just reduce payments to them until they feel the pain and dial it way back.  As my old medical director used to say, “We’re building a Buick, not a Cadillac.” But there are many problems with such a strategy.  For one, the hospitals most dependent on Medicare would be harmed most by reductions in payments.  While workarounds could be crafted for financially stressed hospitals, it’s unclear what effect reductions in payments would have in quality, but it would be hard to imagine that quality in general would improve.  And it’s not clear to me that this really addresses the key drivers of cost: wasteful and redundant care, as opposed to more-expensive-than-it-needs-to-be inefficient care.  Given the volume incentive of the fee-for-service game, reductions in compensation usually just drive increases in utilization, not the other way around.

Ultimately on this point, I have to concede ignorance.  I know that the Medicare Professional Fee Schedule for phyicians is woefully inadequate and needs to be increased.  I do not know if the same applies to the hospital fee schedule — I’m just not well-enough versed in the economics of that game.  I should point out that while medicare payments to physicians have been essentially frozen since 2001, the facility fees, unconstrained by the SGR, have risen year over year to keep pace with inflation.  I never did see any disagreement with my original points, by the way, that for professional services, the underfunding of Medicare is leading to decreased access as physicians close their practices to new Medicare patients, and that hospital-based physicians are unable to opt out due to the nature of their relationships with the hospitals who employ them.

*This blog post was originally published at Movin' Meat*