IS There Really a “Crisis” in U.S. Health Care: Chicken Little vs The Optimists?

The “Group”
For quite a number of years now, I have been a member of a group composed of University of Misouri-Columbia professors. The group (which is also officially known as “The Group”), meets once a month during the academic year to hear a reasonably scholarly presentation from one of our members about whatever they wish. Invariably, presenters discuss topics related to their academic disciplines. As a physician (one of two in the group), I am expected to enlighten the attendees about something medical. Last spring, I gave a talk about the obesity epidemic and last week I spoke about type 2 diabetes, a logical extension of the talk about obesity.

My Presentation

I started out talking about what diabetes is (you already know that it’s really a group of medical disorders with three things in common- insulin deficiency, hyperglycemia, and risks for serious vascular complications). Type 2 diabetes, which used to be called maturity-onset diabetes and more recently, non-insulin-dependent diabetes (NIDDM), is the most common form of diabetes, affecting about 9.5% of the U.S. population. About 20% of people over 60 years of age have type 2 diabetes. Treating the condition accounts for a large chunk of of the money spent on health care in the U.S. (at least 35% of all Medicare expenditures!). Anyway, I was moving along through all the background information and got to the part where I stated that data show that as many as 90% of people in the U.S. with type 2 diabetes are not achieving recommended care goals, when th presentation got seriously derailed; the distinguished professors wanted to focus on how things could possibly be so bad in the richest country in the world, with the best high-tech mecical care, and which spends (by far) more than any other country in the world on health care?

Why are so many people with diabetes not achieving recommended care goals and what are the consequences?

It is much easier to address the consequences of of poor diabetes care than why it is happening. What makes diabetes serious is not the major inconvenience of the currently recommended treatment plans, but the complications that develop in so many of the patients. In fact, most of the costs of treating diabetes are for treating the complications (e.g., kidney failure, heart disease, nerve disease, peripheral vascular disease, limb amputations), all of which are preventable with currently available therapies.

The “why” part is more complicated and I will only touch on what I told my professor friends last week. First of all, U.S. health care is definitely not what it could and should be, particularly given how much money we spend on it. The U.S. is far down the list of economically developed nations in the quality of health care (as measured by longevity, infant mortality rates, etc,). The reasons include (in no order of relative importance) the following: more than 40 million people without health insurance and many more with inadequate insurance; inadequate numbers of well-trained health care providers, particularly in non-urban areas; high costs which are rising rapidly- many people cannot afford ther prescribed medications, even with insurance/Mediacare. I could go on and on and it was a bit uncomfortable presenting this information to my professor friends who seemed truly shocked by the discussion.

Where to go from here?

When it came to the part about what to do about the problems, I didn’t really have any convincing answers for my professor friends, at least in terms of a comprehensive “solution.” I have been giving this quite a bit of thought lately and will come back to health care issues soon, in future entries. Clearly, it doesn’t matter how smart a doctor is and how many great medications he has in his therapeutic armamentarium, if a patient with diabetes can’t afford the clinic visit or the medications or can’t even get an appointment for 6-7 months even with good insurance coverage, we are in trouble. We are in trouble.

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