http://www.nytimes.com/2006/01/11/nyregion/nyregionspecial5/11diabetes.html


It might require that you register for free, which isn't that bad considering it is a wealth of knowledge (or at least that is what my professors keep telling me).





"The center's demise, its founders and other experts say, is evidence of a medical system so focused on acute illnesses that it is struggling to respond to diabetes, a chronic disease that looms as the largest health crisis facing the city.

America's high-tech, pharmaceutical-driven system may excel at treating serious short-term illnesses like coronary blockages, experts say, but it is flailing when it comes to Type 2 diabetes, a condition that builds over time and cannot be solved by surgery or a few weeks of taking pills."



How sad. Especially when prevention is much cheaper than treating the complications. But hey, don't worry, we'll bill your insurance! :occasion1


Another reason for consumer driven health care (http://www.bullshido.net/forums/showthread.php?t=29825&highlight=consumer+driven)

Really though, the prevention for the adult-onset diabetes that becoming epidemic, the diabetes associated with the metabolic syndrome, is what doctors have been telling people for years, and people have been ignoring - eat right and exercise - metabolic syndrome is highly associated with obesity.

Exercise is big, really - exercise induces glucose uptake into muscle cells that mimics the effects of insulin. This helps moderate blood glucose levels and prevents insulin insensitivity.

Prevention is so simple - stay active. That people don't do this is not an argument for consumer driven health dare, it's symptomatic of a more general culture to a culture of inactivity.

You don't think the fear that the rest of us won't pick up the tab for their medical bills might just get their motivation up just enough to get of the couch? People can sit and pray that their diabetes (or whatever lifestyle disease) will get better on its own, but if they realize that not only will they suffer, but they will have to pay their own money to treat the complications if it doesn't, maybe it will be the last straw to get them moving...



Of course, if the fear of losing a foot doesn't motivate you, probably nothing will. Dammit.

Which is why you should never have a national health care system. You should be free to put whatever the F you want into your own body, be it cigarette smoke in your lungs or lightbulbs in your rectum. But I'll be damned if I'm paying for your doctor bills.

OMG. I agree with Phrost. Perhaps I've gone so far to the left that I am now at the right...yang has become yin. Enjoy that.



But one of the limitations of consumer-driven healthcare is that it won't bring down the one of the factors causing such high costs - heroic treatment at end of life...unless, of course, we just scrap all the elderly folk's health care. That would go over well.



Edit: I've always heard that the most expensive medical care is given in the last few days a patient is alive, but I'm going to check on that to see if it is accurate.

My original intent with the article was to stimulate discussion on how the current system focuses more on the complications of DM as opposed to the prevention of complications. But this seems like an important piece of data to nail down since many other observations are built off it.

Hey Quikfeet509, edit your post with an updated link from this site:
http://nytimes.blogspace.com/genlink

no-registration required nytimes link (http://www.nytimes.com/2006/01/11/nyregion/nyregionspecial5/11diabetes.html?ex=1294635600&en=fded9fcd1209c016&ei=5090&partner=rssuserland&emc=rss)

p.s. I know this is my first post, but this isn't spam or anything.

My original intent with the article was to stimulate discussion on how the current system focuses more on the complications of DM as opposed to the prevention of complications. But this seems like an important piece of data to nail down since many other observations are built off it.

My take on the article was more on the business of health care. Seems health care business won't cover the cheap, regular visits that prevent disease, but instead cover the more expense treatments. Hospitals can't profit on the cheap visits - both because of the higher expenses, and because insurance won't reimburse.


They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.

and


Dr. Diana K. Berger, who directs the diabetes prevention program for the City Department of Health and Mental Hygiene, said the bias against effective care for chronic illnesses could be seen in the new popularity of another high-profit quick fix: bariatric surgery, which shrinks stomach size and has been shown to be effective at helping to control diabetes.

"If a hospital charges, and can get reimbursed by insurance, $50,000 for a bariatric surgery that takes just 40 minutes," she said, "or it can get reimbursed $20 for the same amount of time spent with a nutritionist, where do you think priorities will be?

and


The center also lost money, its former staff members said, every time a nurse called a patient at home to check on his diet or contacted a physician to relate a patient's progress. Both calls are considered essential to getting people to change their habits. But medical professionals, unlike lawyers and accountants, cannot bill for phone time, so more money was lost.

And the insurance reimbursement for an hourlong diabetes class did not come close to covering the cost. Most insurers paid less than $25 for a class, said Denise Rivera, the secretary for the center.

To me a lot of the problem, at least with metablic syndrome, is not with health care, but basic education. People should be taught enough about how their bodies function to know the handle such simple things as how to eat right and to keep active.

You posted earlier about the effects of long term diabetes - but do most people really understand what can happen? Probably not - not in my experience teaching.

My take on the article was more on the business of health care. Seems health care business won't cover the cheap, regular visits that prevent disease, but instead cover the more expense treatments. Hospitals can't profit on the cheap visits - both because of the higher expenses, and because insurance won't reimburse.



and



and



To me a lot of the problem, at least with metablic syndrome, is not with health care, but basic education. People should be taught enough about how their bodies function to know the handle such simple things as how to eat right and to keep active.

You posted earlier about the effects of long term diabetes - but do most people really understand what can happen? Probably not - not in my experience teaching.


I was referring to consumer-driven healthcare when talking about end-of-life care, not the original article. Looking back at my post I see that I wasn't very clear about that...for some reason, when I am watching my son and trying to post at the same time, it doesn't work very well.


Back to the original topic. It might be that patients know the possible end result of their diabetes, but think it won't happen to them. That attitude is pervasive in our society. Tell a smoker about cancer and they'll think it will happen to the other smokers. Tell people they should lock the doors to their house, they think somebody else's house will get broken into instead of their own.

Maybe having the "diabetes boot-camp" made people realize that the complications will happen to them if they don't stay on top of their disease. It is sad that we tend to neglect our own health unless somebody is watching over us. One could argue that personal responsibility is key and if the patients don't want to take care of themselves, they have only themselves to blame. There is probably some truth to this. But even if we want to look at it from a cold and purely fiscal perspective, the diabetes boot-camp idea is a winner because it is cheaper to prevent then it is to treat the complications.

Now if we could figure out how to drive the point home that people are responsible for their own health, we could go on Oprah, make tons of money, get addicted to smack, then fall from grace by getting caught with a hooker in a motel.


Ah, the American dream.