Diabetes complications soar in US, but not Canada, as teens become young adults
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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.
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.
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.
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.
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?
(Is it better to have a better insulin on the shelf because you can't afford it?
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...
[0] https://link.springer.com/article/10.1007/s11606-019-05006-6
[1] https://www.nih.gov/news-events/news-releases/rates-new-diag...
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.
"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...
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.
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.
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.
Of course, not everyone in the US has good coverage through work...
The truth is American elites systemically abuse poor people and feed them propaganda to make sure they don't question their terrible conditions. You're repeating that propaganda.
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.
I know a couple people over 65 who are at Kaiser.
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.
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...
[0] https://link.springer.com/article/10.1007/s11606-019-05006-6
[1] https://www.nih.gov/news-events/news-releases/rates-new-diag...
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!”
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.
Once again, my original point was not that people should be left to die, but rather that it doesn't seem horrifically immoral, as the parent was suggesting, to believe that people should have to face the consequences of choices they knowingly make, especially where there are real costs to real people to mitigating those consequences.
I also just think it's important to acknowledge that we're explicitly not trusting people and instead deciding what is best for them, as opposed to a situation like extreme sports, where we allow people to risk their lives. I think it's a fine position to take, but I think it's slightly hypocritical to allow extreme sports, but not allow people to make their own healthcare decisions (though once again, a perfectly valid position as a matter of policy).
In my prior post, I wasn't trying to suggest that we should willy-nilly leave people to die, just that we don't live in a world of infinite resources and that I don't personally believe it's horribly immoral to let people make choices even when those choices can have terrible consequences, assuming they know the risks.
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...
In any case, my post above was about what is (and what to properly call it), not what ought to be.
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.
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.
It’s not like ACA or even Medicare covers all Rx...hence Medicare Part D (ie drug coverage) which was done under GW Bush, at the time the GOP distanced themselves and later Obama tried to dismantle Medicare part D, but the dems has to pull him back (politically dems couldn’t gut drug coverage for Medicare patients).
[1]: https://www.bloomberg.com/news/articles/2018-08-07/trump-for...
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.
https://www.healthaffairs.org/do/10.1377/hblog20170602.06037...