A Healthcare Follow-Up


First of all, thank you to everyone who commented on my post yesterday about the long-term consequences that the new American healthcare legislation might  have for the treatment options for people with diabetes. I’m used to getting comments (from other sites, not A Sweet Life!) saying that I’m an idiot and should never be allowed to write again, so it’s really nice to get feedback that’s so thoughtful and considerate, even when people disagree with my opinion.

I’m writing now because this afternoon I was driving back from San Francisco and heard a piece on PRI’s The World that added to the feeling of nausea that’s been in my stomach since Sunday night. You can listen to it here — but here’s the basic idea: the man being interviewed was a British guy who’d lived in the US for about eight years, and who therefore had experience with both systems. Shortly before returning to the UK, his son was diagnosed with Type 1 diabetes. The interviewer asked him what differences he’d experienced between the two countries’ systems, and he said that while both had their pluses and minuses, one thing that the UK system was lacking was access to medical technology. Here’s a quote:

In Britain everything was free. . . . the test strips that you test your blood with, you go to a British doctor and you say, ‘I’d like some more, please,’ and they say ‘Yeah, how many?’ and then they just give them to you. . . . So here in Britain all these thing are handed out. But, although the medicine [in Britain] is just as good and there’s no question in my mind that Sam is as well treated here as he was in America, I have to say the technology — and in particular that pump, that pump that pumps insulin into him, [which] is a very state-of-the-art thing — it is not at the moment available in the UK, the particular pump that Sam uses. And that is at least in part because the pump makers can make money in America and they can’t in the British NHS.

Now, I’m in no way implying that the legislation Obama just signed into law is the equivalent of the British NHS — far from it. But it points out the Catch-22 of medical technology: ideally, it would be accessible for little or no cost to everyone who needs it — but it requires money to develop (and a profit motive to push it forward). It would be nice if healthcare were purely about philanthropy, but when it comes to advances in areas like diabetes, money is also important.

Obviously, we are not going to immediately regress to a world where insulin pumps are no longer available. But it does make me worry about the effects that the new tax on durable medical equipment, among other things, is going to have on companies’ motivations to create innovative new products to treat diabetes. I don’t like thinking of myself as adding to some medical equipment company’s bottom line (see Karmel’s recent post here), but at the same time, I want them to create products that will change my life for the better — products that I hope, much like test strips and glucometers and insulin pumps, will eventually become standards in diabetes care.

I really don’t mean this to sound callous — obviously, America’s diabetics need better access to insurance and medical care, and this bill attempts to provide it to them. The ban on excluding customers with pre-existing conditions is going to change thousands of people’s lives for the better. But while I think it’s ludicrous that more people don’t have access to pumps and other quality diabetes care  (at this point, can pumps really be considered “cutting edge technology,” by the way? They’ve been around since the early 90s), I also recognize that in order for technology to advance, someone has to pay for it. Britain can give out all the “free” test strips it wants — but unless there’s a way for companies to make money off of new innovations in diabetes care, the “cutting edge” is going to become increasingly dull.

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12 years ago

Nici, that’s a very interesting point — I just recently heard about the Veo and have been wondering why it’s not available in the US. I do think, however, that that might have more to do with FDA approval issues than it does with insurance coverage. It seems like it’s harder to get things approved here sometimes. Anyone else out there have information on that?

12 years ago

I am a US citizen, now living in the US, but I lived in Germany between 2006-2008. While there, I had mandatory “public” insurance that I purchased through the private insurance company of my choice. People don’t believe me when I tell them that it was the best insurance coverage and medical care I ever received. Test strips and even my new Medtronic insulin pump were 100% free (and easy to obtain.) I never had to wait to see a doctor and the care I received was top notch. As far as the pump that was not available to the… Read more »

Jeff Nobles
Jeff N.
12 years ago

These are important points, and I appreciate you for raising them. I wasn’t giving this much thought before I read your posts. In the UK it is definitely more difficult to obtain approval for an insulin pump than it has become in the U.S. I understand it’s easier in Germany than it is in Britain, but it seems to have gotten so much easier to get approval for a pump in the U.S. than it was even 10 years ago, that I would bet we Americans have it easier than European diabetics. I don’t think it’s too likely that we’ll… Read more »

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