Anyone else catch the story yesterday about how children with Type 1 diabetes are living longer than previous generations of kids with the disease? According to a study published on July 30 in Diabetes (and summarized here), there’s been about a 15-year improvement between a cohort born between 1950 and 1964, and another born between 1965 to 1980.
This makes good sense to me — the later you were born, the more technology you had available to keep your blood glucose levels under check. I feel very grateful — in as much as one can feel grateful for such things — to have been diagnosed in 2001, soon after Humalog, right before Lantus, and within a few years of the first US continuous glucose monitor. I never had to pee on a stick, or rely on porcine insulin. Even the best-intentioned diabetic born in 1950 would have had fewer resources available for blood sugar control than someone born in 1980 — so it would make sense on average for the people born later to be doing better.
But here’s an angle I hadn’t thought of, which is pointed out by the afore-linked press release: insurance. “[L]ife expectancy improved from the 1950-1964 to 1965-1980 type 1 diabetes diagnosis subcohorts of the Pittsburgh EDC study,” the authors wrote in the study. “These results support the need for insurance companies to update their analysis of the life expectancy of those with childhood-onset type 1 diabetes, because the current weighting of insurance premiums is based on earlier, outdated estimates.”
That last sentence jumped out at me, because up until that moment, I hadn’t given too much thought to how, exactly, insurance companies evaluated people with Type 1 diabetes. I didn’t have to think about it — because as anyone with T1D knows, up until now Type 1 diabetes has been an automatic disqualifier if you’re self-employed and are trying to get an individual plan. (My solution was to get married.) But now we’ve got the new healthcare law which supposedly is going to prevent insurers from automatically disqualifying people based on preexisting conditions. That leaves me with a big question: how are they going to set premiums?
That’s where I fear things could get screwy. In general, I actually think it makes perfect sense to charge people with diabetes more for insurance (from an economic, if not moral, standpoint) because let’s face it: we’re expensive! Either we don’t take care of ourselves and need someone to chop off a leg, or we do take care of ourselves, and require $1/strip glucose meters, $100+ per-bottle insulin, plus — if you’re like me — thousands of dollars in pump and CGM supplies. Insuring someone like me is kind of like trying to get insurance when you already know your car is broken.
But, with that said, I don’t know how much more that should be, since an investment in our current health will pay off with fewer long-term complications. It would be really screwed up if insurance companies set premiums based on statistics on complications and deaths for people born when the discovery of insulin was a mere 30 years old. Things are different now. Yes, my supplies are expensive, but at the same time I am not going to require emergency room visits because I take care of myself very well (and a couple trips to the emergency room would cost my insurer more than all my supplies — so economically, it makes sense to help me take care of myself). Even with the cost of my technological maintenance, I am likely cheaper than someone born in 1950 who now is dealing with complications.
Also interesting is that, partially because of my disease, I take care of myself better than most people WITHOUT diabetes! I exercise. I don’t smoke. I eat an obscene amount of produce. Sometimes I walk around the streets of Philadelphia and engage in a very critical and judgmental inner dialogue, in which I look around at people eating McDonald’s and smoking cigarettes and think, “What the hell are you doing to yourself?” The crazy thing is that from an insurer’s standpoint, someone who never exercises, smokes, drinks, and exists on Big Macs is probably going to look better on paper than I am.
I’m hoping that as more studies like this are published, insurance companies will take note that even though responsible modern-day diabetics are expensive to maintain, it is possible for us to be LESS expensive in the long-term than a. people who had Type 1 when technology and insulins were in their infancy, and b. irresponsible non-diabetic members of society who don’t give a crap about their health till they land in the ER with a heart attack.
So let’s rework those actuary tables.