
Diabetes complications soar in US, but not Canada, as teens become young adults - howard941
https://medicalxpress.com/news/2019-05-diabetes-complications-soar-canada-teenagers.html
======
jimrandomh
The article talks about people being uninsured, but this is a misunderstanding
of the problem. I'm type 1 diabetic, and the reasons for this are pretty
straightforward.

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.

~~~
albuterol
Same goes for asthma medication. Epinephrine got removed from OTC options a
few years ago, and now it's impossible to treat asthma without getting pushed
into steroid treatments with whopping price tags.

~~~
mikecsh
Do you not have access to beta2 agonists such as salbutamol?

~~~
x86_64Ubuntu
Still need a script to get it.

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ecpottinger
I am type 2, but here in Canada my cost to buy Insulin is way lower, I have no
medical plan and buy OTC about 4 months supply for $60 CDN.

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.

~~~
docker_up
Having employer-sponsored medical insurance is generally better than Canadian
health care. I'm Canadian living in the US. Of course, having Canadian public
health care is better when you don't have much money.

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.

~~~
vkou
Kaiser doesn't treat many people over the age of 65, because the overwhelming
majority of them aren't working, and those that are, aren't working somewhere
they can get Kaiser healthcare.

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.

~~~
docker_up
I don't think you've been in a Kaiser facility if you believe this.

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lolc
Wow this is sad. To me, insulin is like food. If I don't get it I die. I will
literally starve without it. It's also like food in that my fridge is stocked
and it's just part of regular expenses.

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.

------
xenospn
Reminds me of the height differences between South and North Koreans.

------
qntty
At these ages, it's mostly type 1 diabetes we're talking about.

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...](http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-
report-2017.pdf)

~~~
nickles
The referenced article studied individuals aged 12 to 30. Additionally, while
type 1 and type 2 diabetes rates among youths are rising, type 2 diabetes is
becoming more common in that group.

[0]
[https://link.springer.com/article/10.1007/s11606-019-05006-6](https://link.springer.com/article/10.1007/s11606-019-05006-6)

[1] [https://www.nih.gov/news-events/news-releases/rates-new-
diag...](https://www.nih.gov/news-events/news-releases/rates-new-diagnosed-
cases-type-1-type-2-diabetes-rise-among-children-teens)

~~~
qntty
The results from the study linked in the second article
([https://www.nejm.org/doi/full/10.1056/NEJMoa1610187](https://www.nejm.org/doi/full/10.1056/NEJMoa1610187))
seems to be identical to the ones that I cited for 2011-12.

~~~
nickles
I missed the breakdown of growth rates in your original source, seeing only
the absolute incidences, but I think we're in agreement. It looks like growth
in youth type 1 diabetes was reported at 1.8%, while growth in type 2 diabetes
was reported at 4.8%.

------
kevin_b_er
This really is a study on the political consequences of an underregulated
free-market economy and the result of political demands for more libertarian
ideals as applied. The consequence is the poor cannot afford to live.

~~~
Prophasi
This perception of the US as having a free-market economy, particularly in the
area of healthcare, is curiously persistent.

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...](https://www.statnews.com/2019/02/11/drug-patent-protection-
one-done/)

Tax distortion: [https://www.forbes.com/sites/theapothecary/2017/07/30/why-
ta...](https://www.forbes.com/sites/theapothecary/2017/07/30/why-tax-reform-
should-address-incomprehensible-and-indefensible-inequities-in-health-
subsidies)

Insulin prices: [https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-
expe...](https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expensive)

Free market? [https://fee.org/articles/the-idea-that-the-us-has-a-free-
mar...](https://fee.org/articles/the-idea-that-the-us-has-a-free-market-
health-care-system-is-pure-fantasy/)

~~~
howard941
We had a free market for drugs. So free and freely abused that it gave birth
to modern journalism (muckraking) and the Pure Food and Drug Act of 1906. For
good reasons few yearn to return to those truly free times.

[https://en.wikipedia.org/wiki/Pure_Food_and_Drug_Act](https://en.wikipedia.org/wiki/Pure_Food_and_Drug_Act)

[https://www.u-s-history.com/pages/h917.html](https://www.u-s-
history.com/pages/h917.html)

~~~
Prophasi
Thanks for the links - that's interesting to consider when weighing the
tradeoffs of an FDA-less country. Of course, the FDA is only one part of the
story, and conceding a need for its general existence in no way means that its
current purview and methodologies don't need extensive revision.

In any case, my post above was about what is (and what to properly call it),
not what ought to be.

------
coldpie
In other words, stop voting for Republicans.

~~~
genzoman
Big Pharma knows no party.

~~~
minikites
Then why are only Democrats pushing for Medicare For All and other
comprehensive public health plans while Republicans want to dismantle the ACA
(Obamacare)?

~~~
danharaj
A subset of Democratic politicians and officials are pushing for Medicare for
All. Most of the Democratic party machine is tepid-to-opposed.

~~~
minikites
There are more than zero Democrats working on the problem. There are zero
Republicans working on the problem.

