Now What?

Now What?

John Kenneth Galbraith in a letter to then President Kennedy wrote; “Politics is not the art of the possible. It consists in choosing between the disastrous and the unpalatable.” Diabetic Investor is reminded of these words when the House, on a partisan vote, finally passed President Obama’s Health Care Reform package.  

After the vote the American Diabetes Association (ADA) issued the following statement; “Today is a day for celebration for the 23.6 million American children and adults who are living with diabetes. The passage of health reform by the House of Representatives finally tears down the wall that keeps people with diabetes from the health care they need,” commented Nash Childs, PE, Chair of the Board, American Diabetes Association. 

“With the passage of health reform ‘just because you have diabetes’ will no longer be a lawful excuse to deny coverage, to charge exorbitant rates, or to take away care just when a person with diabetes needs it most.  It gives all Americans with diabetes a fighting chance at controlling this devastating disease before they face blindness, amputation, heart disease, and kidney failure.

“The bill is also an essential step in the fight to stop diabetes through primary prevention using the tools we know can make a difference for the 57 million Americans with pre-diabetes and the one in three children who will end up with diabetes if our nation doesn’t change course.

“We thank the House of Representatives for their success in passing meaningful health care reform.”

Given the bill is over 2,000 pages long, Diabetic Investor has not yet undertaken the herculean task of actually reading the bill. That being said our comments today are based on a combination of comments and excerpts written about or from the bill.

First and foremost the passage of healthcare reform will do nothing to improve outcomes for the millions of patients with diabetes or pre-diabetes. All along Diabetic Investor has stated that healthcare reform really has nothing to do with helping patients achieve better outcomes, from the beginning healthcare reform was about money. Specifically who is able to get insurance and who pays for which services. Diabetic Investor has said it before and we will say it again; the fact that a patient has health insurance in no way means the care this patient is receiving is any good. About all it means is that someone will be paying for this care.

There are some who will contend that providing health insurance to patients with diabetes will somehow improve therapy compliance. The general argument is that drugs are expensive and patients with diabetes fail to take their drugs as prescribed because they cannot afford the drugs. While there is a small amount of validity to this argument, the main reason patients fail to stay compliant with their therapy regimen has more to do with the patient then it does with how much drugs costs or who pays for the drugs. Several studies have shown that therapy non-compliance really has more to do with the lack of patient education than the cost of the drugs.

The deeper one gets into this bill, the clearer it becomes that improving healthcare was the last thing Congress and the President achieved. The bill fails to address some fundamental problems with the healthcare system such as improving outcomes, preventive care and patient education. The passage of this bill is about one thing and one thing only; money.

The real question that should be asked about this so-called historic achievement is; what now? Or put a different way; has anything, other than who pays for what services, changed?  Will this bill in any way improve the future for the millions of patients with diabetes or pre-diabetes? Will it improve how the FDA functions? Will it help physicians more effectively treat their patients with diabetes?

The answers to these and many more questions, is of course unknown. (Although Diabetic Investor is pretty sure at this very moment a group of researchers is designing a study that will measure the impact of healthcare reform on patient outcomes.) Diabetic Investor also wonders, given that several provisions in the bill don’t take effect until 2014, what changes will be made once this bill becomes law. If there is one thing everyone can count on is Congress will definitely tinker with the bill between now and 2014.

Perhaps one day we will see a bill passed that will actually deals with healthcare and not just money. As a wise man once told Diabetic Investor; “Money only solves the problems that money creates.” The fact is helping the millions of patients with diabetes and pre-diabetes will take more than just money, it will take a fundamental shift in how patients are treated and educated.  

To Diabetic Investor this bill can best be summed up by something Samuel Johnson wrote over 200 years ago; “Why, Sir, most schemes of political improvement are very laughable things.”