[acb-diabetics] Universal Care?

[Patricia LaFrance-Wolf]

Being uninsured and having diabetes is a lethal combination according to a
new study. 

 

A new study shows uninsured American adults with chronic illnesses like
diabetes or high cholesterol often go undiagnosed and undertreated, leading
to an

increased risk of costly, disabling and even lethal complications of their
disease. 

 

The study, published online in Health Affairs, analyzed data from a recent
national survey conducted by the Centers for Disease Control and Prevention

(CDC). The researchers, based at Harvard Medical School and the affiliated
Cambridge Health Alliance, analyzed data on 15,976 U.S. non-elderly adults
from

the National Health and Nutrition Examination Survey (NHANES), a CDC
program, between 1999 and 2006. 

 

Respondents answered detailed questions about their health and economic
circumstances. Then doctors examined them and ordered laboratory tests. 

 

The study found that about half of all uninsured people with diabetes (46
percent) or high cholesterol (52 percent) did not know they had these
diseases.

In contrast, about one-quarter of those with insurance were unaware of their
illnesses (23 percent for diabetes, 29.9 percent for high cholesterol). 

 

Undertreatment of disease followed similar patterns, with the uninsured
being more likely to be undertreated than their insured counterparts: 58.3
percent

vs. 51.4 percent had their high blood pressure poorly controlled, and 77.5
percent vs. 60.4 percent had their high cholesterol inadequately treated. 

 

Surprisingly, being insured was not associated with a widely used measure of
diabetes control (a hemoglobin A1c level below 7), a finding the authors
attribute

to the stringent definition of good diabetes control used in the NHANES
survey. Even with excellent medical care, many diabetics fail to achieve
A1c's

below 7%. Using less stringent hemoglobin A1c thresholds of 8 and 9,
uninsured adults had significantly worse blood sugar control than their
insured counterparts,

the researchers found. 

 

Lead author Dr. Andrew Wilper, who worked at Harvard when the study was done
and who now teaches at the University of Washington Medical School, said,

"Our study should lay to rest the myth that the uninsured can get the care
they need. Millions have serious chronic conditions and don't even know it.

And they're not getting care that would prevent strokes, heart attacks,
amputations and kidney failure."

 

Referring to a study released in the American Journal of Public Health last
month, which has been widely quoted by Sen. Max Baucus and others, he added,

"Our previous work demonstrated 45,000 deaths annually are linked to lack of
health insurance. Our new findings suggest a mechanism for this increased

risk of death among the uninsured. They're not getting life-saving care." 

 

Dr. Steffie Woolhandler, professor of medicine at Harvard and study
co-author, said, "The uninsured suffer the most, but even Americans with
insurance

have shocking rates of undertreatment, in part because high co-payments and
deductibles often make care and medications unaffordable. We need to upgrade

coverage for the insured, as well as covering the uninsured. Only
single-payer national health insurance would make care affordable for the
tens of millions

of Americans with chronic illnesses." 

 

Dr. David Himmelstein, associate professor of medicine at Harvard and study
co-author, said, "The Senate Finance Committee's bill would leave 25 million

Americans uninsured and unable to get the ongoing, routine care that could
save their lives and prevent disability. No other wealthy nation tolerates
this,

yet Congress is turning its back on tens of millions of Americans." 

 

"Hypertension, diabetes and elevated cholesterol among insured and uninsured
U.S. adults," Andrew P. Wilper, M.D ., M.P.H.; Steffie Woolhandler, M.D .,

M.P.H.; Karen Lasser, M.D ., M.P.H.; Danny McCormick, M.D ., M.P.H.; David
H. Bor, M.D.; David U. Himmelstein, M.D. Health Affairs, Oct. 20, 2009
(online).  

 

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