Having just returned from a wonderful and pretty much off the grid trip to America’s southwest, I discover some pennies have dropped.
Roe is now in Wooly Mammoth land; New Yorkers, and soon many others, will now find it easier to pack a bit of heat; the EPA (and, presumably a lot of other governmental agencies) is no longer going to be able to regulate what its been regulating for the last 50 years; the January 6 Select Committee continues to unearth the sewer-living sludge of the Trump Big Lie; another mass shooting happened, the 309th of 2022, at a July 4th parade no less (only in America); the charlatan Boris Johnson is officially on the way out; and, this past Friday morning, a 41-year-old Shinzo Abe hater, assassinated the former prime minister of Japan at a campaign stop. Abe’s killer made the gun himself, because it’s nearly impossible to procure a gun in Japan—Japan, the country with the lowest rate of handgun violence in the developed world.
With all of that, I’m thinking Chicken Little was right, and the sky is about to fall any minute now and land on my bucolic, Berkshire back deck.
Nonetheless, today’s Letter is not about any of that sky is falling stuff. We’ll get to all of it later. No, today’s Letter is about a momentous, and non-COVID, medical development that happened while I was gone, when California’s Governor Gavin Newsome announced the state would commit $100 million to making its own insulin for California’s diabetics.
Diabetes kills one American every three minutes. It affects children and adults, both genders, every race and ethnic group and leaves a vicious imprint on those who suffer from it and on those who love them. It is a leading cause of blindness, heart disease, stroke, kidney failure and non-traumatic amputations.
According to a nationwide survey by the Juvenile Diabetes Foundation International, 75 percent of Americans do not know how deadly the disease is, and 38 percent believe that either insulin cures diabetes, makes it harmless, or they don’t know what effect it has.
In 2017, the nation’s total direct medical cost due to diabetes was $237 billion. Average medical expenses for diabetics were 2.3 times higher than for non-diabetics.
Based on information found on death certificates, diabetes was the 7th leading cause of death in the United States in 2015, with 79,535 death certificates listing it as the underlying cause of death, and 252,806 listing diabetes as an underlying or contributing cause of death. However, diabetes is underreported as a cause of death; studies have found that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on their death certificates and only 10% to 15% had it listed as the underlying cause of death. An example of best practice would be, “Death caused by infection contracted from hemodialysis due to kidney failure, a complication of the patient’s diabetes.”
At 10.2%, California ranks 31st among US states in the percent of adults with diabetes*. There are more than 3.2 million of them in California, the great preponderance being Type 2 diabetics.
There are close to 35 million Type 2 diabetics in the nation. T2Ds still make some insulin, just not enough. For most, lifestyle changes will improve their health, sometimes to the point where they will no longer have to inject insulin. Some will become insulin dependent, and without it, those people will face life-changing complications.
There is a rarer, but much worse, kind of diabetes. That would be Type 1, also known as Juvenile Diabetes. There are 1.6 million T1Ds in the country. According to the CDC, of all the states, California has the lowest rate of juvenile, Type 1 diabetes. T1Ds make no insulin and will die quickly if they don’t get it. Type 1 diabetes can happen at any time in life, but is vastly more prevalent in young people. My daughter came down with Type 1 diabetes at 21 years of age; my late wife Marilyn, at 12. You wouldn’t be wrong to think I’m invested in this topic.
I have argued strenuously in the past (here and here) that the country should guarantee insulin to T1Ds, regardless of their ability to pay for it. It is quite literally a matter of life and death. I can think of no other disease in which, if a patient is deprived of their medicine, death will result within a couple of weeks. But that’s the world T1Ds inhabit.
While it is true that most of the ~50% of Americans who have employer sponsored insurance (ESI) only pay co-pays of $30 to $50 for a month’s supply of insulin, nearly all of them pay the full, painful cost until they meet their pharmacy deductible requirements. And one thing more to keep in mind: before Congress Passed the Affordable Care Act in 2010, the 1.9 million diabetics without ESI found their diabetes treated as a pre-existing condition. They paid full freight every time. Fast forwarding to now, some T1Ds are dying, because they either ration, or even go without, their insulin. Why? Because they can’t afford the price.
In my 2018 series on this topic, What Price Life?, I concluded:
So, here’s a question: Should anyone in the United States who requires a daily drug just to stay alive be forced to come up with the money to pay for it? Or, should that be a government-sponsored, health care right, as in the Declaration Of Independence’s “self-evident…unalienable right…to life.”
Gavin Newsome has answered that question. He has had enough. In taking matters into his own hands, he is extending a lifeline to California’s diabetics who struggle with the cost of staying alive. His move will both help those diabetics and provide good paying jobs to the people hired to build the manufacturing process and supply chain. He promises to provide California’s insulin to its diabetic citizens at “a little above cost.”
I don’t know what you think of Gavin Newsome. He certainly has his critics. But on this critical, life and death issue, he is showing a brand of leadership seldom, if ever, seen in that bought-and-paid-for vacuum of mediocrity we call the United States Senate.
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*It may not surprise you to learn the states with the highest incidence of diabetes, primarily Type 2, are the states whose citizens have the worst health care problems in the country. They are Red states, and are led by Senator Joe Manchin’s West Virginia at 15.7%, followed by Louisiana, Mississippi and Alabama. Mississippi. Always Mississippi. Pounded so low it has to look up to tie its shoes.
Tags: diabetes
