Better Medical Resources ≠ Better Medical Care
Over the past century, humans have made incredible progress in our understanding of medical ailments and how to properly provide treatment to those affected by them. Major advancements in the development of technology and different medications have played a significant role in this growth of the medical field. With instruments that allow us to better study human pathogens, screen for various diseases, provide extremely precise care, and much more, we are living in a world in which people of the past never would have thought could exist. Within about 120 years, we have progressed from a nation where an average of one in every 40 Americans die annually to a significantly lower rate of about one in every 120 Americans and, although this average rate is affected by numerous factors, discoveries and advancements in the medical field have played a tremendous role in its steady improvement (Penn Wharton, 1). One cannot deny the benefits technology has provided us in our quality and duration of life, however, technology has also been a driving force of widening disparity within our healthcare system. Despite continuous breakthroughs in medical care through the use of technology, many of these new forms of care remain inaccessible to a majority of the population and distort our views of the medical world. The diabetic population clearly illustrates this growing disparity within the healthcare system and demonstrates our need to improve current policies to better utilize the incredible achievements we have made as a species.
“Living with diabetes means people usually don’t realize or understand what you’re living with”Nick Jonas
What is Diabetes and How Does Technology/Medication Play a Role?
Type 1 diabetes is an autoimmune disease in which the immune system irreversibly destroys the insulin-producing beta cells of the pancreas. Insulin is the hormone released by our body in response to the consumption of food as it allows glucose within the bloodstream to be taken up by cells for the production of ATP. For a diabetic that has lost the ability to produce insulin, that glucose will remain in the bloodstream and prevent cells from producing energy for the body while leading to many negative effects, such as the blood becoming acidic, loss of vision, damaged nerves, kidney failure, amputation of limbs, and much more. Type 1 diabetes is a chronic condition, meaning once a person is diagnosed, they will live with the disease for the rest of their life. Furthermore, it is a condition that requires 24/7 monitoring and care, often leading to drastic changes within a person’s everyday life and causing their whole world to revolve around this medical condition. Just over 100 years ago, a diagnosis of diabetes was a death sentence in which a child, as type 1 diabetes is primarily diagnosed in early childhood, would not be expected to live more than 3 years (Distiller, 3). However, medical discoveries and major advancements in technology have provided patients with the ability to live full and high quality lives as we now have access to synthetic insulin, insulin pumps, continuous glucose monitors (CGMs), improved education, and more. It is impossible to deny the tremendous amount of good these technological and medical achievements have made in the lives of people living with such a life-altering condition, however, this also begs the question of how there can be such large disparities in the quality of life for a disease we now know so much about and have incredible resources for managing.
“We have the greatest hospitals, doctors, and medical technology in the world – we need to make them accessible to every American.”Barbara Boxer
Barriers to Medical Care and our Misconceptions of Diabetes Management
In today’s world, we have access to insulin pumps that will automatically deliver precise amounts of insulin, CGMs that allow a person to know their exact blood sugar at any given moment without the need for finger pricks, inhalable glucagon that saves lives when used during hypoglycemic emergencies, and so much more. So why is diabetes still such a hard disease to manage? Aside from the fact that diabetes is an irregular disorder that may still have complications regardless of near-perfect management, the primary barrier to effective diabetes management remains access to supplies. A majority of diabetics struggle to access the life-saving medical supplies we have available that transform a burdensome and debilitating condition into one that is manageable. This disparity in access is due to a number of factors, however, the main barrier remains the cost of insulin and diabetes technology. While various technologies such as insulin pumps and CGMs greatly improve a person’s ability to manage diabetes and can have life-changing results, it is still possible to manage one’s condition without these technologies through the use of traditional insulin syringes and finger pricks. Insulin, however, is required for a person with diabetes as they cannot survive without it. As previously mentioned in this discussion, insulin is needed to take up glucose from the blood for energy production and when insulin is not present, the body will turn to other sources for energy. The method for providing energy that the body primarily turns to is a process in which fat is converted into energy, however, unlike the regular process involving glucose, this secondary process produces ketones as a byproduct. This results in the buildup of ketones within the blood, turning it acidic and leading to a life threatening condition called diabetic ketoacidosis (DKA). Aside from this dangerous condition, sustained levels of elevated blood sugar can also lead to the many debilitating long term consequences that were mentioned earlier, such as loss of vision, kidney function, feeling in extremities, and limbs. This is why insulin is essential for not only living a high quality life, but for survival itself. With over 1 million diabetics having to ration their life saving insulin everyday, our healthcare system needs a dramatic change (Norton, 1).
Why is Insulin so Expensive?
According to Ashley Driesbach’s research, a study conducted in 2018 found that on average it costs about $2.28-$3.42 to produce a single vial of human insulin and a year’s worth of insulin only costs $48-$71 per diabetic patient (Driesbach, 8). So how can so many people still be struggling to afford their life saving medication? The answer comes down to the lack of regulations surrounding the major insulin-producing companies. Insulin is manufactured by just three major companies: Eli Lilly, Novo Nordisk, and Sanofi (Martínez, 1). These companies face very few regulations in how they manufacture and sell their product, which is what allows them to increase the selling price of insulin to about $25-$100 per vial for older insulins and $174-$300 per vial for newer insulins merely for the sake of profits. Although insurance may help with some of the cost, many people with insurance are still forced to pay a hefty amount out of pocket and those without insurance are often left helpless (SingleCare, 6). A study from 2019 and 2020 found that insured diabetics were still forced to pay an average of $35 for a 30-day supply of insulin while many others are forced to pay more (Lovelace, 11). Recent studies have also shown that this inflation crisis is only getting worse as insulin prices have increased by about 600% over the last 20 years (Inskeep, 1). The cost of insulin has proven to be a major barrier to diabetics living a full and healthy life and as this crisis continues to worsen, leading to the deaths of people around the globe that could have been prevented with access to insulin, many are wondering what can we do as a society to solve this problem.
“Universal coverage, not medical technology, is the foundation of any caring health care system.”Richard Lamm
What needs to be done
Reducing the growing disparity diabetic patients face in accessing their medical supplies and technology is something that needs to happen, but there is no clear and simple solution for achieving this. From reading the current research and hearing the life experiences of diabetics around the world, I believe our best chance at reducing this disparity is reducing the cost of diabetes supplies. Although there may be other factors that make accessing medical supplies difficult for a diabetic, cost of insulin and other diabetes supplies remains the most significant barrier as insulin pumps themselves cost an average of $4,500-$6,500 (Vaida, 16). To help alleviate some of the financial burden faced by millions of Americans living with diabetes, we must form new policies that regulate these costs, whether that be introducing policies to provide greater healthcare coverage for uninsured patients, policies that require insurance companies to cover more of the costs for things like insulin and insulin pumps, or policies that regulate the major insulin-producing companies and how much they can sell their product for. It is difficult to say when policies such as these may become possible or if they will ever become possible, as the US is still a long way away from adopting universal healthcare and pharmaceutical companies and insurance companies have remained relatively free to make decisions that directly benefit them at the expense of their “customers” for decades. Whether or not policies such as these are achieved in the US someday, we must continue to raise awareness of the issue as healthcare costs continue to be a widespread epidemic that plagues non only diabetics, but millions of Americans affected by other conditions as well.
Catastrophic spending on insulin in the United States, 2017–18. (n.d.). Retrieved February 21, 2023, from https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01788
Centers for Disease Control and Prevention. (2022, December 30). Types of insulin. Centers for Disease Control and Prevention. Retrieved February 20, 2023, from https://www.cdc.gov/diabetes/basics/type-1-types-of-insulin.html
Distiller L. A. (2014). Why do some patients with type 1 diabetes live so long?. World journal of diabetes, 5(3), 282–287. https://doi.org/10.4239/wjd.v5.i3.282
Drugmakers that dominate the world’s insulin market must scale up access efforts globally. Access to Medicine Foundation. (n.d.). Retrieved February 20, 2023, from https://accesstomedicinefoundation.org/news/how-the-dominant-global-insulin-producers-must-scale-up-access-efforts-to-reach-people-with-diabetes-worldwide#:~:text=The%20three%20companies%20that%20dominate,%2Dincome%20countries%20(LMICs).
Facts. JDRF. (n.d.). Retrieved February 20, 2023, from https://www.jdrf.org/t1d-resources/about/facts/#:~:text=Some%201.45%20million%20Americans%20are%20living%20with%20T1D.&text=64%2C000%20people%20are%20diagnosed%20each%20year%20in%20the%20U.S.&text=2.1%20million%20people%20in%20the,to%20have%20T1D%20by%202040.
Inskeep, S., & Aubrey, A. (2022, September 12). Insulin costs increased 600% over the last 20 years. states aim to curb the price. NPR. Retrieved February 20, 2023, from https://www.npr.org/2022/09/12/1122311443/insulin-costs-increased-600-over-the-last-20-years-states-aim-to-curb-the-price#:~:text=The%20price%20of%20insulin%20remains,patients%20ration%20this%20lifesaving%20drug.
NBCUniversal News Group. (2022, July 24). Why is insulin still so expensive for diabetes patients in the U.S.? NBCNews.com. Retrieved February 20, 2023, from https://www.nbcnews.com/health/health-news/why-insulin-so-expensive-diabetes-united-states-rcna39295
NBCUniversal News Group. (n.d.). Insulin costs will be capped in 2023, but most people with diabetes won’t benefit. NBCNews.com. Retrieved February 20, 2023, from https://www.nbcnews.com/health/health-news/insulin-cost-cap-people-diabetes-no-benefit-rcna58165
Over a million Americans are rationing insulin due to high cost. (n.d.). Retrieved February 21, 2023, from https://www.usnews.com/news/health-news/articles/2022-10-18/over-a-million-americans-are-rationing-insulin-due-to-high-cost
PPI, W. (2018, December 19). Mortality in the United States: Past, present, and future. Penn Wharton Budget Model. Retrieved February 20, 2023, from https://budgetmodel.wharton.upenn.edu/issues/2016/1/25/mortality-in-the-united-states-past-present-and-future#:~:text=The%20United%20States%20has%20enjoyed,of%20more%20than%20two%20thirds.
Team, S. C. (2023, February 8). How much does insulin cost? The Checkup. Retrieved February 20, 2023, from https://www.singlecare.com/blog/insulin-prices/#:~:text=A%202018%20study%20estimated%20that,133%20per%20patient%20per%20year.
Vaida, B. (n.d.). What diabetic supplies do I need, and what are the costs? – goodrx. Retrieved February 21, 2023, from https://www.goodrx.com/conditions/diabetes/supplies-for-diabetics
Xplore. (n.d.). Medical Technology quotes. BrainyQuote. Retrieved February 20, 2023, from https://www.brainyquote.com/topics/medical-technology-quotes