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Monday, June 29, 2009

Testimonials

This is a request for feed-back from any readers, past or present, here or on various diabetes forums, who believe that reading my ideas may have helped you.

I don't intend to make requests like this often, this is the first and only. But at this time some testimonials could be rather useful for me.

I started this blog just under three years ago. It grew from a need to find a way to archive some of the responses I was making on the ADA forum and other less active forums. I needed a way to be able to refer newly diagnosed people to some basic ideas. I found I was repeatedly typing much the same suggestions each day to each new person. As a two-finger typist that was getting to be a bit of a chore. Using the blog I could change that to a brief greeting and "please read Getting Started". Yeah, I know, I'm just lazy. But it worked and it let me write to many more people.

Slowly, it grew. I added the contents index on the side-bar because this blog is not just an occasional collection of my thoughts and opinions but also a reference source for myself and others who choose to use it that way. I recently added site-meter and was quite surprised to find that the blog is averaging 4000 different visitors a month, with 10,000 page views. One in four are repeat visitors; although the majority are from the USA, UK, Canada, Australia and New Zealand visitors have come from over 60 countries.

A number of people suggested that I should collect some of these ideas in a book intended for type 2 diabetics who do not have web access or who are uncomfortable with using the internet. I started drafting that book last Christmas, but I have found it a slow process because it is a new experience for me. This blog is the only form of published writing I have ever done; I find I am continually revising the presentation and content of the book.

However, I expect to finish it within a couple of months. Then I will need to decide whether to seek a publisher or to self-publish; another field in which I am a babe in the woods. But I can learn.

It could help a great deal if I can present a publisher with a few testimonials from past readers, or, if I self-publish, I could include those testimonials in the opening pages.

If you decide to post a comment, be aware that I will presume that in posting you are giving permission to include that comment, or a section from it, in the appropriate section of the book. I will be contacting those who have sent private emails in the past to seek their permission.

Thanks in advance,

Cheers, Alan

Everything in Moderation - Except Laughter.

Monday, June 22, 2009

Choices, Consequences and Responsibility

Life is full of choices. Diabetes is one of those conditions where we are presented with many choices. From the start we have to choose who to listen to, who to ignore, what foods to eat, what exercise to do, what medications to take; the list goes on and on.

Naturally we seek qualified professional advice to help us make those choices. Some of us place our lives in the hands of those advisors, some of us use them as just one source of information and seek input from others such as other diabetics, support groups, forums, the internet, blogs, books and similar to assist us.

But that has dangers. There is an awful lot of dangerous nonsense on the web. That is particularly true concerning diabetes, diet and medications. So we must filter those sources using common sense, research and our medical advisors to pick the good information from the rubbish.

There is no doubt that our medical advisors should be our first port of call and the source of the best information. We should value that source above all others. But sometimes that is not always true. Our medical advisors can only offer advice based on their training and professional experience; however, that training syllabus may not always be up to date. If it is current, the research leading to that training may still be continuing, making new discoveries that change the basic premises that advice is based on.

For example, the diagnostic blood glucose levels for diabetes have been steadily reducing over the past few decades. I was not diagnosed for several years when my fasting blood glucose levels were around 7.9mmol/l(140) but a diagnostic fasting blood glucose of 8 applied in Australia. Of course, when I was finally diagnosed the official level had come down to 7(126).

Similarly the guidelines for good blood glucose levels are slowly being reduced. Despite that I see many people reporting their doctors quoting the old ADA guidelines of 2hr post-meal BGs of less than 180 as "tight control" or that it does not matter how high the peak BG spike is, provided that your 2hr BGs have returned to an acceptable level. I mentioned earlier the nonsense we hear from many official sources about our vital need for lots of "good, healthy" carbohydrates.

If those examples are representative of the quality of advice you are receiving from professional sources, try this small test. A multi-choice question for you.

Choose one answer.

Who or which of the following may go blind, lose a limb, suffer kidney failure or have a heart attack if the advice from your Doctor, your Dietician, your Diabetes Educator or the ADA/NHS/DA (Diabetes Australia) is discovered to be incorrect in ten years time?

A. Your Doctor

B. Your Diabetes Educator.

C. Your Dietician

D. The ADA/NHS/DA

C. You.

D. Me.

D. None of the above.

You may use the following links as reference materials while considering your answer:

Research Connecting Organ Damage with Blood Sugar Level

Blood Glucose Targets

Cheers, Alan

Everything in Moderation - Except Laughter.

Friday, June 12, 2009

Health Care Funding By Governments

I write on several groups and forums; the most active ones are heavily US-oriented. As a result I have learned to automatically translate mg/dl to mmol/l and I understand that some parts of the world consider an entree to be a main course and that ketchup can be a staple food group. I also write on several UK forums.

Consequently, over time I have become well aware of the strengths and failings of both the US and UK health-care systems from a consumer's point of view as expressed by many diabetics in both lands. To a lesser degree I have read reports by diabetics in different Canadian Provinces commenting on their systems and from writers in Germany and the Netherlands on theirs.

I've noticed when the subject comes up the views of many writers in the US seem to be polarised. Some see any government involvement in health provision or funding as socialist. That is a word that US writers seem to define differently to the rest of the world. It seems, to an outsider, that it is considered to be socialism if the US Federal Government uses its authority or taxpayer's funds to support any activity other than Defence of the Nation or Foreign Affairs.

All governments have taxes; in democratic nations those governments usually spend the majority of those taxes on the services their constituents elected them to provide. Different countries choose different priorities for those politicians.

We are just one place you might compare to. Here, we choose to include basic Health-care provision as one of those priorities. However, unlike the UK, we have a strong parallel private health-care system which complements the public system.

I don't present the following as a criticism of any other system, but as just one example of the many systems operating around the world. Those in other lands may wish to use it as a basis for comparison and possibly as something they could learn from and improve on. Or not, as you wish.

Our system is not perfect and needs some major improvements. There are problems in some hospitals (which are usually administered by State Governments, but partly funded via Federal money) and shortages of medical staff in rural regions to mention just some of the shortcomings. A major part of the problem is the separation of Federal and State responsibilities, so quality of care can vary a bit between States.

I am sure that a search of our newspapers right now will find a crisis somewhere; there may be delays in elective (non-life-threatening) surgery, or delays with ambulance response, or insufficient beds or staff in certain hospitals. There is always something. But, every single time I, or a member of my family, has needed medical care we have received what we needed, when we needed it at a minimal financial cost.

This is a layman's description by a consumer; if any experts on the Australian system are reading this I am happy to be corrected if any errors are noticed.

I'm covered by the Australian Federal Government Medicare system (absolutely nothing like the US system by the same name). This web-page explains what Medicare covers, and this explains how Medicare works at the consumer level.

Included in the Medicare system is the Pharmaceutical Benefits Scheme. That provides heavily-subsidised prices to citizens for the majority of prescription drugs. The subsidies are greater for old-age pensioners, qualifying veterans and some others. Sometimes there are complaints that new drugs are not covered but usually they will be after safety and other considerations have been met. Of course, there will always be exceptions; for example it took years to add Lantus to the list.

An important sub-section of the PBS is the NDSS, the National Diabetes Services Scheme. That provides subsidisation of things such as blood glucose test strips, insulin consumables and similar items.

As I write this the annual cost to the Federal taxpayer works out at about AU$3,400 per person. That seems pretty cheap to me when I compare with overseas prices. It is paid for by a levy on taxpayer's taxable income of 1.5%. I never found that onerous when I was fully employed and paying higher taxes than I do today, nor do I find it onerous now as a self-funded retiree. (2016 edit: now 2%). There are some State taxes involved too, but those vary by State and are difficult to assess for Health. They are certainly not at the same level as the Federal allocation.

Because I prefer to choose my own doctor, and also to avoid the possible delays I mentioned earlier in public hospitals, I choose to add Private Health Insurance. This is my own insurer; their premiums and benefits are representative of most: Defence Health Insurance. I've paid taxes since I was 16 years old; so I reckon I've paid my dues for Medicare. For the Private Health Insurance I pay top cover, which is about $200 per month for the two of us. That premium is also partly subsidised because it entitles me to some tax deductions in my annual tax return.

Between the Government cover and private insurance I don't get charged much for visits to the doc, medications, operations or hospital stays for myself or my wife. Additionally, for the leukemia and the diabetes I'm covered by DVA (Department of Veterans Affairs) so I pay even less for bills related to those, such as test strips. I paid those dues by serving for 20 years.

I'll repeat that our system is not perfect and needs some major improvements. But when I look at the financial and medical tragedy for those who are under-insured or unemployed in the US system; and the other extreme of the unwieldy inertia, restriction of treatment via the "post-code lottery"and bureaucratic waste of the UK NHS I'm very glad that I live where I live.

Everything has a price. Provision of a government healthcare system has a price; so does the absence of one. The first is paid in dollars; the second may be paid in misery.

Cheers, Alan
Everything in Moderation - Except Laughter

PS. For anyone interested in how the Australian system came into being, this links give an insight: 


Medicare - Background Brief

(edited to replace or delete changed links 4 July 2012)