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Re: [IP] On My Soap Box

I had hoped more time had been taken to read my message more carefully...see
responses below...

>I would like to differ with the opinion expressed by Ryan Bruner that the
>insulin pump is not always a medical necessity.

It is NOT ALWAYS medically necessary.  Many diabetics live long, healthy
lives without it.  I never said that most don't benefit from it...only that
there are times when it is NOT medically necessary.

> I also feel strongly that
> just because someone does not have the financial means, that he or she
> be denied the best medical treatment available.

I never recall suggesting such a thing. But if EVERYONE always got the best
medical treatment available, medical costs would be so prohibitive, NO ONE
could afford medicine nor the insurance premiums to cover it.  But, if an
insurance company is, in fact, denying medically necessary coverage...then
something is wrong.  Take test strips as a small example.  I'm sure I could
get better control if I tested 15 times a day instead of the 8 I do now.
But, should an insurance company be required to pay for almost twice the
strips when the difference I would improve would not be medically

>Unfortunately, having
>diabetes is an uphill struggle to get one's needs met.  It is ludicrous to
>state that the pump isn't more effective than MDI in treating diabetes,
>for those who maintain excellent control.

I also never stated that it isn't more effective...only that it isn't
medically necessary for everyone.  I have met diabetics who would NOT do
well on the pump based on the way they take care of themselves.  I also know
that there are those who manage tight control without a lot of effort, such
as the friend from church I mentioned.  (When I suggested pump therapy to
him, he said that he was doing quite well without it.)

> Having a device which does a much
> better job of mimicking a healthy pancreas can't help but improve the odds
> against developing major complications.

Believe me, I understand why a pump works so well, etc.  But again, the pump
isn't the only factor.

> This is especially true for young
> children who have not spent years suffering from high blood sugars.  I
> several docs who provide me with regular medical attention.

I think children are certainly the ones who are probably most needing the
pump.  The most difficult time I had with keeping control of my diabetes was
when I was young.  I'm sure the pump would have helped.

Perhaps I left the impression that I didn't think pump therapy was a great
thing.  I know I never stated such a thing, nor did I imply it.  I'm
cautioning people, however, to not just preach the pump without taking the
time to be OBJECTIVE about it. If one can maintain BGLs in the sixes on MDI
without a lot of lows, then the pump is NOT medically necessary.  There is
no getting around that.  It just isn't.  That doesn't mean that the pump can
improve the A1c even more and make life easier...but it is NOT medically
necessary.  The difference in complications from a 6.5 to a 5.5 is neglible.

> All of these
> specialists made the comment that being on the pump will no doubt increase
> liklihood that I will live years longer.

Absolutely...providing you weren't able to get tight control on MDI without
a lot of lows!!!!!!!

> My cardioligist said she did not
> understand why the pump was not recommended to all of her type 1 patients.

Because it is VERY expensive...and if every diabetic in the world were put
on one, LOTS of insurance companies would either go out of business, or
insurance costs would skyrocket.  The long-term cost savings of the improved
care would matter little to the insurance company that is trying to survive
TODAY.  They will have to pay the thousands now instead of some OTHER
insurance company (in all likelihood) having to pay later.

> She believes it helps tp prevent heart disease in type 1's.  I find it
> offensive and insensitive to read words which suggest that all of us don't
> deserve the very best in treatment.

The PUMP does not prevent heart disease.  Tight control does.  The pump is
an aid in attaining tighter control. But, many (not most,but many) people
can achive the tight control needed to prevent heart disease WITHOUT the
pump as well.  Believe me, there are plenty of people out there with
perfectly normal PANCREASES that have heart disease.

I cannot be held responsible for being offensive when there was never any
intention to offend...Merely to get people thinking more objectively.  I
LOVE my pump...but I don't let that cloud my ability to think about the
whole picture.

> Not everyone can afford to get their own
> medical needs met.  That IS what health insurance is for...and we should

Yes.  Medical NEEDS, however, is not the same as improving lifestyle.  If
the only real benefit to getting a pump is to make life easier, does that
make it medically necessary?  No.  For SOME people, that is all the pump
would give them.  There are those who I think should NOT go on the pump,
based on what I know about them.  But, for the majority of people who would
do well, I most definitely would recommend it. (Have I mentioned that I love
my pump?)

> expect the best, whether we have Medicaid, Medicare or private insurance.
> I will get off of my soapbox.

Fundamentally, my point isn't about the pump at all...but in taking the time
to try to save others money. By saving money for the insurance companies,
you are actually saving money for the people who pay the premiums.  I called
my insurance company to let them know that the DME supplier that I go
through to get my test strips was charging them an outrageous price.  They
then attempt to renegotiate pricing.  We can ALL be a part of the solution
for rising medical costs to some extent.

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