More on Diabetes

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The US is seeing modest, steady growth in the incidence of diabetes among children and teens. A new analysis of data from 2012 to 2012 shows

  • An increase in Type 1 Diabetes of 1.8% per year and
  • An increase in Type 2 Diabetes of 4.8% per year.

While there’s a genetic component, diabetes risk is associated with

  • Family history
  • Immune system issues
  • Diet and weight (and exercise)
  • Blood pressure

Europeans understand that how you care for yourself affects health care costs and health insurance rates for everyone around you. It’s not just about you. Teaching a child to veg in front of a computer or TV simply shortens the child’s life.

However, one of the frustrations with public health data is lack of currency. Has the situation gotten better or worse in the last five years?  My guess is worse, but we simply don’t know.


Sources:

  1. Elizabeth J. Mayer-Davis, Jean M. Lawrence, Dana Dabelea, Jasmin Divers, Scott Isom, Lawrence Dolan, Giuseppina Imperatore, Barbara Linder, Santica Marcovina, David J. Pettitt, Catherine Pihoker, Sharon Saydah, Lynne Wagenknecht. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. New England Journal of Medicine, 2017; 376 (15): 1419 DOI: 10.1056/NEJMoa1610187
  2. NIH/National Institute of Diabetes and Digestive and Kidney Diseases. “Rates of new diagnosed cases of type 1 and 2 diabetes on the rise among children, teens: Fastest rise seen among racial/ethnic minority groups.” ScienceDaily. ScienceDaily, 14 April 2017. <www.sciencedaily.com/releases/2017/04/170414105821.htm>.
  3. International Diabetes Foundation, “Risk Factors.” http://www.idf.org/about-diabetes/risk-factors
  4. Mayo Clinic, “Diabetes.” http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091

Just how smart are you with your money?

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The Future is coming, whether you like it or not. In fact, some parts are going to be very ben_franklinpositive, and some aren’t. You have to be prepared to deal with both. The sooner you start to prepare, the lower your costs will be!

We like to think about buying a house, buying a car, fancy weddings, babies and graduations. We don’t like to think about down payments, maternity costs or paying for college. However, as economist Milton Friedman famously wrote, “there’s no such thing as a free lunch.”

The statistics are simple.

  • The average life expectancy (LE) in the US is 78.8 years (1) — shorter for the poor and Southerners; longer for women and the affluent.
  • The healthy life expectancy (HLE) in the US is 68.1 years. By comparison, the HLE for Bosnia is 68.8 years and for Canada it’s 72.3 years. (3) HLE in the US varies by state and is shorter for Southerners. (2)
  • The difference between LE and HLE is the amount of time you can expect to have to deal with some kind of physical impairment. In the US, that amounts to a decade of trouble on average.

A new study confirms what people with elder parents already knew: older people need help with daily living. Even if they are fairly independent, both finances and medications can get out of control. They may not have or want to be dependent on family members to manage either.

Over 10 years, 10.3% of those aged 65 to 69 needed help managing medications and 23.1% needed help managing finances. These rates rose with age, to 38.2% and 69%, respectively, in those over age 85. Women had a higher risk than men, especially with advancing age. Additional factors linked with an increased risk for both outcomes included a history of stroke, low cognitive functioning, and difficulty with activities of daily living. (4/5)

There are resources, but they aren’t free.

  • The average cost of in-home healthcare in the US is $3,600 per month, as I mentioned in a prior blog. The average cost of a nursing home is $9,200 per month. Medicare can pick up the first 100 days. One of the Trump proposals for Medicaid reform involves eliminating Medicaid as a way to deal with these expenses.
  • There is a  category of professional, “daily money managers.” These aren’t financial planners, but they deal with records management, budgeting, checking the validity of expenditures, and bill payment. Costs for these services vary but can start at around $450 per month. (6) Not only do they keep things together for their clients, they are an important line of defense against scammers preying on seniors.

So, how are your parents going to deal with this? How are you going to deal with this when it’s your turn?

These problems are  best addressed when you do what most people don’t — act early on them.

  • Set aside dedicated savings for retirement.
  • Purchase permanent life insurance with a rider that allows you to take up to 50% of the face value of the policy for disability and long term care expenses. (7)

Both of these actions are best done earlier in life rather than later

  • Starting savings early allows the most time for compounding of interest.
  • Starting life insurance early minimizes cost. Insurance premiums are directly related to the length of time the carrier expects to have your money before they have to pay out. The earlier you buy, the less it will cost and the more you can afford. For example —
    • In NJ, for a woman age 24 non-smoker, a new $200,000 whole life policy might cost $113.68 per month.
    • In NJ, for a woman age 44 non-smoker, the same policy would cost $365.08 per month.
    • In NJ, for a woman age 59 non-smoker, a new $100,000 policy would cost $395.08. From the carrier used to quote these examples, a $200,000 whole life policy would not be available for someone that age.

With age, the price goes up and what you can buy goes down.

Procrastination costs you money. Don’t put this off.

If you practice a healthy life style, you can try to minimize the gap between LE and HLE, but you can’t count on eliminating it. There are just too many factors outside of your control (e.g., ice, drunk drivers, pollution, etc.).

 


Sources:

  1. Centers for Disease Control and Prevention, “FastStats,” 17 March 2017. https://www.cdc.gov/nchs/fastats/life-expectancy.htm
  2. Centers for Disease Control and Prevention, “State-Specific Healthy Life Expectancy at Age 65 Years — United States, 2007–2009,” 19 July 2013. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6228a1.htm#fig1
  3. World Health Organization, “Healthy Life Expectancy at Birth — 2000 to 2015,” http://gamapserver.who.int/gho/interactive_charts/mbd/hale_1/atlas.html
  4. Nienke Bleijenberg, Alexander K. Smith, Sei J. Lee, Irena Stijacic Cenzer, John W. Boscardin, Kenneth E. Covinsky. Difficulty Managing Medications and Finances in Older Adults: A 10-year Cohort Study. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14819
  5. Wiley. “Many older adults will need help with managing their medicines and money.” ScienceDaily. ScienceDaily, 7 April 2017. <www.sciencedaily.com/releases/2017/04/170407113035.htm.
  6. For those in the NJ area, I have a friend, Nancy Sobin, who offers these services. Please see her at http://paperwork-services.com/. She belongs to the American Association of Daily Money Managers, http://www.aadmm.com/.
  7. There are some companies that offer these riders for term insurance, which is much less expensive than permanent. The problem is that term insurance typically terminates by age 65, and home or nursing home care expenses typically start after that age. There’s no point having a rider that’s not going to be in force when you need it.

Life Expectancy in the US: Falling Behind

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The current (2016) life expectancy from birth for the US as a whole is 79.8 years.(1) How does that compare with other countries? Countries where people live longer than in the US include

  • Andorra 82.8
  • Anquilla 81.4
  • Australia 82.2
  • Austria 81.5
  • Belgium 81.0
  • Bermuda 81.3
  • Canada 81.9
  • Cayman Islands 81.2
  • Faroe Islands 80.4
  • Finland 80.9
  • France 81.8
  • Greece 80.5
  • Guernsey 82.5
  • Hong Kong (China) 82.9
  • Iceland 83.0
  • Ireland 80.8
  • Isle of Man 81.2
  • Israel 82.4
  • Italy 82.2
  • Japan 85.0
  • Jersey 81.9
  • Korea, South 82.4
  • Liechtenstein 81.9
  • Luxembourg 82.3
  • Macau (China) 84.5
  • Malta 80.4
  • Monaco 89.5
  • Netherlands 81.3
  • New Zealand 81.2
  • Norway 81.8
  • Saint Pierre and Miquelon 80.5
  • San Marino 83.3
  • Singapore 85.0
  • Spain 81.7
  • Sweden 82.1
  • Taiwan 80.1
  • United Kingdom 80.7
  • Virgin Islands 80.0

Of course, the issue is that the US spends more per capita on healthcare than any of these other countries.  In many cases, far more.

What’s a year of life worth to you?

On top of that, the US is falling behind in growth in life expectancy.(2) Kontis et. al. forcast growth in life expectancy in industrialized countries, and the US ranks near the bottom of the list, with minimal improvement.  South Korea, which is already ahead of the US, ranks near the top in growth in longevity.

lifeexpectancychangeYou spend a lot on healthcare and health insurance.  What exactly are you getting for your money?

 


SourcesI

  1. CIA World Factbook. https://www.cia.gov/library/publications/the-world-factbook/fields/2102.html
  2. Vasilis Kontis, PhD, James E Bennett, PhD, Colin D Mathers, PhD, Guangquan Li, PhD, Kyle Foreman, PhD, Prof Majid Ezzati, FMedSc, “Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble,” The Lancet, 21 February 2017. http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/fulltext

 

How Healthcare Reform Will Hurt Medical Professionals and Patients

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The Affordable Care Act is a complex piece of legislation with multiple goals:

  • Universal access to health care regardless of pre-existing conditions17456_1269532813224_1076952025_30803996_7657050_n
  • Reduction of costs of health insurance by averaging costs between healthy and unhealthy individuals
  • Reduction in actual outlays for medical services by
    • Reducing use of expensive emergency room services
    • Screening and earlier identification and treatment or prevention of major illnesses

The “repeal” effort to date addresses none of these goals, and in fact backtracks on them.

In addition, there is a continuing expansion of “cost sharing,” a euphemism for the shifting of costs from employers to employees for those workers who have access to group health insurance.

Physicians saw increased office traffic in 2016, but this is not likely to continue in the future.  Alicia Ault, writing for Medscape, comments,

Use and intensity of services and prices are the two biggest components of American health spending growth, the economists said. Overall use and intensity of healthcare goods and services continued to grow in 2016 as more people gained healthcare coverage through Medicare, Medicaid, or private insurance, and as disposable personal income rose. (1)

As the amount of money consumers have to spend for healthcare increases, their use of health services will decrease.  Economists with the Centers for Medicare and Medicaid Services (CMS, the agency that administers the Federal Marketplace as well as children’s programs) are expecting a reduction in use of physician services just in response to increased cost sharing, even without changes or repeal of the ACA.

Historical data show that greater cost sharing leads to less use of healthcare, Sean Keehan, a CMS economist, told Medscape Medical News. “People think twice about seeing the doctor if it’s going to be much more than it was before,” said Keehan, who is also lead author on the article in Health Affairs.(1)

Other factors will drive down use of health services over the next several years:

  1. Inflation which will reduce what consumers have available to spend
  2. Relatively stagnant wage growth, meaning that wages will not keep up with inflation

The CMS estimates are optimistic, excluding any impacts of ACA repeal.  A sharp increase in the number of people who cannot afford health insurance would be a game changer, and, frankly, could force some primary care physicians to close their practices.  The areas likely to see the greatest impact are poor and rural communities.

What you need to consider:

  • For most people, money is going to be a problem.  Do you need to improve or acquire skills to allow you to get a higher paying job?
  • Relocation to an area with better local public health services? 
  • How will you deal with older relative who may find themselves in trouble?

Sources:

  1. Alicia Ault, Physician Services to Decline With More Cost-Sharing, CMS Says. Medscape. Feb 15, 2017.
  2. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html

Health Care “Reform” and Suicide

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lights-1088141__340ACA repeal and Medicare reform may increase the suicide rate among middle age and older Americans.

While for years, suicide has been considered as a major threat among children and those of college age, the two age groups with the highest rate of suicide are

  • 45 to 64 year olds, followed by
  • those age 85 and older.

Those most prone to suicide are non-Hispanic white and Native American males.

Suicide rates are lowest in highly urban states with strong social service support systems:  e.g., New York, New Jersey and California.

The highest rates are in largely rural states, in the Plains and the South.  These states tend to have low spending on social services and lax gun laws.

  • The two states with the highest rates are Montana and Wyoming.
  • Half of all suicides are by gun.  Men prefer guns; women prefer poison or drug overdose.

While these states have lower costs of living, they also have lower household incomes.

The explanation for suicides is largely inferential and anecdotal.  No one to my knowledge goes around collecting suicide notes to tabulate causes.

Statistical inference points to economics, partly because that’s the data available, as per the quote from Professor Putnam, below.

“This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health,” said Robert D. Putnam, a professor of public policy at Harvard and the author of “Our Kids,” an investigation of new class divisions in America.

Anecdotal evidence also points to the role of finances in suicide decisions.  Some of us know people who have shot themselves on receiving a cancer diagnosis when they have no medical insurance to cover the cost of treatment.

  • When the patient is unable to afford treatment and has only slight chance of recovery, suicide may just make sense.
  • Some may do this to keep their spouse from financial ruin.

Adding to this, statistical inference also suggests that states that make it easier to file for bankruptcy have lower suicide rates.  California, for example, leads in bankruptcy filings but has a very low suicide rate.

What does the ACA repeal have to do with this?

  • Access to doctors was designed to encourage screening and early detection of disease, when the illness is less obvious or painful, more easily treatable and less costly to treat.
  • Removal of access is going to mean that more disease is caught at later stages,  with patients having fewer options, pain, less likelihood of success and higher costs that may be unaffordable.     Repeal will put more people in this impossible position.  What do you expect them to do?

_____________

Sources:

How Americans Die

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Life expectancy for Americans declined in 2015, the first such decline since 1999.  (The 2015 data are just now becoming available.)

The leading causes of death are in the list below.  The ones marked with an asterisk (*) showed an increase in incidence in the current report.

  1. *Heart disease
  2. Cancer
  3. *Chronic lower respiratory tract diseases
  4. *Accidents (unintentional injuries)
  5. *Stroke
  6. *Alzheimer’s disease
  7. *Diabetes
  8. Influenza and pneumonia
  9. *Kidney disease
  10. *Suicide

Cancer as a cause of death has actually declined.

Overall, the change is small — the equivalent of the loss of about 6 weeks of life.  However, the small overall change masks meaningful changes in subgroups of the population.

It is well established that life expectancy varies with wealth in the US (Chetty et. al.).

Being poor in the United States is so hazardous to your health, a new study shows, that the average life expectancy of the lowest-income classes in America is now equal to that in Sudan or Pakistan.” (Reuell)

Life expectancy also varies by location in the US, as does access to state-of-the-art healthcare.  The Reuell article shows maps of the US, reproduced below.  Darker colors indicate shorter life expectancy. Frankly, Ohio, Indiana, Illinois, Michigan, Missouri, Texas and Nevada are questionable places to live.  The Northern Plains region gets a pass in this analysis due to lack of data.

The best places to live appear to be New England, Arizona, Utah, Colorado. Minnesota and the West Coast.  Women fare better in the South than men do.  Conversely, men fare relatively better than women in Hawaii.

922men

Of course the gender comparisons are always relative.  Women simply live longer.


Sources: