September 16, 2013
More Debate on Test Strip Accuracy
This is about what I expected, age discrimination by the Centers for Medicare and Medicaid Services (CMS). CMS's Dr. Elizabeth A. Koller made that perfectly clear. Have no doubt, she will carry this forward and make sure her discrimination will happen. To quote what she suggested, “That glucose test accuracy standards might not need to be as stringent for many Medicare beneficiaries, most of whom have type 2 diabetes, because the evidence is lacking for a clear benefit from intensive glycemic control in this type of diabetes.
This is why test strips are so limited for Medicare beneficiaries to prevent evidence from being collected to disprove her statement. This is why NIH and other government sponsored research does not include senior citizens. They want to treat us as second-class citizens not deserving to be considered as being able to manage our diabetes. According to other statements, Medicare beneficiaries have too many other comorbidities to accurately assess how effective wasting money on us can benefit us. Discrimination is the accurate term for how Medicare beneficiaries are treated and thought about to diminish our worth.
Granted Dr. Koller later limited her comments to type 2 patients who don't use insulin; however, don't think she did not mean all type 2 patients and type 1 patients. If you can't believe this, then why did she take to the tack on cardiovascular disease stating that aggressive glucose control does not mitigate the CVD risk? This alone confirms she is talking about all patients with diabetes, on insulin or oral medications.
Then she seals this with the kiss of death when she says, "The goals and what is needed by our population may not be appropriate for what is needed for other populations.... In addition, there are actuarial considerations for our population, issues of expected lifespan and the burden of comorbid disease."
Then she tries to say that Medicare is particularly concerned about the avoidance of hypoglycemia among its beneficiaries. Oh, really? Then why does Medicare strictly limit testing supplies for all type 2. One test strip is not very valuable for people taking sulfonylureas when they have hypoglycemia. Three test strips for type 1 and type 2 on insulin is not very valuable for hypoglycemia when it may be necessary to test 5 to 8 times to bring hypoglycemia under management. No, Medicare DOES NOT CARE. Presently their only interest is in cutting corners at the expense of the Medicare beneficiaries.
The final concern is expressed by Gary A. Puckrein, PHD when he says, "Using the word 'actuarial table' to refer to diabetes patients is scary. He noted that glycemic control among minority populations with diabetes is exceptionally poor, and we need to get them under control. Medicare is government social insurance and has no right to pick winners wherever they are in the system."
Dr. Koller has carefully positioned the CMS to continue business as usual and made no statements that conflict with this. To this I say – Give us back out test strips!