Type 2 Diabetes and Social Class

I haven’t had Type 2 diabetes (yet) but I have experience with gestational diabetes which is treated almost exactly the same. And here is my conclusion: even with a very good insurance, this is not a cheap disease to have.

Copays for doctor visits, Metformin, insulin, lancets, test strips, syringes, syringe-disposal boxes, alcohol pads, skincare products, etc easily come up to  $150-200 per month. Diabetic – friendly diet of the kind that will help you not drop off with a heart attack in a few years is quite costly. Diabetics have to be physically active, so a gym membership is indispensable. And the best, most helpful thing for people with diabetes mellitus is psychological assistance of the expensive kind (meaning the drug-free one).

The problem, though, is that Type 2 diabetes is not an illness limited to the rich. It’s very likely to develop in people who are lucky to have any health insurance at all, let alone all the extra cash and resources that I enumerated.

Plus, it’s an illness that requires a very stable lifestyle and the capacity to control one’s routine to at least a degree. For instance, I met this woman with gestational diabetes whose boss wasn’t letting her have any snack breaks and constantly messed with her lunch break. And this sort of instability is very bad for diabetics.

Diabetes is not a rare disease. There are millions who are diabetic or pre-diabetic in this country. (Although the numbers have plateaued in recent years, which is good.)

The point that I’m trying to make is this: getting everybody health insurance is just the baseline. It’s crucial but insufficient. I would have never found out how deeply involved the disease is with issues of class if I hadn’t gotten it myself. And it’s important that everybody realize how much more difficult poverty makes treating illness even if people have insurance.


12 thoughts on “Type 2 Diabetes and Social Class

  1. Everything about healthcare is associated with class. That’s why life expectancy among the poor is in decline. They don’t get screened. Diagnosis and treatment tends to be late. Stage IV for many diseases is still largely a death sentence.

    The other side of this is that the latest and greatest treatments for specific diseases aren’t distributed equally across the country. Arguably, the preferred treatment venue for brain tumors is Duke University Hospital. For prostate cancer, based on a new report, it may be the Univ. of Texas at Houston. However, most people can’t afford to leave work and pack up and move someplace for several months for treatment.

    That’s where a company like Aflac fits. The company has policies starting at around $20/month that provide case to people to help deal with medical expenses (copays, deductibles and other expenses health insurance doesn’t fully cover, or cover at all, like travel). My wife has had an Aflac accident policy since 1990, and she’s received roughly a 300% return on the policy.

    So there are resources that supplement the ACA to help people cover their expenses. Sufficient resources? Not necessarily. But the odds of getting universal healthcare through in the current climate is probably slim to none.


    1. “the odds of getting universal healthcare through in the current climate is probably slim to none.”

      The odds are “NONE.” Remember in last night’s DEMOCRATIC debate where Hillary criticized Sanders’ plan for single-payer healthcare as actually being a big tax increase on the middle-class?


  2. And the best, most helpful thing for people with diabetes mellitus is psychological assistance of the expensive kind (meaning the drug-free one).
    Ok, why do you think this? In other words, what about diabetes specifically requires psychiatric help?


    1. No, as I said, it’s the opposite of psychiatric. Psychiatry prescribes drugs and gives diagnoses but this won’t help diabetics. What’s needed is pecisely non-psychiatric help that will assist people with accepting the need for a complete lifestyle change, help them settle into a routine, quit smoking, quit alcohol, quit binge – eating, emerge from a chaotic lifestyle into a very strictly controlled one.

      Many people won’t understand this but for me, for instance, the most enormous, incredible achievement of my psychological treatment is that I now can get up in the morning, brush my teeth, get dressed, have breakfast, read the paper, and settle down to work. It sounds so simple but I never ever thought I would be able to live such an orderly, simple lifestyle. And without an orderly lifestyle, there’s no managing diabetes.

      These are all also issues of social class because disordered, chaotic lifestyles are more common among the more deprived people.


  3. My eldest daughter is currently undergoing treatment for Hepatitis C which she has had since her birth due to a bad blood transfusion. A 12 week course of anti-Hep C pills will cost $80,000 of which her healthcare plan at the University of Michigan is going to pay the entire amount except for a $15 dollar deductible. It’s not just class but also your employer’s healthcare plan.


    1. It’s not just class but also your employer’s healthcare plan.
      Which, again, is strongly linked to class. Who, overwhelmingly, has great healthcare plans through their employers? If you have a great healthcare plan you either 1)make over a certain amount or 2)are in a workplace that is strongly unionized.
      Big employers who want to maintain the reputation of being great employers cling to having great healthcare plans; and those that don’t will just issue nam-ke-vaste plans and force their employees on the exchange, where the health plans are a joke.


  4. Ongoing support is needed because even a very compliant patient can find his/her disease progressing and that can be very demoralizing. You can do everything right and your diabetes can still get worse. It is very complicated condition and it evolves over time.


    1. Absolutely. Many people like to be judgmental of the sick folks for not keeping to the diet, not losing weight, not quitting smoking but that’s a profound incomprehension of coping mechanisms and the difficulty of creating different coping mechanisms without any help.


  5. Though I should add that the support doesn’t have to come from a psychologist necessarily. An ongoing relationship with a diabetes educator, nurse or doctor could very well do.


    1. The diabetician I had back in 2013 was just so not good, especially when she had to work with anybody who was not on the very typical American diet. And we are a small town, we didn’t have an alternative specialist. Of course, people with cars can drive to another city. But that, once again, is social class issue.


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