Diabetes Could Sink Medicare, Study Suggests

WASHINGTON — How big a health threat is diabetes?

Consider this: At least 1 out of 8 federal dollars spent on providing health care go to treat diabetes and its complications. Moreover, that figure could double in the next two decades.

And "if the incident rate is going to double," said Mary Kahn, spokeswoman for Center for Medicare and Medicaid Services, "it's clear that its cost could threaten the continued viability of Medicare and Medicaid unless dramatic steps are taken to prevent and control the disease."

That mirrors the conclusion of a major study of federal spending on diabetes this year financed by Novo Nordisk, a health care company that manufactures diabetes products.

The study, conducted by Mathematica Policy Research Inc., found that $60 billion – roughly three-quarters – of the federal money spent on treating people with diabetes in 2005 came from Medicare, the federal program for the poor and elderly. That's nearly 1 out of 5 Medicare dollars spent annually.

One study found that roughly three-quarters of the federal money spent on treating people with diabetes in 2005 came from Medicare. That's 1 out of 5 Medicare dollars spent on managing the disease every year.

"Considering it now costs the federal government $80 billion to take care of people with diabetes, these costs will pale in comparison when there are 138 percent more Americans with diabetes in 2025," said Sean Clements, associate director of media relations for Novo Nordisk.

Another study, reported in April by the American Association of Clinical Endocrinologists, said Medicare spent $88.3 billion in 2006 on diabetes and related illnesses.

Determining precisely how much Medicare spends on treating diabetes is difficult because the disease's complications are often reported as other ailments – including heart disease, stroke and high blood pressure, according to a U.S. Centers for Disease Control and Prevention fact sheet.

One thing is clear, however. The bite diabetes takes out of Medicare is big, and likely to get much bigger.

In 1994, no state had 7 percent or more adults with diabetes. In Florida, less than 5 percent of adults were diagnosed.

By 2005, half of the states – including Florida – had adult diabetes rates of 7 percent or more, according to the National Center for Chronic Disease Prevention and Health Promotion.

Despite its prevalence, diabetes still may not be the costliest ailment for Medicare. A 2003 report in the journal Health Affairs found that while diabetes accounted for about 18 percent of Medicare fee-for-service beneficiaries, compared with 14 percent for congestive heart failure, the latter accounted for 43 percent of Medicare fee-for-service spending.

But Ann Albright, director of the CDC's division of diabetes translation, said two factors combine to increase diabetes' impact on Medicare: Americans are living well beyond age 65, and the incidence of diabetes tends to increase with age.

That's important to health officials in Palm Beach County and the Treasure Coast because nearly 40 percent of people with diabetes are 65 or older.

Albright traced the growth of diabetes to lifestyle and other changes that sparked an obesity explosion in the 1980s, echoed by a jump in diabetes in the 1990s.

That explains why roughly 90 percent to 95 percent of all diabetes cases in the United States are type 2 – formerly known as noninsulin-dependent diabetes – according to the CDC.

"That's great news," Albright said, because "we know that you can prevent or certainly postpone the onset of type 2 diabetes."

Added Kahn: "In 2001, we could have saved nearly $3 billion in the Medicare and Medicaid programs if we had appropriately treated this disease."

American Diabetes Association spokesman Zach Goldberg noted that President Bush earlier this year called for an increase of less than 1 percent in the National Institutes of Health's diabetes research and no increase for the CDC's division of diabetes translation.

That doesn't bode well for Medicare in the long term.

"The government has not done much to slow the growth of diabetes," he said, "and eventually the government is going to have to pay for that in the form of more emergency room visits by the uninsured and Medicare and Medicaid recipients."