Wil Dubois

Welcome back to our weekly diabetes advice column, Ask D'Mine — the final edition before the New Year, 2018!

As we exit what's been an oft-stressful and uncertain year in politics and healthcare in particular, our own veteran type 1, community D-educator and author Mr. Wil Dubois is taking a moment to peer into his crystal ball at what's possibly ahead in diabetes this coming year.

btw, our team just published our annual comprehensive Diabetes Year in Review 2017, and soon enough we'll offer our annual preview of diabetes nonprofit orgs' plans, and D-technology for the new year.

Meanwhile, here's Wil with his own take...


Ask D'Mine buttonLeslie, type 1 from Colorado, asks: Hey Swami Wil, what do you prognosticate for us PWDs in 2018?

Wil@Ask D’Mine answers: Thanks for writing, Leslie, and thanks for the honorific. It was the first thing that made me chuckle in months. Frankly, I’ve been down in the dumps; I guess it serves me right for trying to be an informed citizen by watching the nightly news. And they say diabetes triggers depression. Hah! Diabetes’ ain’t got nothing on modern reality!

Now, what do I prognosticate? Well folks, you’d better put some Jamison in your coffee this morning because looking into my crystal ball I’m seeing a lot of dark, dark storm clouds building. And for healthcare the darkest of all comes from an unexpected source which isn’t getting the kind of attention it should. Yes, I’m talking about “tax reform.”

By the time you read this, I fully expect that “tax reform” will have passed both houses and been signed into law. I had to put “tax reform” into quotes, because calling it what it is, the most brazen theft of the scant remaining wealth of the underclasses for the benefit of the wealthy, might cause me to be branded a correspondent of the Fake News Network (FNN), and I wouldn’t want that.

Or maybe I would. 

But moving on: The pathetic thing is we could stand some decent tax reform. The conservative side of my liberal nature can even see the logic of aligning our corporate tax rates to better match those of other countries. I’m open to trying that out. I can even see where that might stem the tide of offshoring our industries. Perhaps, it might even stimulate the economy, although history doesn’t support lowering business taxes as a reliable method of stimulating economic growth.

But lowering the taxes on the richest of the rich? By adding to the deficit? Lincoln must be spinning in his grave. But what the hell, maybe some day I’ll be rich too, and I sure wouldn’t want to have to pay my fair share then. So I’m not going to get worked up about that.

And I can forgive and forget all the Christmas presents members of Congress left themselves under the tree this year, hidden in the 429 pages of this bill. You know, all those little perks the leadership had to hand out to buy votes. That’s the way things are done in Washington, no need to get upset about that either.

But when people start killing babies to get richer, well, now I do have a problem with that. Yes, you heard me, our own government has just declared genocide on the poor, and ironically, they’ve killed their own Golden Goose in the process.

Read on, if you dare.

What I’m talking about are the consequences of the removal of the individual mandate that every citizen have health insurance. That I am pissed off about. Really pissed off. Partly I’m pissed off because it’s mixing apples and oranges. It’s a backdoor way to kill the Affordable Care Act, something that the ruling party couldn’t manage to do directly, and has nothing to do with intelligent tax reform. But mostly I’m pissed off about it because it’s stupid.

And I can tolerate a lot of things, but I can’t tolerate stupidity.

Here’s how American healthcare is going to go stupidly down the drain, and it’s going to happen faster than a house of cards collapsing. Let me take you though what’s going to transpire, why babies are going to die, and how this will bite the ruling party in the butt eventually.

In case some of you have forgotten, we are one country. Like it or not, we are interconnected. We are dependent on each other. For example, public health experts have long recognized what’s called the herd effect in vaccines, wherein a large percentage of the population needs to be vaccinated for the vaccine to be effective. The individual mandate was an economic vaccine. It leveled off the costs of our sicker members by asking healthier members to contribute to the national economic burden of health care.

This is what healthy societies do. They take care of each other for the common good.

Of course it didn’t work. This time the Right is, well, right: Obamacare is going broke. Costs are rising. Insurance costs are rising. Insurers are pulling out of some markets. And insurance companies, desperate to hold on to their profits, are covering less, and less, often with flawed logic.

A quick true story: My wife’s insurance company has decided to deny her Victoza, which she’s taken for a number of years. Why? Because her A1C went up. They said, as it wasn’t improving her numbers, they wouldn’t pay for it anymore. I guess they’ve forgotten that type 2 diabetes is a progressive disease. I guess they’ve forgotten that no matter what you do as a patient, it will get worse. But here’s the shortsighted part: If they think her A1C looks bad now, can you imagine what the next one will look like without her primary medication?

Sorry, I got a little side-tracked there. Back to our main subject: Why didn’t the economic vaccine work? 

It’s simple. We started too late. We let our population become one of the sickest in the world before we decided to try to do something about it. Too many people were sick before we started giving vaccines. The epidemic was well underway. Vaccines, economic and otherwise, only work before the illness is widespread.

But pulling the plug now dooms a large percentage of the population. Without some healthy users in the system, the people left in it will eat up the resources disproportionately. Premiums will go up. Coverage will go down. Health plans will get too expensive for some people. Well, more than some. Try 13 million people on for size. Meanwhile the rest of the country will be paying double for their insurance in ten years as the Congressional Budge Office projects an average 10% per year increase in premiums for the next decade. So much for all that extra money in your pocket from that (temporary) tax break. You’ll spend that, and more, just on your health insurance.

Until you can’t afford it any more, and have to drop it.

And as people are forced to drop their health insurance, they will start getting sicker and sicker. They won’t seek care until they are really sick, because they wont’ be able to afford it out of pocket. I’m not kidding when I say babies will die. So too will elders. Within a few short decades I predict that American life spans will be measurably shorter because of this abandonment of our society’s obligation to each other.

But it doesn’t end there. The doomed won’t go silently into the graves. Instead, they’ll go to the Emergency Room for last-ditch help. ERs are the most expensive form of care in the world. And the new uninsured won’t be able to pay their bills. Hospitals will have to absorb those losses by charging more for every other service. We’ll be back to double-digit growth in healthcare costs.

He’s an open secret no one thinks about much: Right now healthcare spending eats up 17.9% of the nation’s gross domestic product. And double-digit increases in costs are unsustainable in an economy, much less in a sector that already comes close to eating up a fifth of every dollar produced.


What was that? Yeah. That was the Golden Goose. Falling to the ground. Dead as a duck. All that beautiful, beautiful money that the ruling party promised would be generated by the tax cuts eaten up by the explosive growth of the costs of healthcare. Simply because they decided to put apples and oranges in the same legislative basket.

I prognosticate it won’t be a happy New Year. For anyone. Sorry.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.