By Tim Bonfield
The Cincinnati Enquirer

Slowing down the rising toll of death and disability from diabetes will require millions of Americans to look in the mirror, become alarmed and start taking better care of themselves.

So says Tommy Thompson, Health and Human Services secretary, who visited Cincinnati Monday for the first of several town meetings about diabetes - the nation's sixth-leading cause of death.

Medicaid called ripe for reform

Even as a controversial Medicare reform bill rolls out during the next two years, a top federal health official says Medicaid should be the next big program to be reformed. Tommy Thompson, secretary of the Health and Human Services Department, said state budgets are being slammed by the rising costs of providing health services for the poor. And there isn't support in Washington to pump more federal money into the program. "Medicaid has to be transformed," Thompson said Monday at a meeting with the Enquirer's editorial board. "The costs of health care are so big and they keep going up, so we have to put more emphasis on prevention." Thompson said Monday he is waiting for an association of governors to recommend a Medicaid reform plan because the Senate shot down a reform proposal he made a year ago. "It has to be a bipartisan group of governors," he said. Thompson said he supports the idea of splitting Medicaid into two programs, one for long-term nursing care, the other for acute health care. One could be paid for by the federal government, the other by states. But even if such a proposal is made, Thompson won't be around to deal with it. Even if President Bush is re-elected in November, Thompson said he plans to step down as health secretary. He would not speculate on what he plans to do next.

"This is a serious problem facing our nation and a problem that if we don't do something about, it's only going to get worse," Thompson said during the session at the Netherland Hilton Hotel downtown.

But to hear it from an audience of several hundred that was peppered with people wearing red "Diabetes Advocate" T-shirts, Ohio isn't doing nearly enough to help people face this chronic disease.

Several speakers won loud applause as they blasted state officials. Ohio is among the last three states in the nation that haven't required insurers to cover diabetes supplies and the training programs needed to teach people how to care for themselves.

"I'm really, really disappointed in what Ohio has done on diabetes," said Maggie Sullivan, a nurse who has Type I diabetes. "I've had good coverage all my life. But in my job, I see people every day who have not been offered the same benefits I've had."

More than 18 million people nationwide have diabetes, which means their bodies cannot properly control blood sugar levels. That figure could rise to 39 million people by 2050, according to the Centers for Disease Control and Prevention.

Diabetes already is the nation's leading cause of blindness, foot amputations, and kidney failure - which leads to the need for expensive dialysis treatments and rising demand for kidney transplants. Diabetics are up to four times more likely than others to suffer heart attacks or strokes.

Some have Type I diabetes, also known as juvenile diabetes or insulin-dependent diabetes. For these people, their pancreas doesn't make enough insulin to keep blood sugar levels in proper balance. Most take insulin shots and some depend on insulin pumps.

Most have Type II diabetes, which used to be called adult-onset diabetes but isn't anymore because so many children are being diagnosed with the condition. Type II diabetes is closely linked to obesity, and many experts say the rising number of cases is due to people eating too much and not getting enough exercise.

For most of Monday's town meeting, panelists described what state health departments, local schools, insurance companies and researchers using federal grants are doing to combat the disease.

"Diabetes is an epidemic in the Commonwealth of Kentucky. Since 1995, we've seen a 50 percent increase in diabetes," said Dr. James Holsinger, secretary of Kentucky's Cabinet for Health Services.

But Holsinger also said it appeared unlikely, despite three months of lobbying, that the state legislature would create a commission for promoting healthy lifestyles.

U.S. Secretary of Health and Human Services Tommy Thompson, far left, and other panel members view a presentation at a Diabetes Town Hall Meeting held Monday at the Hilton Cincinnati Netherland Plaza in downtown Cincinnati. (Gary Landers photo)

Jerry Mallicoat, a senior vice president of Anthem Blue Cross and Blue Shield and a leading member of Gov. Bob Taft's Healthy Ohioans Business Council, said that group's latest effort is to develop an awards program to recognize companies that promote healthy workplaces.

"It's really the little things that make a big difference," he said.

But Debbie Martin, a nurse with a 6-year-old daughter who has diabetes and an uncle who died at age 56 after complications from diabetes, said insurers and employers in Ohio have things backward when it comes to diabetes care.

"My uncle was a small businessman in Cincinnati, and he could not get insurance for the most basic of diabetes supplies. But he could get coverage for the heart surgery that cost $150,000," Martin said.

While he couldn't speak for other insurers, Mallicoat said most Anthem members already are covered for the services that would be required in a proposed state diabetes bill. He told the audience that his company has resisted the state proposal anyway because mandated benefits tend to drive up the costs of health insurance.

Thompson, who as a former governor of Wisconsin signed the nation's first state law requiring insurers to cover diabetes education, made no comments to the audience about Ohio's lack of action on the same issue. But he did address the topic at a meeting later with the Enquirer's editorial board.

"I'm not going to push legislation on the states. They don't need somebody from the outside telling them what to do," he said.

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E-mail tbonfield@enquirer.com