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I went to one of Joslin's branch clinics for three years, and all I can say is, the service and care I received there was so terrible, they should be going out of business!

See this post for more background...

It seems that this issue, where diabetes care doesn't pay, is also being highlighted by the NYT as well as in your book.

As someone with diabetes who's concerned about this type of issue what's the most likely way to fix this problem. Does is require legislation that mandates increased coverage for diabetes treatment -- and I THINK that's what we now have in Massachusetts, after several years of hard work by a group of us d-advocates -- or do we start with the insurance companies?

Because here's what I believe. The only way to fix this problem is to get a (large) set of concerned people to act together to influence the folks who can effect a change. My problem is, I don't know whether to start with legislators, or health insurers, or somewhere else.

James, if you were king for a day, where would you start to try and change this situation?

You are absolutely right that the economics of diabetes are bad and getting worse. For example, New York City, which has a population bigger than many states, has only one comprehensive diabetes center, and that survives only because of an endowment from Russ Berrie in honor of his mother Naomi. You can count the number of such centers in the U.S. on your hands, even as the number of diabetes patients swells.

While Joslin's contributions to the field have been many, I believe Kahn's being replaced as CEO is long overdue for many reasons. While a businessman may help Joslin to make some needed changes, the reality is that until our entire medical system shifts away from treating acute illness towards chronic illness, we will never really address the issue effectively.

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