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Diabetes on the decline? Switzerland votes on single payer!

For those of you who want to read more, go here:

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
Diabetes on the decline? Switzerland votes on single-payer. This is Healthcare Triage News.

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Our first story's actually some good news. Rare, I know. When we talk about obesity or diabetes, it's almost always bad news, but last week, a paper was published in JAMA with something to smile about.

Researchers used the National Health Interview Survey to examine trends in the prevalence and incidence of diabetes in the United States. In the 1980s, those rates were pretty steady. Not surprisingly to anyone who hasn't been living under a rock, rates started to rise after that, and in each year from 1990 to 2008, there was a pretty dramatic increase in the age-adjusted prevalence and incidence of diabetes. But what is surprising is that starting in 2008 and continuing through 2012, there was no significant change. In fact, the incidence seems to be dropping.

Look at these charts. The one on the left is prevalence, or the number of people per one hundred persons per year who have diabetes: stable in the '80s, rising scarily in the '90s into the 2000s, but starting in 2008, the number of people has flattened. That's progress.

This chart's the incidence of diabetes, or the number of new cases per one thousand persons per year: same rise as with prevalence, but starting in 2008, the rate's been dropping. Dropping!

There are always caveats. There have been changes to how diabetes is diagnosed over this time, but the 1997 changes were well into the increase and didn't seem to affect the rate much. The 2010 change shouldn't have affected things that dramatically, either, and there are still subgroups, such as Hispanic and African American adults, for whom incidence is still rising, and even if the incidence continues to drop, the increased prevalence will mean that diabetes-related health issues and costs will continue to be a problem in the US.

That said, any good news about diabetes in the United States is welcome. If this is real, then something has changed. A continued decrease in the incidence of diabetes in the future will have major implications for our health and our spending on health care.

In international news, the Swiss just took a vote on whether to completely overthrow their health care system. Hey, Stan, can we borrow that Switze-reel from CrashCourse World History?


Fans of our series on international health care may remember that Switzerland has a universal system that relies on the mandated purchase of private health insurance. There's a number of similarities to what we in America just established with ObamaCare, minus the Medicare and Medicaid. If you want to stop here and go watch the Switzerland video to catch up, we'll wait. Actually, no, we won't, but you can pause me and come back on your own.

The knock against Switzerland's system is that it's expensive, somewhat inefficient, and relies a lot on out-of-pocket spending. Its outcomes and access are really great, though. Some advocates collected more than a hundred thousand signatures to compel a vote on turning their system into a single-payer one. Think Canada. You did watch that video, right? I mean, these international health care system videos are a hit. The prime minister of Singapore tweeted about our one on his country. You really should be watching them.

Anyway, although some initial polling made this look like it might happen, it's not going to. About two thirds of voters opposed the change. They made the decision that they'd rather pay the extra money for what they're getting. So be it.

On a personal note, we appreciate not having to redo the Switzerland video, so, thanks, I guess.

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