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Obamacare Hits the Most Vulnerable

The opinions expressed by columnists are their own and do not necessarily represent the views of

Everyone agrees that the burden of dealing with escalating health care costs should not fall on the most vulnerable, right? Democrats in particular are always at pains to convince us that they are sensitive to the needs of the less fortunate. Yet among the many new taxes Obamacare will impose is one that hits wounded veterans and sick children especially hard -- the 2.3 percent annual tax on medical device manufacturers set to begin in 2013.

All of those fantastic prosthetic limbs, powered wheelchairs, stents, pacemakers, artificial hips, and other miraculous technologies that improve the lives of maimed soldiers will now be more expensive. Some estimates suggest that the tax will amount to 17 percent of profits for the industry.

As Ed Morrissey reported last May, Massachusetts medical device companies have already begun to plan layoffs to cope with the new tax. According to the Massachusetts Medical Device Industry Council, "(A)bout 90 percent of the 100 medical-device firms said they would reduce costs due to the new tax tucked into the recently passed health-care reform bill."

Almost certainly, this will mean reductions in research and development. As the maxim goes: If you want less of something, tax it. If you want more of something, subsidize it. By taxing medical devices, Obamacare has probably postponed the day my 17-year-old Type I diabetic son is most looking forward to -- the invention and marketing of an artificial pancreas.

In Type I diabetes, the pancreas, probably as the result of an autoimmune process that is incompletely understood, abruptly ceases to produce insulin (whereas in Type II diabetes, the far more common type, the body gradually loses its ability to use insulin). Our son was 9 when he was diagnosed. Normal blood sugar is between 60 and 120. David's was over 700 when we checked him into the hospital. Without daily injections of insulin (it cannot be taken by mouth), along with multiple finger sticks to check blood sugar levels, Type I diabetics would sicken and die.

The first wearable insulin pump was invented by a Los Angeles physician in the 1960s and was so large it had to be carried in a backpack. Today's versions are about the size of a cell phone and easily slide into a pocket. Through an infusion site inserted three times a week under the skin, pumps deliver a steady dose of insulin 24/7. The user also "boluses" or gives himself extra insulin every time he eats based on carbohydrate counting. Modern pumps also help diabetics with the complicated calculations of dosages based on activity level, carbs consumed, the presence of ketones, and other variables.

Short of a cure, the great hope of Type I diabetics everywhere is the artificial pancreas. The insulin pump (or an improved model that can dispense glucagon as well as insulin) is half of the equation. The other half is the CGM or continuous glucose monitor. The CGM measures blood sugar using a catheter under the skin, and has only been available since 2007. CGM is in its early stages and requires more work before it can completely supplant finger sticks (because it measures glucose in interstitial fluid, there is a lag time of up to 15 minutes).

But the Holy Grail will be an integrated system consisting of a pump and CGM that talk to each other -- amounting to an artificial pancreas. Such a system, while not without nuisance and discomfort, would solve two huge problems: 1) It would significantly reduce the danger of extremely low blood sugars, which can lead to sudden death by warning the user about plunging glucose levels, and 2) reduce the incidence of diabetes complications like blindness, heart disease, and amputations to near zero for conscientious users.

But the 3 million Americans with Type I, including nearly 180,000 under the age of 20, will have to wait.

We have ensured, through Obamacare, that we will get less research and development of medical devices. We have also guaranteed that medical spending will increase dramatically. In Massachusetts, which passed a similar "reform" in 2006, health spending has increased by 8 to 10 percent per year, double the national average. And yet 200,000 Massachusetts residents remain uninsured.

Obamacare is a train wreck of a law. We cannot rely on the courts to reverse it. The only hope for sensible policy, both for fiscal and physical health, is repeal.

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