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Interesting and valuable post. I believe those with diabetes will appreciate your post. Thanks.

Gaining favor with employer groups, health-care organizations and health payers, these programs are being increasingly questioned

Well what are us people with chronic disease and pain supposedf to do if we don't have insurance.

I guess we will just have to die huh

Most people don't realize that the majority if there health conditions derive from past actions and occurances. Eventually you will reap what you sew.

thanks lot

Excellent articles and some very sound advice.

Type 2 Diabetes, the main reason behind is the unawareness of people towards the food that must be consumed.

I am following your comments about chronic disease management with great interest. I agree that patients must take more responsibility for their health, but their behavior -- like most things -- is determined by multiple factors.

I remember reading one physician's quote that non-compliant diabetics should be fired from their practice. That appears to be the logical extreme of adhering to the doctrine of personal responsibility.

On the other hand, I also know patients who do not have the intellectual capacity to understand the information they are being presented, despite our use of video, comic books and printed material to explain the principles of self-care. Some are too financially constrained or socially overwhelmed to do the right thing. Sometimes paying the rent and putting some food on the table is m ore important than exercising or taking your pills. Other patients are too depressed to motivate themselves to proper self-care. Others seem to have had some unpleasant interactions with the healthcare system or perhaps a personality disorder (this is a somewhat charitable way of describing the peculiar dysfunctional manipulations of a sorry minority).

The grand fallacy of relying on personal responsibility is that people have at their disposal all the choices to be made. The worst can't do better.

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