top of page

A Hobson's Choice?


When a choice isn't really a choice

When offered a choice between the last chocolate chip cookie in the case or nothing at all that is still a choice (1). But when that cookie is swapped out for your lifesaving devices and medicines is that a choice we can live with?

Sadly, our choices are dwindling. As a person with diabetes who has lived over a half a century I want to raise the issue of a looming crisis. It's the matter of dwindling choices which patients with diabetes and their families are experiencing in regards to diabetes devices and medications. The phenomenon driving this is known as commoditization. It's hardly a new concept and inhabits many other facets of our lives. For example, we're quite comfortable with price being the primary reason we purchase many food products, fuel, phone service, and utilities. With commodity items, price generally drives demand. Everyone wants cheaper gas, water and electrical power since the products are considered largely equal regardless of provider. Quality is "assumed". In the world of diabetes supplies, where patient access to devices and medications has an intermediary, the pharmacy benefit manager, the people making the decisions are not the patients, but rather the insurers and their agents. Over the last several years, more diabetes supplies and technologies have moved into the commodity category. Insulin, insulin pumps, and glucose meters lead the list. This