Silent & Expensive: The Truth About Diabetes and High Blood Pressure

Nearly half of American adults have high blood pressure. Over 40 million people have been diagnosed with diabetes, and another 115 million are prediabetic. Most of them feel completely fine — while the damage builds silently in their arteries, kidneys, and nerves.

In this episode, host Paul Thomas breaks down what diabetes and hypertension actually do to the body before symptoms ever show up, and what they cost: a $412.9 billion annual diabetes bill, $219 billion in hypertension-related costs, and complications like dialysis running $54,000 a year or more. He explains — without conspiracy and without sugarcoating — why American drug prices work the way they do, what's actually changed under recent Medicare reforms like the $35 insulin cap, and why zip code, food access, and income shape who gets sick and who doesn't. And he addresses a trend too few people are talking about: type 2 diabetes, once called "adult-onset," is now rising sharply in kids and teens.

This isn't a scare tactic. It's the data, laid out plainly, with a clear answer to the only question that matters afterward: what are you going to do about it?

In this episode:

• Why hypertension and diabetes are called "silent diseases" — and what silence actually costs
• The real financial burden of chronic disease, from diagnosis to complications
• An honest look at U.S. drug pricing and what the Inflation Reduction Act changed
• How food access and geography shape health outcomes
• The alarming rise of type 2 diabetes in American youth
• What the research actually supports for prevention and management — no hedging, no hype

Transcript

SPEAKER_00 0:09

Somewhere in America right now, while you are listening to this podcast, someone is being told for the first time that they have a disease that they did not know about. They feel fun, they went in for something else: a physical, a work screening, a headache that could not quit. And the data came back with a number, a blood pressure reading, a blood sugar level, and in that movement their life spit before the eyes. That person does not know it yet, but they just joined a club with over 130 million American members. You may already be one of them, you may be 30 days away from becoming one, and I am not saying that to scare you, I am saying it because somebody has to, and most of the healthcare industry has no financial incentives to say it as plain as I am above to tell you. Welcome to the healthcare management masterclass podcast. I am your host, Paul Thomas, and I am not here to comfort you today. I am here to tell you the truth, the whole truth. For the next one hour, no matter how uncomfortable it gets. If you cannot answer that in five seconds, I already know something you do not know. I know you are guessing about your own body, and guessing is exactly how 130 million Americans end up where they are. This episode is not for people with diabetes or people with high blood pressures. That femin is a trap, and it is the first thing I want to take away from you today. This episode is for the 26 years old eating gas station food between two jobs, the mother stretching one gracious budget across three kids and four jobs worth of exhaustions. The man in his 50s who has not seen a doctor since his kid created high school, the teenager who thinks this is an all-pressing problem, and I am going to prove to you in the next few minutes wow that stop being truth, and it is for you. Yes, you especially you just felt that sentence bounce off you and lean on someone else in your head that deflections does not protect you. That is the exact mechanism that get people that knows as 50 instead of morning at 30. Here is the only promise I am making you today. By the end of this episode, you will not be able to see nobody did not tell you what to do with the information is up to you. Let's start with the questions nobody asks as loud. People stuck on at a birthday party like it is milk, inconvenience in still of one shot. When did carry a pillow organizer become a wrath of passive instead of a red flood? Here is what's actually happening in this country. Nearly half of all American adults, 48.1%, roughly 120 million people have high blood pressures right now, according to the CDC, most national health survey not at risk of half it right now while you are listening to this podcast. Nearly 60% of non-Hispanic black adults live with high blood pressure compared to roughly 45% of white Hispanic and Asian adults. That gap is not random, and we are going to talk honestly about why in the next episode. Diabetes is not far beyond the most recent CDC figure put over 40 million Americans living with diagnosed diabetes and another 150 million adults with pre-diabetes. Add it up and you are looking at a world over half of the entire adult populations of this country either managing this disease or standing one bad decade away from it. I want you to sit with that that is not France conditions, this is an American default setting. If you are metabolically heard of in America today, you are statistically the exceptions not the rules, and yeah, the part that should really stop you in your seat. This is no longer just another problem. CDC funded research through the search for diabetes in young studies found that tattoo diabetes diagnosis in kids and teenager rose 95% between 2001 and 2017. That if current trends continue that two diabetes kills in people on 20 horas but has smashed as 700 by 2016 with the sharpest increase hitting black, Hispanic, Asian, Pacific, Islanded and American Indians or Alaska Native Youth. We are not talking about a disease of Asian animal. So again, when did this become normal? It is not happening overnight, it happens once kid wake up at a time, one fast food dinner because there was no time to cook and no energy left to try. Once I will get my blood pressure check next year, that turned into five years, one decade of five hours of sleep because hustle culture told you rest was weakness and stillness failures. The disease does not announce itself, yet it's what makes this genuinely dangerous, not annoying, not inconvenience dangerous. High blood pressures and tattoo diabetes are silent skills. They do not harm, they do not slow you down at first. They do not send you a warning text. You can have both conditions feel completely normal, go to work, raise your kids, hit the gene on a good week, and still be sustaining real measurable compound internal damage the entire time. While you feel completely fine, high blood pressures is quietly scanning your authorite, screening your heart muscle, damaging the delicate fatorin structures in your kidney and putting pressure on the blood vessels in the back of your eyes. While you feel completely firm, elevated blood pressure sugar is quietly damaging blood vessels in the nerve throughout your body, raising your risk of heart disease, kidney failures, vision loss, stroke, and in advanced cases, amputations. Data call this silence disease for a reason. And I want to walk through what silence actually causes in the body because the word makes it sound gentle, it is not gentle. Let's talk about kidney specifically, one of the most undiscussed consequences of both conditions. Diabetes and hypertension are the two leading causes of chronic kidney disease in American adults. More than 37 million adults are living with it. Here is that part that should genuinely alarm you. As many as 6 out of 10 people with chronic kidney disease do not know they have it. Do not know it is silently progressing in 10 of millions of Americans who feel complete defined. And it progresses in stage. CDC research tracking medical patients found that early stage kidney disease cost roughly 1800 to 9500 a year to manage. But once it advanced to kidney failures, what is called end-stage Breakman disease that another cost jumped to more than 46,000 for dialysis and treatment for a kidney transplant can run over 79,000 in the first year alone, more than once in every $3 Medicare spent on kidney patients. 141.1 billion a year goes towards treating chronic kidney disease. About 360 people begin dialysis or transplant treatment every single day in this country. A meaningful share of them are working that role because hypertension or diabetes went unmanaged for years. Now let's talk about amputations because I am not going to soften this. Diabetes related lowered extremity amputation is not right and it is not cheap financially or physically. Research tracker Medicare beneficiary form the average cost of an amputation event run close to 36,000 in the year it happened and continue costing thousand more every year after. Beyond every one of those numbers is a person who woke up one day and could no longer walk the way they used to. A basis kidney function partner these are 5 to 15 minutes check that can tell you the truth. Yes, sometimes a full decade before your body force you to hear it the hard way. One that trees a few minutes of meal discomfort now for years, sometimes decades of expensive, irreversible damage later. Now let's talk about money because this is where the obstructions end in the bank statement begins. The American Debesity Associations put the total annual diabetes in this country at 412.9 billion that is 306.6 billion in direct medical costs and another 106.3 billion in lost income missed work and reduced productivity people with diagnosed diabetes non-account for roughly one out of every four healthcare dialogue in America one in four for one disease and it is getting worse not better. Medicare medical cost for people with diabetes claimed 35% over the last decade. Insulin spending alone has tripled since 2012. If you have diabetes, your health care costs run 2.6 times higher than someone who does not, meaning a disease that already touched one in four healthcare dollars is trending towards a higher share, not a smaller one. Hypotentials tell the same story on a different scale. The CDC estimates the annual cause of high blood pressures in the United States are 219, with people who have it spending nearly 2800 more per year on medical care than people who do not. In 2024, high blood pressure was primarily all distributing cost of more than 680,000 deaths in this country. Now I'm stuck the complications on top of the basis disease because this is where family get blindsided a born Medicare beneficiary alone, diabetic complications, kidney disease, heart failures, amputations and other cause over 35 billion in a single year. These are worst case horror stories. These are documented average drawn from real medical claim data for outcome that happened to real people every single day in this country. The 455 pills I open this podcast with. People ask me all the time why is American healthcare so expensive? I am not going to give you a conspiracy, I am also not going to give you a fairy tales, I am going to give you the truth, which is mercier than either doctors, nurses, and misses of overwhelming it go into medicines to take care of people. That is real. But they operate inside a system, hospitals, insurers, drug manufacturers, wholesaler, femic benefit managers, fast makeup that has to generate revenues to keep functioning. That is also real. Both of those things are true at the same time, and pretending all the while does not help you. Just press in the United States are shaped by research costs, patient protection, manufacturing, competitive, and critical it a negotiation structures that is different from almost every other wealthy country. In most peer nations, government negotiates job press directly with manufacturers before a just event reaches a fantasy shift. Here, press has historically been set through a tangle of negotiation between manufacturers, insurers, and fantasy benefit managers with the patience often have the least leverage of any in that room. That is starting to change. The first round of negotiated press to infect in January 2026, covering 10 drugs with discount of lease press ranging from 38% to 79%. $35 a month and starting in 2025, Medicare Paddy added its first ever honor capped on out of packet just costs now sitting at roughly $2,100 a year, replacing what used to be unlimited exposures for beneficiaries with expensive conditions. It is also not finished line. 50 more drugs get added to the negotiations for 2027 and 2028. And 20 more each year after that. And some manufacturers has responded negotiated discount by raising land price as well in their portfolios, which tell you the online incentives structure has not been rebuilt just partially constrained. So yeah, the honest answer to why does it cost so much? Is there evidence that the American healthcare system is deliberately designed to keep people sick for profit? No, I am not going to tell you that because it is not supported by the evident, and I am not in the business to tell you comfortable lies or scare you. What the evidence does show is a system with competitive financial incentive, incentive that does not always line up with keeping you healthy, and that mismash is worth being angry about and worth demanding continued reforms for without addressing it as a plot. The most expensive health care in America is late health care. A heart attack costs more than a decade of blood pressure medications, a dialogue costs more than preventing diabetic kidney disease, even could have. Stay informed, stay proactive. And remember, your greatest investment is not the money in your account, it is the health that lets you enjoy it.