Look out obese America!
You have assumed from smokers the mantle of Public Health Enemy
No. 1, this time in the federal fight against fat and the bottom
line.
Of course, federal lawmakers are coming after the nation’s
overweight to save them — from themselves — and they
apparently want to spend a lot of money on this rescue
operation.
Just how much isn’t yet clear.
This week, a bipartisan group of U.S. representatives,
including Wisconsin western
district Congressman Ron
Kind, introduced the Treat
and Reduce Obesity Act,which would
give Medicare beneficiaries and their health-care
providers “additional tools” to treat and reduce obesity.
“We know how severe the health risks of obesity are, and the
actual costs of care for obesity-related illnesses are just as
alarming,” Kind said in a statement. “This bipartisan legislation
will help bring health care costs under control, by providing more
tools for those trying to overcome obesity and lead longer,
healthier lives.”
Among its provisions, the bill would “allow” Medicare to cover
additional obesity treatments such as prescription drugs for
chronic weight management, which Medicaid already covers in more
than 20 states. Weight-loss surgery is the only obesity treatment
tool currently covered by Medicare.
The legislation also would require the Centers
for Medicare and Medicaid Services to highlight Medicare
coverage of intensive behavioral counseling for obesity for seniors
and their doctors, and give CMS authority to “enhance Medicare
beneficiary access to benefits for intensive behavioral counseling
by allowing additional types of providers to offer this
service.”
THE BOTTOM LINE: A bipartisan bill making its way through the
House would pump more money into America’s growing obesity
problem.
There’s no doubt about it: Obesity is a huge health issue in
America, with related health-care costs pegged at nearly $200
million.
A 2009 report titled, “The
Future Cost of Obesity: National and State Estimates of the Impact
of Obesity on Direct Health Care Expenses,” estimates that
“if current trends continue, 43 percent of U.S. adults will be
obese and obesity spending would quadruple to $344 billion by 2018.
The report was based on research by Emory
University health-care economist Ken Thorpe,
Ph.D., executive director of the Partnership to Fight Chronic
Disease.
Thorpe this week teamed up with former Wisconsin Gov. Tommy
Thompson, who served as Health and Human
Services secretary under President
George W. Bush, to urge policymakers to act expeditiously
in fighting what they and many others define as an obesity
epidemic.
Thompson, in the op-ed piece headlined, “Targeting
Obesity with Health Care Reform,”warned, “We cannot afford to
wait until patients are on Medicare to fight obesity. Rather, we
need to encourage weight control over the course of patients’
lives.”
In other words, the government needs to save the increasingly
average American from himself.
Thompson had some kind things to say
about Obamacare and the potential for its applications,
some things he may not have gone on the record to say when he stood
by repeal of the contentious health-care act during his unsuccessful
bid for U.S. Senate in 2012.
“Fortunately, we now have an ideal opportunity to implement
reforms. The new health insurance exchanges created under
the Affordable Care Act can
establish effective care coordination strategies to
identify and treat chronic conditions earlier, addressing not just
the immediate conditions but the underlying ones as well,” the
op-ed piece asserts.
Thompson and Thorpe argue Medicare can adopt the strategies, and
the “benefits for both patients and taxpayers will be
substantial.”
Proponents of government intervention into a chronic condition
now classified as a disease by the American
Medical Association, say federal investments – whatever they
may be – will pay off multi-fold over time.
Perhaps these prevention crusaders would be well served to dust
off a 2009Congressional
Budget Office report which shows preventative medicine –
at least the kind the federal government likes to doctor – is
rarely cost-effective.
Pound of prevention
How much would the Treat and Reduce Obesity Act, or TROA, cost
taxpayers? Nobody seems to know. Kind’s office did not have cost
projections. An official from the Congressional Budget Office on
Thursday told Wisconsin
Reporter there won’t be a fiscal estimate until the bill
is reported out of committee.
In an August 2009 letter to the House’s Subcommittee on Health,
the Congressional Budget Office broke down its analysis
titled, “The
Budgetary Effects of Expanding Governmental Support for Preventive
Care and Wellness Services.”
In short, “expanded governmental support for preventive medical
care would probably improve people’s health but would not generally
reduce total spending on health care.”
The problem, according to the CBO report, is that even when the
unit cost of a particular preventative service is low, costs can
accumulate quickly when a large number of patients are treated
preventively. Such is the case in Wisconsin, where 28
percent of the population is obese, in a nation with a 26.2 percent
obesity rate.
Thorpe argues institutional changes could save the United States
$200 billion in obesity-related health-care costs.
The CBO report, however, notes that researchers who have
examined the effects of preventive care “generally find that the
added costs of widespread use of preventive services tend to exceed
the savings from averted illnesses.”
A research paper in the New England Journal of Medicine,
after reviewing hundreds of previous studies on how preventive care
affects costs, concludes that less than 20 percent of the services
that were examined save money, while the rest add to costs.
A study by researchers from the American Diabetes
Association, the American Heart Association and
the American Cancer Society found use of highly
recommended preventive measures aimed at cardiovascular disease
would substantially reduce the projected number of heart attacks
and strokes that occurred but would also increase total spending on
medical care because the “ultimate savings would offset only about
10 percent of the costs of the preventive services on average.”
Of course, as the CBO analysis points out, just because a
preventive service adds to total spending doesn’t mean it is a bad
investment. Saving a life, improving someone’s quality of life,
most would agree, are inherently good things. But those who argue
they do not come with a cost, or that the cost benefits eventually
outweigh the initial taxpayer outlays, are ignoring critical
research over time.
The CBO also notes the overlap often associated in services
under federally mandated preventive programs.
“Consequently, a new government policy to encourage prevention
could end up paying for preventive services that many individuals
are already receiving – which would add to federal costs but not
reduce total future spending on healthcare,” the report states.
Ted Kyle, a pharmacist and chairman of the Obesity
Society’s Advocacy Committee, has a family history of obesity
and has struggled with the disease.
He said the current health care system as it relates to
overweight Americans is “insane.”
“My health plan would not pay for obesity treatment. I paid for
it out-of-pocket, and in doing so I forestalled the need for
lipid-lowering medicines,” he said. “When my condition (worsened),
they happily would pay for those kinds of medicines but they were
not happy to pay for the costs that would keep me healthier across
the board.”
Kyle said he understands the criticism of those who see the
ineffective results of spending on wellness, preventive and
treatment programs not grounded in evidence-based research. But
Kyle believes the Treat and Reduce Obesity Act would be well worth
the investment.
Freedom to be obese
Curbing obesity, as laid out in the bill, is about encouraging
lifestyle changes. The CBO report underscores the challenge in
government-funded programs to induce people to live healthier
lives.
“Even successful efforts might take many years to bear fruit and
could involve significant costs,” the report states.
And, at some level, it does come down to fruit –that is,
choosing fruit over fast food, say those in the individual rights
camp. It’s a question of choice, they say: The individual’s or the
collective’s. Who makes those kinds of health care decisions is a
growing matter of debate.
This article
originally appeared on Watchdog.org.