By M.D. Kittle | Wisconsin Reporter
MADISON – 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.”
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 2009 Congressional 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.
Contact Matt Kittle at firstname.lastname@example.org