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lapietra 07-20-2004 05:48 PM

OBESITY: Thompson Announces Revised Medicare Policy
News Index

Blue Cross Blue Shield Association, 7/19/2004

As expected, HHS Secretary Tommy Thompson on Thursday announced at hearing of the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education that the department would remove language from Medicare's coverage manual that states obesity is not an illness, but the program will not classify obesity as a disease, the Washington Times reports (Higgins, Washington Times, 7/16). The decision will allow for expanded Medicare coverage of obesity treatments. Previously, the program only covered obesity treatments when beneficiaries also had related conditions such as diabetes (American Health Line, 7/15).

The new policy does not specify which treatments will be covered, but it "opens the door to what is expected to be a flood of applications from individuals, doctors and companies for Medicare to begin paying for therapies," such as stomach-reduction surgeries, diet programs, and psychological and behavioral counseling, the Washington Post reports. Coverage will be extended for "interventions [that] improve health outcomes for seniors and disabled Americans who are obese," according to Thompson. CMS plans to review scientific evidence on treatments for obesity at a meeting this fall and determine which treatments Medicare will cover, according to CMS Administrator Mark McClellan (Stein/Connolly, Washington Post, 7/16).

Demand for Treatment
CMS officials said that it is too early to estimate how many beneficiaries will seek treatment for obesity, the Washington Times reports. According to CDC, which requested the policy change in 2001, obesity contributes to 400,000 deaths each year, making it the second-leading cause of preventable deaths nationwide, the Washington Times reports (Higgins, Washington Times, 7/16).

Currently, 37% of Medicare beneficiaries are overweight and 18% are obese, according to the American Obesity Association. Between 1991 and 1998, the prevalence of obesity among people between the ages of 60 and 69 increased 45%. Last year, Medicare and Medicaid spent $75 billion on obesity-related illnesses, according to a joint report by CDC and RTI, a North Carolina-based research group. U.S. Surgeon General Richard Carmona last year said that the nation spent $177 billion on obesity-related illnesses in 2000 (Simon/Rivera, Los Angeles Times, 7/16).

Implications for Private Insurance
The policy change "suggests that private insurers likely will feel pressure" to make similar policy changes, according to USA Today (Weise, USA Today, 7/16). Several insurers already cover obesity treatments, and many companies said the announcement "will not lead to a change in their policies," according to the Washington Times. About 50% of all large employers cover bariatric surgery, in which the stomach is stapled to make patients eat less, and about 33% of employers offer coverage for the procedure on the condition that employees also participated in behavior-modification programs, according to a 2003 William Mercer National Survey of Employer-Sponsored Health Plans.

An unnamed national panel member of the Society for Human Resource Management said the Medicare policy change could lead to higher health care costs for employers and their workers. "It's going to put more pressure on the system. There's going to be less coverage, higher deductibles and more copays," he said (Haberkorn, Washington Times, 7/16). "From an insurance point of view, you would look at covering things that are more expensive," according to Morgan Downey, executive director of AOA. However, he added, "We think going to the root of the medical problem is better than just treating the symptoms" (Glassman, New York Times, 7/16). Helen Darling, president of the National Business Group on Health, said the new Medicare policy could lead states to adopt mandates on additional obesity coverage, which would increase overall rates and could cause small businesses to drop health plans altogether (Higgins, Washington Times, 7/16). Karen Ignagni, president of America's Health Insurance Plans, said, "We're going to be watching this very closely. We're going to be looking at what they are evaluating and what their results are" (Washington Post, 7/16).

"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely," Thompson said (Higgins, Washington Times, 7/16). McClellan added, "The question is not whether obesity is a disease or risk factor. What matters is whether there's scientific evidence that an obesity-related medical treatment improves health" (New York Times, 7/16). The decision "recognizes that obesity is not simply a cosmetic issue," Richard Atkinson, president of AOA, said. He added, "This decision will open the door not only for better insurance coverage but more medical research and increased education on obesity at the nation's medical and other health schools."

Dr. Peter Pressman, an obesity specialist at the University of Southern California, said, "I'm hoping [the decision] will in effect coerce us as a profession to be more responsible about considering clinical nutrition and obesity as an expanding component of our formal education" (Los Angeles Times, 7/16). Paul Campos of the University of Colorado-Boulder, author of "The Obesity Myth," said the decision is "not just a bad idea -- it's completely unscientific" because being underweight is a greater health problem for the elderly than being overweight (Washington Post, 7/16). Sen. Tom Harkin (D-Iowa) said the measure is a good first step but added, "[W]e are doing precious little to address the root problem: our neglect of prevention and wellness" (Higgins, Washington Times, 7/16). He added, "This is illustrative of the problem we have with Medicare. If you've got a problem, we'll fix you. Medicare should have programs to prevent obesity" (Washington Post, 7/16).

AllegroNg 07-21-2004 01:33 AM

Oh boy! :stapling stomach:

trisherina 07-21-2004 03:54 AM

Oh man! Bariatric surgery is horrible!

zenbabe 07-21-2004 04:05 AM

quit eating shit and you wont be fat...oh yeah...and don't forget to excercise....

funkytuba 07-21-2004 05:23 AM


Originally posted by zenbabe
quit eating shit and you wont be fat...oh yeah...and don't forget to excercise....
quit moving to Arizona and you won't have to deal with 113 heat....oh yeah...and don't forget to write....

lapietra 07-21-2004 02:53 PM


Originally posted by zenbabe
quit eating shit and you wont be fat...oh yeah...and don't forget to excercise....
See - that's the thing.

The way everything's set up - it's getting harder and harder to do this. Hence the higher percentage of fat people in America (and other countries, for that matter) lately.
It's all well and good to tell people this. Creating an environment where good habits and awareness of the difficulty in keeping them up integrated into our daily lives would go a long way toward reversing this trend.

Saying things like this doesn't empower people to do what's good for them. Obviously.

masterofNone 07-21-2004 03:30 PM

i really have no idea what to think about this. clearly something needs to be done to address it... i'm just not certain if it's good public health policy. i think we'd be better off dealing with it through education and counseling, maybe? i've never really had a problem with weight unless it was being too skinny when i was a kid. i think i feel about this the way i feel about abortion. it doesn't affect me personally so i'd be hesitant to get behind any legislation either way.

lapietra 07-21-2004 03:33 PM

Yeah - I had that thought too - that people who don't have problems with weight, whether it be because of metabolism, thyroid issues, diabetes, or just plain old overeating and underexercising, don't need special programs or health coverage...

Aphrodite 07-21-2004 08:37 PM

Since this is what I do for a living, I will add my nickle's worth of advice.
I teach and motivate good eating habits. I teach and motivate good physical activity concepts. I teach and motivate people to use educated judgement when faced with unhealthy situations.

The majority of my clients right now are Doctor referals. I could do well if I advertised more.

I am paid by the client, and while this adds to their motivation and commitment, it would improve things for the client and myself if the gov't or insurance paid a portion. I could then hire more staff and help more people. The illnesses related to obesity cost our health systems far more than would good quality weight management programs.

priceyfatprude 07-21-2004 08:50 PM


Originally posted by zenbabe
quit eating shit and you wont be fat...oh yeah...and don't forget to excercise....
She's blunt but she's right.

No one ever got fat from bingeing on broccoli and fresh black grapes.

lapietra 07-21-2004 09:09 PM

Well of course she's *right* -

My point is - that doesn't help. There are way too many reasons why people are overweight. In some cases, it's kind of like saying to someone who's addicted to nicotine and has a cold, "Hey - you know you'd get better faster if you stopped smoking." You ever tried that? In the best cases, they just look at you and go, "Uh-huh", cough and light up.
In others, you've got people who have incredibly hectic schedules, a job, a family to raise, maybe a slow metabolism, and very little money. How do you convince this person that they can put aside the time to figure out a menu for themselves, feed their family what the family wants, buy special food for themselves, make time to exercise... Just put yourself in their shoes.

Many of us know how to work out, what foods are nutritious and what aren't, but that doesn't mean that all of us put it into practice. And excuse me, but it's not laziness or lack of will power. It's habit, and environment, and it's really really hard to try to do it on your own when your environment or circumstances aren't conducive to it.
I know there are programs available, but you have to pay for them, and they aren't necessarily appropriate for everyone...

I wish more companies would include a gym membership in their health benefits packages... One of the companies I worked at had a small gym, nothing fancy, but it was right there, and there were shower stalls in the men's and women's bathrooms. It was *great*. You could go any time, before, during or after work. I wonder why more companies don't do that.

trisherina 07-21-2004 11:03 PM

The genetic set point of the individual is a strong factor in maintaining weight status. There is a fair bit of evidence that weight can only be altered around 5-15% in variance beyond the genetic set point of the individual, and that's with significant and prolonged effort (something which nobody likes; I mean, even the cravings from cigarettes diminish fairly rapidly as compared to the daily grind of dietary restriction and exercise required to make an Oprah an Uma).

Also, there is a fair bit of evidence (read Glenn Gaesser's Big Fat Lies to get the skinny) that simply maintaining a high weight has little to do with overall health and longevity, removed from other factors. More reliable indicators of health and longevity (in longitudinal studies done in the Netherlands) are centered around behaviour, particularly dietary habits (eating a balanced diet) and activity (namely, incorporating some into daily living). People who eat right and exercise live a long time regardless of what they weigh; in fact fat people who eat right and exercise live much longer and healthier lives than skinny people who don't.

The bottom line, of course, is that people don't generally seek weight loss for longevity or health; it's not motivating for long. They seek it for their appearance, which is far more intrinsically motivating for most people. But that's a whole other story.

masterofNone 07-21-2004 11:31 PM

trish... you write so well it hurts sometimes.

zenbabe 07-21-2004 11:54 PM

I just wish I had any kind of insurance that would cover me if I say, broke my leg, or got in a car accident or something. I think saying that the environment around you isnt condusive to eating healthy is not an acceptible way to think. Only you control what you eat, and if it is stopping at jack in the box and spending $5 on a burger....spend the $5 on a head of lettuce and some low fat cottage cheese.

People don't want to take any blame for anything in this country...saying it is somebody else's fault because you are fat is the most absurd.

Of course there is a low percentage of actual cases, like the thyroid problem, but for the most part, it is because people don't take the time to just make something healthy as opposed to grabbing a bag of chips and a coke. If you are cooking for a family, it takes the same amount of time to make a healthy meal as it does to make an unhealthy one.

masterofNone 07-22-2004 12:12 AM

although a low fat, high protein diet costs more. there's a lot of macaroni and cheese being eaten in impoverished neighborhoods because tuna steak is too expensive. there are some economic factors in obesity.

as far as the national obesity issue goes... i think if we just stopped drinking coca-cola and beer and stopped watching 20 hours or more of TV at night we'd trim the national waistline by enough to make a difference.

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