Medicare should cover obesity treatments

Washington loves overcomplicating things. The tax code, famously, is more than 67,000 pages long. The Affordable Care Act exceeds 900 pages. Even the presidential proclamation for Grandparents Day went on longer than the Gettysburg Address.

But not every problem needs a complicated solution, and there appears to be an endemic belief among policymakers that the holy grail of healthcare — higher quality for less money — requires Byzantine fixes. But that thinking is exactly backwards.

The treatment of obesity is a perfect example of how we overcomplicate and frustrate efforts by patients and health professionals to do what they know is right. In fact, with obesity we know how to obtain improved health for fewer dollars. We’re just not providing the right incentives.

The stakes here are enormously high in both human impact and the financial realities. Seventy-eight million Americans are obese. Nearly $150 billion dollars are spent each year to treat obesity-related illness. And if we do nothing, that number will top a half-trillion dollars by 2030. Doing nothing isn’t an option — nor is triaging the issue for another few years. We must begin working to bring the cost of care down now.

This is not an insurmountable task. It doesn’t take much weight loss to improve health and drop costs. Weight loss of just 5 percent dramatically reduces an individual’s progression to Type 2 diabetes.

And we know how to treat obesity. It isn’t easy; the body has few defenses against gaining weight and a myriad of ways to prevent loss.

But we know the basics. Stacks of studies show that better nutrition has an impact. So does exercise. So does medical intervention with new and varied medications that have been Food and Drug Administration-approved for weight loss. We know that a combination of these approaches works better than any single intervention. And we know that the involvement of a healthcare professional can do wonders to coordinate therapy and integrated care.

So why are we spectacularly failing to do the simple things that we know will beat back the march of obesity? For starters, the system of reimbursements fails to recognize the importance of the team approach: An obese patient with Medicare doesn’t have to worry about the cost of seeing his or her doctor for advice, but the moment the patient gets counseling from a dietician or a nurse, it’s on the patient’s dime. Fad diets might not be better or safer or more effective than seeing a professional, but they certainly are cheaper.

Our payment rules also tie the hands of doctors. Supervised diet and exercise programs have been shown to take weight off, and combining those programs with weight-loss drugs creates significantly more weight loss. But such medication is not covered by Medicare.

And so patients, far too often, go without optimal care.

The simple solution is to ensure — at a minimum — that those covered under the Medicare programs aren’t financially punished for getting the obesity care that they need. And a bipartisan bill called the Treat and Reduce Obesity Act, now before the House and Senate, does just that, pushing for common-sense reimbursement and calling on the secretary of Health and Human Services to potentially coordinate the way that the government is attacking obesity.

To be sure, covering more services or medications has an immediate and negative impact on spending. And while few can seriously argue that these upfront costs and more won’t be made back through better health in the future, it could take years for those savings to materialize. That’s why it’s critical to insist that we look at the budgetary impact over 75 years, a longer time horizon than is typically used by the Congressional Budget Office.

In a world of over-complication, the Treat and Reduce Obesity Act clocks in at fewer than 1,000 words. It’s simple. Straightforward. Effective. The approach doesn’t require fancy accounting or a new bureaucracy. We know what we need to do to start rolling back obesity. We just have to get started. And soon.

Thompson, a Republican, was the secretary of Health and Human Services from 2001-05 and governor of Wisconsin from 1987-2001. Since leaving public service, he worked for Akin Gump, Deloitte and other firms providing advice for lobbyists on healthcare issues.
You can follow him on Twitter at @TommyForHealth.