Politics. A nation that dedicates a holiday to 28.5% of the seven deadly sins is, in typical American fashion, conflicted.
Before we learned how to twist the meaning of words out of the tyranny of common understanding, obesity was considered a lifestyle choice. That tacit understanding led Congress to forbid Medicare reimbursement for drugs that served an aesthetic purpose, including weight loss. The taxpayers, they reasoned, were not obligated for such things.
(In their defense, the weight loss product areas have been rife with misleading claims and sometimes, like with Phen-Phen, proved to be dangerous.).
Now Congress finds itself in a pickle.
On the one hand, GLP-1 drugs hold great promise for getting rid of America’s COVID 19 – which is actually more like 27 lbs. – and addressing the many knock-on effects of obesity.
On the other hand, since the government got into the health care business there have been many promising New, New things that will save the taxpayer’s money. That rarely proves to be true and cynicism on Capitol Hill is usually justified.
Over at buzz-kill central, also known as the Congressional Budget Office, the data still rules. The CBO has put out an all call for research that would support claims of GLP-1’s salutary effects on the woe begotten federal budget. In the meantime, they are sticking with their conclusion that GLP-1 drugs will cost money and offsets from reduced cardiac, diabetes and renal care remain unknown.
Sen. Bill Cassidy has presented the idea the Medicare cover GLP-1 drugs for a short period of time – perhaps a year – to allow for lifestyle changes and reduce the necessary budgetary offsets.
Not what the industry wants until you remember Congress’ favorite year-end activity – Medicare extenders.
Policy. Failing Sen. Cassidy’s approach, CMS is hard at work transmogrifying obesity from a choice to a chronic condition using the favored tool of policy makers these days, word choice.
In the name of health equity, obesity is now frequently preceded by the verb, “having.” With that the word obese goes from a descriptor to a condition seeking treatment. The approach may enhance the possibility of Medicare coverage – although I am skeptical – but it also attempts to separate obesity, “having” or otherwise, from the consensus that caused Congress to group weight loss drugs with aesthetic procedures in the first place.
For years, DVA and the rest of the dialysis industry have avoided scrutiny of their outcomes because so much of the End Stage Renal Disease population is obese, thus placing the responsibility for results mostly on the patient’s choices. Earnings transcripts are filled with references to the American obesity problem as a way to assure the sell-side, the pipeline remains robust.
Overweight, obese, and excessively obese conditions are certainly choices for the majority of people – speaking with a little first-hand knowledge here – and the health care system’s indifference to the results is also a choice.
Unfortunately, choice of words is not likely to fix it. Hence the ongoing conflict with GLP-1 drugs.
Power. Removing gluttony and sloth from the list of seven deadly sins and adding it to the chronic disease category has put the Department of Defense in a difficult position. Like most employers it does not want to appear discriminatory. However, it has the unique challenge of operational readiness that presupposes most officers can slip into their first uniform.
It also did a stupid thing when it discharged thousands of men and women for refusing a COVID vaccine in 2021. Obesity rates, relative to the general population, shot up. Perhaps there is some relationship between people that refuse vaccines and low BMI? The military is silent on that topic.
Last week, the Department of Defense sent notes to those discharged advising them they can get the circumstances of their discharge amended and, by the way, we would sure like you to come back.
What the DoD is not prepared to do is prescribe GLP-1 drugs unless you have spent a little time on nutritional counseling and other step-up measures, putting them at odds with other agencies that are more conflicted and creating another standard for Congress to consider.
Despite all the realities of America’s swelling waistlines, I hope you have a wonderful Thanksgiving holiday with or without gluttony and sloth.
Have a great rest of your weekend.
Emily Evans
Managing Director – Health Policy
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(Politics, Policy & Power is published in the quiet of Sunday afternoon or holiday Monday and attempts to weave together the disparate forces shaping health care. It makes no attempt to defend or prosecute the views of any established political party or cause. Any conclusions to the contrary rest with the reader alone.) in the U.S.
