http://www.statesman.com/news/content/a ... 4004f.htmlMedicare opens door for coverage of obesity treatments
By Rob Stein and Ceci Connolly
THE WASHINGTON POST
Friday, July 16, 2004
WASHINGTON -- The federal Medicare program on Thursday abandoned a long-standing policy that obesity is not a disease, removing what has been a major roadblock for many people trying to get treatment for the burgeoning health problem.
After years of review, the Centers for Medicare & Medicaid Services, which runs the health program for elderly people and people with disabilities, announced it was dropping language that had led the agency to routinely deny coverage for many weight loss therapies.
Although the decision does not declare obesity a disease or automatically mean any specific treatment will be covered, the move opens the door to what is expected to be a flood of applications from individuals, doctors and companies for Medicare to begin paying for a variety of therapies.
These include stomach surgery, diet programs, and behavioral and psychological counseling.
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and die prematurely," Health and Human Services Secretary Tommy Thompson said in announcing the long-awaited decision. "With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese."
The move, the latest in a series of steps the federal government has taken to fight the nation's rising obesity problem, was hailed as a major step forward by public health experts, anti-obesity advocates and individual doctors.
"Conceptually, this is a huge change, for the medical profession, for insurers and for employers, to treat this just like any other disease," said Morgan Downey, executive director of the American Obesity Association, an advocacy group that has been lobbying for the change.
Because private insurance companies often pattern their coverage after Medicare, the decision is expected to put strong pressure on them to EXPAND COVERAGE FOR WEIGHT LOSS TREATMENTS. Representatives from the insurance industry, which recently has begun scaling back on payments for stomach surgery, welcomed the decision and signaled companies would take their cues from Medicare.
"We're going to be watching this very closely," said Karen Ignagni, president of America's Health Insurance Plans, the industry's primary trade group. "We're going to be looking at what they are evaluating and what their results are."
In addition to the practical implications of getting insurance to pay for more treatment, many experts said the move would help counter the stigma that often plagues people who are overweight and obese, encouraging more doctors to treat the problem like other medical conditions and encouraging more overweight individuals to seek help, experts said.
"The lack of recognition of obesity as disease has cast a pall over the field. Now Medicare is saying obesity deserves treatment like any other disease," said Louis Aronne, president elect of the North American Association for the Study of Obesity.
But the decision was denounced by critics who argue that the health consequences of being overweight have been EXAGGERATED and ANY REAL PROBLEM IS ONE OF INDIVIDUAL RESPONSIBILITY.
"This is truly a DUMBING DOWN OF THE TERM 'DISEASE.' This is the only disease that I'm familiar with that you can solve by REGULARLY TAKING LONG WALKS AND KEEPING YOUR MOUTH SHUT, said Rick Berman, executive director of the Center for Consumer Freedom, a food industry-financed advocacy group. "It's terrible to start using taxpayer money like this when there are other legitimate diseases that need to be addressed."
The decision is irrational, given that being underweight is more of a health problem for the elderly than being overweight, said Paul Campos of the University of Colorado, author of the recent book "The Obesity Myth."
"It's not just a bad idea; it's completely unscientific," Campos said. "We're in the grip of a kind of OUT-OF-CONTROL CULTURAL HYSTERIA on this issue that leads to really irrational social decisions, such as making obesity a disease among the elderly."
Because it was unclear exactly what Medicare would eventually pay for, there were no immediate estimates of what the policy change would cost the government.
But former Austinite Mark McClellan, who heads the Medicare program, said the decision would enable the government to begin paying for treatments that work.
The agency was planning a fall meeting to review the scientific evidence on the types of care to cover, with stomach surgery at the top of the list, he said.
Sen. Tom Harkin, D-Iowa, called the decision a "partial" improvement.
"This is illustrative of the problem we have with Medicare," he said. "If you've got a problem, we'll fix you. Medicare should have programs to PREVENT obesity" instead.
Harkin is pushing comprehensive legislation that would promote exercise in schools, require nutritional labeling on chain restaurant menus, provide Medicare coverage for screening and prevention services and give the Federal Trade Commission power to restrict food advertising that targets children.
Thursday's decision will not affect weight loss drugs, but Downey said his group planned to press Congress to address that issue the next time it reconsiders Medicare's new prescription drug benefit.
