If you’ve done any traveling lately, like I have, you’ve probably spent a lot of time in airports. If you look around an airport, you’re struck by an undeniable fact – many Americans are obese. What can be done about this?

Grace-Marie Turner, writing for Galen.org, says obesity is a serious health problem for millions of Americans. In fact, about 42% of Americans are living with obesity. The association with other chronic conditions including heart disease, Type 2 diabetes, and stroke is incontrovertible.

Obesity also has been identified as one of the greatest risk factors for severe COVID-19 infection and death, and its burden does not fall equally on all communities. It is a particularly significant concern for communities of color. A newer generation of innovative anti-obesity medications (AOMs) is emerging that can provide another treatment option for those living with obesity.  But not all health plans cover these drugs, and under current law, few seniors have access to them through Medicare.

Medicare doesn’t currently pay for many of these drugs in an effort to save money. Medicare already is going broke, but its bankruptcy will be accelerated if it continues to pay for care only to treat diseases instead of allowing a broader range of treatment options to help get and keep people healthy. Both political parties stress their commitment to Medicare, and it is important to identify ways to improve the health of the Medicare population to reduce overall medical costs. Covering AOMs would be an important step in that direction.

When former President George W. Bush promoted creation of the Medicare drug benefit in 2003, he argued Medicare needed to be reformed “because it did not provide prescription drug coverage.” “Medicare would pay for a surgery, say, like ulcer surgery, for $28,000,” he said, “but wouldn’t pay $500 for the prescription drugs that would have prevented the ulcer in the first place.” Mr. Bush argued that “medicine had changed with the advent of prescription drugs, but Medicare hadn’t.”

This was a step forward to getting badly needed prescription drugs into the hands of seniors who needed them most. But not all drugs were eligible. The Medicare Modernization Act (MMA) passed in 2003, and the Medicare Prescription Drug Benefit (Part D) program it created began covering seniors in 2006. But the legislation banned coverage for medicines or classes of medicines “when used for anorexia, weight loss, or weight gain.”  And the ban still stands. And the results speak for themselves – just look around the airport!

In a classic example of Medicare policy gone awry, today Medicare will pay for expensive bariatric surgery – the last-resort of treatment for the morbidly obese – as well as treatments for more than 200 comorbidities linked to obesity such as certain cancers, dementia, and Alzheimer’s disease, but not for new treatments that scientists have developed that can address the disease itself. Only the government could come up with such utterly ridiculous healthcare policy.

This policy is costing American lives and money. A study by Harvard University researchers found that annual medical costs for adults living with obesity were $1,861 higher than medical costs for people of healthy weight and $11,481 higher for people with severe obesity. A study by Brookings Institution scholars found that people living with obesity have nearly 36% higher average annual health costs compared to healthy-weight individuals.

An unlikely alliance of groups is coming together to urge Congress to allow coverage of anti-obesity medications in Medicare. “It’s not every day that the pharmaceutical industry, the NAACP, a cancer center, and a nonpartisan think tank are all lobbying to achieve the same policy goal,” an article in STAT reads. “But an effort to expand Medicare coverage for obesity drugs has managed to unite them all, and many more groups across the health care industry, too.”

It’s time America woke up to the alarming obesity problem in our population. The problem threatens the lives of many Americans, the healthcare budget of the nation, not to mention the availability of many of our youth for military service. There is some indication, however, that Americans are aware of the problem. They rated obesity as the second greatest threat to public health, after opioids and fentanyl in a recent Axios-Ipsos American Health Index survey.

Turner summarizes, “Prevention saves money and lives. As the obesity problem grows, patients should be able to choose for themselves, in consultation with their physicians, from a full range of treatment options, including innovative anti-obesity medications.”

That would be a healthcare policy that actually makes sense!

The Affordable Care Act, better known as ObamaCare, was passed in 2010. Thirteen years later we have a much better perspective to judge its effectiveness in achieving its goals. What is the ObamaCare reality in 2023?

John C. Goodman is a healthcare economist and public health policy consultant. Beverly Gossage is a Kansas state senator and insurance broker. Here’s what they write in his blog at independent.org, which was also published in The Wall Street Journal on September 12, 2023. “When Democrats passed the Affordable Care Act of 2010, President Obama and lawmakers made the same claim over and over: The act would make good, affordable health insurance available to people with pre-existing conditions. The actual result has been the opposite. ObamaCare makes health insurance as good as possible for the healthy and as bad as possible for the sick.”

The Progressive spin on ObamaCare has not let up under the Biden Administration. According to President Biden, health insurance in America is free or almost free (“as little as $10 a month or less” after subsidies) for about 80% of people who acquire it in an ObamaCare exchange. Most preventive care – the only kind of care healthy people require—is also free.

But this is much like the fact that banks are always eager to lend you money when you don’t need it – but very reluctant when you do! If you are sick, things are different. Consider a hypothetical middle-aged couple in Dallas earning $70,000 a year. Suppose they have two children, both of whom have serious birth defects. Although this family will pay no premium for a Blue Cross bronze plan in the ObamaCare exchange, they will face a $9,100 deductible for each child. Their total out-of-pocket exposure is $18,200 a year.

It gets worse. Patients with serious diseases often require the care of highly trained specialists who usually work at centers of excellence. But that family in Dallas will discover that their Blue Cross plan isn’t accepted at leading cancer providers nearby, including Baylor University Medical Center and the University of Texas Health Science Center, or MD Anderson Cancer Center in Houston.

Goodman describes the situation in Texas, because that’s where he lives. But the problem isn’t unique to Texas. ObamaCare plans have very skinny networks in every state. They tend to pay providers Medicaid rates or close to them. As a result, ObamaCare looks like Medicaid with a high deductible. A great many providers, including prestigious medical institutions, won’t accept Medicaid managed care—the version of Medicaid most recipients receive—or ObamaCare. When a patient with ObamaCare coverage goes out of network, the plan usually pays nothing and the patient’s payment doesn’t apply to his deductible or out-of-pocket maximum.

In addition to ObamaCare’s high medical expenses for the sick, there is an implicit tax on their earned income. Suppose our Dallas family earned only $60,000. According to Healthcare.gov, their children could qualify for CHIP, (the Children’s Health Insurance Program) or Medicaid, and they wouldn’t be allowed into a subsidized private exchange plan. Given their lower income, the best exchange plan the family would qualify for would now be the Blue Cross silver plan, which carries zero premium. This means that if the parents stay healthy, they would have no out-of-pocket medical expenses.

But things quickly change if they rose to $70,000 household income again. The penalty would be an $18,200 increase in maximum medical costs—a marginal tax rate of 182%. Even with the children on CHIP, the parents could have serious medical problems of their own and an accompanying implicit tax on income. At an income, say, of $30,000, the best option is a silver plan with a small premium combined with a small deductible. But if their income doubles to $60,000, the out-of-pocket exposure will increase by $14,200. That’s an implicit marginal tax increase of 47%.

The plain truth is that ObamaCare was designed to save the government money! It works great for the healthy, but not for the sick. But Goodman says this design wasn’t really done by Obama or even Democratic lawmakers. It was done by special interest groups – those that are profiting from the system. ObamaCare is pouring about $60 billion a year of new money into the healthcare system. The beneficiaries of this government largess are the hospitals, insurance companies, and some doctors – though there is no evidence of any overall increase in the amount of healthcare delivered.

The lesson learned from this real-life story is simple – stay healthy. The Affordable Care Act is only affordable for the healthy.

We’re discussing mistakes to avoid when signing up for Medicare. It’s open enrollment time and all seniors must decide whether to stay with their current healthcare plan or make a switch. If you want to switch, this is the time to do it. But beware of possible mistakes you can make.

In Part I of this series, we discussed the two pitfalls to avoid when signing up for your healthcare.  Anna Wilde Mathews, writing in The Wall Street Journal, warns us of five pitfalls. The first two pitfalls were avoiding the Medigap Trap and choosing the Wrong Doctors. Today, we will cover the other three pitfalls to avoid.

Paperwork Problems

Medicare Advantage plans can sometimes delay or block access to care. A recent government investigation found some beneficiaries were denied services that should have been covered. You might need to get approval from the insurer before you get a surgery, or a referral from your primary-care doctor to see a specialist. You may also find that those nifty extra benefits touted in ads are extremely limited.

Seniors often don’t focus on these issues, particularly when they are healthy, said Tatiana Fassieux, education and training specialist for the nonprofit California Health Advocates. “Tomorrow you may end up having a stroke,” she said. “Once you start using the more costly care, that’s when the brakes come in.”

To understand the hurdles, you should look at plans in the Medicare.gov tool. As you scroll down each table, you will see small “limits apply” notices next to specific types of care, such as inpatient hospital use or radiology scans. Click on them, and you will find more details about what requirements you might face to get that kind of service, such as prior approval from the insurer.

For a more in-depth explanation, you should go to the insurer’s website and look at key documents, such as the summary of benefits and the full “evidence of coverage.” They are difficult and complicated, but they include pretty much everything there is to know about the plan.

Drug Deficits

Your drug coverage can come through a stand-alone Part D plan—needed if you are in traditional Medicare—or wrapped into your Medicare Advantage. Either way, you can use Medicare.gov to see if your prescriptions are included. This is worth doing every year. You may also want to go to the insurer’s own website and look for restrictions on access as well as the “comprehensive formulary” document that lists all covered drugs.

Biased Advice

Be careful where you turn for advice. Ads peddling Medicare Advantage plans may flash pictures of government Medicare cards and include a toll-free hotline that looks official but isn’t the real federal number. Watch out for websites tied to particular insurers or online agencies that may have strong incentives to push certain plans. One tip is helpful; if the site ends in .gov or .org, it’s more likely to be unbiased.  To find real, impartial information, start with Medicare.gov and go from there. There are also counselors in every state under the State Health Insurance Assistance Program. There is also a national helpline maintained by The Medicare Rights Center.

As a senior, and a doctor, I recommend staying with Original Medicare if you can afford the costs, which are higher than Medicare Advantage plans. Original Medicare will give you the greatest freedom to choose your doctors and the least restrictions on the care you will receive. It’s time to choose, but choose wisely.