I trust government to soften the harshness of capitalism via subsidies (food stamps, welfare, housing vouchers), to provide health insurance (Medicare for the elderly and disabled; Medicaid for families poor enough to qualify), to build roads and bridges, to maintain clean water, air, and land. Governments maintain “law and order,” wage war, negotiate treaties.
But, whatever Uncle Sam’s strengths, he can’t readily make us slim down, exercise, and get “fit.” He can try.
Here is a tale of one such effort. Between the cup and the lips, it fell apart.
The rationale behind the Center for Medicare and Medicaid Services’ diabetes prevention program was sound. Roughly half all Medicare beneficiaries are on the cusp of diabetes. If they slimmed down and exercised more, they might thwart the diagnosis.
The bureaucrats in the Obama administration saw a bureaucratic solution. If Uncle Sam enrolled those “at-risk” beneficiaries in a regimen that would force them to get into shape, Medicare would see fewer instances of Type 2 diabetes. The savings would be huge. One optimistic estimate promised that 50,000 to 110,000 beneficiaries would undergo “weight loss training and education” from 2018 to 2027, yielding a net savings of $182 million. (The assumption is that the training would lead enough people to exercise enough to waylay diabetes).
The person behind the rosy actuarial prediction was the former chief medical officer of the Y — a confluence of interest not rare in Washington. Last year he ran for Congress from Michigan.
This idea morphed into a program.
The headline in Politico sums up the results: “Medicare diabetes prevention program helps a few hundred instead of hundreds of thousands.”
Last year 200 beneficiaries participated. The first quarter of 2019: 396. Admittedly, those numbers may understate the total since billing data have not yet registered everybody.
Yet the other number — that of providers — points to wishful thinking on the part of bureaucrats. They envisioned Ys and health clubs, as well as pharmacies and supermarkets, signing up.
Pharmacies and supermarkets didn’t. Thus far, 20 Ys qualified. Ten states have no providers. For beneficiaries in Washington, D.C., the nearest provider is Baltimore.
We have a plethora of explanations. The bureaucratic hurdles to prevent fraud are substantial. Programs must verify the status of beneficiaries. They must collect the Social Security numbers of board members. They must ensure privacy. They must erect cybersecurity tests. They must institute an infrastructure to administer the program as well as bill CMS. Many Ys found the costs of participation outweighed the benefits.
To skeptics who declare all the verification standards and screens ridiculously overblown, imagine the ease of scamming Medicare with fraudulent beneficiaries in fraudulent fly-by-night programs. Medicare has seen fraudulent opiate rehab programs, fraudulent dialysis clinics; even an optimistic must concede the possibility of fraudulent diabetes-and-exercise programs.
The central question, though, is whether government can encourage, force, incentivize — pick your verb — people to do what they know they should do. Exercise. Eat prudently. Lose those excess pounds. Uncle Sam wants to pare the Medicare tab (which falls ultimately on taxpayers). We should want to live longer, live healthier.
The nation has a network of Ys and health clubs. Many offer discounted memberships to seniors and people with low incomes. Local governments’ recreation departments often give residents the chance to swim, to dance, to jog. As for “nutrition education,” I doubt that anybody older than age 15 considers beer, chips and cake “good,” and vegetables, fruit and grains unnecessary. Some fast-food restaurants list the calorie-count of their offerings; and labels on processed food list calories, carbohydrates, sodium, and fat. Most Americans know the basics.
Uncle Sam can improve our health. He can provide health insurance (for all of us, not just the elderly and disabled). He can support basic medical research. He can see that our environment is clean, our food supply safe, our nursing homes and hospitals well-run.
We needn’t waste Uncle Sam’s time, and our money, on “disease prevention” programs like this.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, December 1, 2019
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