While the Affordable Care Act continues to badly stumble out of the gate, it is instructive to look at the last major change to our health care system - the addition of a prescription drug benefit to the Medicare program.
Ten years ago (December 8), President Bush signed into law the Medicare Modernization Act (MMA), providing seniors with access to affordable prescription medicines through Medicare for the first time. It also is a program that - unlike the Affordable Care Act - kept its promise to American taxpayers by providing a valued product at a below budget cost.
How so?
· Ten years in, 90 percent of Medicare beneficiaries receive comprehensive prescription drug coverage - and 90 percent of them are satisfied with their coverage.
· Ten-year Medicare Part D costs $346 billion (45 percent) less than originally projected.
· Not only that, the prescription drug benefit helped reduce costs elsewhere in the Medicare system (such as hospital, nursing home stays) by $1,200 per beneficiary.
In short, MMA has proven to be wildly popular while coming in under budget and removing - yes, removing - costs from elsewhere in the Medicare program. Name another federal program that enjoys 90 percent approval ratings while costing less than expected.
It did so by embedding competition into its very design, giving seniors a new choice under an already popular program, and providing needed flexibility to adapt to an evolving health system. The prescription drug benefit did not force patients into paying for things they did not need or want; nor did it take away what they did need and want.
These are lessons the administration and Congress should heed as they sort through potential next steps as they cope with the major difficulties in the early days of the Affordable Care Act if it is to remain economically viable into the future.
Yet, despite its many successes, Medicare must continue to evolve and improve.
For example, MMA specifically prohibits Medicare from covering obesity treatments. This prohibition was included in the law for a variety of reasons, including the lack of solid science and evidence of efficacy around obesity treatments a decade ago.
Now, however, there are an array of FDA-approved treatments that have been deemed safe and effective, and the American Medical Association recently - and rightly - classified obesity as a disease. This has sparked an important conversation about treatments of coverage of obesity under Medicare and other insurance plans.
With these advances, Medicare must begin covering obesity treatments because it leads to so many chronic diseases that are a primary driver of higher costs in the Medicare system. If Medicare begins covering obesity treatments, it will significantly reduce the long term costs associated with obesity-related chronic diseases.
And the problem isn't going away. Consider:
· More than one in three adults in the United States are obese.
· Obesity-related medical costs are $190 billion a year - and growing.
· Medical costs for people who are obese are more than $2,700 a year more than those of normal weight.
Obesity is a condition that we would be wise to cover and treat early and often, because the tidal wave of diseases - including diabetes, heart conditions and some cancers - that come in its wake are much more costly in dollars and lives. If Medicare begins covering obesity treatments, it will significantly reduce the long term costs associated with obesity-related chronic diseases, as MMA has repeatedly demonstrated.
During the Medicare Part D debate, actuaries came in with astronomical costs - because they were only looking at the price per prescription and multiplying.
They were wrong.
Instead of paying $100,000 for a hospital stay, Medicare was paying, say, $100 a month for prescription drugs. That in turn reduced costs elsewhere in the Medicare system because access to affordable medicines kept patients healthier longer - and out of the more expensive hospitals and care facilities.
Now, we must do the same with obesity treatments under Medicare - and the health exchanges under the Affordable Care Act.
Congress must pass the Treat and Reduce Obesity Act, which would require Medicare coverage of obesity, because we simply must stop waiting for people to get sick and then spend infinitely more trying to make them well again.
Covering obesity is a no-brainer - and we must begin behaving rationally if we are going to come to grips with rising health costs and a population that's getting sicker.