Commentary

Obesity and Medicare

By William A. Niskanen
July 18, 2004

“Compassionate conservatism” is apparently the Republican version of being generous with other people’s money. The most recent example is the decision by the Department of Health and Human Services (HHS) to broaden Medicare coverage to include weight-loss therapies such as stomach surgery, diet programs, and behavioral and psychological counseling. This is a dreadful decision for the following reasons:

Obesity is a widespread and sometimes tragic private health problem but, despite the public statements by HHS Secretary Tommy Thompson, it is not a public health problem. Obesity is not contagious. No one person’s obesity reduces the health of other people in any way. The fact that obesity is now the second-largest cause of preventable deaths in the United States should caution all of us about our personal behavior. But it is not a sufficient basis for a massive new tax-financed program to insure obesity therapies.

Obesity is primarily a consequence of life-style choices about drinking, eating and exercise — not a consequence of accidents, age, or genetic conditions over which one has no control. For that reason, obesity is a condition that is expensive to insure because insurance reduces the cost of irresponsible life-style choices and is likely to increase the incidence of the insured condition. Private insurance companies have covered some obesity therapies for only a few years, and the number of disability claims directly related to obesity more than doubled at Metropolitan Life from 2001 to 2003.

With 64 percent of the U.S. population described as overweight or obese, the HHS decision to cover some obesity therapies in Medicare has huge potential costs for both taxpayers and those covered by private health insurance. This decision, however, was made with no explicit legislative authority. Any decision of this magnitude should be made only after an informed public discussion and congressional approval, not on the basis of the judgment of some regulators and a department secretary who is obsessed with the obesity problem.

Medicare is already grossly underfunded, with a fiscal imbalance — after adding about $17 trillion of net liabilities for prescription drugs — of about $62 trillion. When are we going to stop adding questionable benefits for the current generation of the retired at a huge cost to our children and those who are yet to be born?

In the interests of America’s future, members of Congress should annul the HHS decision to include the coverage of obesity therapies in Medicare before they leave for their summer recess.

William A. Niskanen is chairman of the Cato Institute and a former acting chairman of the Council of Economic Advisers under President Reagan.