# Medicare’s Obesity Problem 

Medicare doesn’t need to cover Ozempic. It needs to take Ozempic.

February 6, 2025 • Commentary 

By [Michael F. Cannon](https://www.cato.org/people/michael-f-cannon) 

This article appeared in [*National Review (Online)*](https://www.nationalreview.com/) on February 6, 2025.

As president, Joe Biden [unilaterally](https://www.federalregister.gov/documents/2021/02/02/2021-02252/strengthening-medicaid-and-the-affordable-care-act) [expanded](https://www.federalregister.gov/documents/2022/04/08/2022-07716/continuing-to-strengthen-americans-access-to-affordable-quality-health-coverage) wasteful spending in government health programs. On his first day back in the White House, Donald Trump [revoked](https://www.whitehouse.gov/presidential-actions/2025/01/initial-rescissions-of-harmful-executive-orders-and-actions/) two Biden-era executive orders that had increased the incidence of [fraud](https://paragoninstitute.org/private-health/the-great-obamacare-enrollment-fraud/) in Obamacare Exchanges — on top of the other burdens that government health-care programs already impose on taxpayers. Trump should continue his effort by blocking an unlawful Biden White House proposal, released in December 2024, to have Medicare subsidize obesity drugs.

For most of human history, gaining weight was difficult and losing it was easy. Humanity has made such stunning progress against [starvation](https://store.cato.org/products/superabundance) that now the reverse is true. Today, we wrestle not with starvation but with obesity, and with the health problems that follow.

Medicare doesn’t need to cover Ozempic. It needs to take Ozempic.

Medicare is a federal program that subsidizes health care for the elderly. Since it socializes the costs of [personal health decisions](https://www.cbo.gov/sites/default/files/cbofiles/images/pubs-images/50xxx/50877-landing-Figure1_0.png), the program has developed its own obesity problem. While U.S. residents spend, on average, 70 percent more on health care than do their peers in other advanced nations, elderly U.S. residents — i.e., the folks Medicare subsidizes — [outspend](https://pmc.ncbi.nlm.nih.gov/articles/PMC7411536/?report=printable) their peers in other advanced nations by 80 percent. The best available data [suggest](https://www.kff.org/wp-content/uploads/sites/2/2011/07/expertv7.pdf) that one-third of the $1 trillion that Medicare spends each year is pure fat. The program is the [main reason](https://www.cbo.gov/publication/60127#_idTextAnchor016) federal deficits are growing faster than the economy and why the federal debt will [surpass](https://www.cbo.gov/system/files/2024-02/59710-Outlook-2024.pdf) the size of the entire economy this year.

Since Medicare spends a lot to treat obesity-related illnesses, some people wrongly think it should subsidize the new miracle-drug GLP-1s (short for “glucagon-like peptide 1 receptor agonists”) for weight loss. GLP-1s include liraglutide (Saxenda), semaglutide (Ozempic, Wegovy, Rybelsus), and tirzepatide (Zepbound).

These drugs may have other health benefits, too, such as [lower cardiovascular mortality](https://www.nejm.org/doi/10.1056/NEJMoa2307563) among those with cardiovascular disease and [lower all-cause mortality](https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.15185) among type‑2 diabetics. Medicare already covers GLP-1s for these conditions.

In the waning days of the Biden administration, however, Medicare bureaucrats hatched a plot to require taxpayers to subsidize GLP-1s for weight loss. The proposal flouts federal law.

Congress often lets Medicare bureaucrats subsidize new treatments and thereby expand the program without congressional action. But not in this case. In 2003, Congress explicitly prohibited Medicare from subsidizing drugs for weight loss. It has since rejected every proposal to authorize such subsidies.

Yet in a 714-page [missive](https://public-inspection.federalregister.gov/2024-27939.pdf) the Biden administration released after Election Day, Medicare bureaucrats wrote:

> Increases in the prevalence of obesity in the United States and changes in the prevailing medical consensus towards recognizing obesity as a disease … have compelled \[us\] to re-evaluate \[Medicare\] coverage of anti-obesity medications.… We are proposing to reinterpret the statutory exclusion … to allow \[subsidies for GLP-1s\] when used to treat obesity.

If Medicare bureaucrats finalize this proposal, it would not merely “allow” subsidies. It would compel taxpayers to finance them through Medicare and Medicaid, contrary to federal law and the Constitution.

It’s tempting to think that subsidizing GLP-1s would reduce overall Medicare spending by preventing obesity-related illnesses. But preventive care generally [does not reduce health spending](https://www.cato.org/blog/1-oz-prevention-1-oz-cure). The Congressional Budget Office projects that subsidizing GLP-1s for weight loss would increase Medicare spending by [$4 billion](https://www.cbo.gov/publication/60816) annually. Others say [$6 billion](https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.00356?journalCode=hlthaff). Since the proposal would apply to Medicaid as well, it would impose additional costs on federal and state taxpayers.

Trump must stop the implementation of this proposal.

The Left complains that U.S. health spending exceeds that in other nations, then it repeatedly turns around and demands more of it. They sing odes to democracy and the rule of law, but when they sense an opportunity for gain, they [act](https://www.cato.org/blog/how-david-brooks-created-donald-trump) like the Constitution applies only to [little people](https://content.time.com/time/specials/packages/article/0,28804,1891335_1891333_1891317,00.html). The hypocrisy *almost* makes one wish for a debt crisis to put the federal government on a diet. A far more preferable solution would be a [balanced-budget amendment](https://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.6.2.13) to the Constitution. Requiring Congress to tax current voters for every dollar it spends would put a tighter rein on the legislative branch — and on rogue executive branch bureaucrats.

In the meantime, the federal government can increase access to GLP-1s simply by eliminating unnecessary regulation — specifically, regulations requiring consumers to obtain prescriptions before purchasing them.

The Food and Drug Administration unnecessarily [requires](https://www.cato.org/white-paper/drug-reformation-end-governments-power-require-prescriptions) that consumers obtain prescriptions before purchasing medicines such as insulin, naloxone, and oral contraceptives. Those requirements increase the price and other costs of accessing medicines that consumers could use safely on their own. On the rare occasions when the FDA has removed prescription requirements, medicines have become more accessible, largely because greater price competition causes prices to plummet.

The FDA should [eliminate](https://reason.com/2024/05/22/its-time-for-over-the-counter-ozempic/) prescription requirements for GLP-1s. Patients would likely still seek advice from doctors about how to use them, and they would still be able to sue the pants off pharmaceutical companies who expose them to unwelcome risks.

To make health care more universal, bureaucrats don’t need to step outside the law or impose additional burdens on taxpayers. They just need to get out of the way.

##### About the Author 

[![Michael F. Cannon](/sites/cato.org/files/styles/author_picture/public/2021-01/Michael%20Cannon.jpg?itok=0UROn8Dc)](/people/michael-f-cannon) 

##### [Michael F. Cannon](/people/michael-f-cannon)

Director of Health Policy Studies, Cato Institute

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