Medicare Adds Preventive Services for Obesity

Today the Centers for Medicare and Medicaid Services announced today that it will begin covering payment of screening for obesity, a nutritional assessment for those who qualify and counseling services through primary care providers.

Obesity is a large problem in the United States (no pun intended) and unabated can lead to many chronic illnesses, not the least of which are heart attack, stroke and diabetes. This preventive program is another measure via the Affordable Care Act and is a good weapon to have in the preventive services arsenal.

Like so many things in life, prevention of illness or disability is preferred to treatment of the same. Motivated obese Medicare recipients will likely reap the most health benefit from these newly covered services.

What I think is unfortunate is that the medical aspect of obesity treatment is not being linked to the mental health aspect of it. The way the system is currently designed, payment for these services will only be provided when a person goes through a primary care practitioner, which means a physician, nurse practitioner, physician assistant or clinical nurse specialist in a family medicine, internal medicine, or geriatric medicine.

I entrust my health care to practitioners in these specialties. In fact, I have always chosen a family practitioner because of their broad knowledge base. But I think counseling, even for obesity, belongs in the realm of mental health. The problem of obesity is a complicated one and, it seems to me, to call for the integrated services of a medical practitioner and a mental health practitioner for the most positive outcome for the individual.

As a taxpayer, I understand that the cost of mental health services in some areas may be cost prohibitive at this time. As an individual who understand you don't change a lifetime of habits overnight, I lament this well-meaning but inadequate decision.

How do you feel about these newly covered services?

Advance Directives Are a Far Cry from Death Panels

It sets my teeth on edge to think that Sarah Palin's inept sound byte of "death panels" or "death squads" is being used by the media in reports about the new Medicare ruling that went into effect January 1, 2011. The new ruling allows health care providers to discuss with their patients advance directives once a year, with the yearly physical and be paid through Medicare to do so.

I've read accounts and comments that show people are likening this patient/provider discussion as if the topic were euthanasia. Folks don't seem to understand that advance directives don't give power to health care providers--they give power to the individual to make their wishes known ahead of time before a health care crisis or end-of-life situation. Advance directives empower the individual; they empower freedom of choice for the patient before there may come a situation where the patient has no voice.

The new ruling doesn't mandate that anyone has to complete any advance directives if they don't want to. It's about giving information to people from a reliable source. The yearly physical is merely the device through which the discussion can happen. If you're not interested, don't do anything as far as an advance directive.

In the absence of any advance directives, medical personnel will provide any and all care to keep your body alive, including respirators, feeding tubes and more. If this is the type of care you would want, then you don't need an advance directive at all.

Some people have strong feelings about being hooked up to medical devices to sustain their lives when in situations such as a permanent, vegetative coma. Other people make advance directives to remove the burden of health care decisions from their loved ones. Some folks may want feeding tubes but no ventilator. Advance directives are for these situations and many more.

If everyone would just calm down and find the facts before awfulizing a situation, there would be less fear-mongering and confusion--it's common sense.