“There Ought to be a Law?”

Did anyone catch CBS Evening News tonight? Katie Couric reported on RJ’s Law, a bill being introduced in this legislative session of the California State Assembly by John J. Benoit. It was drafted by a high school student, R.J. Field, who won a writing contest called “There Ought to be a Law.”

The bill will require all poor women receiving welfare benefits to be tested for narcotics. Those who test positive will be required to undergo treatment or lose their public assistance, including healthcare. The rationale behind the bill is to dispense state healthcare dollars prudently and to protect children from health problems due to women who do drugs while pregnant. Of course, such a mandate will ensure that these women will avoid any prenatal care at all to the greater detriment of their babies. The young student who wrote it suffers from cerebral palsy after being born prematurely to a drug addicted mother.

While it is easy to understand the well-meaning intentions of a 16-year old boy, if one steps back to think of the proverbial slippery slope, what other unhealthy behaviors might a politician find potentially harmful to children or costly to the state and similarly choose to regulate by force...?

What about having to maintain an “ideal” weight, comply with treatments and take prescribed medications for “ideal” health indices, engage in “healthy lifestyle” behaviors, eat low-fat diets, not smoke, and put in two hours of exercise each week, all in order to receive Medicaid benefits?

Sound far-fetched? Such health and "wellness" programs have already been launched in Florida and Idaho, according to the Center on Budget and Policy Priorities in Washington, DC in a June 1, 2007 white paper. “California, Kentucky, Michigan, Missouri, Pennsylvania, Texas and Wisconsin are considering this strategy,” it said. The Idaho Behavioral Preventive Health Assistance Program, for example, is currently voluntary and gives Medicaid beneficiaries who agree to quit smoking or lose weight $100 vouchers. “[O]nce they have visited a doctor and agreed upon a plan to treat their condition,” smokers can then use the vouchers to purchase counseling, nicotine replacement products (such as a patch or gum), or medication.

West Virginia is taking a different approach by making the availability of certain health care benefits contingent upon specified behaviors,” it reported. "West Virginia’s penalty-based incentive approach, which restricts health benefits for beneficiaries who do not follow a particular behavior plan, is unlikely to produce health improvements. In fact, it risks harming people who do not comply with the plan because of mental health or other problems, by denying them needed health care services,” their report concluded.

Among the CBPP’s key findings, it reported that there is little evidence that incentive programs, such as for reducing smoking and obesity, actually impact health-related behaviors or see financial returns. Nor is there evidence that these programs “are effective at getting people to stop smoking... And obesity is more difficult to treat than smoking.”

Last October, UniCare, the largest provider of Medicaid coverage for West Virginia began training medical professionals providing care under their plan on how to measure BMi and to treat obesity in the state’s 75,000 Medicaid recipients. UniCare’s parent company, WellPoint, Inc., is looking to expand it in 13 other states.

As we already know, but politicians appear to be ignoring, is that the U.S. Preventive Services Task Force has found no evidence to recommend screening for obesity or counseling by doctors for healthy behaviors, for long-term effectiveness of weight loss interventions or preventive measures, or that they improve long-term health outcomes; nor that the potential harms of such programs are being considered. The state governments and insurers are targeting the poorest, mostly women and children, who are less likely to have the means or able to risk speaking out to object to these programs, which may be why most Americans are unaware of what they’re being subjected to.

In 2006, three counties in West Virginia instituted a managed care (“medical home”) program for Medicaid recipients. The program is to be phased in statewide. It includes binding contracts for health behaviors that Medicaid beneficiaries must sign in order to receive enhanced healthcare benefits. The agreements require them to follow a prescribed “health improvement plan,” take the prescribed medications and keep appointments for weight loss, smoking cessation, mental health treatments, diabetes and heart disease management. Freedom to not comply isn’t an option if they want to receive enhanced benefits, care any recipient with special needs would definitely require. The doctor for each patient receiving public assistance “would be forced to report noncompliance to the state,” according to the December issue of the American Medical Association’s Virtual Mentor. “West Virginia monitors patient adherence to recommended screenings and health improvement programs, appointment schedules, and medication regimens and tracks patient compliance to the agreement using claims data.” A challenge for doctors, it said, is that they must determine who is sufficiently engaging in ‘healthy lifestyle’ behaviors to comply with the state’s mandates or if their behavior would be defined as noncompliant and reportable to the state.

Read that last paragraph again. This isn’t a look back to 1930 Nazi Germany’s healthism or Medizinischepolizei program, this is today in the United States.

Government-provided healthcare being envisioned by many Americans isn’t anything like the reality of the managed care that politicians and government agencies, and the vested interests behind them, are envisioning for us.

“There Ought to be a Law” may sound good until one stops to think about where such a law is taking us.