Chronic Tonic or Chronic Stupidity?

Chronic disease is in the news a lot lately because of the Make America Healthy Again (MAHA) agenda championed by new HHS Secretary Robert F. Kennedy Jr., but let’s be real. MAHA is nothing more than a bone for the worried well to chase as RFK Jr. does his job of dismantling the public health system.

Let’s pretend just for a moment that MAHA is real. Let’s also pretend that lowering healthcare costs and making the federal government more efficient is real and not simply a big lie told by RFK Jr.’s boss to line his and his friends’ pockets with taxpayers’ money.

If both those things were real, where would you start? How would you make America healthy again by reducing chronic disease and save the government money by making it more efficient?

The answer is simple. You can find it in a new study published in the Journal of the American Medical Association.

A group of 25 health services researchers — 25! — most of them from organizations and universities in Seattle, wanted to know how much the U.S. spends on chronic diseases. To find out, they analyzed data from 40 billion insurance claims and administrative data from 836 million hospital admissions and visits. The claims data came from Medicare, Medicaid and commercial health plans. The study period was 2010 through 2019.

The researchers teased the claims into 148 chronic health conditions and then ranked them by spending and by who paid the bill for treating those chronic health conditions in 2019.

By far, the No. 1 chronic disease was Type 2 diabetes. That’s when your body doesn’t produce enough insulin to process the amount of sugar that you take in, and you end up with high glucose levels in your blood. You manage Type 2 diabetes with diet, exercise and prescription medication.

Total U.S. spending on Type 2 diabetes was $143.9 billion in 2019, according to the study. A very distant second was “other musculoskeletal disorders” at $108.6 billion. That’s the catch-all category for issues with your muscles, bones, tendons, ligaments, cartilage, joints, etc.

Who paid the bills for Type 2 diabetes in 2019? It was Medicare first at 39.6% followed by private health plans (34.7%), Medicaid (12.9%) and patients out of pocket (12.8%). Combining Medicare and Medicaid, those two public health insurance programs picked up more than half the tab at 52.5%.

Now, if we only had a wonder drug that would treat Type 2 diabetes effectively? Oh wait, we do. They’re called GLP-1s. Not only do they treat Type 2 diabetes effectively, medical research has shown GLP-1s to be effective in treating other chronic diseases effectively, especially those linked to obesity.

So, if you wanted to make America healthy again by reducing chronic disease and save the government money by making it more efficient, you would require Medicare and Medicaid to pay for GLP-1 drugs to treat chronic disease.

That’s exactly what the previous administration proposed on Nov. 26, 2024, in a new rule. The proposed rule would extend Medicare and Medicaid coverage for GLP-1s starting in 2026. That’s smart.

Unfortunately, the new administration is anything but smart. It’s especially petty and vindictive. Anything with Biden’s or even Obama’s name on it or anywhere near it — no matter how effective — is now a target for erasure from history. So, at this point, the fate of the new rule is unknown.

Given that MAHA and government efficiency are shiny objects to divert your attention away from what’s really happening, my guess is the new rule will die simply because it’s on the list. That’s too bad.

Chronic tonic? More like chronic stupidity.

Thanks for reading.