Medicare abuses aren't just at the hospice

The New York Times reported today that hospice care in the U.S. is getting abused at an increasing rate. The government dished out $12 billion in 2009 for hospice care compared to $2.9 billion in 2000. Four out of 10 Medicare patients now use hospice for end-of-life treatment, which is what hospice is there for. But what's largely going overlooked, or rather underreported, is why this abuse has been increasing and how to actually fix it.

Briefly, the NY Times reporter cites that patients are deciding to avoid life-support treatments in the hospital for pain-relieving medication through hospice care, which can be at a nursing home or privately in your own home. This still doesn't answer why, however. Hospice is for patients who are expected to live no more than six months, but with mental diseases and autoimmune diseases increasing in the American population -- where often proper lifestyle changes and reduced stress can increase life expectancy -- many of these patients are living longer than the six months expected.

In other topics on Medicare and Medicaid, the abuse doesn't stop at hospice care. Recently, I reported in Automative Fleet magazine on how Medicaid van services can largely go overlooked, despite the hustle of contractors to oversee these services. When picking up Medicaid riders is a main source of income for a service fleet, it might be easy to report a higher number, as reported by some fleet contractors.

While the health care reform will work to curb some of these abuses, legislators aren't necessarily informed and educated enough on all these gaps to make effective change. What America needs is a nonpartisan committee to find these holes in government medical services to help prevent waste. As well, this could open other questions for legislation, such as why more and more people are bypassing life-prolongment treatment for a more peaceful end through hospice care. And also this raises questions to the medical community: What defines a terminally ill patient? Maybe the attention and personal services given through hospice care were all that were needed to make the illness not so terminal.

Health care costs cooked up by overeating

In debates on health care reform, one that doesn't seem to come up too often, is why health care costs have become exceedingly expensive.

In a recent article from The New York Times cutting costs on health care is examined through food and habits of Americans -- one aspect of many that could potentially help reduce health care costs nationwide. According to a study from the journal Health Affairs: The Policy Journal of the Health Sphere, 75 percent of the United State's annual health care spending of $2.5 trillion is related to four chronic illnesses: heart disease, cancer, obesity and Type 2 diabetes. All of these are loosely related to diet, exercise and habits like smoking cigarettes. 

Health care costs directly due from obesity illnesses account for 9 percent of health care spending. The article speculates that this will increase to 20 percent by 2018 if Americans don't start re-evaluating the foods they buy and their lack of exercise.

One of the most overlooked pieces of advice for healthy eating habits, is acknowledging when you're full. Studies show that even Americans who eat healthy have a difficult time not stuffing themselves when eating a food that's most enjoyable to them. Changes in food availability in schools, the workplace and community markets are playing a role in keeping obesity from rising in some areas. For example, according to Centers of Disease Control and Prevention, in states like Arkansas obesity rates in children have been leveling out instead of increasing like they have been in the last few decades. 

Since the '80s, obesity rates have doubled in adults and tripled in children. A stagnant rate of obesity is the first sign to a healthier America, medically and maybe even financially. 

In looking at how much medical costs have increased between 1987 and 2001, 27 percent of the increases were directly related to disease associated with obesity. Also according to the CDC, employers spend anywhere between 29- to 117- percent more on obese workers in health care costs compared to employees with regular weight. While healthy eating and getting some exercise seems like an oversimplified argument in the economic world, when looking at the figures for employers, insurance agencies and government-run insurances, if less people were walking into doctor's offices for obesity-related health issues, these institutions could focus on better wages, more coverage, program investments, etc.

Below is the new food pyramid (graphic from The Washington Post) recommended by most doctors and the U.S. Department of Agriculture.


The CDC has listed the following as health consequences of obesity:

• Coronary heart disease
• Type 2 diabetes
• Cancer (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis (degeneration of cartilage and underlying bone within a joint)
• Gynecological problems (abnormal menses, infertility)

The government Web site: Fruits and Veggies Matter serves as a great site for easy-to-follow tips and misconceptions about what's considered healthy for your body.