The American public is being sold a bill of goods that enrolling everyone in government-approved health insurance — primarily managed care — will improve the nation’s health and close the troubling disparities between the health of Black and white Americans. President Obama made insurance coverage the signature issue of the Democratic Party.Now Democrats in Congress are revving up for a fight to spend hundreds of billions of dollars more subsidizing managed care plans, while Republicans are opposed. Politics aside, the facts show the money could be far better spent.The trillions spent have not resulted in improved health. The uninsured rate has been cut in half, but Americans are sicker, and their life expectancy is stagnating. Doing more of the same can’t be the answer.New research in Lancet shows that life expectancy for Black Americans stalled during the vast expansion of Medicaid managed care and Affordable Care Act plans. The opposite of what was promised.America ranks a disappointing 49th in life expectancy — lower even than Costa Rica and Chile, and trending downward.We can’t rely on the managed care industry and the lackadaisical public health establishment to make the urgently needed changes. They’ve failed us.Under the ACA, Americans ceded too much control of their medical decisions to insurers instead of the doctors examining them.Managed care preceded the ACA, but Mr. Obama became managed care’s biggest booster, telling the public to trust insurers instead of greedy doctors he blamed for prescribing unnecessary tests procedures to get rich.That was demagoguery to sell his health law. In 2011, Stanford researcher Mark Duggan showed that managed care does not produce health improvements. The National Bureau of Economic Research shows that putting Medicaid patients with high medical needs in managed care is detrimental.UnitedHealthcare officially states that it is moving health care “from volume to value,” to enable people to “stay healthy over the course of a lifetime.” That’s hot air.In truth, there are virtually no published studies showing managed care improves health.Americans are feeling the impact of insurers second-guessing their doctors and demanding prior authorizations of routine medications and procedures.Many states are considering legislation to limit prior authorization requirements.The Trump administration also should act. Insurers should collect premiums, provide financial backup when you’re sick, and defer to the doctor who knows you.Nowhere has managed care failed more miserably than in responding to the nation’s stagnating life expectancy and its chief cause: obesity.Sadly, the nation’s public health agencies have also shown a ho-hum attitude. A Trump shakeup is needed. Senators considering President-elect Trump’s health nominees should welcome disrupters.Drug-related deaths account for roughly 10 percent to 18 percent of life expectancy declines, but obesity is the biggest culprit, according to Pennsylvania State University research.If you don’t have a weight problem, your life expectancy isn’t affected, but your wallet is. The obesity epidemic is costing taxpayers and premium payers a fortune.The Trump administration needs to launch a campaign against unhealthy eating the way the American government successfully combatted smoking.The Food and Drug Administration updated its definition of “healthy” foods in December, but the new guidelines won’t go into effect until 2028. Why the snail’s pace?The Centers for Disease Control and Prevention says it’s still “studying what works” for people to “have a healthier diet.” Ridiculous.It’s not American medical care that is failing us. American cancer survival rates are among the world’s highest.Yet the public health agencies, including the CDC, “don’t want to take responsibility” for obesity and lives cut short, says Dr. Ravi Sawhney, a former National Institutes of Health researcher on shortened American lifespans.Trump advisers Elon Musk and Dr. Mehmet Oz also are pushing for wider coverage of semaglutides such as Wegovy, which in Dr. Oz’s words do “massive good.” Thirteen state Medicaid programs cover them, but New York’s does not.Robert F. Kennedy Jr. expressed skepticism, but he needs to consider the evidence. Research in Current Cardiology Reports on “Curbing the Obesity Epidemic” confirms the benefits of semaglutides to prevent cardiovascular, kidney, and other metabolic conditions.JAMA Health Forum disclosed on December 13 that the American obesity rate declined for the first time in more than a decade, reflecting the success of semaglutides.Senator Booker rails that nearly half the population is prediabetic or diabetic, but he insists Trump “has no intention of bringing needed change.” That partisanship is unfortunate.As Congress fights over Trump’s health nominees and spending on health plans, both sides of the aisle need to look at the science. It’s time to change course — curbing managed care controls and focusing resources with laser-like intensity on combatting obesity. Otherwise Americans will be doomed to shorter lives.Creatos.com
