In the spirit of political debate, I have been interested in the various proposals related to health care in the United States.
My view of our health care system has been shaped by my frustration with our willingness to pay for "sick care" but not for wellness or prevention. Most insurers will fork out thousands of dollars for cholesterol-lowering medications or bypass surgery but most do not include benefits for visits to a dietitian.
Over the years, I have been able to help clients lose weight, lower cholesterol and keep blood sugar in better control. But there were countless others who chose not to make an appointment because their insurance did not cover my services.
Employers who offer health insurance to their employees recognize that profits can be significantly reduced by medical expenses. In an effort to control these costs, many companies have instituted worksite wellness programs. Healthy employees are more productive, miss fewer days of work and have lower medical bills. Our own BlueCross Blue Shield of Mississippi allows its employees 30 minutes a day for on-site exercise above and beyond breaks and lunch.
Medicare and Medicaid are government-funded health insurance plans. Medicare added coverage for visits to a dietitian several years ago but only for those with kidney disease or a diagnosis of diabetes. This year congress voted to expand those benefits to other diagnoses, but all the details have not been worked out. Medicaid in Mississippi has not paid for diabetes education, but Medicaid will pay for an emergency room visit or hospital stay for diabetes that is out of control. Which would be more cost-effective?
Medicare will pay for home health services for our home-bound elderly. A patient who may not have been taking medications correctly ends up in the hospital. Upon discharge from the hospital, the doctor can order home health services so that nurses can visit this patient at home.
Once the patient is stable and doing well, Medicare requires them to be discharged from home health. In many cases, this cycle is repeated until the decision is made to place this patient in a nursing home. Medicare and Medicaid pay for nursing home care, but it seems much more cost-effective to keep patients at home and well as long as possible.
Our "sick care" system is slowly changing to include more preventative health services. I would vote to spend my tax dollars on wellness.
Kathy Warwick is a registered dietitian, certified diabetes educator and nutrition consultant. E-mail her at kwarwick@canufly.net.
