Health Equity for a Price in Obesity Care

Is the price for health equity in obesity care too high? Or do policy makers simply not care to make it a priority? Writing in the Washington Post, Reverend Al Sharpton tells us that advances in obesity care bring an appalling failure of health equity into plain view:

“Despite rates of obesity among people of color that clearly eclipse those of White Americans, access to anti-obesity drugs remains out of reach for large swaths of Black America, including millions who are denied access to it by programs such as Medicare.

“The debate surrounding the question of insurance coverage often starts and ends with the same refrain: ‘It’s too expensive.’ But let me be clear: Medicare’s refusal to cover medications prescribed for weight loss is not about cost — it’s about priorities. And the health of Black Americans is not a priority.”

The Price Tag

With a new analysis in Health Affairs, Benedic Ippolito and Joseph Levy suggest that the price tag for a Medicare policy change to cover obesity medicines outright would be between three and six billion dollars annually. But these estimates are highly dependent upon assumptions about prescribing behaviors, inevitable changes in prices, and new indications for these medicines that will expand their utilization regardless of any policy change.

In the end, though, they point to a basic fact about the policy decision ahead of us:

“Evaluating the merits of expanding Medicare coverage to include these products requires weighing cost estimates against clinical and nonclinical gains experienced by patients. Although doing so was beyond the scope of our article, some of our findings affect both.”

In other words, do we care enough to make equitable access to care for this disease a priority?

An Absurd Situation

Can we afford the price of obesity care more than we can afford huge gaps in health equity? In JAMA Health Forum, David Cutler argues that we must find a way:

“When viewed holistically, the situation is absurd. Diabetes and obesity are major public health problems in the US, and more effective treatments are now available. There must be a way to use those treatments in an affordable and sustainable manner.”

Where there is will, there is a way. We must summon the will to close these gaps.

Click here for free access to Sharpton’s commentary, here for the economic analysis by Ippolito and Levy, and here for Cutler’s essay.

Old Timer Structural Worker, photograph by Lewis Hine / WikiArt

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August 16, 2024