One of the latest rumors to circulate on the internet about the Obamacare nightmare is that it will require all Americans to undergo BMI (Body Mass Index) screening by 2014. Presumably, the BMI results will be used to ration health care in some manner as finite numbers of doctors, nurses, and hospitals struggle to cope with unlimited demand for their services.
To find the truth, I examined the full text of HR 3590, The Patient Protection and Affordable Care Act, as well as its companion bill HR 4872, the Health Care and Education Reconciliation Act. This takes some time, even scanning with the search function on a browser, since the HR 3590 contains a whopping 906 pages and HR 4872 adds an additional 55 pages. That is quite a number of dead trees for a law that is supposed to simplify and lower the cost of health care. If you would like to examine the text of the laws for yourself, the site that I used is: http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm.
I conducted my examination by searching both documents for “bmi.” This resulted in a large number of hits, but only two referred to “Body Mass Index.” The majority were some form the word “submit,” which says a lot about Obamacare in itself.
The first reference is in section 2703 State Option to Provide Health Homes for Enrollees with Chronic Conditions on page 203. BMI is mention here as one of the medical conditions that defines the term “chronic condition” (specifically a BMI over 25). There is no mention of mandatory screening for BMI.
The second reference to BMI was in section 4004 Education Outreach Campaign Regarding Preventive Benefits on page 428. In this section, BMI mentioned as one of the factors that that people will be able to use to determine their disease risk on a website. Again, there is no mention of mandatory BMI screening.
The second bill, HR 4872, contained several references to “submit,” but no references to Body Mass Index.
At this point, I was ready to declare the mandatory BMI screening a hoax. Just before I published this article however, someone pointed me in the direction of a document called HIT (Health Information Technology) Standards 170.302. This document purports to show Secretary Kathleen Sebelius’ new certification standards for electronic health records (EHRs).
Further, a CNS News report (http://cnsnews.com/news/article/69436) refers to section 3001 Office of the National Coordinator for Health Information Technology of the American Recovery and Reinvestment Act of 2009, the stimulus bill, rather than the Obamacare law itself. The text of this law can be found here: http://www.opencongress.org/bill/111-h1/text.
Section 3001 in Part C Duties of the National Coordinator Subpart 3 paragraph (a) (ii) states that the National Coordinator shall “update the Federal Health IT Strategic Plan” with “utilization of an electronic health record for each person in the United States by 2014.” This constituted the basis for Sebelius’ new EHR standard.
The Code of Federal Regulations Part 170 can be found here: http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf. On page 61 (of 228) this document does state that EHRs will calculate BMIs. An additional document (http://healthcare.nist.gov/docs/170.302.e.2_BMI_v0.2_fulldoc.pdf) refers to certification criteria for EHRs and specifically shows that BMI will be part of the vital signs included in EHRs.
Therefore, it appears that the rumor is true as far as the claims that Obamacare will require an EHR for all Americans and that the EHR will be required to include a calculation for BMI. The speculative claim that the BMI will be used to ration health care is so far unsubstantiated. I will leave it up to the reader to decide whether and how much to be alarmed by the BMI requirement.
I will say that it is extremely likely that Obamacare will result in health care rationing. Massachusetts enacted what President Obama called an “essentially identical” plan in 2006 and the result has been skyrocketing costs (http://bit.ly/dvTxyU). Rapidly increasing demand with a static level of supply led to sharply increasing costs. To deal with these increasing costs, Governor Deval Patrick enacted price controls in the form of denying insurance companies to increase rates.
Jon Kingsdale, who directed in Massachusetts’ version of Obama’s health insurance exchanges, said recently, “"If you're going to do health-care cost containment, it has to be stealth. It has to be unsuspected by any of the key players to actually have an effect." He further stated that the solution to the problem was finding a “significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less'” significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less'” (http://bit.ly/dvTxyU). In other words, the government will have to quietly ration care.
This shows the ultimate importance of efforts to defeat Obamacare. If you value your health care, vote for candidates who will repeal and defund the new law. Also support state and local candidates who will support efforts such as the lawsuit by Georgia and several other states against the law.
Reform the reform!
Sources:
http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
http://cnsnews.com/news/article/69436
http://www.ihealthbeat.org/articles/2010/7/13/final-rules-on-meaningful-use-ehr-standards-released-today.aspx
http://www.opencongress.org/bill/111-h1/text
http://healthcare.nist.gov/docs/170.302.e.2_BMI_v0.2_fulldoc.pdf
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf
http://www.slate.com/id/2221031
http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html?KEYWORDS=massachusetts+health+costs
Comments
Through a mandate of the Health and Human Resources the Stimulus Bill has granted additional funds to include documentation of BMI with every physical
www.newsweek.com/2010/03/24/big-problem.html
BMI is calculated using your height and weight. Most doctors record your height and weight as a matter of routine. This means, effectively, that your BMI is already in your health record.
The author implies in his article (while admitting that there is no factual basis for his argument) that government healthcare will be rationed, and that one's BMI will be used by the government to deny care. This is paranoid, alarmist, reckless -- and I would say malicious.
Adding BMI data to one's health record is like adding one's blood pressure or pulse rate. Including that information should not cause alarm or be seen as an intent to ration healthcare -- unless you think that all other statistics maintained by doctors in order to monitor your overall health will result in the same kind of rationing.
Constructive responses to the healthcare bills will serve the country and its citizens better than paranoid speculation.
It would be different if it was staying in your doctor's office, but it's being reported to the CDC - I never volunteered to be part of a study, did you? Further, I received a letter from my Senator calling it an "epidemic" (it's not contagious, therefore it's impossible for it to be an epidemic). He also said "Being overweight or obese pputs one at risk for many diseases and conditions." Um, LIFE does that doesn't it? So does eating steak, but you don't see them tracking your steak consumption - but give it time; I'm sure that's coming as well:)
I don't imply BMI will be used to ration healthcare. That was the basis of the email and claims in several articles. I found no basis for that claim.
I do explicitly state that Obamacare will end up rationing care based on the experience of numerous other countries. When there is a dramatic increase in demand with no corresponding increase in supply, there will be a shortage. Government will have no choice but to ration care or return to a competitive market.
It is not reported to the CDC. The CDC conducts the Behavioral Risk Factor Surveillence System (BRFSS), which is a telephonic survey, to do these estimates.
The CDC and state organizations actually do collect a great deal of other data. These are critical to health research and understanding such things such as environmental risk factors for rare diseases and cancers where survey research such as the BRFSS would be insufficient.
An epidemic does not have to be 'contagious' -- it is being used in this case to mean "highly prevalent" or "widespread."
Mr. Thornton: while you are not stating BMI will be used to ration healthcare, you are most certainly implying it in this article. If you were simply answering the email question, you would have stopped where you said that the claims of BMI being used to ration care are unsubstantiated.
One-third of the care received in this country is completely unnecessary. There are substatial savings by simply providing the right care at the right time. The 'rationing' fear-mongering is unnecessary.
It may be that much health care consumed is unnecessary, but what care is given should be between the patient and the doctor, not the government.
I don't imply that BMI will be used to ration care. I do explicitly state that some form of rationing will be used eventually. Even Dr. Donald Berwick, President Obama's Medicare head has acknowledged that rationing will be necessary. It is necessary everywhere that government controls the health care industry.
It is an economic impossibility to provide more care for more people at a lower cost without rationing and/or price controls. When something is free, people consume more of it. When prices are kept artificially low, there is less of an incentive for people to produce that good or service. There will be fewer doctors and hospitals attempting to provide more services to more people. You do the math.
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