作为一名医生,我职业生涯中的大部分时间都在治疗慢性病患者。很快你就会发现一个显而易见的道理:防止患者病情恶化,永远优于等到其健康状况恶化后再进行治疗。
As a physician, I have spent my career treating patients with chronic diseases. One lesson becomes obvious very quickly: preventing a patient from getting sicker is always better than treating them after their health has deteriorated.
遗憾的是,联邦医疗保险的现行规则却本末倒置。如今,超过3500万美国人加入了联邦医疗保险优势计划,其中超过85%的人至少患有两种慢性疾病。这些病症中有许多与饮食有关,可以通过营养干预的临床治疗得到改善。研究表明,有针对性的营养干预能够改善健康结果,并减少费用高昂的住院治疗。医生知道这一点,患者也知道这一点,但联邦医疗保险的政策却没有跟上。
Unfortunately, Medicare's current rules have it backwards. Today, more than 35 million Americans are enrolled in Medicare Advantage, and more than 85 percent have at least two chronic diseases. Many of these conditions are diet-related and can be improved with nutrition-based clinical interventions. Research shows that targeted nutrition can improve health outcomes and reduce costly hospitalizations. Doctors know this. Patients know this. Medicare policy hasn't caught up.
根据现行规则,联邦医疗保险优势计划只能向范围很窄的一部分患慢性病的老年人提供健康食品福利,而且通常要等他们产生高额费用后才符合资格,其中包括面临较高住院风险以及需要重症医疗管理。想想看,这是多么本末倒置。
Under current rules, Medicare Advantage plans can provide healthy food benefits to a narrow subset of chronically ill seniors, but generally only after they incur high costs, including being at significant risk for hospitalization and requiring intensive care management. Think about how backwards that is.
医生可能知道,改善营养有助于患者控制糖尿病或管理心脏病。但联邦医疗保险实际上是在说:等患者病情恶化、治疗费用增加之后,再为他们提供这种干预手段。与此同时,联邦医疗保险优势计划却可以从第一天起就报销保龄球、无线网络和滑雪通行证等“健身福利”。
A physician may know that better nutrition could help a patient control his diabetes or manage her heart disease. But Medicare effectively says: wait until that patient gets sicker and more expensive to treat before making that tool available. Meanwhile, Medicare Advantage plans can cover "fitness benefits" like bowling balls, wi-fi, and ski passes, from Day One.
是的,你没有看错。按照联邦医疗保险的规则,报销一个保龄球,竟然比报销医生开具的、用于管理慢性病的健康食品处方还要容易。
Yes, you read that correctly. Under Medicare's rules, it’s easier to cover a bowling ball than healthy food prescribed by a doctor to manage chronic disease.
我们今天就能解决这个问题,不需要国会立法,不需要创设新的福利资格,也不需要再花纳税人的一分钱。我最近牵头签署了一封信,敦促联邦医疗保险署署长穆罕默特·奥兹承认:对于符合资格的联邦医疗保险优势计划患者,健康食品应被视为一种“主要与健康有关”的补充福利。
We can fix this today, without an act of Congress, without creating a new entitlement, and without spending another taxpayer dollar. I recently led a letter asking Medicare administrator Mehmet Oz to recognize healthy food as a "primarily health related" supplemental benefit for qualifying Medicare Advantage patients.
这项符合常识的调整将使各项计划能够在患者治疗早期提供临床适宜的营养支持,从而预防更严重、治疗费用更高的并发症。这不是食品援助,也不是不受限制的杂货福利,而是针对患有慢性病患者的定向临床干预;符合条件的食品须与政府官方饮食指南相衔接。作为一名医生,对我而言最重要的一点是,当医生认定老年人有医疗必要时,他们就应该能够获得健康食品。
This common-sense change would allow plans to make clinically appropriate nutrition available earlier in a patient's care, when it may actually prevent more serious and expensive complications. This is not food assistance or an unrestricted grocery benefit. It is a targeted clinical intervention for patients with chronic conditions, with eligible foods tied to the government's official dietary guidelines. Most important to me as a physician, healthy food should be available to seniors when their doctor determines it is medically necessary.
如果医生知道更好的营养今天就能帮助患者控制糖尿病,为什么华盛顿还要要求患者的病情更加严重,之后联邦医疗保险才会向医生提供帮助所需的资源?从纳税人的角度来看,这项建议同样合理。医疗保险与医疗补助服务中心已经向Medicare优势计划提供数十亿美元的纳税人资金,用于补充福利。该提案不会增加一分钱支出,只是允许各项计划把现有资源用于预防疾病,而不是为疾病后果买单。
If a physician knows better nutrition can help a patient manage diabetes today, why should Washington require that patient to get sicker before Medicare gives the doctor the tools to help? There is a taxpayer argument here, too. The Center for Medicare and Medicaid Services already sends billions of taxpayer dollars to Medicare Advantage plans for supplemental benefits. This proposal doesn’t spend a dime more. It simply allows plans to put existing resources toward preventing disease rather than paying for its consequences.
长期以来,我们的医疗体系奖励的是治疗疾病,而不是促进健康。特朗普政府和卫生与公众服务部部长小罗伯特·F·肯尼迪推动的“让美国再次健康”议程,正通过应对慢性病并将预防放在首位,改变这一模式。医疗保险与医疗补助服务中心有机会将这一原则转化为行动惠及数百万美国老年人。这是联邦医疗保险历史上首次正式承认健康食品可作为预防和管理慢性病的定向临床干预。
For too long, our health care system has rewarded sick care rather than health care. The MAHA agenda of the Trump administration and HHS Secretary Robert F. Kennedy Jr. is changing that paradigm by addressing chronic disease and putting prevention first. CMS has an opportunity to turn that principle into action for millions of American seniors. For the first time in Medicare's history, we can formally recognize healthy food as a targeted clinical intervention to prevent and manage chronic disease. We don't need a new government program.
我们不需要设立新的政府项目,不需要增加数十亿美元支出,只需要让联邦医疗保险的规则跟上证据,让医生能够在患者住院前及早进行干预。这将带来更好的医疗效果、更好地管理纳税人资金,并使联邦医疗保险计划更加健康。医学博士格雷戈里·F·墨菲代表美国北卡罗来纳州第3选区。众议院。
We don't need billions in new spending. We just need Medicare's rules to catch up with the evidence and give doctors the ability to intervene before their patients end up in the hospital. That's better medicine, better stewardship of taxpayer dollars and a healthier Medicare program. Gregory F. Murphy, M.D., represents North Carolina’s 3rd District in the U.S. House of Representatives.