ACA, Medicare, and the Stupidity of Government

It is always useful to see the provision of Government controlled health care through one's own lens. Now I am one of the few who try not to get sick, and to that point I watch diet and exercise especially watching blood glucose. To wit, I record each day for the past ten years fasting and post prandial glucose, weight, food intake, etc. Ten years of daily data, never a miss, truly. It is plotted, managed, watched, just to be certain we keep from getting Type 2 Diabetes. You see I am my own petri dish.

CMS stated to me in their correspondence:

A claim for blood glucose test strips was filed with NHIC, Corp. (NHIC) and an initial determination was performed on January 7, 2011. The clEiim was found unfavorable because similar items were already provided...The reconsideration case file included a Reconsideration Request Form,  re-determination Request Form, Medicare remittance, physician's order, delivery ticket, and clinical
documentation...

Our Medical Review Panel, consisting of a nurse and a physician, has reviewed the submitted
documentation and decided that payment cannot be allowed for blood glucose test strips....

In addition, there was no progress notes submitted for review current to the date of service. The one submitted establish progress note is after the date of sen/ice in review and cannot be used ... Medicare, the patient's medical record must contain sufficient documentation of the patient's medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). The information should include the patient's diagnosis and other pertinent information including,

When I turned 65 the Government took over control of my glucose monitoring. I could not buy the tabs anymore, the Government, some physician and nurse, yes some unknown nurse, said my 10 years of daily data were not proof that prevention works. I even sent them my book on Obesity and Type 2 Diabetes! For CMS, it appears, I must gain 50 or more pounds and have HbA1c in excess of 7.0 before they would allow me to buy it myself. Well thank God for Amazon, they sell them and I buy them, and I stay well! And thank you Government, for the ACA, you really created a monster. Happy Second Birthday.

But to the most strange part is the recent NIH News, stating that intervention and prevention works, namely I am doing the right thing.

They NIH state:

Prevention programs that apply interventions tested in the landmark Diabetes Prevention Program (DPP) clinical trial would also improve quality of life for people who would otherwise develop type 2 diabetes. The analysis of costs and outcomes in the DPP and its follow-up study is published in the April 2012 issue of Diabetes Care and online March 22 at http://diabetes.org/diabetescare. 

The DPP showed that lifestyle changes (reduced fat and calories in the diet and increased physical activity) leading to modest weight loss reduced the rate of type 2 diabetes in high-risk adults by 58 percent, compared with placebo. Metformin reduced diabetes by 31 percent. These initial results were published in 2002. As researchers monitored participants for seven more years in the DPP Outcomes Study (DPPOS), they continued to see lower rates of diabetes in the lifestyle and metformin groups compared with placebo (www.nih.gov/news/health/oct2009/niddk-29.htm). Lifestyle changes were especially beneficial for people age 60 and older. 

The economic analysis of the DPP/DPPOS found that metformin treatment led to a small savings in health care costs over 10 years, compared with placebo. (At present, metformin, an oral drug used to treat type 2 diabetes, is not approved by the Food and Drug Administration for diabetes prevention.) The lifestyle intervention as applied in the study was cost-effective, or justified by the benefits of diabetes prevention and improved health over 10 years, compared with placebo. 

 So NIH wants prevention but CMS, that is Medicare prohibits prevention, or at least that nurse in Tennessee says so. Remember my fear of some bloated GS 9 denying coverage! Well she is in Tennessee. And she is a contractor!

The stupidity of CMS, the intent should be prevention, not waiting until the disease takes over. I even wanted to pay out of my own pocket, denied. Back to Amazon! Thank you Dr. Bezos! Perhaps Amazon could open a full service Medical practice as well. The of course DC would send in  the thugs and shut it down, perhaps even send in EPA!

Thus with the new ACA, on one hand they deny prevention and on the other hand they praise the need for prevention. In case anyone has noted this happens all the time with big Government. And we are only 2 years into this mess!