BUSH'S NEW ROLE: DIETICIAN IN CHIEF

What does one call a man who lifts weights, chooses egg salad over a corned beef sandwich and runs three miles daily in about 21 minutes, an impressive pace for a 56 year-old? Call him "Mr. President." With obesity rampant in the land, George W. Bush is moving against the tide by trying to persuade his fellow Americans to exercise and eat their fruits and vegetables.

In a recent publicity blitz, the president announced an expanded role for the President's Council on Physical Fitness and Sports; a fee-free weekend in the national parks to encourage walkers and hikers; and a new website, www.healthier.us.gov, to spread the fitness gospel.

EAT YOUR BROCCOLI, DAD!
President Bush, in his fitness quest, sometimes sounds as if he wants to be the nation's dietician in chief. During a recent reelection fund-raising trip for his brother, Florida Governor Jeb Bush, the president told a group of elders that "people should develop good eating habits. Let me put it another way. You need to eat your vegetables--and your fruits. We've been working on Dad for a while on the broccoli issue." The memory of his father's presidential disdain for the green vegetable brought laughs from the crowd.

So serious is the president about putting fitness on the national agenda that on Air Force One, following the Florida trip, assistant press secretary Scott McClellan told reporters that Bush had lunched on "egg salad on toast, and I think he had a diet Coke with it." He did not partake of the inflight meal served to the press corps: corned beef sandwiches, steak fries and cheesecake. McClellan assured reporters that although "part of this Healthier U.S. initiative is eating a nutritious diet . . . , [the president] talked about how every now and then he's prone to a chicken-fried steak." A reporter asked wryly, "So, he's not trying to kill us slowly back here?"

Jokes aside, the Administration is convinced that some of the massive sums Americans pay for healthcare could be avoided with exercise and better nutrition. A Department of Health and Human Services (HHS) study indicated that Americans spend $117 billion a year on health problems linked to overweight and obesity. Tobacco gets the bad publicity, with 400,000 deaths a year associated with smoking and its aftermath. However, 300,000 deaths are associated with the overweight and obesity that can result from poor health habits.

The majority of adults ages 18 and older in the United States are overweight, as are 13% of children, according to HHS. The proportion has doubled since 1980 for adults and tripled for children and adolescents. The National Institutes of Health determines overweight and obesity with a body mass index (BMI), a calculation using weight in kilograms divided by the square of the person's height in meters. (The Medical College of Wisconsin has a website where people can calculate their BMI.) In addition, less than 33% of the U.S. population meets the federal exercise standard of 30 minutes of moderate physical activity five days a week. About 40% of adults get no exercise at all.

HHS correlates obesity in adults with a 50% to 100% higher risk of premature death from diseases such as heart disease, stroke, cancer and diabetes. A key issue, according to HHS, is not that people are eating more; they eat about the same amount of food as did past generations. However, today's Americans exercise much less.

THE LINK TO MEDICARE
One of the hottest issues in Washington is the discussion about creating a new prescription drug benefit for the 40 million Americans enrolled in the federal Medicare program. Although pharmaceuticals are vital for a health, the problems of an indolent population that eats too much and exercises too little will worsen with time--and increase the demand for medications. In 30 years, when the youngest boomers are old enough to collect Medicare benefits, there will be from 65 to 70 million people over age 65, about one in five Americans. Keeping them supplied with medication will be a costly enterprise.

That is why the debate over a Medicare drug benefit is intense. Already, Democrats and Republicans are squabbling over the price tag. The Republican-controlled House voted for a plan costing $350 billion over the next 10 years. It was approved on a party-line vote of 221 to 208, with eight Democrats backing the bill and eight Republicans opposing it.

The bill would allow Medicare beneficiaries to buy drug coverage from private insurance companies, with charges of $33 a month in premiums and a $250 annual deductible. Then the government would cover 80% of costs up to $1,000, and 50% of the tab up to $2,000. Beneficiaries would pay full charges for costs between $2,000 and $3,700. Anything above $3,700 a year would be fully financed by the federal government.

The House did not vote on a Democratic proposal that would have created a new drug benefit as a direct expansion of Medicare. The estimated price tag would range from $750 billion to $800 billion over 10 years. It would have a $25 monthly premium and a $100 deductible. Medicare would pay 80% of costs up to $2,000. Any prescription costs above that figure would be fully paid by the government.

The Democrats control the Senate and are expected to adopt the much more expensive plan than the one passed in the House. It seems doubtful that the two chambers of Congress will reach compromise on a bill before the November election. Now, both parties think they can make a winning issue out of Medicare and are likely to finish the fight at the voting booth rather than in the halls of Congress. Next year, after the elections, may be the time when they reach a compromise.

Robert A. Rosenblatt is the "Health Dollars and Sense" columnist for the Los Angeles Times. He regularly contributes "Potomac Sources" to Aging Today.

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