Denying Gastric Bypass to the Stupid

[docB]

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So insurance companies are trying to prevent stupid people from having gastric.

http://www.foxnews.com/story/0,2933,246519,00.html

As callous as it sounds I'm not totally against this. I think the insurers are clearly trying to duck the bills but I see so many complications and problems in gastric patients in the ED because they just didn't really grasp that they couldn't eat the way they did before that I can't call this a totally bad idea.

 

[Genetics]

I see this as more of an educational tool for people who want to undergo this type of surgery.

So insurance companies are trying to prevent stupid people from having gastric.

http://www.foxnews.com/story/0,2933,246519,00.html

As callous as it sounds I'm not totally against this. I think the insurers are clearly trying to duck the bills but I see so many complications and problems in gastric patients in the ED because they just didn't really grasp that they couldn't eat the way they did before that I can't call this a totally bad idea.

 

[Miami_med]

So insurance companies are trying to prevent stupid people from having gastric.

http://www.foxnews.com/story/0,2933,246519,00.html

As callous as it sounds I'm not totally against this. I think the insurers are clearly trying to duck the bills but I see so many complications and problems in gastric patients in the ED because they just didn't really grasp that they couldn't eat the way they did before that I can't call this a totally bad idea.

Have we come to such a low point in the expectation of personal responsibility, that it is now morally unacceptable to expect people even to kNOW what to do. If the patient doesn't do the right thing, they might actually die. This could actually save lives.

Another thing from the article. Maybe health insurance exclusions are a good way to prevent people from doing stupid things, like riding motorcycles without helmets, without any government intrustion whatsoever. I'm not sure why the "advocates" quoted in this article find this to be "unacceptable discrimination." It may be a good way to minimize risk and reduce insurance premiums, with people paying rates based on risk taking. That would be an interesting topic perhaps in another thread.

 

[twohearted]

This is the happiest day of my life.

 

[trustwomen]

So insurance companies are trying to prevent stupid people from having gastric.

http://www.foxnews.com/story/0,2933,246519,00.html

As callous as it sounds I'm not totally against this. I think the insurers are clearly trying to duck the bills but I see so many complications and problems in gastric patients in the ED because they just didn't really grasp that they couldn't eat the way they did before that I can't call this a totally bad idea.

Maybe I'm misreading this, but in the news report, Blue Cross says that the screening does not influence who gets the surgery and who doesn't, but rather the level of follow-up care that the patients receive afterwards.

Molehill + Fox News = Mountain.

 

[trustwomen]

I see so many complications and problems in gastric patients in the ED because they just didn't really grasp that they couldn't eat the way they did before that I can't call this a totally bad idea.

We are studying GI right now and it seems to my mostly-uneducated M1 self that bariatric surgery is a drastic and dangerous treatment. If you have to do surgery, and I realize that for many people that's what it will take, why not disable receptive relaxation instead? (Would it be too difficult to selectively damage that particular branch of the vagus?).

Just curious.

 

[trustwomen]

It may be a good way to minimize risk and reduce insurance premiums, with people paying rates based on risk taking. That would be an interesting topic perhaps in another thread.

I think the tricky part would be evaluating the level of risk taking in an objective manner, considering that the patients would have an incentive to lie about it. There's a cheek swab they use to identify smokers, but what would you do about other lifestyle risks?

 

[Miami_med]

I think the tricky part would be evaluating the level of risk taking in an objective manner, considering that the patients would have an incentive to lie about it. There's a cheek swab they use to identify smokers, but what would you do about other lifestyle risks?

Well, the plan would simply cover payment for everything but the excluded. If the patient seeks medical care for injuries resulting from an excluded activity (like riding w/ no helmet), they would be responsible for payment. That way, lying is irrelevant. The cause of the injury will be what is important.

 

[docB]

Maybe I'm misreading this, but in the news report, Blue Cross says that the screening does not influence who gets the surgery and who doesn't, but rather the level of follow-up care that the patients receive afterwards.

Molehill + Fox News = Mountain.

"The term IQ test is misleading," Mary Thompson, spokeswoman for BlueCross Blue Shield of Tennessee, told FOXNews.com. "It really measures the patient's knowledge of the surgery itself and the eating and lifestyle changes necessary afterward."

BlueCross's own documentation, however, spells out strict guidelines for patients considering the procedure that includes the need for both an IQ screening approved by the American Psychological Association, and additional tests designed, as Thompson indicates, to measure eating behavior or attitudes, along with other evaluative materials from a psychologist or psychiatrist.

Thompson, however, said no patients have been turned down for surgery to date based solely on their IQ score.

When I read that there are IQ guidelines for patients considering a procedure it sure sounds like someone may get denied if they fall below the minimum. The fact that they said no one has been denied yet sounds to me like they just haven't pulled the trigger yet.

As I mentioned I am fairly ambivalent about the issue but I thought it would make for an interesting discussion. I'm surprised that someone who dislikes Fox News so much is so willing to accept the claims of benevolence on the part of an insurance company.

 

[docB]

Well, the plan would simply cover payment for everything but the excluded. If the patient seeks medical care for injuries resulting from an excluded activity (like riding w/ no helmet), they would be responsible for payment. That way, lying is irrelevant. The cause of the injury will be what is important.

I agree with the premise of what you say, that people should not be forced to do things for their own good but should not be compensated or supported when they suffer the consequences of bad decisions. The counter argument which predominates (at least enough to give us seat belt and helmet laws and the current litigation crisis) is that you can't just let the unwise die on the side of the road so you (society) will end up paying for them anyway. And once the government decides it's going to pay for something it gets to regulate everything that impacts it.

 

[Miami_med]

I agree with the premise of what you say, that people should not be forced to do things for their own good but should not be compensated or supported when they suffer the consequences of bad decisions. The counter argument which predominates (at least enough to give us seat belt and helmet laws and the current litigation crisis) is that you can't just let the unwise die on the side of the road so you (society) will end up paying for them anyway. And once the government decides it's going to pay for something it gets to regulate everything that impacts it.

That counter argument line of thinking is probably what has gotten us into about 95% of our trouble, though I understand what you're saying.

 

[McDoctor]

To me, anything that tightens up the patient selection process when it comes to gastric bypass surgery is a good thing. I see way too many patients who have the procedure, yet continue to smoke, continue to consume >14 drinks of alcohol a week, and as already mentioned, continue try to eat the way they did before surgery. I just don't see the point sometimes. We take this drastic step to reduce obesity morbidity, yet some of these patients continue to smoke cigarettes? Give me a freaking break.

Nowadays, the procedure has moved outside of large multispecialty centers and into smaller community hospitals, and IMHO too many surgeons are just too happy to cut and get paid. Somebody has to take the reins on the patient selection process. It might as well be the company that is tasked with paying for it.

 

[Faebinder]

To me, anything that tightens up the patient selection process when it comes to gastric bypass surgery is a good thing. I see way too many patients who have the procedure, yet continue to smoke, continue to consume >14 drinks of alcohol a week, and as already mentioned, continue try to eat the way they did before surgery. I just don't see the point sometimes. We take this drastic step to reduce obesity morbidity, yet some of these patients continue to smoke cigarettes? Give me a freaking break.

Nowadays, the procedure has moved outside of large multispecialty centers and into smaller community hospitals, and IMHO too many surgeons are just too happy to cut and get paid. Somebody has to take the reins on the patient selection process. It might as well be the company that is tasked with paying for it.

It's getting to a point where 2 procedures (lap band and bypass) are making the whole thing a subspecialty.... Sooner or later they will become regular procedures.

 

[trustwomen]

When I read that there are IQ guidelines for patients considering a procedure it sure sounds like someone may get denied if they fall below the minimum. The fact that they said no one has been denied yet sounds to me like they just haven't pulled the trigger yet.

As I mentioned I am fairly ambivalent about the issue but I thought it would make for an interesting discussion. I'm surprised that someone who dislikes Fox News so much is so willing to accept the claims of benevolence on the part of an insurance company.

Eh, I don't think they're benevolent. I just figure they would never try anything like that if they have even one lawyer on staff - knowing that they could be sued in a heartbeat. Their explanation makes sense, kind of, and they would have a heck of a time denying someone the surgery solely based on intelligence: on clear unwillingness to change their lifestyle, maybe, which could be correlated - and is tested separately - but not on IQ alone.

It makes more intuitive sense that following research and information on the main reason bariatric surgery fails - which is lack of post-surg compliance - they would try to reduce their emergency and/or damage-control costs by better education and screening. And that Fox jumped on it because it was a slow news day or something.

Or maybe they do intend to deny the surgery to the terminally stupid. In which case I'm sort of ambivalent about it too. Not because stupid people don't deserve the care, but because the surgery might well be useless to (or even actively harm) them if they can't be compliant.