# Should the government be paying for obesity suirgery? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 25, 2005, 11:04pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741 "2005-11-25T23:04:05Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [November 25, 2005, 11:04pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/1 "2005-11-25T23:04:05Z")
Per the linked article I was surprised to see this surgery was covered under Medicare. Doesn’t this fall squarely under a “disease” that is (in the vast majority of cases) entirely preventable and controllable by adjusting eating and lifestyle habits? Should the government be paying $ 13,000 a pop for surgery for people who basically eat too much? [Gov’t may change Medicare rules for obesity](http://seattlepi.nwsource.com/health/1500AP_Obesity_Surgery.html) > [@](#): > > WASHINGTON – The government proposed on Wednesday expanding Medicare coverage of weight-loss surgery for the disabled, but eliminating coverage of such surgery for the elderly. > > The Centers for Medicare and Medicaid Services said gastric bypass and other weight-loss surgeries may help people with extreme obesity. That is why the agency is proposing to make it easier for the disabled to get the surgery. > > Currently, Medicare covers the cost if the surgery is recommended to treat other health problems. The proposed expansion would allow for the treatment of obesity before associated health problems set in. > > “While the best proven treatment is a nutritious diet and regular exercise … some beneficiaries may significantly reduce their health risks through surgery,” said Mark McClellan, the agency’s administrator. ---
**Author:** ![alice\_in\_wonderland](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alice_in_wonderland/32/176_2.png) [@alice\_in\_wonderland](https://boards.straightdope.com/u/alice_in_wonderland)\ **Post date:** [November 25, 2005, 11:12pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/2 "2005-11-25T23:12:45Z")
> [@astro](#): > > Should the government be paying $ 13,000 a pop for surgery for people who basically eat too much? Well, I think this is a huge oversimplification of the issue. Like HUGE. However, I think the govt or insurance providers should pay. But then I think they should pay for _EVERYTHING_ so I may not be the best person to answer. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 25, 2005, 11:42pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/3 "2005-11-25T23:42:14Z")
If I was convinced that it was safe and it actually worked, then I’d advocate it being a covered benefit for refractory morbid obesity with documented failure on other therapeutic modalities. Unfortunately, I don’t think the data is all that good on either it’s long-term efficacy (getting the weight to come off and _stay off_) or it’s safety. ---
**Author:** ![DiosaBellissima](https://avatars.discourse-cdn.com/v4/letter/d/a8b319/32.png) [@DiosaBellissima](https://boards.straightdope.com/u/DiosaBellissima)\ **Post date:** [November 25, 2005, 11:42pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/4 "2005-11-25T23:42:18Z")
I think it depends on the severity of the case. Some people are so fat that they simply cannot work it off (at least initially) and in these cases, the surgery is justified. Then again, this type of surgery is becoming the easy answer for a lot of people (I’ve seen shows about people GAINING weight so they can qualify for the surgery…all because they wouldn’t put in the necessary effort). Maybe the government should cover gym memberships before they jump right into expensive surgeries. ---
**Author:** ![Harriet\_the\_Spry](https://avatars.discourse-cdn.com/v4/letter/h/e56c9b/32.png) [@Harriet\_the\_Spry](https://boards.straightdope.com/u/Harriet_the_Spry)\ **Post date:** [November 25, 2005, 11:53pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/5 "2005-11-25T23:53:16Z")
It may well pay for itself on a strictly dollars and cents basis, assuming the government is responsible for all medical expenses for these disabled people. For example, what are the chances it may reduce needs for medication, prevent the need for a knee replacement, etc.? If Medicare is providing your health coverage due to disability, not age, you are generally pretty seriously disabled, to the point you are unable to work and receiving Social Security Disability benefits. So the possibility of returning the people to some level of economic productivity is also a plus to the government. If the cost benefit is positive, including the safety and effectiveness concerns raised by **QtM** , I am definitely in favor of it being covered for these folks. In that case, I see not covering it as costing me tax dollars to attempt to teach people a lesson. Y’know what I’d like to see the government pay for more of? Sidewalks. Seriously. If people could walk places without wading through underbrush and fighting killer traffic, that would be a great help to keep our country in shape. ---
**Author:** ![Fish](https://avatars.discourse-cdn.com/v4/letter/f/bc8723/32.png) [@Fish](https://boards.straightdope.com/u/Fish)\ **Post date:** [November 26, 2005, 7:40pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/6 "2005-11-26T19:40:12Z")
Like **Harriet** , I wonder if that $13,000 surgery is cheaper than the other costs of disabled care: government funding for Dial-A-Ride, providing motorized wheelchairs, long-term hospitalization for things like congestive heart failure, etc. A person who is morbidly obese may not even be able to get good diagnostic care to find out _what_ is wrong with him. I hate to put it quite this way, but there are some patients who don’t fit into our MRI machine. X-rays don’t penetrate well on patients who are carrying too much extra meat. (I heard of one patient who had to be sent to get an MRI at the zoo because she was too fat.) If that $13,000 were surgery out of the blue, a surgical cost in the absence of other treatment, it’d be a little silly. If it’s _instead_ of treatment that costs as much per month (or year), then yeah, it could be a net benefit — if it works. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [November 26, 2005, 8:14pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/7 "2005-11-26T20:14:52Z")
I’d agree with Qadgop that this surgery very frequently does not solve the problem nor address the root causes. It has a limited use for people who have genuinely tried everything else. ---
**Author:** ![UntouchedTakeaway](https://avatars.discourse-cdn.com/v4/letter/u/d78d45/32.png) [@UntouchedTakeaway](https://boards.straightdope.com/u/UntouchedTakeaway)\ **Post date:** [November 28, 2005, 4:27pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/8 "2005-11-28T16:27:35Z")
Yes. But out of the gate, I should say I’m biased, having had the surgery on 11.11.04. My health has been restored. There should be an approved network of surgeons for this. The patient should undergo a battery of pre-approval testing - psychological, pulmonary, cardiac, GI. A series of visits with a nutritionist should be required. A 6-month physician supervised weight loss program should be taken. Why? Because I had to go through all of this to be approved by my insurance company. I think there’s a misguided assumption that this surgery is for losing that last pesky 20 pounds before summer bikini season. It’s not. It’s a final solution for those who have tried everything. A link to my [obesityhelp.com](http://obesityhelp.com) profile if anyone is interested: [http://www.obesityhelp.com/morbidobesity/members/profile.php?N=P1046365298](http://www.obesityhelp.com/morbidobesity/members/profile.php?N=P1046365298) VCNJ~ ---
**Author:** ![alice\_in\_wonderland](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alice_in_wonderland/32/176_2.png) [@alice\_in\_wonderland](https://boards.straightdope.com/u/alice_in_wonderland)\ **Post date:** [November 28, 2005, 6:21pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/9 "2005-11-28T18:21:58Z")
> [@Veuve\_ClicquotNJ](#): > > A link to my [obesityhelp.com](http://obesityhelp.com) profile if anyone is interested: Well, ignoring your fabulous skinny self for just a moment - you have got some FABULOUS shoes girl! \<_drool_\> ---
**Author:** ![UntouchedTakeaway](https://avatars.discourse-cdn.com/v4/letter/u/d78d45/32.png) [@UntouchedTakeaway](https://boards.straightdope.com/u/UntouchedTakeaway)\ **Post date:** [November 28, 2005, 7:22pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/10 "2005-11-28T19:22:10Z")
😃 Just a small representative sample, actually. I had the dreaded “Glamour Shots” done & they asked me to bring in a “prop” that would personalize the picture. I am noted for my shoes - so, voila! VCNJ~ ---
**Author:** ![tdn](https://avatars.discourse-cdn.com/v4/letter/t/94ad74/32.png) [@tdn](https://boards.straightdope.com/u/tdn)\ **Post date:** [November 28, 2005, 7:31pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/11 "2005-11-28T19:31:47Z")
> [@Veuve\_ClicquotNJ](#): > > There should be an approved network of surgeons for this. The patient should undergo a battery of pre-approval testing - psychological, pulmonary, cardiac, GI. A series of visits with a nutritionist should be required. A 6-month physician supervised weight loss program should be taken. I believe it is mandatory to go through all of that. At least it is at this hospital. It’s not a little light cosmetic surgery. It’s serious business. Oh, and Happy Birthday! 😉 ---
**Author:** ![UntouchedTakeaway](https://avatars.discourse-cdn.com/v4/letter/u/d78d45/32.png) [@UntouchedTakeaway](https://boards.straightdope.com/u/UntouchedTakeaway)\ **Post date:** [November 28, 2005, 8:23pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/12 "2005-11-28T20:23:32Z")
Thank you very much! 🙂 VCNJ~ ---
**Author:** ![mojave66](https://avatars.discourse-cdn.com/v4/letter/m/5f9b8f/32.png) [@mojave66](https://boards.straightdope.com/u/mojave66)\ **Post date:** [November 28, 2005, 11:12pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/13 "2005-11-28T23:12:55Z")
Actually, I’m going under the knife myself on 12-15-05. I didn’t do this lightly (NPI), I’ve been up and down the scale most of my life-- everywhere from 170 (my “ideal” weight at the age of 30) to 355 lbs. Right now I’m at about 330. Believe me, candidates for surgical weight-loss techniques (Bariatric surgery) aren’t just a bunch of people looking for an “easy” solution. I’ve tried every method out there, and my long-term failure rate falls within the norm-- no non-surgical method has more than a 20% success rate over five years. In contrast, bariatric methods have an 85% success rate over five years. That’s pretty damned good. For most morbidly obese people, you’re not only fighting food and lifestyle issues, you’re also fighting genetics. You can have food addiction issues and be rail thin, or you could eat the average unhealthy American diet and be morbidly obese. However, one of the biggest factors out there is that it is much harder to exercise and to keep up exercise for morbidly obese people. Bariatric surgery with follow-up works, and it works well, especially now that laparoscopic methods have helped with surgical morbidity. Cites: > **[Bariatric Surgery](https://jamanetwork.com/journals/jama/article-abstract/199587)** > > Context About 5% of the US population is morbidly obese. This disease remains > largely refractory to diet and drug therapy, but generally responds well to > bariatric surgery.Objective To determine the impact of bariatric surgery on weight... > **[A Simplified Approach to the Management of Non–ST-Segment Elevation Acute...](https://jamanetwork.com/journals/jama/fullarticle/200664)** > > Incorrect Data: In the Clinical Review entitled > “A Simplified Approach to the Management of Non–ST-Segment Elevation > Acute Coronary Syndromes” published in the January 19, 2005, issue of JAMA (2005;293:349-357), incorrect data were reported. In the... ---
**Author:** ![Brynda](https://avatars.discourse-cdn.com/v4/letter/b/e79b87/32.png) [@Brynda](https://boards.straightdope.com/u/Brynda)\ **Post date:** [November 29, 2005, 1:14am UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/14 "2005-11-29T01:14:32Z")
Should the government not pay for cancer treatment for people who smoke too much? Surgical repair for people who drive poorly? Medical care for those who drink too much? Casts for the clumsy? Color me :dubious: about the OP’s argument. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [November 29, 2005, 1:54am UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/15 "2005-11-29T01:54:05Z")
Yes. MOST health problems are due to lack of personal responsibility. By personal responsibility I mean irrational levels of it, not rational levels that Joe Everyman can be expetected to follow. If everyone Never smoked Never drank, except in moderation Ate better Exercised intensely Meditated daily Was extremely religious Loved themselves unconditionally Didn’t have anger Didn’t have stress Never got divorced Was extremely close to their family Took a variety of vitamins and various other nutritional supplements Got screened for almost everything Then most diseases could be avoided. But rationally its not going to happen. You might as well mandate whether medicare should pay for the healthcare of angry people. Anger causes heart disease. Atheism will also make your health worse. [http://www.users.bigpond.com/rdoolan/christianadvantage.html](http://www.users.bigpond.com/rdoolan/christianadvantage.html) Eating poorly and not exercising (especially at the level necessary to cause massive, sustained weight loss) requires as much, if not more effort than it does to do all the things I’ve listed above. You can’t pick and choose which ones the government shouldn’t fund. If we did then medicare wouldn’t be willing to pay for heart surgery for a CEO who voluntarily chose to pursue a high stress career. ---
**Author:** ![UntouchedTakeaway](https://avatars.discourse-cdn.com/v4/letter/u/d78d45/32.png) [@UntouchedTakeaway](https://boards.straightdope.com/u/UntouchedTakeaway)\ **Post date:** [November 29, 2005, 4:16pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/16 "2005-11-29T16:16:31Z")
Mojave: Much good luck to you! If you need any help or have any questions, please feel free to drop me a line! VCNJ~ ---
**Author:** ![VunderBob](https://avatars.discourse-cdn.com/v4/letter/v/839c29/32.png) [@VunderBob](https://boards.straightdope.com/u/VunderBob)\ **Post date:** [November 29, 2005, 6:21pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/17 "2005-11-29T18:21:19Z")
> [@Veuve\_ClicquotNJ](#): > > Mojave: > Much good luck to you! If you need any help or have any questions, please feel free to drop me a line! > > VCNJ~ Me, too, Mojave. I’m six months post-op myself, and I love answering serious questions about the experience. ---
**Author:** ![Doug\_Bowe](https://avatars.discourse-cdn.com/v4/letter/d/df788c/32.png) [@Doug\_Bowe](https://boards.straightdope.com/u/Doug_Bowe)\ **Post date:** [November 29, 2005, 8:11pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/18 "2005-11-29T20:11:42Z")
Good Luck, mojave! 1 year, 2 months and 145 pounds later. One of the first things you have to sign in the CYA agreements is the acknowledgement that 1 in 200 people who undergo this surgery die. If the Medicare paid for this could Medicare be the object of a lawsuit? ---
**Author:** ![amarinth](https://avatars.discourse-cdn.com/v4/letter/a/3be4f8/32.png) [@amarinth](https://boards.straightdope.com/u/amarinth)\ **Post date:** [November 29, 2005, 8:34pm UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/19 "2005-11-29T20:34:46Z")
> [@astro](#): > > Per the linked article I was surprised to see this surgery was covered under Medicare. Doesn’t this fall squarely under a “disease” that is (in the vast majority of cases) entirely preventable and controllable by adjusting eating and lifestyle habits? If that’s your criteria, do you expect the government to pay the medical costs for treatment of lung cancer and heart disease? Not that I think it should (or shouldn’t) be covered - I don’t know. But “it’s your fault you’re sick, so we won’t cover you” doesn’t work for me. ---
**Author:** ![mojave66](https://avatars.discourse-cdn.com/v4/letter/m/5f9b8f/32.png) [@mojave66](https://boards.straightdope.com/u/mojave66)\ **Post date:** [November 30, 2005, 1:05am UTC](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741/20 "2005-11-30T01:05:56Z")
Veuve\_ClicquotNJ, VunderBob & Doug Bowe, thank you MUCHLY for the well-wishes, very deeply appreciated. I _will_ drop y’all a line if I have a question. (sorry for the off-topic) [Next page](https://boards.straightdope.com/t/should-the-government-be-paying-for-obesity-suirgery/332741.md?page=2)