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How Obamacare Touches Some of Us Sparkies

Sunday, October 13, 2013

Wow, the news headlines are an endless treasure trove of thought-provoking blog topics. You can include "weight loss" in your Google news notifications too, and get there. No reason I should have all the fun. No matter...

Have you had obesity-related surgery (I "know" some of you well enough now to know the answer in some cases is "yes.")? Would you consider it? Would its coverage by insurance, in whole or in part, dictate whether you would consider it? Whether you had it or not, do you judge it as medically necessary (and thus insurance-eligible) or as a form of, well, cosmetic or elective surgery akin to Botox or teeth whitening? Many of us say the former, though a few may choose the latter.

Now, the questions get a little harder. Do you buy the premise that obesity is self-inflicted and thus a matter of choice? And if so, should corrective or (what's the word here?) ameliorating surgery be something that is insurance eligible? Should a primary care physician make this determination? If so, under what criteria? More horrifying is whether your insurance company should determine your eligibility for coverage based on "managed care" and all of the horrible unfairnesses and miscarriages of medicine that those two words conjure.

So here in the super-soggy Mid-Atlantic, we have taken a momentary pause from feverish ark construction (it's still too dark at 7AM on a Sunday morning to measure cubits with accuracy; the shipwrights are sleeping in) to read the news. This one about obesity surgery insurance coverage and its consequence on insurance rates jumped out:


For those too busy or lazy to click through, here is the upshot: "Consumers shopping for health coverage in new online marketplaces may... come to a handful of plans in Virginia... (that) cost more than $1,800 a month... The plans do not include gold-plated hospital beds or guaranteed same-day access to doctors. Instead, those premiums reflect an add-on benefit for a type of costly surgery for obesity... a Virginia consumer considering gastric bypass or bariatric surgery will have to pay up to $1,500 a month more for plans that cover the procedure.

"Consumers in Maryland, by contrast, could buy any policy in the marketplace — and for dramatically less than the Virginia rider plans — and be covered for bariatric surgery because that state requires all plans to pay for it." It's built into our rate structures fundamentally, and thus stands out as less glaring.

Now I know more than to ask whether the government shutdown over Obamacare (or over Obama in general) is righteous and just and necessary, or whether it is ridiculous bordering on treasonous. That is another blog, but if you know me you know where I stand. And if you do not, you have not been paying all that much attention here, have you?
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  • MARYANN2323
    As in all cases of obesity related surgery, there are always some that are deemed necessary, ie life threatening. If that is the case, our medical system (here in Canada) would cover it. But it must be a board approved necessity.

    I don't claim to know much about the US system, other than it is a costly one. Here, a married couple, making over $30,000 (that is the top of the scale cutoff) pays $120 per month to cover both. A family of 3 or more would pay $133 per month, total. There are times when you may have to wait for certain procedures, but those are very specialized procedures. Things like Physical therapy and Chiropractor visits incur a small co-pay. And prescriptions are not covered.
    These are costs for a normal working family. The elderly and low incomers pay a lot less or nothing. emoticon
    2465 days ago
    We have insurance (through our previous employer) - but I don't know if bariatric surgery is included, or not.

    That said, I personally believe that if a dr prescribes a procedure based on medical need, well then, that should be covered by medical insurance.

    I also think that one of the (few) problems with "Obamacare" is that each state is doing their own thing. If it's a nationwide system, I think it should be national, and the same from state to state. The way Social Security is. Too easy to discriminate against certain populations if we do things state by state, versus nationally.
    2466 days ago
    My 2 cents -- I had WLS (Lapband) and it was one of the BEST decisions I ever made. It was not for cosmetic reasons, unless you want to assert that looking at a 270+ lb man is a "bad" thing and that requires cosmetic changes (well I'm sure it was tough to look at me, but that is beside the point!), but what I can say is prior to my surgery, I was Type 2 diabetic, had to have both of my knees operated on (arthroscopic), and God knows what else was wrong with me. Today: 175 lb, run 5K's, no Type 2 diabetes, and I've traded in my size 44/46 jeans for size 32!

    Is WLS for everyone? Probably not, but how many people have decided they can't improve their lives the way I have but could not do so due to the $20K price tag for Lapband WLS? I shudder to think!

    I'm lucky! My employer provides me with a GREAT health benefits! But affordable health care should not be a "luck" thing. Hopefully ACA will give more people the opportunity to change their lives they way mine has been changed!

    As I said, my 2 cents!

    2466 days ago
    don't follow the ... will pay the fine and not buy into his .... plan it cheaper for me i gave up following the news made my BP go up and eating things that should not go into my mouth like a bag of Candy Corn !!!! not good for the waist line and not very sparky. and don't want to have to be treated for high blood pressure.
    the premiums 1.500 are more than i make in two months !!!! either i have a place to stay and eat or insurance i choose food and a place to sleep. emoticon
    2466 days ago

    Comment edited on: 10/13/2013 7:20:31 PM
    I can't comment because I haven't been paying attention. I don't really know what Obamacare is and don't really care.
    2466 days ago
    One obstacle that Canada had to overcome was technology. Being able to share medical records from different providers.

    That is a huge opportunity for the US. One of the goals of ACA is to provide more efficient health care. Improvements in the medical record arena would align with that goal.

    However, IMHO the act does create efficiencies, but both also adds and transfers costs. The main focus is on the uninsured issue, not the cost side. But the cost side impacts the surviving insurers in the process (e.g. Medicare, Tricare, etc.).

    Need to make major changes in the cost side and the new regulations for this NOT to derail the US economy.
    2466 days ago
    Great blog. Speaking of VA, do you listen to Macrini in the morning? I listen from San Diego via computer and find VA politics interesting.
    2466 days ago
  • FLYER99

    I live in Canada and our healthcare system is called "free", although it really isn't as we pay for it in our taxes, BUT at least it carries with us no matter where we live in the country. Some provinces pay for the odd drug or procedure that another province doesn't but for the most part all provinces are the same. There are long wait times in some cases, but those who require immediate attention get it. I wouldn't change it for the US system and I count myself as fortunate in that regard.

    If I lived in the US it seems that each state has its own health care plans available. I can see that for some people, it would be wise to move from one state to another depending on what they require in their health care and the affordability of it. I have some friends and relatives in the US and hear about the US system quite regularly. The ACA certainly threw a wrench into the entire healthcare system.

    I hope for US residents that it all gets straightened out!

    Have a most blessed day!

    2466 days ago
    Even outside of insurance considerations, bariatric surgery is definitely a mix of emotional and physical considerations. Insurance aside.

    The feeling that bariatric surgery is a "cop out" is totally not how I feel @ all. I have dealt with health issues (thyroid disease, type 2 diabetes) which BOTH affect the metabolism and thus gaining (or ability to lose) weight. So, the idea that weight loss is of our choice, is not the truth! Yes, choices ARE part of any equation in reaching goals, no matter what those goals are. BUT, there are outside situations that affect our ability to reach the bottom line as well.

    For sure, I think the analogy between smoking cessation and weight loss. BOTH of these things definitely have huge health impacts and DO need attention. The health care industry as a whole, IMHO, does NOT pay enough attention to preventive are.

    I was diagnosed with type 2 diabetes (and already had/have autoimmune thyroid disease) and really had to search before a Dr. would listen to me! FINALLY when the thyroid issue was stabilized and then the proper medication for my type 2, and my health went from abysmal to great! That was the combination that allowed me to FINALLY lose weight and regain health.

    When you're in a position that necessitates bariatric surgery, IMHO, it should be covered.

    IF it is possible to lose the weight without it, so be it! Honestly I did. I finally got the right meds to get my metabolism regulated and for me, that was what I need to get my health back, my life back, my eating controlled. That's ME.

    I do feel that there are so many who are unable to take care of their health because of no insurance. However, I am not thinking Obamacare is the "cure all" for that

    LOTS in the news to think about for sure!!
    2466 days ago
    For some reason when I put comments in on your Spark Page I have to do it blind and can't correct: should have been of course "Steve Siebold" for the "addiction to the approval of others" adage.

    And as for Obamacare -- here in the GWN we have transferrable from province to province medicare for each and every one of us, for which I am enormously grateful. My own health care and that of my family members over the decades would have cost hundreds of thousands of dollars . . . and for which I've never paid more than hospital parking fees. And that would include bariatric surgery if medically necessary but not as a "cosmetic choice". (Nope, that's not how I lost 90 pounds and kept it off). The Canadian system is by no means perfect but what always astonishes me is not just the quality of the care but the genuine kindness and concern with which it's provided: something that you cannot possibly mandate but something that seems to be part of the ideology regardless of hospital politics/working conditions. I simply don't know why or how that happens. But I have had reason to appreciate it many many times. I did read recently that a fairly standard birth in Chicago with some fairly minor complications (much less than I experienced with the birth of my two children) was billed in excess of $800K. Astonishing.

    So yes, I have followed the debate in the US but won't comment further because it's not my country/not my political system.
    2466 days ago

    The ACA falls between Medicare and Medicaid in terms of the state's role. Medicare pays providers based on geograhic rates but your benefits are the same in each state, Medicaid vary's widely from state to state as Washington provides some of the funding but the program design and benefits vary dramatically from state to state.

    The ACA has minimum requirements but if a state opted in, they had the ability to design the plans to "fit their citizens". I for one, would like to know what healthcare tweaks benefit us in North Carolina vs. say Illinois?

    The decision to opt in or out was driven more by having to expand Medicaid as a price of admission. That is central to poor timing of the ACA. Had state budgets been in less impacted by the recession, then a more favorable climate for ACA would have existed.
    2466 days ago
    I am opposed to the ACA. We do need health care reform. But not legislation that has so many negative aspects.

    In terms of weight loss surgery and should it be considered elective? If one argues that this is a lifestyle choice and should not be an essential benefit, then where do you draw the line? Lifestyle choices are the precurser to many diseases, e.g. heart disease, cancer, etc.

    Sure someone MIGHT be able to modify their food intake and or exercise to lose weight and avoid the surgery. Someone MIGHT also quit smoking and avoid cancer. But would you deny them cancer treatment because they smoked?

    There is an interesting correlation between smoking and weight loss. There are 3 factors that affect premiums (in the federal marketplace): age, geograhic location and smoker, non-smoker.

    So, since premiums are already impacted by smoking, it's logical that obesity could also be an "add-on".
    2466 days ago
  • COOKIE_AT_51
    I am emoticon to admit that I haven't really paid attention to Obamacare as at the current time I haven't "had" to look into it (for which I am thankful, mind you).
    That is absurd that the government allows the states to have such leeway with what the possible choices contain.
    If they are going to mandate something it should be a "nation wide" inclusion decision (not a one size fits all) but all include or none include.
    Since I live in VA ... guess I will just have to continue with the old fashioned way of losing weight and getting healthy. emoticon

    Ok ... enough weighing in on politics "shudders"

    Cookie emoticon
    2466 days ago
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