Wednesday, September 20, 2006

Ye Olde Can o' Worms

Talk about opening a can of worms! The Travis County (Texas) county commisioners are planning to fund a pilot program to pay for a few of their employees to undergo weight loss surgery:

The Travis County commissioners approved using county tax dollars to pay for a weight loss surgery for county employees. County Commissioners will pay for up to 15 bariatric surgeries per year during a five-year trial.

This is a very radical concept. The whole idea of this came about because the county was looking at a way to control health care costs, and 400 Travis County employees are classified as obese.

"We think that surgery costs anywhere from $25,000 to $30,000 a year, but these employees right now probably cost us that much anyway. If you look at this in five or six years, that cost will cover itself," Travis County Judge Sam Biscoe said.
Travis County is big --- it basically is the Austin area, and I'm sure has a large number of employees. I would assume, as the article does not specify the particulars, that Travis County is self-insured and it currently does not include bariatric surgery as a covered benefit for its employees. Each corporation or public entity makes choices about what they want covered for their insurance dollars --- breast augmentation, for example, is never covered, but many other things that are considered experimental or less than effective are not covered either --- and a fairly substantial number of them do not cover bariatric surgery.

Why do this? What is the benefit to the county? To the employee? To the taxpayer? As Judge Biscoe states, the idea is that if the employees lose enough weight that their immediate and long-term medical costs substantially decrease, the end result will be an overall reduction in the amount of money the county will spend in health costs. In theory, then, everybody wins --- the county saves money in the long run (and gets healthier, more productive employees to boot), the employee is healthier and has a big decrease in out-of-pocket medical expenses, and the taxpayers end up with a slightly smaller tax burden for this component of government expense.

That's the theory.

There are some cold, hard realities that need to be addressed, as well. Most importantly, although they may have 400 employees that are classified as obese, many will simply not be a candidate for surgery ---- for one, simple, critical, reason: motivation. This is not an operation for the person who feels it would be a "quick fix." There are substantial changes that they need to make in order to be successful, and only the well-motivated patient who has carefully considered this option for some time and understands its ramifications will be successful (in other words, compliant) over the long haul. For this reason, this is not an operation that will work well for the patient who is told by his/her physician (or, possibly, by his/her employer) to "go get this operation -- period."

To their credit, the county commisioners have implemented a rule that will in all likelihood screen for the most motivated employees:
To qualify, county employees would have to be diagnosed with morbid obesity and go through one year of monitored unsuccessful dieting and exercise....Employees identified as possible candidates would be required to complete exercise and nutrition programs and submit to thorough health exams one year prior to the surgery. It would still cost them a $1,000 deposit along with whatever their deductible is.
OK. That's a long-winded introduction to what I found to be the most interesting part of the article: the reader responses (scroll to the bottom of the article)!! Regardless of what I, or other physicians who may or may not feel that weight reduction surgery is beneficial, it is very instructive to read the comments of many (well, let's be honest --- most) readers. Here's just a sampling (warning, it's not very pretty):
Certifiably nuts. Why on Earth should the taxpayers pay for this?

Hell no!!! That makes no sense at all!! I agree with Glenda! There is a whloe lot more useful ways to use that money, and that is not one of them, OBESE OR NOT!!

You gotta be kidding me!@#*& Morons!! Good for you Hill Country! I'm not obese, but if I were I wouldn't expect the tax payers to pay for an operation. Just like I don't expect the tax payers to pay for anything for me!!! LUDICROUS!!!

Absolutely NOT! NO WAY!!!! Don't the County EE have Health Insurance? If it is medically necessary,then Health insurance has to pay for it. They should pay for it with the corresponding deductibles and co-insurance.

Absolutely not!. Their insurance premiums should be used to pay for it.
The last two commenters obviously don't know that they are already paying for the health benefits of these workers.
Next thing you know we'll be paying for them to have all that extra skin removed!!! UNBELIEVABLE!!!!!!!!!!! How about implementing SAFETY meetings that teach PORTION CONTROL!!!!

I think its time for new personnel to make decisions for the people of Travis county. This is the most idiotic, imbicilic and moronitic thing i have ever heard of. Simple solution: PUSH YOUR FAT A***S AWAY FROM THE TABLE>
Interesting, and instructive, don't you think? BTW, you gotta love the grammar and spelling!