When Lifesaving Medical Care is "Cosmetic"

When Lifesaving Medical Care is “Cosmetic”

Shawn Alvarado is not healthy and he knows it. He has a sedentary job, working as a dispatcher for a moving company. Now 53 years old, he’s been gaining weight ever since he was a teen. He weighs almost 500 pounds. He has heart disease, diabetes, and sleep apnea. Without a gastric bypass, his cardiologist says he will be dead within 10 years. And yet, the LA Times reports that Alvarado’s health plan – HealthPartners – says that procedure would be cosmetic.

They’ve refused twice to authorize him for this lifesaving procedure.

Clear Data: Longer Lives and Better Health

Here’s the thing. Because of stigma about obesity, many people hang on to a bias against bariatric surgery. “This shouldn’t be necessary,” says that little voice in some people’s heads.

But the facts don’t line up with that. Close to 40 percent of Americans have obesity. About 20 million have severe (class 3) obesity. For at least some of those people facing severe obesity, the only chance for a long and healthy life is bariatric surgery.

The data is clear. Bariatric surgery leads to longer lives and fewer health problems. For someone with type 2 diabetes and obesity it’s especially clear. The odds of putting diabetes into remission are dramatically better with bariatric surgery. Far better odds than even the best intensive medical care can provide.

Weirdly Favoring More Costly Complications

The dumbest thing about this situation is that HealthPartners is paying much higher expenses for the complications of leaving Alvarado’s obesity untreated. Last year, hospitalizing Alvarado for congestive heart failure cost them almost $100,000. Bariatric surgery would cost $20,000.

Alvarado’s cardiologist told the LA Times:

To say this is a cosmetic surgery is unbelievable. His lifespan is going to be markedly shortened by this decision. They just don’t want to pay, that’s what this is.

HealthPartners says they can’t discuss the details of an employer’s benefit design. But the real question is how can you morally justify selling an anti-health plan to any employer?

Click here to read more in the LA Times and here for more on how these decisions can cut lives short.

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

February 20, 2018