"I'm your top prime cut of meat
I'm your choice
I want to be elected"
-- Alice Cooper
"I don't know where I'm going
The future one big mirror of the past"
-- Steve Goodman (Hillary Clinton's high school classmate)
Bariatric weight loss surgery saved my life. My gastric sleeve surgery on December 1, 2014 helped this 57-year-old recovering fat person lose over 110 pounds, reverse my diabetes, maintain normal blood pressure and start to live an active life. I'm competing in this year's CrossFit games and have run in 3K and 5K races.
Since weight loss surgery worked so well for me, I've become an advocate. However, surgery can be hard to obtain. I had to pay for my own, without any help from my health insurance company. I live in Kentucky, but if I had lived in 23 other states, I could have purchased coverage through the Affordable Care Act for surgery to cure my morbid obesity. In Kentucky, if I had lost all my money and went on Medicaid, I could have gotten the surgery for free. If I had managed to stay healthy until age 65 and went on Medicare, I could have gotten the surgery for free. If I had been elected to the Kentucky legislature or to Congress, my insurance would pay for the surgery and its complications. Most government entities offer insurance that covers the surgery and its complications. If I had worked for a large company, most of them offer weight loss surgery, or at least cover the complications of weight loss surgery.
Bariatric surgery is an example of where Main Street loses to Wall Street. Small businesses can't buy the same kind of coverage that people who are richer, poorer, or working for a large organization get. Some individuals and small businesses can get coverage for obesity surgery through a health insurance exchange. It all depends on where you live. Kentucky joined 27 other states in not offering obesity surgery as part of their health insurance exchange. A story on NPR noted the almost direct correlation between the states with highest obesity problems and the states that are not offering obesity surgery through their exchanges. The worse the obesity problem, the less the politicians want to do anything about it.
With the presidential elections in full swing, it would be a good idea to find out where the presidential candidates stand on full access to weight loss surgery. I've been searching to find that answer.
The best advocate for the morbidly obese would have been Chris Christie. To my knowledge, he is the only presidential candidate in history to have bariatric surgery and Christie lost over 100 pounds. His state of New Jersey is one that offers weight loss surgery as part of their health insurance exchange. Mike Huckabee is no longer in the race, but lost 100 pounds without surgery several years ago. He appears to have gained a lot of it back, but at least he understood the struggles that overweight people face.
Bernie Sanders advocates universal, single payer health insurance. If that would mean expanding the current coverage of Medicaid and Medicare, that would give everyone a chance to have weight loss surgery. His home state of Vermont offers bariatric surgery coverage. Hillary Clinton's website says that she will "defend the Affordable Care Act" which would lead me to believe that she would maintain the current system where 23 states offer coverage and 27 do not. New York state, which she represented in the United States Senate, offers bariatric surgery coverage.
Most of the Republican candidates are in favor of repealing Obamacare, but are not specific about what kind of health care coverage they would advocate to replace it. Ironically, Ted Cruz, Jeb Bush, Marco Rubio and John Kasich are all from states that do not offer bariatric surgery as part of their health care exchange coverage.
There is definitely a red state/blue state divide as to which states offer coverage for weight loss surgery. Most of the states that traditionally vote for Democrats in presidential elections have it and the states that favor Republicans do not. Since there are obese people of every political persuasion, you would think weight loss surgery would be a non-partisan issue.
It gets even more complicated for those of us who own small businesses in the 27 states without coverage.
I could not purchase a plan for my small business or an individual health insurance policy that would even cover the COMPLICATIONS of weight loss surgery. I purchased Anthem group insurance for my Kentucky-based businesses and pay 100 percent of the premium for my employees and their families. I had the best insurance brokers in Kentucky search high and low for a policy that would cover weight loss surgery. No luck. All my employees were willing to switch to a different plan if it could help me get weight loss surgery, but we had nowhere to go.
I wound up paying for own weight loss surgery, but complications remained an overwhelming concern. If I had a heart attack during surgery or the day after, my health insurance wouldn't cover it. If I didn't get the surgery and had a heart attack induced by my obesity, the insurer would pay for that. They would also pay for all my blood pressure medicines, CPAPs, diabetics medicines, walkers, amputations, hospital stays and doctors' visits along the way. I was lucky to eventually find a company, BLIS, that offered coverage for complications through my surgeon.
The health insurance company attitude doesn't make sense long-term, but the companies are not thinking long-term. One of the big arguments in favor of a single-payer system for health insurance is that insurance companies are not interested in expensive solutions to long-term problems. Like most publicly traded companies, health insurance companies are focused on the next fiscal quarter, not the next decade. Or their patients as individuals. What is best for the consumer may not be best for the immediate profit margin.
From a cash flow basis, many health insurance carriers find it more profitable to pay for medicines, sleep apnea equipment, doctor and hospital visits and things associated with obesity than to write a large, one-time check for weight loss surgery. People can change insurance carriers on a regular basis, and an insurer can write a check to make a person healthy only to have them jump to another company. According to the Obesity Action Coalition, the cost of surgery is paid for in 3.5 years, but most health insurance carriers choose the immediate over the long-term.
Forgot about the overwhelming public policy reasons of fighting obesity; a smart presidential candidate should take up the cause of coverage strictly for self-interest. Around 200,000 people have weight loss surgery every year and that number would easily double if surgery was more easily available.
A bloc of 200,000 can swing a presidential election. Al Gore won the popular vote in 2000, but another 200,000 votes in the right places might have assured his electoral victory as well. John Kennedy only received 112,827 votes more than Richard Nixon.
For those of us who want to see universal access to weight loss surgery, it would be much simpler to have a federal solution than trying to change each state's policies. It would be a good way for a campaign to build enthusiasm in a group that has been universally ignored by presidential candidates so far.
Don McNay, CLU, ChFC, MSFS, CSSC, is a best-selling author and former syndicated columnist who lives in Lexington, Kentucky. He is the founder of McNay Settlement Group and is a structured settlement and financial consultant who serves as an expert in legal proceedings. His latest book, Brand New Man: My Weight Loss Journey, is being published by RRP International Publishing and will be available on February 27. You can read more about McNay at www.donmcnay.com