Insurance coverage and liability for weight loss surgery procedures

Healthcare Ethics -- Bearing the Cost of Gastric Bypass

Should insurance companies limit the cost associated with gastric bypass surgeries and other weight loss interventional procedure?

The question of whether or not insurance companies (or public resources) should have to bear the costs of gastric bypass surgeries and other weight loss intervention procedures depends substantially on the reason that the patient is suffering from obesity. That is not at all to suggest that the issue is cut and dry or easy by any means. About the only scenario where it is clearly justified for third-party payers to bear the costs associated with these procedures is where the patient had absolutely no role in the obesity problem. Whether the individual suffers from thyroid issues or more obscure problems that predispose him to obesity through other mechanisms, there is absolutely no basis for distinguishing between the costs of weight loss intervention procedures and other medical procedures necessitated by bona fide medical conditions.

The issue becomes more complicated with respect to other obesity cases, in principle, because the patient presumably contributed to the problem through volitional choices and behavior. On the other hand, most people who are obese do not choose to be obese and even where obesity appears to be attributable to choices, there may be many contributing factors underlying behavior that appear to be choices. Individuals raised in homes where food is typically a family focus or used as a reward beginning in infancy mean that some people with normal metabolism are nevertheless at a much greater risk of obesity as a result of their "choices." It is up to medical ethicists to determine whether or not fault should be a factor in the decision, but in that case, the same principle should apply to the costs incurred by asthma patients who smoke, liver cancer patients who drink, and some accident victims who choose to ride motorcycles recreationally.

How would you determine if people qualify for the procedure / reimbursement?

If you were going to limit cost reimbursement to some patients but not others, the factors used to make those distinctions would have to be logically consistent and fair. In principle, the logical basis for making any such distinctions would relate to whether or not patients could reasonably be considered to have contributed to the problem in the first place. The easiest choices would be individual at both ends of the spectrum: those who suffer from medical conditions that are known to be responsible on one end and those whose conditions are entirely the result of irresponsible choices. Almost everywhere else in between those extremes requires some kind of value judgment or the drawing of a line that is at least somewhat arbitrary. Generally, the more a person can be fairly considered to have caused his condition, the less right he has to demand free procedures; conversely, the less a person in responsible, the more right he has to the same.

When these surgeries have serious complications, should patients have the right to sue their doctors, even though the risk are known?