This is a big topic in healthcare today, and rightfully so as this impacts health insurance cost in a significant way. There is a high percentage of overweight and obese people in America today, and the numbers continue to grow. There are tremendous costs with weight loss programs, surgery, medications, etc. and high medical price for being overweight and obese. This article will discuss all of this and the ultimate question of weight loss programs being covered by insurance.
Why This Is A Problem
This is not a small problem but a gargantuan problem; the CDC estimates the obesity rate at 42 .4%. This means that almost half of Americans are at risk due to their current weight. Just think about the consequences of having nearly half of Americans receiving weight-loss benefits from their insurance companies and what that would do to premiums. Today’s health insurance makes up approximately 17% of this country’s GDP; adding almost half of Americans to weight loss programs would quickly push this into the mid-twenty percent. Today’s health insurance is virtually not affordable; adding half the population to weight loss treatment programs would make health insurance costs out of reasonable levels.
As a quick side note, the medical industry recognizes obesity at a Body Mass Index (BMI) rating of 30 and higher. There are many issues with the BMI that are subject to inaccuracies as this calculation is solely based on height and weight. The BMI calculation was invented in the 1830s, that’s right, almost 200 years ago, by a Belgian astronomer. The formula was used to focus on the gravitational pull of humans on the Earth. Yet today, this calculation is the barometer used for indicating a person’s acceptable weight levels. A much more accurate method is body fat percentage, which does not take into account height. Body fat percentage requires skinfold calipers measuring on various parts of the body and the person’s weight to come up with an accurate number. With this said, using BMI exclusively probably skews the numbers more to the obesity side than it is.
Cost Now Or Cost Later
The almighty dollar comes into play very with this question of health insurance paying for weight loss. There are costs on both sides of this equation, obesity cost and weight loss cost, and both are very high. So if the insurance company pays for one side, do they have to take away from the other? Let’s look at some of these costs starting with the obesity side.
Packing on pounds includes packing on cost for medical treatment. As most people know, obesity is associated with heart disease, many forms of cancers, stroke, diabetes, and a whole host of other medical issues. Looking at the top 10 leading causes of death in America, heart disease, cancer, stroke, and diabetes are in positions 1,2,5 and 7 and represent ~71% of the leading causes of death. All this sum up is not just numbers and positions on a chart but that many illnesses today are caused by weight and have a very high cost. For quick reference, heart disease cost hundreds of billions of dollars and accounts for $1 of every $6 spent on healthcare in total. Just remember big numbers are in play.
Many medications treat high blood pressure, cholesterol, prediabetes, and other health weight-related issues. Unfortunately, once on these medications, the individual is generally on them to balance their life. These medications can come with a high price tag costing insurance companies lots of money. These medications are also high in toxins and have known side effects, which can become problematic and require more medications to offset the original medicines’ side effects. This is the pharmaceutical industry’s dream with one medication used to treat the symptoms of another medication. And the pharmaceutical industry is the winner, with the insurance company the loser in this scenario.
On the other side, there is weight loss surgery that is also expensive and cost about $30,000. That is just for the surgery, not all the medications and time lost. There are FDA-approved medications that have proven effective with weight loss, but they come with a high cost, as you can imagine. Some of these prescriptions have a $1,200 a month price tag. One of the unknowns of weight loss medication is how long does one have to stay on this for the rest of your life or not? Then there is Weight Watchers, Jenny Craig, and other diet solutions, but these come with a cost.
Then there’s the possible outcome of putting an individual on weight loss treatments or surgery paid for through the insurance company, which doesn’t work. And this case, the person would incur the cost for weight loss treatment then incur the fee for obesity-related issues. This is the ultimate double whammy for an insurance company, and one reason they probably will not pay for weight loss prevention. This would increase their dollar exposure incrementally with no return in their favor. Until there is a much higher percentage of success using these weight loss methods at a lower cost, the insurance companies will probably stay on the side of just paying for the obesity side.
Who Should Be Responsible
Is a weight issue the responsibility of the individual, the doctor, or the insurance company? Who is to blame for the problem and take responsibility for the cost? Ultimately, everyone’s health is their responsibility. Your doctor can give you advice, direction, and guidance but will not put in the work and effort to lose weight for you. Also, doctors are trained by the pharmaceutical industry, which prefers to prescribe medication first, which is contra to weight loss. This is because most medicines are high in toxins, which strain your liver, and your liver is your primary organ for weight loss and maintenance. When the liver is overworked, filtering toxins out, it cannot perform its normal regular duties, allowing for the promotion of weight gain.
Health insurance companies are on the back end of this and have the least amount of communication with patients. Their goal is to collect the premiums and pay the claims when they come due. However, health insurance companies have the most to gain and lose from weight issues; they tend to be the most silent. This will be explained in the next section very shortly.
Can This Problem Be Fixed
There are solutions to fix this problem, which will require a complete overhaul of thinking and doing if they are ever implemented. The government and insurance companies do not have the foggiest clue of how to fix the obesity epidemic. Your doctor is also in the middle and does not want to have extremely healthy patients, as this will reduce their revenue, but their job is to care for their patients.
Over the past decades, we have seen iteration and iteration of healthcare reform and change with zero results. Health insurance companies are also trying everything possible to slow spending, as seen over time by introducing co-pays, increasing co-pays, adding deductibles, raising deductibles into the thousands of dollars, coinsurance, and other various attempts to push more costs to the customer. All of this has resulted in zero improvements and changes, just more money being inefficiently used.
A solution to fix this crisis would be to have individuals take responsibility for their health, including their weight. This can be done by changing the way health insurance companies offer their insurance, including the government changing Medicare and Medicaid to follow. An abstract of this would be that each individual would be rated based on their current health and pay their fair share based on their current health rating. If an individual chooses to be healthy, then they would pay less for their insurance. For individuals who do not have a vested interest in their health, it is okay to know that their health insurance will cost them more. To learn more about this, please read the article that I wrote on fixing the health insurance industry.
It is in everyone’s interest to solve this problem once and for all. For the individual, this would lead to a more vibrant, healthier life with a healthy weight. It would save the health insurance company billions of dollars every year in medical cost treating symptoms caused by weight issues. At the current increasing rates of insurance, who knows how long Americans can afford the cost.
The unfortunate answer to the question of weight loss being covered by insurance is mostly NO! There is limited coverage under the Affordable Care Act that will cover some doctor’s visitations and weight loss counseling, and obesity treatment in the form of counseling. And in extreme cases, bariatric surgery, which includes gastric bypass, lap band surgery, and sleeve gastrectomy, may be covered if deemed a medical necessity. The only required benefit that insurance companies must provide is obesity screening, which, as we discussed this is via BMI, which is just height and weight. Some states have adopted mandatory coverage for some bariatric surgeries, but this is not universal across the nation and is limited to certain types of health insurance plan.