We allow these folks to be treated as second-class members of our society because of the incorrect and prejudicial bias that will power or self-discipline alone can cure severe obesity.
By Barry L. Fisher Special to the Review-Journal
John McSherry, a major league baseball umpire, collapsed and died behind home plate while working a game. This event was witnessed by many Nevadans who were watching the game on television. His fatal heart attack was caused by morbid obesity from which he had suffered for many years.
In 1985, the National Institute of Health officially described morbid obesity as a chronic disease. In 1991, it endorsed surgery as a reasonable alternative to medical therapy. In 1992 it confirmed the ineffectiveness of dietary approaches in this group of people. In 1993, an article in the Journal of the American Medical Association confirmed that more than 300,000 people in the United States each year die as a result of medical conditions directly related to obesity.
Morbid obesity is a chronic disease and is a major killer of young to middle-age people in our society. The medical problems that are associated with morbid obesity include high blood pressure, diabetes, heartburn, apnea, shortness of breath, high cholesterol and heart disease, to name a few. Many patients who undergo specific surgery achieve long-term success in significant weight loss, and concomitant improvement in the same associated conditions that can lead to early death.
Although many health insurance plans, HMO's and managed-care entities understand this and are willing to cover obesity surgery, others have specifically excluded benefits for weight management or the complications of medical or surgical weight management therapy. Others profess coverage, but routinely deny benefits _ many such denials are based on incorrect information and bias, despite literature attesting to the positive effects of the weight loss resulting from such surgery. None of these companies employs specialists with expertise in surgical care of the super-obese to adjudicate these denial decisions.
The 1997 Legislature passed Assembly Bill 169. It restores many rights of appeal and provides recourse to many Nevadans who have been denied payment for appropriate medical care. This bill specifies that a specialist review denial decisions. However, many Nevadans are exempt from the provisions of this legislation due to a 1974 federal law called the Employment Retirement Insurance Security Act. It pre-empts all otherwise available remedies under state law. The companies are, at most, only liable for the benefits they should have paid in the first place, and _ in some limited circumstances _ attorney's fees. A patient cannot sue for damages. Treatment is not given, because patients are not inclined to litigate to obtain their benefits. Although insurers say their financial decision to refuse coverage does not amount to practicing medicine, the effect of their decisions determines whether or not most patients receive the care they deserve.
Legislation is being introduced in Congress which would reinstate patient rights to sue the insurers or managed-care plans for damages in the event they are victims of improper claims-handling practices. It is called the Patient Access to Responsible Care Act of 1997 and would revoke the protection for insurers in the Employment Retirement Insurance Security Act. This bill will not only help the morbidly obese obtain adequate treatment, but will also assist many other people with health problems which are largely ignored by insurers.
The last vestige of socially acceptable discrimination in our society is against our overweight citizens. We allow these folks to be treated as second-class members of our society because of the incorrect and prejudicial bias that will power or self-discipline alone can cure severe obesity. Patients are discriminated against in the workplace, in the media and all types of social situations _ and, tragically, also by their medical insurance carriers. Discrimination against the morbidly obese in the workplace and by their insurance carriers has to be eliminated. One avenue for accomplishing this is the passage of the Norwood bill aiding morbidly obese patients denied appropriate medical therapy on the part of their insurers. Care providers are expected to accept responsibility for the medical decisions they make. When insurers deny coverage for appropriate medical therapy, and this denial results in the patient not receiving the medical therapy due to its high cost, and the patient's inability to afford it, insurers should be held responsible. We obtain insurance for the specific purpose of avoiding the devastating financial impact of costly medical care that may have become unaffordable despite being appropriate, indicated and life saving. It is time to hold all insurance plans, their medical directors and executives, responsible for the significant influence they exert on medical care and the suffering that may result therefrom.
Dr. Barry L. Fisher is associate professor of surgery at the University of Nevada School of Medicine. He writes from Reno.
