Courting the fat vote

In the news release accompanying the recent decision by Tommy Thompson, secretary of health and human services, that loosened the longstanding federal restrictions on Medicare coverage of obesity-reducing medical treatments, it was noted that “[t]he new policy is not expected to have an immediate impact.”

If not designed to meet an immediate or urgent need, why then would the administration, especially a Republican administration theoretically interested in reducing, not expanding, government programs, announce such a far-reaching and costly policy? Could it be because there are more and more obese people in America, and the Bush administration discovered they vote? Is this a cynical play for the “fat vote?”

The change in policy was accompanied by the usual hoopla, using all the right buzz words. Mr. Thompson announced “barriers” are being removed to address a “critical public health problem” that causes “unnecessary health problems.” I’m sure some at HHS recommended a trumpet fanfare as the secretary heralded a new way to “improve the quality of life” for millions of obese Medicare “beneficiaries.” Break down barriers. Save the public from the scourge of obesity. Improve the quality of life. Another pre-emptive strike for the neocons.

Interestingly, however, the fine print of the change in the Medicare Coverage Issues Manual (CIM) reinforces the point that the change in policy actually means far less than meets the ear. In other words, it’s more hype than substance.

For example, while the official Medicare Web site notes with a touch of pride that the new policy will remove “confusing language” from the existing CIM that “obesity is not considered an illness” (which actually is not confusing), it replaces this language with a paragraph of gobbledygook. Henceforth, a Medicare “beneficiary” who is fat — which may cover up to 31 percent of the 41.3 million Americans on or eligible for Medicare — may or may not be covered if they are fat enough to be considered “obese” (that is, really fat).

Some medical conditions are covered, others aren’t; some procedures designed to reduce fatness are covered, others aren’t, depending on whether they are “reasonable,” “necessary” or “integral.” What’s confusing is the new language, not the old.

But, what’s the real point here? If it is to signal a truly seminal change in federal Medicare policy so virtually anyone who is obese can have certain corrective surgeries for “free” (i.e., using other peoples’ money), then the newly unveiled policy is a flop. It will not — at least in the short run — open the floodgates for publicly-financed, anti-obese surgery.

If the point was simply to score points and make obese Americans on Medicare feel they now have a claim to the money the rest of us pay into the system, and for them to feel they now have at least a shot at having the tummy-stapling they yearn for covered by the feds, the announcement was a smashing success. Not good policy. Not even clear policy. But probably a PR coup.

Regardless of the substance of the announcement, the usual army of lawyers and con artists waiting to take advantage of any expansion in the size of the public trough are already rushing the gates. Lawyers who only recently were slapped down by the courts in their bid to make McDonald’s responsible for kids who scarf down too many Big Meals, have a new lease on life thanks to the position announced by Mr. Thompson.

The policy also provides a green light to folks so desperate for the government to fund their desire to lose weight they would actually make themselves even fatter, just to be able to qualify for certain higher-risk medical procedures designed to reduce obesity. I kid you not. There are really fat folks out there who do not meet the weight criteria for certain surgeries, such as gastric bypass surgery, so they gain weight just to qualify.

Some doctors, such as one unnamed surgeon in Fresno, Calif,, will tell their obese patients who are not quite fat enough to qualify for gastric bypass, “Well, I can’t tell you to gain weight in order to qualify, but … .” According to one news story, the woman to whom this particular doctor expressed this thought with a wink and a nod, went out and gorged herself so she quickly gained 25 to 30 additional pounds, in order to qualify. The doctor reportedly was more than happy to then perform the costly surgery.

As a result of Mr. Thompson’s new rule book for obesity, such tactics will certainly increase, because now the incentives have doubled: Not only will the patient qualify medically for the treatment, he or she may qualify to have other taxpayers to pay for it. Is this a great country or what?

Bob Barr is a former Republican member of the U.S. House of Representatives from Georgia and is a correspondent for United Press International. This article is a special for The Washington Times.