This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! This is the second part of a series answering a reader’s question about weight loss industry “big think” strategies within healthcare. In
The gold standard of insurance approvals is to get CMS to approve a drug for Medicare/Medicaid patients. Most insurance companies base their standard practices on what CMS does with these groups.
Medicaid is problematic because most of its insureds are poorer, and Medicaid monies are more limited and are monitored very tightly by the states as well as the Feds. Too much trouble for the profiteers.
But Medicare's constituents are the elderly (so, everyone eventually, if we are lucky) and the disabled. And so we see the weight loss industry pushing interventions at the very old, just like the very young. Major medical institutions like the Cleveland Clinic and Hopkins bang the drum loudly about the dangers of we-know-what way past the age when studies show that *any* kind of weight loss, even intentional, increases mortality.
Cleveland Clinic is the medical advisor for AARP.
And as for the disabled, well, what a target group. If you can make o*es*ty itself a qualifying disability, we'll that's a gold mine of a market. But even if not, the more you can make it "causal" or at least "contributory" in other disabilities, the more pressure you can put on CMS.
Ironically, some of our best friends in *this* battle are the insurance companies. They don't want to be on the hook for universal, expensive weight loss drugs and surgeries. So we have groups like the OAC suddenly becoming friendly social justice warriors who try to leverage people's everyday distrust of insurance companies into an unholy alliance (trust *us* to help you) that could open the doors to trillions of dollars for them.
From what I've read, in the US, the ADA and the SSA, when evaluating for qualifying for SSI and/or SSDI, will consider o-- a "disability" if it "impairs" the person so much they are unable to work or continue working. This doesn't happen often, but just the idea that it might turns into yet another way to mock the SSI/SSDI system as "free government money for being lazy." As if poverty living is something we all want.
When I applied for SSDI for [long story] reasons, I was evaluated by a doctor of the SSA's choosing. I told him I had problems walking due to my damaged leg. He did mobility tests, then tried to lecture me about how I would be able to walk again if I only got WL surgery. He knew this, he said, because his other part-time job was evaluating people for the surgery.
He didn't expect me to chew his head off. If I wasn't fat right now, would my damaged leg then qualify me for SSDI? And how, pray tell, does losing weight replace the damage done that causes my disability? Is this surgery or does a fairy princess wave a magic wand? He looked quite upset at my reaction and I expected for my application to be rejected. I was astounded when I was accepted - under 20% of applicants get accepted into SSI/SSDI on the first application, without an appeal.
In addition to what you said about weight loss increasing mortality of the aged - there are relatively newer studies that also show that a "normal BMI" is too low for people over 65, and that being "overweight" or "o---" has a far lower mortality rate (although they downplay the "o---" part). Interestingly previous studies have said that once you hit 65, the mortality rate levels out no matter how much you weigh.
To add to Ragen's outstanding analysis:
The gold standard of insurance approvals is to get CMS to approve a drug for Medicare/Medicaid patients. Most insurance companies base their standard practices on what CMS does with these groups.
Medicaid is problematic because most of its insureds are poorer, and Medicaid monies are more limited and are monitored very tightly by the states as well as the Feds. Too much trouble for the profiteers.
But Medicare's constituents are the elderly (so, everyone eventually, if we are lucky) and the disabled. And so we see the weight loss industry pushing interventions at the very old, just like the very young. Major medical institutions like the Cleveland Clinic and Hopkins bang the drum loudly about the dangers of we-know-what way past the age when studies show that *any* kind of weight loss, even intentional, increases mortality.
Cleveland Clinic is the medical advisor for AARP.
And as for the disabled, well, what a target group. If you can make o*es*ty itself a qualifying disability, we'll that's a gold mine of a market. But even if not, the more you can make it "causal" or at least "contributory" in other disabilities, the more pressure you can put on CMS.
Ironically, some of our best friends in *this* battle are the insurance companies. They don't want to be on the hook for universal, expensive weight loss drugs and surgeries. So we have groups like the OAC suddenly becoming friendly social justice warriors who try to leverage people's everyday distrust of insurance companies into an unholy alliance (trust *us* to help you) that could open the doors to trillions of dollars for them.
Oh and bust Medicare by the way.
Big picture indeed.
Excellent comment.
From what I've read, in the US, the ADA and the SSA, when evaluating for qualifying for SSI and/or SSDI, will consider o-- a "disability" if it "impairs" the person so much they are unable to work or continue working. This doesn't happen often, but just the idea that it might turns into yet another way to mock the SSI/SSDI system as "free government money for being lazy." As if poverty living is something we all want.
When I applied for SSDI for [long story] reasons, I was evaluated by a doctor of the SSA's choosing. I told him I had problems walking due to my damaged leg. He did mobility tests, then tried to lecture me about how I would be able to walk again if I only got WL surgery. He knew this, he said, because his other part-time job was evaluating people for the surgery.
He didn't expect me to chew his head off. If I wasn't fat right now, would my damaged leg then qualify me for SSDI? And how, pray tell, does losing weight replace the damage done that causes my disability? Is this surgery or does a fairy princess wave a magic wand? He looked quite upset at my reaction and I expected for my application to be rejected. I was astounded when I was accepted - under 20% of applicants get accepted into SSI/SSDI on the first application, without an appeal.
In addition to what you said about weight loss increasing mortality of the aged - there are relatively newer studies that also show that a "normal BMI" is too low for people over 65, and that being "overweight" or "o---" has a far lower mortality rate (although they downplay the "o---" part). Interestingly previous studies have said that once you hit 65, the mortality rate levels out no matter how much you weigh.