DS: Only the best should get the best?

[Sheanie]

I think I have the same concept of freeloaders that @star0210 does. The idiot contractor who built our garage never paid taxes his entire adult life. No income tax, no payroll tax to his employees, no business tax. And now that he wants to retire, he is collecting Social Security. I have nieces who have several children each, never married, living with the fathers of the children, collecting support on 6 different levels. Housing, food, cash, student assistance, health and child care. AND, they live with the grandparents, rent free. So there is fraud involved in at least two of those hand-outs. Both girls visit the casinos weekly, and up until recently, used their Bridge Card to get cash from the ATM to gamble. In Michigan, you could do that. So I have no exposure to people who actually need assistance who are not abusing the system. My own sister scammed the system for many years, and still is. I know, because I still get phone calls trying to track her down for repayment. We as a nation need to put a stop to this, before our country rots from the inside out. These leeches will bleed us dry.

But with the DS, I've always felt that it SHOULD be more available. Yes, Medicaid should pay for it. All insurances should cover it. But you should have to pass SOME sort of test first. You don't have to be smart, just TEACHABLE.

Everyone who knows me on FB knows about the one DSer who is a known train wreck I post about. She never should have had the DS. She is incapable of simple logical thinking, cannot identify carbs from protein, cannot cook. Yet she got her DS paid for by Medicaid. Never should have happened. So there needs to be some way to screen these people out.

 

[Spiky Bugger]

I think I have the same concept of freeloaders that @star0210 does. The idiot contractor who built our garage never paid taxes his entire adult life. No income tax, no payroll tax to his employees, no business tax. And now that he wants to retire, he is collecting Social Security. I have nieces who have several children each, never married, living with the fathers of the children, collecting support on 6 different levels. Housing, food, cash, student assistance, health and child care. AND, they live with the grandparents, rent free. So there is fraud involved in at least two of those hand-outs. Both girls visit the casinos weekly, and up until recently, used their Bridge Card to get cash from the ATM to gamble. In Michigan, you could do that. So I have no exposure to people who actually need assistance who are not abusing the system. My own sister scammed the system for many years, and still is. I know, because I still get phone calls trying to track her down for repayment. We as a nation need to put a stop to this, before our country rots from the inside out. These leeches will bleed us dry.

But with the DS, I've always felt that it SHOULD be more available. Yes, Medicaid should pay for it. All insurances should cover it. But you should have to pass SOME sort of test first. You don't have to be smart, just TEACHABLE.

Everyone who knows me on FB knows about the one DSer who is a known train wreck I post about. She never should have had the DS. She is incapable of simple logical thinking, cannot identify carbs from protein, cannot cook. Yet she got her DS paid for by Medicaid. Never should have happened. So there needs to be some way to screen these people out.

Years ago, on an OH lapband board, we had a genius there who posted post-op. She was confused and more than a little angry that the band was INSIDE OF HER and that she couldn't eat very much.

 

[Sheanie]

Oh My God. That reminds me of the lady who posted, all pissed off, that they AMPUTATED part of her stomach when they did the "sleeve". Stupid people.

 

[Spiky Bugger]

Oh My God. That reminds me of the lady who posted, all pissed off, that they AMPUTATED part of her stomach when they did the "sleeve". Stupid people.

Well, as Diana often reminds us, by definition, 50% of the population has an IQ at or below average.

 

[DianaCox]

Well, as Diana often reminds us, by definition, 50% of the population has an IQ at or below average.

They not only walk among us, they are HALF of us!





NEW YORK - resident Kathy Evans brought humiliation to her friends and family
when she set a ne w standard for stupidity with her appearance
on the popular TV show, 'Who Wants To Be A Millionaire.'

Evans, a 32-year-old wife and mother of two, got stuck on the first question
and proceeded to make what fans of the show are dubbing 'the absolute worst use
of lifelines ever.' After being introduced to the show's host
Meredith Vieira, Evans was posed with a typically easy initial $100 question.

The question was: 'Which of the following is the largest?'

A) A Peanut
B) An Elephant
C) The Moon
D) Hey, who you calling large?

Immediately Mrs. Evans was struck with an all consuming panic as she did not
readily know the answer. 'Hmm, oh boy, that's a toughie,' said Evans,
as Vieira did her level best to hide her disbelief.
'I mean, I'm sure I've heard of some of these things before,
but I have no idea how large they would be.'

Evans made the decision to use the first of her three lifelines, the 50/50.
Answers A and D were removed, leaving her to decide which was
bigger, an elephant or the moon. However, faced with an incredibly
easy question, Evans still remained unsure.

'Oh! It removed the two I was leaning towards!' exclaimed Evans.
'Darn. I think I better phone a friend.'
Mrs. Evans asked to be connected with her friend
Betsy, who is an office assistant.

'Hi Betsy! How are you? This is Kathy! I'm on TV!' said Evans,
wasting the first seven seconds of her call.
'Ok, I got an important question.. Which of the following is the largest?
B, an elephant, or C, the moon.. 15 seconds hun.'
Betsy quickly replied that the answer was C, the moon.
Evans proceeded to argue with her friend for the remaining ten seconds.
'Betsy, are you sure?' said Evans. 'How sure are you? Duh, that can't be it.'

To everyone's astonishment, the moronic Evans declined to take her friend's
advice. 'I just don't know if I can trust Betsy. She's not all that bright.
So I think I'd like to ask the audience,' said Evans.

Asked to vote on the correct answer, the audience returned 98% in favor of
answer C, 'The Moon.' Having used up all her lifelines,
Evans then made the dumbest choice of her life.

'Wow, seems like everybody is against what I'm thinking,' said the
too-stupid-to-live Evans. 'But you know, sometimes you just got to go with
your gut. So, let's see... I'm going to have to go with B, an elephant. Final answer.'

Evans sat before the dumbfounded audience, the only one waiting with bated breath - and was told that she was wrong, and that the answer was in fact, C, 'The Moon.'
Caution...they walk among us!
----------------------------------------------------------------------------
This one is equally unbelievable. (No comments needed!)

[Pix wouldn't copy - screen shots of a woman being unable to answer the question "What is George W. Bush's first name?" even after getting two of the four possibilities deleted, leaving George and Edmund.]

They Walk Among Us!
-----------------------------------------------------------------

*One day I was walking down the beach with
some friends when someone shouted....
'Look at that dead bird!'
Someone looked up at the sky and said...'where?'

They walk among us!

------------------------------------------------------------- ----------------
While looking at a house, my brother asked the
estate agent which direction was north because
he didn't want the sun waking him up every morning.
She asked, 'Does the sun rise in the north?'
My brother explained that the sun rises in the east
and has for some time. She shook her head and said,
'Oh, I don't keep up with all that stuff.....'

They Walk Among Us!
---------------------------------------------------------------------------------
My colleague and I were eating our lunch in our cafeteria,
when we overheard an admin girl talking about the
sunburn she got on her weekend drive to the beach.
She drove down in a convertible, but said
she 'didn't think she'd get sunburned
because the car was moving'.

They Walk Among Us!
--------------------------------------------------------------------------------
I was hanging out with a friend when we saw a woman
with a nose ring attached to an earring by a chain.
My friend said, 'Ouch! The chain must rip
out every time she turns her head!"
I had to explain that a person's nose and ear
remain the same distance apart no
matter which way the head is turned....

They Walk Among Us !
-------------------------------------------------------------------------------
I couldn't find my luggage at the airport baggage area and
went to the lost luggage office and reported the loss.
The woman there smiled and told me not to worry
because she was a trained professional and
said I was in good hands. 'Now,' she asked me,
'Has your plane arrived yet?'...
(I work with professionals like this.)

They Walk Among Us!
-------------------------------------------------------------------------------
While working at a pizza parlor I observed a man
ordering a small pizza to go. He appeared to be alone and
the cook asked him if he would like it cut
into 4 pieces or 6. He thought about it for some time
then said 'Just cut it into 4 pieces; I don't think I'm hungry
enough to eat 6 pieces.

They Walk Among Us!

 

[star0210]

@star0210 I think part of your feelings about Medicaid clients getting bariatric surgery paid for (which I can tell you from my personal experience, along with Diana, in helping people get insurance coverage for their surgery is actually very challenging) is because your own surgery was NOT paid for, even though you work and have health insurance. And that ain't right!
But what really isn't right here is that your insurance didn't pay for medically necessary care for you. It sounds like you have one of those miserable self-funded policies with an exclusion for bariatric surgery. You are not alone. It is my personal opinion that these exclusions should not be legal. It 's just an easy way for your employer to cheap out on the coverage they provide while still claiming to provide health insurance. We see this a lot, and there is little we can do to help the people with these policies. A few have been successful by arguing to their HR people that they will actually save money by covering the surgery and improving the health of their employee, but this doesn't work often. Everyone else is just screwed, like you were.
Your insurance absolutely should have covered your surgery. You should not have had to leave the country to get the medical care you needed. I'm glad you did, though, as your health is more important than anything else you could have spent that money on. still, it's not fair.

So the way I look at it is that it isn't that you, the working woman, should have had coverage and those Medicaid deadbeats shouldn't, but rather that ALL people should be able to get the medical care they need. I'm not talking about frills and extras like plastics, just genuinely medically necessary care. You got screwed, but denying medical care to others would not improve your own situation.
And just for the record, one of the toughest cases Diana and I ever worked on was a young woman with Medical (California's version of Medicaid) with badly failing health and crippled by her weight who could barely even get basic medical care, let alone bariatric surgery. Even when she won all her appeals the group providing her coverage refused to pay for her surgery. It took months and I don't know how many letters, emails, and phone calls before the group finally caved in. After her DS, she was eventually able to walk again and get a job. Hopefully she is financially stable and off Medical by now. Yes, there are some people who take advantage of the system, but there are also many others who are truly in need and leading very difficult lives.

I'm the one who chooses the benefits for my company. we had to give up our grandfathered status plan and get an ACA plan this year because the cost had gone up so much it was too prohibitive for both the company and my employees. But our old plan didn't include it either. None of the options I had when selecting a plan for my company did. I suppose I could have said to my broker...go find me a policy that covers WLS, but my priority was and always will be what's best for my employees.
But really...my revision wasn't "medically necessary". My cholesterol was back up but early being controlled with a very cheap statin. All of my other co-morbidities are still resolved from the initial loss after the VSG.
I'm not angry that my insurance doesn't cover it...it is what it is.

Ya know, for cases like the one you mentioned where a person is practically disabled because of their weight and other MO health related issues...I can understand that. Those aren't the cases that make me angry.

But the girl who posted on FB the other day looking for a DS surgeon who takes Medicaid but couldn't find one in her state so started asking and researching into self pay. I'm sorry but if she can come up with the money to self pay then she doesn't need to be on Medicaid.

Another one begging for help finding a surgeon because she really WANTS this...didn't say she NEEDS it....just WANTS it. She wasn't too happy to learn that most insurances including medicaid won't pay for it if your BMI is not over 50 or less if you have co-morbidities...which she did not.

I see posts like this every few days on the various boards and FB pages.
While there are some people who WLS is medically necessary, I think more people ha e it for cosmetic elective reasons.

 

[Spiky Bugger]

I really don't want to irritate you more than I already have, but...this?

While there are some people who WLS is medically necessary, I think more people ha e it for cosmetic elective reasons.


As far as I know, insurance only covers wls for the MORBIDLY obese..."MORBIDLY"...coming from a Latin word for "diseased"...being the operative word.

If someone who is MORBIDLY obese is stupid enough...see Diana's examples above....to THINK they need wls surgery for cosmetic reasons...well, you can't fix that kind of stupid. But their insurance will not pay for cosmetic wls surgery.*

And, "elective" means "not a life-threatening emergency." Any surgery you schedule is elective. (It might be urgent and need to be done tomorrow or this week..or even life-saving, like a mastectomy for cancer. But it is STILL elective.)


*I once had an insurance company moron tell me that LASIK surgery is cosmetic...because if you get LASIK, you won't need glasses. I asked how he knew if I looked better without the glasses, because I thought I looked pretty cute with them. My goal was to be able to find my way out of a post-earthquake building with glasses thrown across the room and that had nothing to do with "cosmetic" anything...it had to do with correcting a malformed organ to promote survival. Since then, insurance has gotten smart enough to exclude that procedure...but this was before they were smart.

 

[DianaCox]

"While there are some people who [sic: for whom] WLS is medically necessary, I think more people ha e [sic: have] it for cosmetic elective reasons."

Wow, just wow. Are you KIDDING me?? SB said it nicely - I'm not feeling so nice after reading this. You, with your "VSG should be good enough" - but it wasn't - and "my revision wasn't medically necessary, I just preferred it to taking statins" - TWO surgeries presume to judge others, pre-ops who don't have your advantages? Really?

You know, there may well be VSGers and CrapBandsters who trifle with WLS, and think (or are misled to believe) that bariatric surgery is a safe way to get thin and avoid the pain of dieting (and of course they're wrong on both counts), but there are very few DSers who have that attitude. I think you are projecting your own misguided, elitist and selfish rationale on others. Worse, you claim you were in a position to see to it that your fellow employees and their families had the right to proper medical treatment for their DISEASE of morbid obesity, but - you already had YOURS, and YOU had to pay for it yourself, so why should anyone else get one covered by insurance on your watch??

I'm sorry, this REALLY pissed me off.

 

[chevtow]

I still can't believe the elephant vs the moon lady. Is that really true? I'd think she wouldn't be able to breathe and walk at the same time.

 

[conceit]

I have to say that I don't see the rationale behind the claim that more (more relative to whom?) people get WLS for cosmetic elective reasons, when WLS is 1. only covered for people above a certain BMI- at least clinically severely obese with serious co-morbs aka morbid obesity- 2. even self-payees cannot get WLS for cosmetic elective (most scheduled surgeries are elective anyway) reasons because credible surgeons will not perform the surgery on people below a certain BMI, which must meet the severe obesity criteria. Therefore, WLS is a medical necessity for the very very vast majority of people who get it. Claiming otherwise is, especially, inapplicable to people undergoing the DS, RNY and even the VSG. I haven't looked into the requirements for the lapband.

The cosmetic bit is completely absurd and so is the medical necessity part. In fact, those points are fictitious. I don't want anyone to feel personally attacked here, but I can't, in good conscience, act like this comment isn't exactly as offensive as it is to the struggles of people suffering from a massively misunderstood and stigmatized disease, which results in wide ranging socioeconomic discrimination that is especially perilous for the lower classes. To reduce pre-existing or impending serious health problems to cosmetic concerns simply because you erroneously generalize people receiving a particular type of aided insurance to be freeloaders is dismayingly irrational and dismissive. I only briefly commented on the socio-economic justice aspect earlier and didn't wish to spark a debate, though I can't not comment on that part at this point.

 

[JackieOnLine]

I still can't believe the elephant vs the moon lady. Is that really true? I'd think she wouldn't be able to breathe and walk at the same time.

from my own life: I was living in Minneapolis with a friend and we visited Duluth with her family. as we stood on the shore of Lake Superior looking at the water - you could see a little bit of Wisconsin, too.

my friend's Mom asked "is that Europe?"

 

[southernlady]

Another one begging for help finding a surgeon because she really WANTS this...didn't say she NEEDS it....just WANTS it. She wasn't too happy to learn that most insurances including medicaid won't pay for it if your BMI is not over 50 or less if you have co-morbidities...which she did not.

Actually the criteria for WLS is 40 and above without comorbids and 35 and above WITH comorbids here in the US.
http://consensus.nih.gov/1991/1991gisurgeryobesity084html.htm

Patients whose BMI exceeds 40 are potential candidates for surgery if they strongly desire substantial weight loss, because obesity severely impairs the quality of their lives. They must clearly and realistically understand how their lives may change after operation.

In certain instances less severely obese patients (with BMI's between 35 and 40) also may be considered for surgery. Included in this category are patients with high-risk comorbid conditions such as life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, and obesity-related cardiomyopathy) or severe diabetes mellitus. Other possible indications for patients with BMI's between 35 and 40 include obesity-induced physical problems interfering with lifestyle (e.g., joint disease treatable but for the obesity, or body size problems precluding or severely interfering with employment, family function, and ambulation).

The federal government made the crapband criteria lower than that...if you were a 30 or above, I BELIEVE. http://www.win.niddk.nih.gov/publications/gastric.htm But they had to have one comorbid.

So those of us UNDER a 40 BMI HAVE to prove the health need for WLS unless we go the self pay route.

 

[Larra]

The medical community has determined that a bmi of 40 or more, or 35 or more with specific comorbidities, are the medical criteria that qualify someone for bariatric surgery. The medical community has accepted, more recently, that morbid obesity is a disease. While there are a small number of people who don't meet these criteria having bariatric surgery for cosmetic reasons (and they are all self-pay), this means that the people you disparage and would like to just live with their morbid obesity have a disease and need medical treatment.
Morbid obesity is about far more than what people weigh or how they look. Even for people who are young and don't yet have severe comorbidities, the damage is being done. Internal organs like the liver and pancreas are being damaged, the damage just hasn't shown up...yet. But eventually, it will. Even without a diagnosis of arthritis - yet - weight bearing joints are gradually being damaged by carrying all that excess weight. Eventually, there will be enough damage and loss of cartilage that a diagnosis will be made and disability will begin. Morbidly obese, or even "just" obese people are at higher risk for many kinds of cancer. Heart disease develops gradually, even if it shows up as someone dropping dead. The list goes on.
In other words, those "healthy" morbidly obese Medicaid deadbeats that you think shouldn't have their surgery paid for are not healthy. They are sick in ways that are not visible to you but that will become very apparent, very debilitating, and very expensive at some point. If anything, I wish MORE people would volunteer for bariatric surgery, but in reality only a small minority of the people who meet the medical criteria for this life-saving care ever choose to have it.

I am glad you had the resources to pay for your TWO bariatric surgeries. I am saddened that you, in your infinite wisdom, would deny insurance coverage for others based on what you have now shown to be a very limited understanding of the disease of morbid obesity. And please note that both here and elsewhere, I no longer refer to bariatric surgery as "weight loss surgery" or "wls" even though that would be a lot quicker to type, because this life-saving surgery is about so much more than the number on the scale.

 

[Spiky Bugger]

The medical community has determined that a bmi of 40 or more, or 35 or more with specific comorbidities, are the medical criteria that qualify someone for bariatric surgery. The medical community has accepted, more recently, that morbid obesity is a disease. While there are a small number of people who don't meet these criteria having bariatric surgery for cosmetic reasons (and they are all self-pay), this means that the people you disparage and would like to just live with their morbid obesity have a disease and need medical treatment.
Morbid obesity is about far more than what people weigh or how they look. Even for people who are young and don't yet have severe comorbidities, the damage is being done. Internal organs like the liver and pancreas are being damaged, the damage just hasn't shown up...yet. But eventually, it will. Even without a diagnosis of arthritis - yet - weight bearing joints are gradually being damaged by carrying all that excess weight. Eventually, there will be enough damage and loss of cartilage that a diagnosis will be made and disability will begin. Morbidly obese, or even "just" obese people are at higher risk for many kinds of cancer. Heart disease develops gradually, even if it shows up as someone dropping dead. The list goes on.
In other words, those "healthy" morbidly obese Medicaid deadbeats that you think shouldn't have their surgery paid for are not healthy. They are sick in ways that are not visible to you but that will become very apparent, very debilitating, and very expensive at some point. If anything, I wish MORE people would volunteer for bariatric surgery, but in reality only a small minority of the people who meet the medical criteria for this life-saving care ever choose to have it.

I am glad you had the resources to pay for your TWO bariatric surgeries. I am saddened that you, in your infinite wisdom, would deny insurance coverage for others based on what you have now shown to be a very limited understanding of the disease of morbid obesity. And please note that both here and elsewhere, I no longer refer to bariatric surgery as "weight loss surgery" or "wls" even though that would be a lot quicker to type, because this life-saving surgery is about so much more than the number on the scale.

Exhibit Number Whatever, Your Honor.

I became obese in my late 30s. I became MO in my 40s. I un-became MO in my late 50s. I will be 68 in less than a month.

I am currently dealing with:
arthritis in my knees...damage done over time, starting long ago;
congestive heart failure;
coronary artery disease (maybe getting a stent in next month);
a somewhat fatty liver;
And that's in addition to my COPD, and all the pressure on the lungs from the abdominal fat didn't help that.

But I didn't "suffer" from my obesity until I was in my 50s. If I had had the DS in my 40s, because I already had the disease of Morbid Obesity, I might not be waking up in pain every day and trying to figure out how much longer I will be able to live independently.

Oh...and I paid cash for my LapBand and don't consider that act a badge of honor.

 

[robs477]

Well, as Diana often reminds us, by definition, 50% of the population has an IQ at or below average.

Well, that explains a lot regarding my perception of almost every topic I can think of. I had no idea the number was that high. That explains why TV programming is the way it is. Based on that, I guess I also really need to work on my patience for people doing stupid stuff, if 1/2 of them cant help it that is????