Elected officials have a moral obligation to be wise stewards of the citizenry’s resources. Since government has the ability to coerce from the governed the latter’s resources, it must do so only to address a problem that affects or might affect the entire society that otherwise cannot be solved for by the individual by any means. The Bossier Parish School Board’s decision at present to not pay for an employee’s gastric bypass surgery represents such a hard but just decision.
The school system self-insures and already is facing dramatically higher spending in the area of health care of its employees. Part of the system’s response, mirroring the overall trend in the industry, is to create wellness incentives, so that their insured will undertake actions that can prevent much larger and expensive health care problems down the road. A policy that would pay for gastric bypass surgery is contrary to this philosophy.
An uncontroversial performance of this technique costs tens of thousands of dollars; complicated cases can run closer to $100,000 per individual. In assessing the total potential liability faced by the board by sanctioning this procedure, the estimate at present ran to $3 million, more than this year’s large jump in expenses from all causes.
And the fact of the matter is if there is an area of wellness where individual responsibility can avoid huge medical costs, it concerns obesity. Almost all cases of morbid obesity develop because the individual involved chooses to overeat relative to activity level. That individuals who behave in this fashion who have no medical condition that would cause morbid obesity would expect the rest of society to pay to subsidize this behavior is an immoral request, placing a burden on others when they first have not exhausted all possibilities that they can pursue on their own.
To have a government body grant such a request also would be immoral, both from the perspective of society and the individual involved. By holding out this option to its insured, the district would create a false sense of security for those on their way to morbid obesity, a belief that they could continue to engage in personally destructive behavior without major consequence. Instead, the wise insurer would pay for programs designed to wean away people from this self-destructive behavior.
A person in such straits also has other options than getting taxpayers to pay for her overindulgence. At any time, a person simply can choose to eat less and to seek from the Bossier school system to help make this happen as with any other form of addiction. Stories are legion about people who made a personal commitment to change their diets and whose mastery of urges and self-discipline allowed them to drop hundreds of pounds.
Another option would be seeking employment in the private sector with an employer who does offer surgery as a benefit. Unlike the public sector, those in the private sector represent voluntary associations, so these employers are free to offer whatever benefits they like, just as employees are free to work with whatever employer will hire them. If leaving long-time employment in the school system is necessary to obtain the surgery, then that is a cost of an individual’s suboptimal behavior.
An unpalatable but possible option would be to pay out of one’s own resources for the procedure. It might involve years to pay back a lender or provider, but this possibility as a last option perhaps can serve as a discouragement to those tempted to get on the road to future morbid obesity.
These options do exist, so the action to deny by the Board does not in any way threaten the life of its employees with this condition. By offering incentives to avoid behavior leading to this condition, rather than funding a repair of the consequences of this condition, the Board serves both the purposes of the community and individuals acquiring this syndrome. For that reason, the Board recently decided wisely, and future refusals to include gastric bypass surgery as a reimbursable procedure serve the entire community of employees, children, and taxpayers of Bossier Parish.
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