Dr. Looser's Statement to Our Elected Officials
Hi All,
I thought you might be interested in reading the statement Dr. Kevin Looser read to the legislative sub-committee regarding the insurance mandate issue. I found the piece really compelling. Remember, there is still time to email NH state reps concerning this issue. You can find their emails via this link: http://www.gencourt.state.nh.us/house/members/housemembersem ail.aspx
Best regards,
Grant Sanborn Portsmouth Regional Hospital www.portsmouthhospital.com Parkland Medical Center www.parklandmedicalcenter.com --------------------------------------------------
Statement on Bariatric Surgery
Kevin G. Looser, MD.
April 20, 2008
I would like to thank the subcommittee for giving me time to speak today on the proposal to mandate coverage for bariatric surgery. I would first like to state that, in general, I am against mandates for health care related issues. However, I would like to give you my reasons why I feel that a mandate is needed for this issue.
First of all, it is important that the committee know that until three and one half years ago the insurance companies in this state covered bariatric surgery. That being the case it is hard to believe their statements that the efficacy of bariatric surgery has not been completely proven. Why, you may ask, did the insurance companies take away a benefit that they had covered for years? There are two reasons for their decision. The first is money. By refusing to pay for bariatric surgery the insurance companies felt that their bottom line would be increased. The reality is that while that may be true in the short term; there are any number of studies that have shown that these procedures pay for themselves in 3 to 4 years. They do that by making patients healthier, reducing medication costs, reducing doctor’s visits and reducing the tests that many morbidly obese patients have to get to manage their co-morbid conditions (such as diabetes, hypertension, reflux disease, sleep apnea to name a few). The second reason that the insurance companies dropped bariatric surgery was because they could. Patients who are morbidly obese are generally disenfranchised, and to some extent are shunned by society. The insurance companies understood that there was a high likelihood that no one would stand up for these patients. Can you imagine the hue and cry that would have gone up if the insurance companies had decided to stop paying for cardiac surgery? It is interesting to note that gastric bypass cures more diseases in one operation than any other procedure that I know of (a point that I will come back to).
It is also interesting to note that the insurance companies tried to stop paying for gastric bypass in Maine but were told that they could not do that as Maine law prohibits the taking away of services that are already provided for. They were successful in limiting payment in Vermont and Connecticut and never tried to take away the payment in Massachusetts as I am certain that they knew that Massachusetts would never allow that. As I stated in the beginning, I am generally against mandates but I am not against them when insurance companies blatantly take away a service that they were providing.
It is my understanding that Dr. Richard Lafleur testified last week that the efficacy of gastric bypass had not been totally established. Dr. Lafleur is the medical director for Anthem Blue Cross so I would expect that he would say nothing less. He is either completely uninformed or he is a liar. There are literally hundreds of articles that support bariatric surgery and attest to its efficacy. I have attached a synopsis of one of those articles to the end of this document. The facts are that there have been consensus statements from the American College of Surgeons, The American Academy of Family Practitioners, The National Institute of Health, The National Heart, Lung and Blood Society, and the Academy of Internal Medicine all of which state basically the same thing and that is “that bariatric surgery is presently the only long term solution to the problem of morbid obesity”. As I am sure that many of you are aware the problem of morbid obesity is that it is associated with any number of associated conditions. These include diabetes, hypertension, heart disease, gastrointestinal reflux disease, sleep apnea, joint disease, arthritis, and some cancers (breast, colon, prostate and bladder). The reality is that the following statements are absolutely true:Gastric bypass cures type II diabetes in over 90% of patients, it cures hypertension in over 95% of patients, it cures sleep apnea in almost 100% of patients, it cures GERD in 100% of patients, and it reduces one’s risk of stroke, heart attack and cancer in a significant number of patients. Thus I can say with certainty that there is no other procedure that is performed that can make so many ailments better with just one operation. Another fact is that patients who are morbidly obese can lose weight but the reality is that over 95% will gain it back within 12 to 18 months. Gastric bypass has a long term success rate of over 80%. There is no other treatment that comes close to that number.There are two other points that I would like to bring up to the committee before I close. Last year there was a similar bill that was proposed by Representative Quandt. My partners and I came to Concord a number of times to testify in support of that bill. Part of the feedback that we received back was that since we were the only surgeons that came to support the bill, it was felt that we were some how giving testimony to support our own business. I want to inform the committee that I am a very busy surgeon, as are all the members of my group. I was busy before we started a bariatric program and if we stopped doing bariatric surgery tomorrow I would still be a busy surgeon. I will not kid you and tell you that we do not get paid for these procedures – we do. But I can assure you that that is not the reason that we are here. These operations help people, not only by curing co-morbid diseases, but they give patients back a life. They give patients a life that many have not had for years. I have had patients come back to my office after losing 150 lbs and cry tears of joy in front of me. I have had patients come back who are joyful because they can cross their legs, or go for a walk, or play with their grandchildren or even get on a plane for the first time in years. It is unconscionable and I will repeat that, it is unconscionable that the insurance companies in this state have taken away these procedures in order to increase their bottom line. They have taken away hope from hundreds of patients who see this procedure as a last hope to regain their lives. So the reality here is that we are not asking for a mandate, what we are asking you to do is right a wrong. We are asking you to make the insurance companies in this state give back something that they have already provided. We are asking you to not be deceived when insurance company lobbyists tell you that these procedures will increase the cost of insurance to everybody. That is another lie, for if it were true then when the insurance companies elected not to cover bariatric surgery our rates should have gone down and I can assure you they did not. They also know that these procedures save lives, make for better lives, cure diseases and are cost effective and save money. What we are asking is that you, our representatives, do the right thing for the people of this state who desperately need this service.I thank-you for your attention. Kevin G. Looser, M.D. Portsmouth, New Hampshire
