If you can hold on for one more day"
I'm 55 years old and morbidly obese. Studies show that morbid obesity will knock 10 years off my life. Since normal longevity is 20 years, if I can't control my obesity, I'm in life's ninth inning.
I've tried every diet imaginable, several times, and the obvious solution is bariatric or weight loss surgery. I've had three doctors, who are also personal friends, strongly recommend it. I ducked bariatric surgery for 20 years and when I finally embraced it, I spent years finding a way to make it happen.
Now with a company that provides solutions for specialty surgery, BLIS, , based in Lake Oswego, Oregon, surgery may be possible.
BLIS is not my best chance to get weight loss surgery; it is really my only chance.
I own several businesses based in Kentucky and purchase health insurance for a group of less than 25 people. Not only is it impossible for me to purchase health insurance that would pay for bariatric surgery, there is not a plan that covers the complications of weight loss surgery.
If I pay for my own surgery and had a heart attack the day after, my health insurance won't cover it.
If I don't get the surgery and have a heart attack induced by my obesity, the insurer will pay for that.
It doesn't make sense and then it does. One of the big arguments in favor of a single-payer system for health insurance is that insurance companies are not truly interested in expensive solutions to long-term problems. Like most publicly traded companies, health insurance companies are focused on the next fiscal quarter, not the next decade. What is best for the consumer may not be best for the immediate profit margin
From a cash flow basis, many health insurance carriers find it more profitable to pay for medicines, sleep apnea equipment, doctor and hospital visits and all the other things associated with obesity than to write a larger, one-time check for weight loss surgery. People can change insurance carriers on a regular basis, and one insurer can write a check to make a person healthy only to have them jump to another company. According to the Obesity Action Coalition, the upfront cost of surgery is paid for in 3.5 years, but many health insurance carriers choose the immediate over the long-term.
Risk management can sometimes be like the decisions that Ed Norton's character made in the movie Fight Club. He decided it was cheaper to let people die than to fix a small automobile problem. What is logical is not always most immediately profitable. Or safe for the consumer.
As a licensed life and health insurance consultant, I've spent five years and hundreds of hours looking for bariatric coverage. There are 974 pages in the Affordable Care Act. I've read them all, looking for a provision that would help me. No luck. No insurance carrier in Kentucky will offer small businesses a chance to buy a plan that will cover bariatric surgery or its complications.
I've been outraged by the unfairness. If I lose all my money and go on Medicaid, I can get the surgery for free. If I stay healthy until age 65 and go on Medicare, I can get surgery for free. If I was elected to the Kentucky legislature or to Congress, my insurance would pay for the surgery and its complications. Most government entities offer their employees insurance that covers the surgery and its complications.
If I worked on Wall Street or for a "too big to fail" bank, I'm sure most of them cover it too. Large companies often have weight loss surgery, or at least the complications of weight loss surgery, as part of their coverage.
Bariatric surgery is another example of where Main Street takes a beating. We can't get the same kind of coverage that people who are richer, poorer, or in a different line of work get. Until I heard of BLIS, I never knew of a way to buy any kind of coverage on my own.
Many individuals and small businesses can get coverage for obesity surgery through a health insurance exchange. It all depends on where you live. I live in Kentucky. Kentucky has done a terrific job in implementing the Affordable Care Act, but they joined roughly two dozen other states in not offering obesity surgery as part of their health insurance exchange.
A story on NPR from Kaiser Health News noted the almost direct correlation between the states with highest obesity problems and the states that are not offering obesity surgery through their exchanges.
The worse the obesity problem, the less the politicians want to do anything about it.
I seriously thought about moving to another state. My wife is employed in Louisiana and I could easily move there, but they don't offer obesity coverage either and their ability to implement ACA is light years behind Kentucky. None of the states bordering Kentucky offered the coverage and moving to a state like New York or Maryland takes me too far away from where I do business.
The BLIS insurance coverage works like an extended warranty on an electronic device or collision coverage on a rental car. It's extra protection to allow us to have comfort when making a bold move.
For this middle age, Main Street Kentucky, small businessman, BLIS is the only real option I have.
My Long Strange Trip to Bariatric Surgery
"Good and bad, I define these terms
Quite clear, no doubt, somehow
Ah, but I was so much older then
I'm younger than that now"
Lately it occurs to me
What a long, strange trip it's been
It's hard to believe I am on a relentless quest to have weight loss surgery.
I do many different things under the McNay Consulting umbrella (www.mcnayconsulting.com), but my primary business for 33 years has been helping injury victims with their money and setting them up structured settlements. I frequently do claims consulting and mediation consulting.
I've seen several situations where people died from gastric bypass surgery. I've gotten to know the intimate details of how they died and know their families.
If your primary experience with sky diving is dealing with the families of people who died during jumps, you are less inclined to embrace the idea of parachuting yourself. That's exactly how I felt about weight loss surgery. Not only was I opposed to it, I tried to talk anyone and everyone out of doing it.
All I knew were the horror stories.
Ten years ago, statistics backed up some of my inferential conclusions. CBS News did a story on January 21, 2005, which cited a University of Washington study saying that one in 50 people died within a month of gastric bypass surgery and the figure jumped fivefold if the surgeon was inexperienced.
Rather than betting on a 50 to one chance of coming home in a body bag (or 10 to one chance of dying at the hands of an inexperienced surgeon), it was a simple decision to sign up for Weight Watchers, again and again and again.
I've never had a client (or more precisely, their spouses, children and estate) who died during a Weight Watchers meeting.
You may not drop over in your weight loss meeting, but if morbid obesity knocks 10 years off your life, you are dying slowly and painfully as opposed to dying quickly.
I saw a lot of stories like the one on CBS during that time period. What I missed was the move of the medical community towards fixing the problem. The story quoted Dr. Harvey Sugerman, then President of the American Society for Bariatric Surgery, who noted the development of the "Center of Excellence" programs and strict criteria for surgical facility to be considered a "Center of Excellence."
Being a Center of Excellence is like the "Good Housekeeping Seal of Approval" for weight loss facilities. It separates the players from the pretenders.
A few years ago, one of my trial lawyer friends was discussing weight loss surgery and noted, "They don't seem to be killing as many people as they used to." I thought about his statement and then followed up privately with several star medical malpractice attorneys and found that his statement was basically correct.
When you look at the numbers, weight loss surgery has gotten safer.
A study published in the March 2014 Journal of the American Medical Association (in the journal JAMA Surgery) cited the work of lead researcher Dr. Su-Hsin Chang and others at the Washington University School of Medicine. They concluded that "death rates are, in general, very low."
The study showed that the death rate was between 0.08 percent and 0.31 percent. A dramatic change from 2005.
The team went through 150 studies of weight loss surgery, involving 162,000 patients. Weight loss professionals like to throw around a term called BMI and the average BMI of the group was 46.
A BMI of 46 on a person six foot tall (like I am) would mean a weight of 339 pounds. For those of you who remember William "The Refrigerator" Perry who played for the 1985 Chicago Bears, he was about six foot tall and weighed 330 pounds.
The study showed that their BMI dropped between 12 and 17 points in the five years following surgery.
Translating BMI to layman's terms, that means that if "The Fridge" (or anyone else that size) had weighed in at 330 pounds before weight loss surgery, five years later, he or she would weigh between 250 and 214 pounds.
A weight loss between 80 and 116 pounds.
That dramatically increases the chance to live to a normal age. A huge motivator is the possibility of reversing diabetes. I'm inching into the diabetic category and know that not only is it a killer, it is a horrible and painful killer.
The jury is out as to whether the actual surgery will reverse diabetes or if it works on everyone. A March 31 NPR story said that more than one third of people who had gastric bypass surgery met their targets three years later, but also noted that almost three quarters did not have normal blood sugar.
Since only 5 percent of people who were treated with medicine alone met the standard, surgery is the best hope.
As Tim Robbins' character in The Shawshank Redemption said, "Get busy living or get busy dying." The chance to get busy living has overcome my fear of weight loss surgery.
Try to understand
Try, try, try to understand
He's a magic man
I once saw an interview with Ann Wilson, founder of the group Heart, after she had LAP-BAND surgery in 2002, that because of her high self-esteem, she never really thought of herself as obese, even if the scale said something different.
I understand Ann completely. My self-confidence can be infectious or rub people the wrong way, but I am always the lead singer in the band. I know how to get to the goal line. I've had a wonderful career and am married to a beautiful, intelligent and professionally accomplished woman. I've been on television hundreds of times and never seen any true inference that obesity has held me back.
You can't sell me on the idea that weight loss surgery will make me rich or a sex symbol. I've done just fine on my own.
Being overweight is considered by many to be a stigma in American society. Billions of dollars of advertising convince us that we need to be thinner and the health risks of obesity are very real. As Michael Pollan, Gary Taubes and others have articulately written, we need to wage a full blown battle against fructose and its addictive properties. I reached a point where I was drinking at least six diet soft drinks a day and dropped them cold turkey earlier this year. I felt like a junkie kicking heroin. It took a couple of months before the physical cravings went away. The fructose had become an addiction.
On the larger front, we need to fight for healthier food for everyone. On my personal front, I need to make a move to lose weight now.
I've been incredibly lucky. I've been on blood pressure medicine since age 25 and used a CPAP for my sleep apnea for over 20 years. I've just started inching across the border from pre-diabetic to diabetic. My cholesterol level is something ridiculously low, and I have a great outlook on life. I've been in the hospital twice for short stays unrelated to obesity. Once when I was five and once when I was 50.
Yet, I'm 140 pounds overweight.
Both of my primary doctors are close, longtime friends. So was the doctor I had early on, who volunteered to go to Iraq for military service. I think the reason I have avoided things like heart attack, stroke or having a diabetic limb chopped off is that we have treated each symptom before they led to something more dangerous. I'm sure I would have been dead if I had not treated my blood pressure and sleep apnea at a young age.
My father had a stroke at age 43 and died at age 59. My mother died at age 67. No one in my very extended family has made it as far as I have without a serious illness.
I don't smoke, rarely drink and have reasonably healthy habits for a guy who is morbidly obese. Actually, I have healthy habits for a guy is not morbidly obese. I know what it takes to live a long and healthy life.
I'm a strong believer that a person can achieve anything they set their mind to doing, but losing weight using customary weight loss methods is one area where my theory has not held true.
I seem to be the Amy Winehouse of traditional weight loss. I've been in a medically supervised, university sponsored, rapid weight loss program five different times. I've never lost less than 50 pounds in any of the five appearances and lost as much as 90 pounds (which left me 20 pounds under my ideal body weight). Within two years of each weight loss, I had gained it all back and more. My set point became higher every time for a 25-year period.
I've tried almost every diet program ever invented and even started my own weight loss group. We stayed together for seven years of weekly meetings with yo-yo dieting for all of us. I've had multiple gym memberships, a couple of great personal trainers, did daily Zumba classes and 80 golf lessons in one year. I didn't lose any significant weight playing golf, but I coauthored a best-selling golf book with the PGA professional who taught me.
I befriended a lot of people during my five stints through weight loss programs, and I think every one of them wound up heavier later than when we started. Some have died. Many have now done some kind of weight loss surgery. I've spoken to at least 50 people who've had the surgery and only had one unhappy with the results.
My father was a professional gambler and I have a long background in the financial services industry. I usually view life decisions in terms of odds making.
Going through all the data and information, the odds of me living a longer life after weight loss surgery is better than not having it.
My decision is strictly based on health and longevity.
I will admit that I would love to sit in a coach airline seat or walk into a clothing store and buy something right off the rack. I have to buy two coach seats when I fly or fly first class. I order my clothes online. I'm not going to go through surgery to save a few bucks on airlines and clothing, but it will be a nice benefit.
I don't plan on training for an Ironman race or climbing Mount Fujiyama (which I think is a volcano anyway). My idea of roughing it is staying in a hotel where they don't put a mint on your pillow. My wife won me over on our first date when she said she hated camping. I do too and still will when I am thinner.
I'll play a ton of golf and do other forms of exercise that I enjoy.
I won't be posing nude for Playboy or Cosmo like Carnie Wilson did.
To focus on looks and sex appeal diminishes the basic message: this is all about health. This is all about longevity. I don't want my wife to be a young widow. I have three grandchildren and want to be there in 20 years when they reach adulthood.
I have places to go, people to see and things to do.
The surgery is a tool to make that happen.
How the BLIS Insurance Thing Works
"But she looks in my eyes
And makes me realize
And she says 'Don't worry baby'
Everything will turn out alright"
-Brian Wilson and the Beach Boys
"High risk insurance
The time is right"
I caught up with Regi Schindler, President and CEO of BLIS, Inc by phone while he is attending the World Congress for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) in Montreal. 
Schindler has an extensive background in medical risk management, including several years at the Mayo Clinic, but in 2005 he left the safety net of a corporate career to develop an insurance concept he is passionate about.
Regi helped to create a terrific idea in offering insurance coverage for specialty types of surgery, such as bariatric surgery, plastic surgery and orthopedics that many insurance carriers don't cover. They also provide financing or people who are paying for surgery on their own.
Regi calls BLIS "similar to a new car warranty for post-surgical procedures." I tend to compare it to buying collision coverage at the airport on a rental car. Some of us have auto insurance that covers us when we drive a rental car. Others need short-term protection for a limited experience over a limited period of time.
Schindler calls his program "surgeon-centric" and in a 2012 article in Bariatric Times, he explains his business model in intricate details. I assumed that BLIS would base their pricing on the health of the individual patient. Instead, it is based on the type of procedure and the overall experience BLIS has had with the surgeon doing the procedure.
I have decades of experience in the insurance industry and understand concepts like the "Pool Actual Loss Ratio." When I asked Schindler to sum up by saying, "the better the surgeon, the lower the patient's premium," he tended to agree. Regi has built the company with a laser focus on getting the very best surgeons to participate.
Which makes sense. Like any insurance provider, BLIS wants to keep their claims low and track the individual results and outcomes to make sure that the surgeons in their program are doing their best to stop minor complications from becoming major complications. BLIS seems to focus on quality and dealing with only "A list" (my paraphrase) surgeons.
BLIS and I have parallel goals. They want to increase access to surgery for as many people as possible. I want to increase access for me. Schlinder is passonate in his commitment to making to offering a way to for people to have surgery that could not previously and also that the overall outcome is focused on improving the patient experience.
For a number of insurance underwriting reasons, surgeons in the BLIS program have a number of incentives to look at the bigger picture and focus on minimizing and avoiding complications.
I'm not quite to the "don't worry baby" mindset. Bariatric surgery is serious business. But I am thankful that BLIS is not a traditional health insurance carrier and has a model that seems to put patients over profits.
I will eventually tell you firsthand. I've not been approved for surgery or signed up with BLIS yet but things are moving forward quickly on both fronts and I expect both will happen soon.
As I told Schindler, my frustration is that I did not find BLIS five years ago. In my hundreds of hours of searching, I kept looking for traditional health insurance carriers, rather than thinking outside the box to look for a company like BLIS.
The good thing is that BLIS is well thought of by the surgeons who use their services. Since their universe is extremely small and focused, their name recognition amongst people outside of the surgical world is small.
None of my personal physicians, or physician friends, had ever heard of BLIS. The marketing is directed strictly at the surgical world. Which seems to be working for them. According to their website, which Regi confirmed, the company has offered protection on 11,000 cases since 2006.
Going back to one of my favorite movies, in The Shawshank Redemption Tim Robbins' character Andy Dufresne wrote a letter to his friend Red that said, "Remember Red, hope is a good thing, maybe the best of things, and no good thing ever dies."
BLIS and the possibility of weight loss surgery have given me hope.
For a longer and healthy life.