January 26, 2009
The lap bands of Collin County

I have four things to say about this story, which appeared in the print edition of Monday's Chron but which I could not find on the chron.com site.

About 150 obese Collin County employees have achieved dramatic weight loss with lap-band surgery. And they've done it at taxpayer expense.

The county has spent more than $3 million in public money on stomach-reduction procedures in the past seven years, records show.

Each operation costs $15,000 to $30,000, and the county insurance plan covers almost all expenses.

"I'm totally against it," said new county Commissioner Matt Shaheen, who took office Jan. 1.

He railed against the procedure at his first commissioners' meeting last week and got plenty of support. Other commissioners said they were shocked at the number of lap-band surgeries performed and the expense incurred.

"I think it's probably being used more than it was intended," Commissioner Joe Jaynes said.

Commissioners say they intend to stop covering the procedure. They're scheduled to vote on the issue at their Jan. 27 meeting.

"In an economic situation like we're in now, we need all our spare dollars," Commissioner Kathy Ward said.

Commissioners decided to cover the weight-loss operation several years ago in hopes of cutting down on long-term medical expenses. If morbidly obese employees lost weight, they would incur fewer costly health problems, commissioners reasoned.

Now, however, they say far too many of the county's 1,700 workers are turning to lap-band surgery instead of relying on diet and exercise to shed weight.

"Employees can control what they put in their mouth," Commissioner Jerry Hoagland said. "They don't have to get a rubber band placed around their intestine, or however the procedure works, in order to lose weight."


The county covered 14 lap-band operations at a cost of about $350,000 last year, records show. County Judge Keith Self, who heads Commissioners Court, asked the human resources department to determine if many public or private insurance plans cover the procedure.

Collin County is self-insured, meaning it pays employee health claims from the general fund budget.

"We have limited dollars," Mr. Self said. "That's what government is all about - allocation of scarce resources."

1. If what I observed on the (now defunct) TV show Big Medicine was any indicator, the answer to Judge Self's question is that some do and some don't. The docs on Big Medicine spent a lot of time wrangling with insurance companies over coverage of their procedures. Big shock, I know.

2. As much as Collin County has spent on their employees getting this procedure over the past few years, if they really have that many morbidly obese folks on the payroll then it's not clear to me that this hasn't been fiscally prudent, at least in the long run. Perhaps they would be better served to tighten their approvals process rather than to just unilaterally disallow this. Maybe implementing a wellness program would be a good idea, too. You know, an ounce of prevention and all that.

3. At the very least, it seems to me they ought to get some better data about what benefits they may have gotten as a self-insurer, to compare to the costs. Surely they should know more about the pros and cons of lap band surgery versus other methods of weight management before they make a decision, lest they act as ignorantly as Commissioner Hoagland sounds. Who knows? Maybe if they had it to do all over again, they'd have done the same thing.

4. Whatever else one might say about Collin County Commissioners Court, they're quite consistent in their attitude towards health care for their citizens.

Posted by Charles Kuffner on January 26, 2009 to The great state of Texas

Hey, thanks for the link about Collin County leeching off Parkland Hospital and Dallas County. For some days now I have thought about looking at that issue on a bigger scale. I am sure HCHD and other public entities around the country are similarly burdened by neighboring jurisdictions who won't pitch in for indigent care.

Posted by: racymind on January 26, 2009 5:06 PM
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