Who should pay for obesity surgery?

So, the NY Times reports that a company that makes lap band devices used in bariatric lap band surgery has applied to the FDA to lower the obesity threshold at which surgery can be performed. If successful, the application would double the number of obese people who would qualify for bariatric lap band surgery. Most of the consumers covered by the new threshold could lose weight and not require the surgery by educating themselves and following healthy nutrition regimens. However, with third party insurers footing most of the cost of surgery at the point that obesity becomes life-threatening, why bother wasting time learning about — and adjusting a lifestyle to follow — proper nutrition? Bariatric lap band surgery is expensive. Should consumers who make the effort to control their weight and follow healthy nutrition protocols contribute a part of their health insurance premiums to subsidize surgery for consumers who choose not to do so? If consumers elect to take the risk of health problems from being obese, then shouldn't they have to bear the cost of damages resulting from that risk? And shouldn't insurers be free to elect not to cover consumers who engage in such risky behavior? Doesn't shifting the cost of that risk to insurers (who pass it along to the all insureds) simply encourage the obese consumers to avoid confronting their unhealthy lifestyle? As the late Milton Friedman was fond of saying, consumers will consume as much health care as they can so long as someone else is paying for it.

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