I can get a Roux-en-Y gastric bypass totally for free from the V.A. Nope.
There’s a reason why the VA will pay for a Roux-en-Y: because they have an incredibly good expected value.
At a bariatric center of excellence, mortality rates are sub 1% and morbidity (serious complication rates) are low single digit percentages. Most of the poeple who get an Roux-en-Y have comparable risks EVERY YEAR of death or serious illness from complications of their severe obesity.
Most people lose very large amounts of weight very quickly. The percentage of re-gain is lamentable but is FAR LESS than in any other form of medical diet or through gastric banding. A significant fraction (and a majority in some cohorts of patients) are actually able to transform their eating-and-exercising psychology to (essentially) a naturally skinny person’s, and don’t regain weight ever.
Perhaps most interestingly, and probably very important in the VA’s cost-benefit analysis, is that the restructuring of the GI tract appears to have some permanent co-morbidity benefits independent of the degree of sustained weight loss. T2 diabetes starts to go away before much weight is loss and tends not to come back even if a large loss is regained. The body seems to harvest fat from the throat very quickly and so obstructive sleep apnea also starts to be remedied very quick.