On Healthcare and Personal Responsibility.
I read comment threads on news articles. I do this, and invariably then I’ll sigh and mourn the death of human intelligence, and wish I hadn’t bothered. But then I do it again, anyway. It’s an opportunity to get a sense of what some folk are thinking; what they wouldn’t say out loud to an open room but feel entirely safe saying in text as a stranger among strangers.
Right now, the US is in the midst of a vigorous debate over healthcare reform, which has been by degrees depressing and maddening, and unsurprisingly this has been a popular subject on all forms of the news- and commentary-driven media. The comment threads to many of these articles provide a wild diversity of approaches and opinions, but always, there seems to be at least one person who opines the great injustice that is their potentially having to help pay for some fat person’s healthcare. Combine this with the growing support for implementing some kind of “fat tax” (which, sorry folks, won’t affect this fat person’s wallet, as I never drink soda, nor do I eat snack cakes) and you have a small but vocal minority of folks who think fat people just aren’t punished enough when it comes to healthcare, and that the fat should be forced to either pay more or be shut out altogether. I’m not going to link to any particular comment thread here, but read through the responses to almost any article on the fat-tax or the “obesity epidemic” and you’ll find some guy who thinks he’s a fucking genius for having come up with this idea.
And you know, the reality is, health care costs are skyrocketing out of control. It’s probably not unreasonable, in a logistical sense, to punish the folks more likely to go and be sick (but not to up and die, as they are relatively cheap healthcare recipients) by making them pay more for their coverage (if they’re allowed to have coverage at all). In fact, I have a better idea, one that would likewise save the industry quite a bit of money in healthcare costs.
Let’s just punish all sick people.
It cuts out the middleman. After all, it’s the sick people of all walks of life who are costing the US billions in taxpayer dollars that could be better spent blowing people up halfway around the world. So, henceforth, I propose that anyone who gets sick immediately has their coverage slashed and their premiums raised to pay for all the coverage their stupid sick selves will inevitably require. You’re diagnosed with lung cancer? Tough luck, you irresponsible oxygen-breather. You get critically injured by a drunk driver on your way home from work? Better have your checkbook on you when you get airlifted to the hospital.
Obviously, I’m being glib. It’s a preposterous suggestion. The truth is that this is how insurance works: we all pay, so that the some of us who require healthcare at any given time can access it. That is the purpose of insurance, to pay into a collective system that we can then draw on if we require it. This means some of us will pay in more than we take out, and some of us will take out far more than we put in. But that’s how insurance operates and how it always has. There’s a term for putting money into a system that only you can access, and only when you want to: it’s called a savings account.
Now, if you want to punish the fat because you truly believe that all fat people are necessarily and irredeemably ill at all times, even though I disagree with you, we should think about that proposition. Because ultimately, if that’s what you believe, you’re talking about punishing sick people for using health insurance for the purpose for which it is intended: to pay for medical treatment.
Let’s just mull that over for a minute here.
The money you pay into health insurance helps to pay for the healthcare of countless individuals whose life choices you may not agree with. You may help to pay for the HIV medication for someone who contracted the disease by having irresponsible sex. You may help to pay for chemotherapy for a person who developed throat cancer as a result of smoking cigarettes. You may dislike this; you may think these people are stupid for making mistakes that impacted their health. But you also probably realize that not everyone who engages in these behaviors will end up with these illnesses, just like not every fat person gets diabetes. It’s a roll of the dice. You still don’t get to say, “I don’t want my insurance premiums to pay for so-and-so’s healthcare because I disagree with their choices.”
The trouble with focusing on personal responsibility in regards to health is the reality that not everyone who gets sick is personally responsible for it. Not even fat people. There are plenty of folks who maintain totally “unhealthy” lifestyles by current standards, smoking and drinking with gusto, cooking everything in lard, and still persisting into their eighties and nineties. And there are also a great many people who are obsessively meticulous about the things they eat, and the exercise they get, and the environment in which they live, yet who still wind up dying too young from some unthinkable accident or some unpredictable disease.
Should healthcare only be made available to the virtuous and conventionally-attractive among us? Or to people who aren’t poor and who can therefore afford such things as quality food and gym memberships? Would you argue that only people who are well-educated, or people who are Christian, or people who are able-bodied should get full insurance coverage? Should healthcare only be offered to people who have never failed to report a symptom that resulted in a late diagnosis of a treatable disease? Is healthcare only for people who get themselves screened for breast cancer or colon cancer or prostate cancer at the appropriate ages and as often as recommended?
Is healthcare only for the physically perfect and morally pure?
These questions are a natural extension of the suggestion to restrict the coverage and punish the millions of Americans who qualify as being under that questionable umbrella of “obesity”, for having no self control or discipline, because this argument’s proponents also tend to accept the fallacy that fatness is easily enough managed with a little motivation. And what the “charge fat people more!” comments really come down to, in plain English, is people expressing that they don’t want to pay for certain people’s healthcare because they just don’t like those people. But that’s not how the system works, and arguably it shouldn’t work that way, because that would set a precedent for anybody who didn’t want to contribute to the healthcare of a particular group of people (people who are gay, for example, or people who are legal immigrants, or people who have a history of drug or alcohol abuse, and so on) to make a case against it.
For all the protestations of “fairness” and “equity” on the part of those who feel cheated by fat people allegedly soaking up all the precious healthcare, that’s an awfully unjust way of thinking.
I was healthy as a horse (are horses healthy? are dogs unhealthy? what is up with “sick as a dog?”) until I became sick about sixteen years ago. I’ve been sick ever since. It was nothing I did, and nothing identifiable that happened. I just got sick. This post made me tear up with the… damn fairness of what you’re saying. Which is kind of sad: this perspective should not be so rare. But it kind of IS, so thank you.
I was talking about this with a friend yesterday, who seemed to think that the North Carolina plan to charge smokers and fat people more for their insurance was hunky dory. Correlation/causal issues between fat and health aside, my issue is that this is the first step on a very slippery slope. Before long, when people are charged more for insurance based on their behaviors you won’t actually HAVE insurance anymore at all. You might as well just have everyone paying their own bills, making the sick suffer even more.
I know this is pretty much what you just said, Lesley. I guess I’m just agreeing with you. Strenuously.
This post hits so many nails on so many heads all at once. I don’t even have words, I’m too busy nodding my head.
Great post. I had this very argument with an acquaintance on Facebook recently. Made me so mad I de-friended him (oops…). He thought taxpayers shouldn’t have to pay for *any* condition where the patient brought it on him/herself. I think we can all see why that would be unworkable.
One of the arguments I’ve been using in this debate is why should I, someone who has made the choice not to have children, pay for other people to have as many kids as they want? There’s pre-natal care, hospital births, and pediatrician bills. Surely that puts more of a strain on the system than my blood pressure pills. And then my property taxes go to educate the little buggers… Of course I’m happy to contribute to paying for childbirth and education in the best interest of society, but if we’re talking about (arguably) voluntary choices that strain the healthcare budget, that can’t be removed from the equation.
I read this post yesterday at a moment when I couldn’t comment — but I mentioned it in a conversation about 1 hour later. I brought up the whole “charge smokers and those with a BMI over 40 more scheme,” and interestingly, my (thin) good friend asked me, “is it the same — smoking and having a BMI over 40?” — I thought she was asking me if a BMI over 40 was as mutable as quitting smoking, but in fact she was asking it the other way around. “But, aren’t there people who really can’t stop smoking?” she clarified — taking for granted that the BMI over 40 thing was bullshit. “Yes, and there are people for whom quitting smoking would make their other health conditions worse, even if they could do it.” Personally, I think that never starting smoking is a great idea, as much as we can manage to make that happen, but I don’t know that as long as tobacco is grown, people won’t continue to use it in one way or another.
Lesley, you are my current favorite thinker. Your ability to keep the wheels turning after I’ve finished reading what you’ve written (and sometimes keep giggling afterwards, too) is a major gift. Please write a book or two or ten. I’ll preorder.
The other thoughts that this post had me mulling over were about what the REAL drivers of skyrocketing healthcare costs are, and they are that it’s a growth industry. Because the pockets are deep, and many people falsely believe that every and any procedure is a good procedure (rather than just a money sacrifice to the immortality gods), the health care industry is an economic engine.
If the ability to make money off of health were taken out of the equation, costs would still go up (due to inflation and new technologies) but at a much lower rate than they do now. For-profit health care is fundamentally at odds with lower cost, equitable health care. You can’t do both at the same time.
I actually wrote a column for our local paper about this recently and reposted it to my blog. Of course, I chose to go to the absurd and suggest that men be required to get sex changes because men are less healthy than women:
http://rosenleaf.typepad.com/livingstonipresume/2009/08/here-comes-the-judge.html
People who seem to believe that healthcare should be available only to those who have “perfect” behaviors need to think it out to its (illogical) extensions.
Good post. Thanks!
One of the arguments I’ve been using in this debate is why should I, someone who has made the choice not to have children, pay for other people to have as many kids as they want?
Right on!
Whenever I hear someone making the argument that fat people should pay more for health insurance because of potential health risks that have yet to be proved as fact, I always ask them if they eat meat. Most usually do as vegetarians comprise less than 3 percent of the U.S. population, and so I then ask them if they should also pay higher premiums because eating meat has been associated with gastric cancers, high blood pressure, heart disease and stroke. If they are still on the fence, I then point out the vast numbers of sports-related injuries and ask if these folks should also be made to pay higher premiums. Some see the logic, some don’t.
And as Carrie so eloquently pointed out at BFB, smoking, eating meat, using tanning beds and any other behavior that may result in potential health problems is exactly that: a behavior. There are those who would like to equate fatness with behaviors like overeating and being inactive, but obesity is still simply a descriptive adjective that, in itself, connotes no definable behavior that can simply be stopped at will.
Okay, in my foodie fantasyland, here is how the only “fat tax” that I could possibly entertain the thought of (though it would still be paternalistic and kind of stupid) would work:
1) Soda fountain drinks and a couple of other the-convenience-store-is-ripping-you-off kinds of foods might be taxed.
2) The taxes would be used to put WIC-accessible quality farm produce in those convenience stores.
I don’t think people would ever go for this, because “vice taxes” are supposed to be punitive, not constructive. Still, it would be something besides Suffer Poor Ramen-Eater.
Like rebecca, I teared up at this post.
Not just because of the rightness of it, but because of how easy it is now for health insurance companies to do something like that to me.
If I lose my insurance for >60 days, then suddenly all of my medical problems (most of which are genetic and have no relation to my lifestyle) become pre-existing conditions they don’t have to cover. I’d be lying if I said I didn’t live in fear of that happening. My eventual wedding may very well end up planned around when my boyfriend’s health insurance will allow him to add a spouse, because I’ll lose my state-paid health insurance then. And without my health insurance, I could not begin to afford the $2,000+/month in medications, not to mention all of the specialists and the ER visits that my combination of conditions requires.
It really is a terrifying thing to live under. Loss of health insurance is the sword of Damoclese hanging over my head.
~Kali
www.brilliantmindbrokenbody.wordpress.com
If they start taxing my Sprite, I’ll be forced to switch to gin. Simple as that.
* ; )
The “soda tax” in particular makes me riled-up because I. like. sodapop. For this I get a one-way ticket to taxation hell?? I was weaned on Diet Pepsi and later switched to Diet Coke…then after a kidney stone made me consider drinking less soda, I began drinking G2 or Pwerade Zero, or even (gasp!) water sometimes. I’m a full-grown woman who does not drink a 6-pack of ’straight’ coke every day of my life…I just do not drink tea (black, white, or green!), coffee, mineral water, kombucha, milk (soy or otherwise), or, in general, alcohol.
Am I fat?
Compared to who??
Am I healthy?
Again, compared to who? My cholesterol and triglycerides and blood-pressure were all within acceptable range at my checkup a couple weeks ago. How fat do I have to be before they’d tax me?! Are they just going to go off my BMI..? Because we know that’s caca de toro.
I do not have a solution to offer, but I would not like to see a ’soda tax’ in my lifetime!