Privilege v. Entitlement

posted by meowser

Unfortunately, much of the discussion of privilege focuses around shaming those who are perceived to have it, rather than trying to strategize about how to empower those who may not. – Octogalore, “Entitlement”

Even before the latest dustup, I wanted to write about privilege versus entitlement (that is, a feeling of entitlement). So what better time than now, since we’re sick of it already?

Octogalore’s post is an old one, but she made me think about some things that I think sometimes get lost in discussions of privilege. Namely, that feeling entitled to success (i.e. what you want out of life) is something that isn’t so neatly distributed along “privileged”/”not privileged” lines. Some people with fewer advantages on paper experience more feelings of entitlement, and some people who seem to have more advantages are held back by the feeling that they not only don’t deserve success, but actually deserve abuse. (I’m not going to claim that everyone who is abused believes they deserve abuse, but it’s a pretty safe bet that everyone who thinks they deserve abuse is bound to get plenty of it.)

How much entitlement you feel, in fact, probably doesn’t come down to a formula of any kind, but a lot depends on upbringing, environment, neurobiology, and how all those things cook together over the years. Like Octo says, too much entitlement can curdle into arrogance, which can not only make an intractable pain in the ass of you, but it can actually backfire when it comes to getting what you want (e.g. you think the traffic laws, metaphorical and actual, don’t apply to you because you rule). Does feeling entitled to success trump privilege? I don’t think so, and Octo doesn’t either. (Seriously, that post is amazing, I highly recommend it.) In fact, privilege often reinforces entitlement; if you expect characteristic X to help you in the future because it has in the past, you are less likely to sandbag your future efforts because you don’t want to deal with the roadblocks. (“Why bother applying for that job? They won’t like me.”)

Do I think it’s possible to accomplish things even if you think you’re a useless dirtbag? Yeah, I do. But I’m going to guess that people who succeed despite feeling little or no entitlement don’t enjoy it a whole lot. And aside from relief to have survived, can anything beyond that be considered “success” if you don’t really enjoy it?

I have always had a serious entitlement deficit. Okay, that’s an understatement; I have had serious problems my whole life maintaining a feeling that I deserved to exist. In fact, the way I found fat acceptance, as I’ve said before, was that my therapist in the mid-’90s recommended I get myself a book on self-esteem, figuring I’d live longer if I actually had some. And I wound up with this one. I’d heard of FA principles before, but post medication weight gain, what Carol Johnson said just made way too much sense. “No, it really IS totally illogical to discriminate against people because of their weight! Yes, it really IS about more than calories calories calories! Yes, I really SHOULD dump the boyfriend who’s been acting like I’m corroded because of my newly Zoloft-padded tush!” I had to be feeling at least some sense of entitlement to get that message, yes? I believed, at last, that I was entitled to eat what I was hungry for, to not weigh myself, to actually live and pursue the goals that were important to me, whether I lost an ounce or not.

This was seismic. We all know that most fat people don’t feel entitled to those things, right? (And probably even more so in 1996, when I bought the book, than now that there’s a Fatosphere and everything.) So you’d think that acceptance of my outsides would soon lead to feeling more entitlement about my insides — in other words, that who I was on the inside deserved my respect as much as my outsides did, that I should feel perfectly free to go after exactly what I wanted in life.

Hooboy would you ever be mistaken about that.

Don’t get me wrong, I’m glad I didn’t have to deal any longer with hating myself for being fat on top of hating myself for everything else. That combination might have killed me. But I still could not, for the life of me, figure out why I did or said certain things the way I did, why people just stopped talking to me and told me “you should know, everyone knows” when I asked what the problem was, why I kept getting booted out of homes, jobs, lives, so unceremoniously. Here’s where neurotypical unprivilege comes in and how complicated that can be, folks. Until two years ago, I didn’t have the privilege of having a diagnosis of Asperger’s, partly because such a diagnosis didn’t exist until 1994, and partly because none of the shrinks I saw after that knew jackall about it. So all I could think was what’s wrong with me? what’s wrong with me? what’s wrong with me? on an endless goddamn repeating loop. When you feel that way, you don’t persevere through rejections; you get one rejection, or maybe two if you’re feeling feisty, and then go hide under the bed for a few years, until the pain of not having what you want becomes so severe you try again, and it’s the same damn thing all over. They said no. That proves I suck.

Maybe self-esteem is privilege too, in a way.

Believe me, I’m not going to be all smug about understanding the whole privilege issue better than some people do. I had a terrible time with it, actually. Because I didn’t have a handle on my basic right to exist, when I first started reading about it, it sent me into a terrible downward spiral. How can having privilege not make me a bad person? If I’m costing other people their safety and health and dignity just because I exist, doesn’t that make me a murderer and a thief? I really did believe I deserved to die over that, all because of my belief that life had to be a zero-sum game where one person gets to live and one gets to die and the one who had to die should be me, that nothing could possibly change to distribute things more equitably unless I took my own life. That way, there’d be one less useless white body in the world, right? It would make white people that much less of a majority, right? Yes, I actually did go there, and the fucked-up thing about it was that I knew how fucked up it was to have that reaction, and that just made me feel that much worse.

Mine was an extreme and wildly inappropriate response, I’ll admit, and I’m pretty sure it’s rare for anyone to actually think that way. (My psychiatrist, when I first presented to him, had no trouble confirming my therapist’s diagnosis of Asperger’s, on the grounds that “your depression pattern is extremely atypical.”) But if that episode taught me anything, it’s that ideas can go through people’s filters in a way you can’t necessarily control from the outside. I can see where the defensiveness about privilege comes from; it’s about the belief that there have to be winners and losers at everything, and if you’re not one of the winners who has an advantage over someone else (earned or not), you have to be the loser, and in America being tagged a loser can cost you everything, including your life. Is this a matter of too much entitlement, or not enough? I think it’s a little of each; maybe you feel entitled to your own comfort, but not entitled to a world where you don’t have to be scared to fucking death of losing it for no good reason.

I think I’ll let Octo have the last word here:

At any rate, it strikes me that the endless carping about privilege is mostly for the benefit of the privileged. It allows a shame solution to a problem that really isn’t about whether or not the relatively privileged shamed person takes pride in herself. And therefore lets her off the hook easily, for the price of a mea culpa. Well, fuck that. It’s not that easy.

Fuckin’ A. Okay, I lied, the last word is MINE MINE MINE! Because it’s my blog, and I’m entitled.

Well, I Dood It

posted by meowser

I sent my letter to Sen. Wyden.

It should go out in Wednesday’s mail.

I sent it to the Washington, DC office.

I wrote it out in blue ink (PaperMate Eagle pen, not expensive, but not so cheap it leaks) instead of just printing it, figuring it might otherwise get lost among all the other black and white computer-generated pages. I printed, because my cursive looks like a first grader’s. (My handprinting at least makes it to fourth grade.) I used lined paper because I can’t write straight on unlined paper to save my life. (When I tried it, I actually wound up with part of a sentence on one piece of paper and part of it on another. Yargh.)

I made some minor changes (cleaned up an editing glitch in the second paragraph), but otherwise it’s what you saw here. It wound up being 5-1/2 handwritten pages (I print pretty big). I even put an extra stamp on the envelope, just in case.

Just reminding y’all, I’ve never, ever done this before. So if I can do it, so can you, if you think you might want to.

If I hear anything, I will update, even if it happens on my official blog hiatus next month.

First Draft of My Letter to Sen. Wyden

posted by meowser

Right now, this is about as brief as I can make it without leaving anything out. I haven’t sent it yet, so if you have any feedback for me, I’d love to see it. If you were going to cut, what would you cut?

****

Dear Sen. Wyden:

I am a constituent of yours from Portland, and I have been following the healthcare reform fight with great interest. I am in my 40s, am diagnosed with Asperger syndrome (a form of autism), and I also have polycystic ovarian syndrome (a metabolic disorder that affects an estimated 5% of American women) and take psychiatric medications for severe, life-threatening depression. The drug I am on is the only one that has ever worked to keep my depression in full remission, and in combination with my metabolic disorder, it has also ensured that despite a high-quality diet and moderate activity level, I am teetering on the borderline of “morbidly obese.” I am told by my doctors that this is more common than not for people taking this medication and, keeping my PCOS in mind also, they do not blame me for my weight. I am grateful for this.

However, what these conditions mean is that I am umbilically dependent on a job to give me health insurance, since there is no way on earth I could possibly qualify for individual coverage with my pre-existing conditions, even if I were to (improbably) become “normal” weight. The job I have is one that is being hunted to extinction — I telecommute for a national medical transcription company editing speech recognition files and doing transcription. My bosses and coworkers have, in fact, never seen me in person. These jobs, at least in the U.S., are becoming more and more obsolete as “front end” speech recognition (edited by doctors themselves) and offshoring the work to overseas transcriptionists who are grateful to do the work for pennies on the dollar compared to what they must pay U.S. workers, and even more so because American workers depend on their jobs for healthcare. I am not particularly confident that I will make it to “Medicare age” without having to find another way to secure myself insurance, and with my disability and age, the number of insurance-providing jobs I can qualify for is vanishingly small. Therefore, I hope with all my heart that we can figure out a universal healthcare solution that is affordable and accessible for all, and I admire the work you have been doing to try to make this a reality.

This is why I was particularly dismayed to see that you supported Sen. John Ensign’s amendment to the healthcare bill that would allow companies to charge an insurance rate differential of up to 50% (with HHS approval, which would be no obstacle that I could see) for people whose “numbers” — weight, cholesterol, blood pressure, etc. — fail to meet their standards. It’s pitched as a “discount” for people who “take care of themselves,” but in practice, with most companies having yearly open enrollments for insurance, it amounts to the “good” (i.e. genetically luckier) people being allowed to pay the old, lower rate, while the “bad” people (who drew the short stick for DNA) are charged the new, higher rate.

And yes, the way I see this, it does also add up to punishment for “bad” genes. Surely you understand that there is a huge difference between people who can, for example, lower their cholesterol 30 points just by switching to soy milk, and people who have to go completely vegan plus take three statins (which are risky drugs in themselves) to lower it by even 10, yet both are expected to meet the same numerical standard. And if even one number is “off,” one gets dinged the same as if all the numbers were “off,” leading to disincentive to make any positive changes at all if merely being “imperfect” is going to cost them just as much as being overtly self-destructive (the latter of which is, I think, relatively rare). It’s also worth noting that people who are lower income (and nonwhite) are more likely to have numbers that are “off,” and that “living a healthy lifestyle” as promoted by mass media is largely a prerogative of the financially comfortable.

This hardly seems just, and if the goal is truly to get people to take better care of themselves (as opposed to taking the opportunity to squeeze more money out of employees), it is likely to backfire. People who have less money in their paychecks have less money to invest in fresh fruit and vegetables and high-quality whole-grain products, and people who have less money also have increased stress, which in itself is known to be deleterious to health. And those who must take second jobs or work longer shifts to make up for the shortfall in their paychecks — which would be common for people who work low-paying jobs such as retail — would have much less time for physical activity and cooking.

I know Sen. Ensign’s amendment provides for a waiver in case of medically documented inability to “make goal,” which I would likely get with my history. I also understand that companies are currently allowed to charge up to a differential of 20% for “good” numbers, and that 30% (the allowed differential without the HHS approval) does not sound like much of a difference. But 50% certainly is, and would almost certainly tempt many more employers (like the one I work for now, which currently charges no differential) to start testing everyone’s blood and urine and saliva and weighing and measuring them in order to save money. Even if I qualify for a medical waiver, I can see no good coming of having to tell my boss I have Asperger’s and PCOS and depression bad enough I was once hospitalized for it in order to get that waiver. It seems like a great deal for them to hold over my head.

And while I have never smoked, and I understand the rationale for banning smoking at work since that affects the health of others, I fail to see how testing people’s saliva to make sure they have not had a cigar in the privacy of their own living rooms of late is going to accomplish anything except further eroding trust between employees and employers. It seems obvious to me that top-ranking executives will not be subject to these interventions, and thus my suspicion that this is merely a way to justify pay cuts among the rank and file — no more, no less — is especially keen. Given all this, I hope you will reconsider your support of this amendment.

Sen. Wyden, I am not in the habit of writing letters to politicians; you are my first. I know your reputation for considering all sides of an issue and being open to new ideas, and in considering the impact of the laws you work to pass on people who live lives very different from your own. This is a rare commodity in a Senator, and I treasure it. I also know that people are coming at you from all sides regarding the healthcare issue, and I realize that some people might regard the things I have written about here as mere trivia when considering the “big picture” of reform. However, I also would like any healthcare law that passes to actually be a help to people like myself, rather than a hindrance, which is why I am raising these issues with you here. Thank you very much for your time.

Sincerely yours,

Meowser

Lots of Stuff About Us, All of It Without Us: Writing a Letter to a Senator

posted by meowser

Recently, something happened in the neurodiversity/autistic self-advocacy movement that made me feel right proud, although I had nothing to do with it. Autism Speaks — an organization that allows almost no autistic people to be involved in its operations, and is devoted to the goal of eliminating the presence of autistic folks from the face of the earth — recently came out with a film called Autism Every Day I Am Autism, which they posted on their Web site. Apparently, they solicited footage of autistic kids and adults participating in everyday life, and then overdubbed said footage (without the knowledge of the participants) with a voiceover that was rife with we’re-autism-we’re-coming-to-eat-your-children’s-brains-mwahahahaha cant. (Transcript here.) And it took about two seconds before the participant bloggers in the Autism Hub (a group of linked neurodiversity blogs not dissimilar to the Fatosphere) raised enough of a stink that AS took the video off their Web site. (It can still be found on their YouTube channel, though.) The gist of the protests came down to this: They don’t even talk to us. They don’t even ask us what we think, because they think we’re delusional. All they care about is getting rid of us. Fuck them. They can’t do that to us.

Sound familiar, Fatospherians?

“Nothing about us without us” is a saying adopted by many stigmatized groups, and especially by the disability-rights movement, of which neurodiversity (ND) is a part. But every frigging day we see examples of people talking mounds of shit about fat people, and very few examples of those same people having talked to us in any great numbers. And it’s rarely questioned by anyone but us fringe wackadoodles, although I’m pleased as punch to see there’s a lot more pushback now than there was even a couple of years ago. But it’s hard to pick up a book or read a magazine article or a Web site or see a movie or TV show on any subject without running into an example of fat-bashing. So much about us. Damn near all of it without us. After all, we’re not just physically sick, we’re crazy too, right? Nothing’s getting between us and our baby donuts, and we don’t care about anything else. We’ll run over kittens in the street to get to our donuts, so how can we possibly be believed about anything?

You’ll notice, though, the difference between how the ND groups were received when they protested, and how fat-rights people are received when they protest. No, AS hasn’t changed their minds about us; they still think autism is a scourge, and furthermore, that anyone who has the presence of mind to complain about it can’t possibly be autistic. (A neat trick, no? Way to create a permanent underclass, by claiming everyone who actuallly belongs to said underclass is incapable of self-advocacy.) But they did something. They’re getting the idea that more people are on to them, and they were forced to tone down the rhetoric. And I truly think a big part of that is that 1) autistic people aren’t blamed for being autistic, and 2) NT people haven’t been terrified to death that they’re two slices of pizza away from become autistic themselves, because that’s completely impossible. “Nothing about us without us,” it seems, only really applies when you have no — and I mean NO — chance of ever leaving the stigmatized group in question. If you can just stick to your diet and get out of the group and stay out, what do you have to whine about? So you don’t get your donut, fatty, get over it.

But there’s overlap, oh yes there is. When we protest that we haven’t had any donuts and don’t even particularly want any, that there’s a lot more to body weight than just food, and furthermore it’s hypocritical to tell people to butt out of everyone’s sex life if you’re just going to turn around and butt into their eating life instead, how can we expect anyone, even other fatties, to believe us? Those other fatties raise their hands and say, “Well, I eat whole boxes of donuts and I’d be thin if I didn’t, therefore all fat people who say they don’t eat boxes of donuts are liars,” and we’re sunk. Most fat people think they’re to blame for their weight, so those few of us who don’t buy it aren’t real fatties for the purposes of the argument and therefore don’t count. If we’re lucky, we’re acknowledged as “freak exceptions” who can’t get thin no matter what; if not, we’re lazy liars who don’t want to work for our social rewards like everyone else has to. When they’re doing a story on fatfatfat, and they decide to put on their lipase-repellent outerwear and actually talk to one of us for the few seconds they can stand to, of course they’re going to look for the folks who live on donuts and Pepsi, not the people with metabolic disorders, not the people on heavy-duty psych meds (actual mental illness being another thing that eats into mass-media credibility, of course), not the vegans who have been fat since toddlerhood, not even people who merely eat the omnivorous diet in the same amounts and get as much exercise as their considerably-thinner friends. Confirmation bias.

Just like people want to believe all autistic kids will spend all their days biting passersby and smearing their shit around the walls of their institutions forever, and therefore autism must be wiped off the face of the earth, they want to believe that all fatties are stupid and sick mentally and physically and could stop being sick and stupid if we only tried, or alternatively, if only Big Food didn’t have us under perpetual helpless hypnosis (just a different way of calling us sick and stupid, really). People need their boogeymen. They feel so lost without them that they’ll actually make shit up about them to justify keeping them around. Therefore, eating boxes of donuts is seen as a punchline, something nearly all fatties secretly do, and even a fantasy of the perpetually dieting classes, rather than a relatively rare but vexing illness that’s damn difficult to treat and really is not fun at all for the people who suffer from it. We can’t even pick on the donut-snarfers anymore? PEOPLE HAVE NO SENSE OF HUMOR!

All this is a lengthy prelude to the fact that I’m working on composing my first letter ever to my senator. Or any senator. Or any elected official, ever. The subject: The amendment to the health-care bill that allows employers to give a deeper goody-two-shoes discount on insurance than they’re allowed to now. U.S. employers are currently allowed to have a 20% differential between people whose numbers are “perfect” and people who fall short of the mark; the amendment, proposed by John Ensign (R-NV) would increase that to 30% and could even go as high as 50% according to “HHS secretary discretion.” It was approved by the Senate Finance Committee by a 19-4 vote; all four “no” votes were by Democrats (Schumer, Menendez, Rockefeller, Nelson). Kerry, Stabenow, Wyden, those great advocates of the downtrodden, all voted yes.

Ron Wyden is my senator. As politicians go, he seems like a fairly reasonable person who might be willing to listen to a well-crafted argument about why this bill sucks (and doesn’t actually contain the word “sucks,” in all likelihood). Here’s the main reason: We don’t have total control over any of our “numbers,” let alone all of them. It might not sound too radical to allow employers to give a 30% discount instead of 20% for the halo-wearers, but what it really amounts to is a fine on those of us who don’t 100% comply — you “good” people get the old rate during annual open enrollment, and you “bad” people who put butter and salt on your broccoli pay the new, higher rate! Yes, they provide a waiver for people who have well-documented medical reasons for not being able to comply; being someone with a metabolic disorder on psych meds, I have a pretty good chance of getting that waiver. And it doesn’t seem likely that if the difference is 30% as opposed to 20%, that it’s going to make that many more employers start nosing around in our britches. But if it goes up to 50%? What employer could resist? And at the rate things are going, it’ll be at 50% before we know it.

I fail to see how charging people more for health care is going to make them healthier. Taking more out of their pockets for premiums means they have less money available for quality food, not to mention that it essentially functions as a poverty tax, since many workers live in areas where obtaining quality food is nearly impossible. It probably also means that there is a possibility that people will have to take second jobs to make up the shortfall in income, which would leave them more tired, more stressed out, and with less time for “joyful movement” and “slow cuisine.” And if they think forcing people’s numbers down by any means necessary is going to mean a reduction in health care costs, they’re not seeing the big picture. More pills, more therapy, more tests = more doctor visits. Not to mention that it encourages more and more buttinskyism on the part of employers; not wanting people to smoke on the job is one thing, since that affects the health of others, but how is it anyone’s business if someone has a cigar in their own living room? And do I really have to tell my boss I have PCOS and Asperger’s and depression bad enough that I was once hospitalized for it? What’s next, are they going to get to read all my shrink’s notes, too?

Part of the reason I’ve never written to an elected official is because I have to crunch down everything I’m thinking about into two or three paragraphs. As you know, that’s not necessarily a natural gift of mine. But this is a first step, in trying to get people making the laws think a little harder about the people who are going to be most affected by them, people who are different from themselves in ways they don’t yet understand. I’d love to know if any of you have written a letter to a politician other than a garden variety fan or hate letter, and what the result was.

Anyone Else Planning on Doing NaNoWriMo Next Month?

posted by meowser

I am. First time.

For anyone who doesn’t know, NaNoWriMo means “National Novel Writing Month.” The idea is you sign up (here) and during the month of November, you knock out 50,000 words, which amounts to about 5 or 6 double-spaced pages a day on average. Most people don’t finish. But enough do that the tradition continues, and since I’ve had this book (young adult novel) in my head for almost a decade, and it’s been nagging at me more and more lately, this might be a good time to get it going for real.

I actually had a near-miss on a different YA novel about 12 years ago; I was a finalist in a publishing contest with a book contract as the prize, and they didn’t pick a winner that year (they reserve the right not to). I revised it, got some more rejections, decided the problems were too big for me to fix, and gave up. Then I started to do some work on this book, brought my first few pages to a new writing group, and they got chewed up like an inexperienced tiger tamer. They told me it was awful, it stunk, kids wouldn’t like it, etc. So once again, I gave up. I’m good at that.

But it didn’t give up on me. All these years. So maybe that’s a fat hint that it’s mine to do, regardless of how it turns out. I am not going to say anything more about it (or offer it up for criticism, unless I have a specific question or issue I need help with), until I’m done with a first draft. I know better now.

So during the month of November, this blog will be on official hiatus. If you are doing NaNo and want to buddy up, feel free to leave me a message or email me privately.

Ten, Two, Four

posted by meowser

Heidi’s post today that mentioned soda reminded me of something. Recently there was an episode of Mad Men (see photo above) that was set in 1963 and featured a vintage Dr. Pepper machine (vending 10-ounce glass bottles) in the waiting room of a hospital. Now, there are some people who doubt the historical veracity of that; evidently those machines were common down south and possibly out west then, but almost unheard-of in New York City, where Mad Men is set. But the machine is true to period, and so is its logo, which says “10 2 4.”

Know what those numbers mean? Those were the times of day — 10:00 AM, 2:00 PM, and 4:00 PM — that one was encouraged to down one of those tasty-ass beverages. Yes, all three! According to the Dublin Dr. Pepper site, this was based on research from the 1920s that demonstrated that people who had something to eat or drink at those times of day were more alert and productive on the job — regardless of whether it involved manual labor or not — and shortly after that research came out, Dr. Pepper came out with the “10, 2, 4″ slogan, which was in use for a good 40 years. Evidently, nobody thought it was evil then to encourage people to drink 30 ounces of sugared soda a day. Gasp! The utter decadence of it!

What I want to know is, if we’re all such giant lardfactories because of soda, why were people thinner in the “10, 2, 4″ era? Is it really the corn syrup? Then how do you explain us fatasses who hardly ever consume HFCS? (I avoid it mostly because of taste; to me, all soda sweetened with HFCS tastes the same. And I see no reason to dump it into things like soup and crackers just to get rid of it.) And if it’s not All About the Calories, if it’s actually the chemical content of corn syrup as opposed to cane sugar that’s so fattening, then isn’t the “100 extra calories a day is the difference between a thin person and a lardbutt” meme propagated by cities like New York to justify slapping calorie counts on everything in giant neon, just so much stinky hot gas?

Not that I want soda (of any kind) three times a day, mind you; that’s too much belching for me. But I can remember a Miller beer ad from my childhood encouraging people to drink “beer after beer” and a radio ad for Coke saying that since it was sweetened with pure cane sugar, “you can drink as much as you like.” Just imagine anyone coming out with an ad like that now.

Me Love Colors (Or: Yes, There Is Enough Purple Yarn on Earth to Cover My Entire Big Fat Ass

posted by meowser

Okay, enough heavy horseshit on this blog for now. Let’s talk about something fun for a change: Yarn! (And colored tights!)

The skirt you see above is my adaptation of a pattern in Stitch ‘n’ Bitch Crochet called “Violet Beauregarde.” This, it’s safe to say, is the anchovy of skirts. Either you love it, or you think it’s totally blecherous. Since I made the blasted thing, I think you can probably guess which side I lean to. As soon as I saw the picture, it was: “WANT. NOW. MUST MAKE.” And miraculously enough, the pattern even came up to my size.

There was just one problem. The yarn originally called for in the pattern was Tahki Cotton Classic. Now, this is a wonderful mercerized cotton yarn. I’ve used it on smaller projects quite happily. But this project was going to be a lot of frickin’ yarn. And Tahki’s is $6 for a hank. That’s 108 yards. Multiply that by the 16 hanks minimum I was looking at to make this skirt, probably more like 20 or 22 if I wanted it longer (which I did), plus mistake yarn — we’re talking about well over $100 worth of yarn if I went that route. That was so very much not happening.

But I did still want this skirt. Badly. So, I wondered, could I find a cheaper, non-yarn-snob-approved synthetic yarn in a similar gauge and color scheme? Turns out I could: I used Caron Simply Soft in Violet for the purple part, and Bernat Satin in Sea Shell and Maitai for the light and dark pink, respectively. The colors weren’t identical to the Tahki’s, but they were the same color family and complemented each other well. The total cost turned out to be about $22, a fraction of the cost of the Tahki’s.

It worked out fine, although the first ball of Maitai, for some reason, seemed to be just a tiny bit heftier (and duller) than the Sea Shell by the time I got around to using it.. I know about dye lots, but thickness lots? Never heard of such a thing. Something must have happened to it in storage. And when I ran out and got more of it later, the new Maitai was the same gauge as the Sea Shell, so I really don’t know what happened there. I salvaged it by sizing down to a smaller hook when I used the first ball of Maitai.

This was the first major clothing item I ever made for myself. Boy, what a learning curve. I found out the hard way to mark on your pattern what hook you’re actually using, rather than just picking up the one that’s printed on the pattern; I had sized up two entire hook sizes to make gauge, and didn’t realize it until I picked up the project later and thought the stitches I was making with the F hook looked awfully small. Also, I learned never to use frogged (previously knitted or crocheted and then unraveled) yarn to make a turning chain, because it will twist and make me feel like a doltburger for not being able to keep it straight. I can’t even count how many times I had to pull out my work and start over again because I kept messing it up. Fortunately, crocheting is fairly doltburger-proof, as crafts go.

(In case you’re wondering what those two little spots of Maitai and Sea Shell are around the middle of the skirt, they’re part of the end of the drawstring tie. The Maitai got a little loose, which I realized after the pic was snapped. I did tighten it up afterwards.)

And I still can’t figure out how to do double crochet rows in circles without there being an annoying gap between the last stitch and the first that I have to sew together. But it’s done! It took me a few months, but I actually did it. I made a clothing! (It was a great bus-ride stim, lemme tell you.)

The size skirt I made accommodated a 52″ waist and hip, and that was the largest size they offered. If you like this skirt and want to make it larger than this, though, I could probably help you figure out the math. The pattern itself isn’t that complicated; it’s all double-crochet stitches in rounds, pretty much. Even the shell stitching on the bottom is just a bunch of DC stitches, really. It just takes a while. And some brain-fart safeguards, if your brain functions anything like mine does.

Also, if you have the first edition of S ‘N’ B Crochet, you will want to take a gander at the errata page before you make anything. Apparently, they didn’t have someone who wasn’t the pattern author make these cute-ass things before they printed the book. Oops.

And then I ordered tights from We Love Colors to go with it. I was under the height limit but over the weight limit for the nylon/lycra A/B, and I have thighs and calves that go on for months, so I got the C/D. The fit seems pretty good, although I’ve yet to wear them all day to find out how they hold up. The tights in the photo are Rubine color (I also ordered footless in Light Pink). I will say this: Take the Web site representations of colors with a large pinch of salt, because the Rubine looked like a dark purple on their site and is much lighter than the picture. (And the Light Pink is a bit darker than it looks on the Web site too.) But I like it anyway. If you have any more suggestions for accessorizing this thing, fire away.

And now, off to Seattle for my birthday weekend, thanks to the magic of a 2-for-1 coupon for the Amtrak Cascades! I’m going to Experience Melted Plastic (first time ever) and Benihana’s (free birthday meal, I’m so there) on Sunday, my b-day. I am so stoked!

If You Get Too Fat, We’ll Tax Your Seat (Or Is That “Eats”?)

posted by meowser

I’m sure it must have everything to do with the fact that I get stupider and stupider with each pound I gain — IT’S SCIENCE! — but I am still not getting the point of taxing sweetened drinks and “junk food.”

Is the purpose to increase revenue? I don’t have a problem with any nonessential-for-survival item having a surtax on it if the tax is actually going to be used for something useful, although if the purpose is to create more billboards telling me my fat ass should have cut off my circulation forever by now and also my mother dresses me funny, then they can bite me with extra mustard. But if they’re going to use the money for something like universal health care, I don’t really have a cogent argument to make against taxing sugar-sweetened drinks specifically for that purpose, other than that implementation would be a pain in the keister if you’re going to make C-stores put the sugar-sweetened drinks in a separate fountain from the non-sugar-sweetened ones and charge extra for them, and make restaurants charge for refills on everything except Diet Coke. If you’ve got something else you think I’m missing, though, feel free to say so.

But if what they’re trying to do is decrease consumption, and even more so if they’re doing it especially to make fatties lose weight, I think they’re full of tush-mush, frankly. I already banged on that drum here, so I won’t unduly repeat myself, but here’s the thing about all this “fat tax” talk, whether it applies to beverages or anything else. If you (and you know what “yous” I’m talking about here, readers) don’t want me consuming that stuff because you think its availability makes me a giant inflatobutt, know this: I have never in all my almost 46 years consumed fewer sugar-sweetened drinks than I do today, I have never consumed less fast or processed food, I have never been a “healthier” eater than I am today — and I am fatter than ever. Yes, that’s right — when I ate and drank way more “junk,” I was a lot thinner than this. BECAUSE IT’S NOT ABOUT THE FUCKING FOOD, GODDAMNIT. IT’S NOT.

Screw taxing that stuff, screw it to the wall. You could BAN all those things and I’d still stun you with my ginormitude. I will repeat that for emphasis: You could burn down every fast food restaurant, clear every sweetened or alcoholic beverage off every shelf, sweep all the processed food on earth into a ten-mile bonfire, ban every form of candy, cookies, cake, donuts, muffins, ice cream, you name it, and I would still be a huge freaking child-frightening oxygen-sucking flapping-in-the-breeze Shamu McLardypants. My weight would not change at all, I wouldn’t even come close to losing the “magic” 10%, let alone approach “normal” weight. Those foods are not staples of my diet; they are occasional treats. Banning them would not do anything for me except make my life slightly more annoying. Fortunately, I do know how to cook and bake, and I have time to do it. (What are they going to do, ban cookie sheets? I know, don’t give them any bright ideas.)

But unlike gasbags like Mr. Pollan (oops, I named a name), I understand that not everybody is exactly like me, and not everyone has the time, money, or spoons to do what I do. (They say we aspies lack empathy, but lemme tell you, there’s nothing like being autistic to remind you on a daily basis just how unusual you really are.) Shannon wrote very cogently about this the other day, the idea that it’s all well and good to scream “BUY LOCAL! BOYCOTT BIG FOOD!” at people, but if you don’t understand that there are millions of people who would just love to do that but simply can’t, you’re basically gonna be stuck preaching to the yuppie choir and that’s it. (That’s one reason I prefer Lisa Jervis as a source for the fresh/local/sustainable stuff; she hasn’t forgotten what it’s like to have to punch a clock, or that the burden of “cook at home more!” disproportionately falls to women. Michael Pollan, on the other hand, probably thinks “being written up” means something like, “the Times just did another interview with me.”)

I’m surprised, frankly, that nobody has seized upon the fact that so many fat people don’t drink sugar-sweetened drinks at all, and millions of skinny teenaged boys drink gallons of it, and surmised that we’re so fat because we’re not drinking enough soda. I mean, look at me! I went from three cans of soda a day to two a month, and look at the dent I make in the cushions now! Seriously, though, does anyone really think that banning fast and processed food would mean everyone would eat healthier? No, it’s more like millions of people wouldn’t eat at all. Does anyone remember scurvy? Rickets? Beri-beri? Pellagra? Kwashiorkor? These are dangerous diseases of true nutritional deficiency that used to devastate poor people in this country; now, even the poorest Americans rarely get them, largely due to the readier availability of big bad Big Food.

“But we’ll drop off a big organic veggie box FREE to every household! Give them cooking lessons! We’ll even give them pots and pans and olive oil!” Great. Are you going to cut their working and commuting time to less than 40 hours a week and give them free protein too, enough to feed everyone in the house? And babysit the little ones, too, while you’re at it? Last month, The Well-Rounded Mama wondered aloud why so many people refused her offers of free veggies from her garden; like I told her, lots of people just don’t cook or prepare food much at all now. Some people don’t like to cook or don’t have an aptitude for it, and others aren’t physically or mentally able to do it, and still others are just slammed and don’t have the time, especially if nobody else in the house besides them will eat the veggies. (And anyone who thinks you can “make” kids eat what they dislike, check the dog’s poop for telltale leftovers and you may find out otherwise. Besides, I can’t tell you how many times I’ve heard, “My mother made me eat that shit when I was a kid, I’m not touching it now,” especially from men.)

I don’t think not cooking is a crime, personally, even though I like it and I’ve been doing it since I was 7. And I’m all for more quality and variety being available to more people, but I don’t see how punishing people for not being affluent — which is what a “junk food” tax really amounts to — is going to do it. Hungry people will eat what’s there and what they have the money for. Tired AND hungry working people will grab what’s easiest. If you’re going to replace the cookies and chips in the vending machine with fruit, you’d better make sure the bananas aren’t green and the apples aren’t mealy, and that you’re not going to charge more for them. If you’re going to insist everyone pick the salad over the fries at lunch, you’d better provide for an extra snack in the afternoon because they’ll be that much hungrier. And if you’re going to tax the shit out of soda, that thing young America frequently wakes up on because they can’t afford or don’t like coffee, you’d better make sure the drinking water (and by extension, everyone’s tea) doesn’t taste like a swimming pool. (When I lived in Phoenix, I used to joke that the tap water there was so hard you didn’t have to freeze it to make ice cubes.)

I’m not going to congratulate the shit out of myself or demand a Good Fatty Badge because I get Spud deliveries and don’t live on McDonald’s. I made certain choices, like not having kids and not driving much or having a commute, that not everyone’s in a position to make. And I’m not even part of the El33t Koastal Kreative Klasses, but I’m still more privileged than a lot of people, including the me I used to be — the one who had soda farts all day and weighed 30% less.

(And speaking of gasbags, yes, I read what that flamebaiting buttcyst said on Huffington Post about what a great idea it would be to tax people based on body weight. I’m not even going there.)

Europe et Fat

posted by meowser

If Brian at Red No. 3 ever does a Fat Hate Bingo 3 card, one of the boxes needs to be “Europeans are so much thinner and healthier!” Because nobody in Europe is “obese,” you know. Nobody. The “obesity” rate in all of Europe — and not just in the spendy tourist areas where poorer people can’t afford to live, but everywhere — is zero. Because Europe is one unified country, consisting of nothing but slender, year-round-bike-riding, never-smoking, never-boozing, never-drugging, organic-veggie-gobbling, sugar-free, walk-three-miles-a-day-in-addition-to-all-the-bike-rides, affluent-because-they-deserve-it, stress-management-genius HEALTH NUTS, who’d never be caught dead in a McDonald’s. Yeah. I’ve never even been on the continent — I got only as far as London — but I must call “80 pound bag of BS.”

Here’s a list of “overweight/obesity” charts from the WHO that pertain to Europe, the first one being the most recent, focusing on adults ages 35 to 64. (Sorry, but there’s no direct link to any of them, they have to be opened as spreadsheets.) Have a gander for yourself. Not one European nation has an “obesity” rate of zero, or even close to it. Not one. (And note that women are more likely to be “obese” than men, despite — or because of? — having more expectation of being thin.) Most of Europe has “overweight and obesity” rates combined that equal about ours. And if America has more who are “obese,” has anyone stopped to think that the difference between BMI 29 (“overweight”) and BMI 30 (“obese”) — or, for that matter, the difference between “overweight” and “normal” — is five shitty pounds? That’s all it takes to go from Lifestyle Role Model to Self-Destructive Carbon-Dioxide-Belching Machine. Even if you smoke two packs a day and the Self-Destructive Carbon-Dioxide-Belching Machine has never had a single cigarette ever.

Your Chocolate or Your Life? (Me, I’m Thinking It Over)

posted by meowser

(With apologies to Jack Benny.)

If you are autistic, or you’ve done any reading in depth about it, one thing you have probably heard of is the GFCF (gluten free, casein free) diet. That basically means no wheat or most other grains, and no dairy products. The theory is, firstly, that autistic people are congenitally unable to fully digest those foods, and that’s why we have so many Digestive Iss-Yews. Secondly, advocates of this diet say those foods function as “opiates” for us and thus make us more stuporous than we would otherwise be.

Me, I’m agnostic about it. If you feel better, or your autistic kid does better, eating that way — great. I’m not gonna shove pizza down anyone’s throat. However, it needs to be said that it’s likely most autistic people don’t actually follow this diet, at least not all the time; they (and/or their parents) don’t find it particularly useful or even especially sustainable to keep up. (I don’t think there’s ever been a study done of what the percentages are of autistic people following GFCF; my assumption is largely based on anecdata.) Joel Smith of the blog NTs are Weird believes that the “gut issues” associated with the autism spectrum are mostly about stress, rather than an inherent inability to digest certain foods, and given the ridiculous amount of stress most of us experience throughout our lives, it’s tough to argue with that.

However, Gut Issues are pretty much what I’m all about. I admit it — what I like to eat sometimes (okay, a lot of times) doesn’t like me back, and that fact doesn’t necessarily stop me from eating it again. And it doesn’t have to be “junk” food, either; sometimes a vegetarian meal of legumes and veggies and rice and flatbread that looks perfectly salubrious on paper goes through me like a tornado. This is where all the hatebags will probably descend on me screaming, “See? You fatties, you just eat whatever you want even if it fucks you up and you don’t care about MEEEEEEE and my bank account!” Here’s the problem, though. It’s a lot harder to pinpoint what does “fuck me up” when I eat it than to ascertain what doesn’t. If vegetables and salads do that to me, then it’s probably not just that I have a congenital inability to eat gluten and casein, yadig?

My shrink (who’s not autistic) told me that a couple of years ago, she was having Gut Issues herself. So she, following the advice of a nutritionist who believed in the “systemic candidiasis” gut theory, went on a dietary regime for two years that was not only gluten and casein free, but also low carb. (So much for being vegetarian on a diet like that, huh?) The idea was that those nasty yeasties would have nothing to yeasty-feast on and would eventually die off and go away. She was already quite thin and wasn’t interested in weight loss, and she did eat small amounts of potatoes, brown rice, and oatmeal, enough that she wouldn’t go into ketosis. And she ate as much protein, fat, and non-starchy vegetables as she wanted, lots and lots of each of those, so didn’t go hungry. And, she said, “My gut issues cleared right up.” She’s now back to eating much more omnivorously, with no problems.

Now, think about what a diet like that would consist of. Or, more to the point, think of everything you’d have to eliminate. Obvs, no baked goods, no fruit (!), no pasta, no white rice, probably no alcohol, no desserts — and most especially, no chocolate. For two years. Are your coffee beans broken? I can’t do that. Yeah, there’s an end in sight and I wouldn’t have to do it forever, but would it feel that way? Besides, how do you stick to something like that and never fall off? I don’t have a lot of confidence that there wouldn’t be recidivism, especially living with two skinny men (one an extremely active 18-year-old) who heart their carbs and would be very cranky not having them in the house unless it was a matter of life and death for me, or at least a matter of my being able to work versus not being able to.

I asked her, “Weren’t you depressed eating that way?” I remembered reading Geneen Roth’s Appetites, which was centered around Roth’s experiences with a “Candida diet,” and Roth basically said the diet didn’t do anything but piss her off and screw up everything she’d managed to learn about intuitive eating. Being someone with a history of major depression — not to mention someone who has binged pretty fiercely after restrictive diets — this was not an idle concern for me.

“At first I was,” she admitted. “But after a while I felt so much better.”
She did say that if I decided to do this, I shouldn’t do it on my own, but that I should work with a GI specialist and a dietitian (or naturopath) who knew what they were doing.

When there’s something you really, really want and don’t have, it’s easy to be vulnerable to the claims of people who say they have the Instant Cure. Part of me kept saying, “Oh hell no, I can NOT do that. There’s no way.” And another part of me says, “You’re not going to get to eat everything you want forever, everyone has dietary restrictions if they live long enough, so get over it.” And with me, of course, all of this feeds into normalcy pangs. Don’t you want a group of real friends, living right here in town, to hang out with every week? Don’t you want less gas and not having to spend so much time in the john? Don’t you want a real career? Is chocolate and all those other things worth sacrificing all that for? Think of all the friends you’ll have if you give up carbs! Women love talking about what they’re not supposed to eat! You will be One of Them at last!

Yeah. And I’ll also be living alone because I will have driven my partner irretrievably bonkers. Thanks for playing.

And this isn’t even a “diet” in the weight-loss sense. There’s no getting on a scale or whipping out the measuring tape to see if I’m doing it right. And once it’s done, it’s done; once the two years are up, I can start phasing all those foods I love back in gradually, and life will go on. There’s no going to bed hungry. There’s no getting clipped about the head by a “counselor” who’s pissed at me for cheating with cough drops. Only one thing is important: Do I feel and function better eating this way?

And yet, even this much seems overwhelming to me. Not to mention objectionable in other ways; I would probably have to eat a whole lot more meat than I’m eating now, and I don’t particularly want to do that. I feel guilty enough eating the amount of it that I do, and haven’t ruled out becoming a vegetarian again. And isn’t it true that once you haven’t eaten something for a while, you lose your ability to digest it? What if something looks or smells so good I can’t resist, and by then I don’t have the enzymes to digest it anymore? Won’t that make me seriously sick, much sicker than I am now?

On the other hand, I feel like I’m so weak for not feeling capable of doing this, for being such a slave to my appetites and cravings that I won’t give up anything I love, even if it would help me. I feel like maybe people are right to discriminate against my fat ass, that their perception of me as weak-willed and self-destructive simply by dint of my body shape is accurate. Sacrifice? Hard work? Stiff-upper-lip attitude? Strike one, strike two, strike three. Yeah, it’s true. “My chocolate or my life” doesn’t sound like much of a choice, and I’m not even eating a lot of chocolate or eating it every day. Even doing one of those things — no gluten, no casein, OR low carb — seems like a recipe for feeling mentally lousy, even if it’s time-limited. What if I do have medically related dietary restrictions one day? Am I going to be one of those people who’s chronically noncompliant?

I guess I have some thinking to do. Now, if you’ll excuse me, I have an overripe banana to eat.

What Does Health Care Reform Really Mean to American Fatasses? Conclusion: How Expensive Am I Really?

posted by meowser

The first four parts of the series are here, here, here, and here.

First, I want to thank everyone who’s participated in the discussions here. Even those of you I disagree with on this subject. I’m really impressed by the level of discourse here and by everyone’s willingness to share their experience and insight.

I said in my first post that I was going to talk about the “let them eat emergency rooms” meme, but as it turns out, Dr. Pattie Thomas of Fattypattie’s did it better than I could, here and here. (And in case I’ve never said it, Pattie Thomas just kind of rules in general.) YEAH about the complete waste of resources involved in making people go to emergency rooms for nonemergency care (including the spread of communicable illness, some of it extremely debilitating, from people waiting for hours in an ER lobby), just because ERs can’t ask patients for payment in advance. Contrary to popular belief, though, they certainly do get billed — and how. Like Pattie says, price gouging (e.g. charging $15 for two aspirins that probably cost hospitals less than a penny each) is the name of the game; they figure that if they keep presenting outrageous bills to people, someone will cough up and thus make up for all of those who stiff them. Thus, health care expenses get easily conflated with health care costs.

Which leads me into all the BS I’ve seen lately (I don’t even know how to begin where to link, there’s so much) about how Americans are so costly to treat because we’re such bad little girls and boys (and intersexed kids) who put all kinds of naughty things in our mouths even after our parents (i.e. the superslim health-food el33t) told us a million times not to or we’d be punished but good. Shit, even parents of 2-year-olds manage to put plugs in the light sockets to prevent their little darlings from electrocuting themselves; if they’re going to treat us like children, they might as well go all the way and ban all those things we’re not supposed to be having. Seriously, if two-thirds of us are being smothered to death by our fat, and the foods we eat are drugs of abuse for a substantial majority of the population, why aren’t they banned? Putting out cooked food in front of hungry, tired people and expecting them not to partake because they want to be Goody Goody Good just sounds kind of…I’d say interplanetary, but I suspect even creatures from other planets would think we had flipped.

Part of the reason why, of course, is because if people only ate and drank what they needed to for base survival, our economy would go into the shitter and never come out. They might not want us eating “excess food” but they sure as hell want us buying it. But the other reason is that nobody can especially agree on what everybody “should” be eating for their health. The Atkins-heads and the vegans can’t both be right that their diet is optimal for everyone. Nuts are great, unless you have diverticular disease. Leafy greens rule, unless you have to limit your vitamin K intake because you’re on blood thinners or phlebotomy treatments. Spinach rawks, only don’t touch the stuff (especially if it’s double-cooked) if you have a history of kidney stones. Tofu and soy protein? Fabulous, unless you have to avoid soy isoflavones because they mess up your hormones. And of course, we all know about all the mercury in the fish and the hormones in the chicken and the beef, unless we spend a squillion dollars a pound for the untainted stuff or grow it ourselves on our own private farms. Not to mention all the people who have illnesses and disabilities for whom cooking a “good wholesome meal,” especially day in and day out, would just use up all their spoons and make them feel worse. As Barry Glassner said, “A diet that is harmful to one person may be consumed with impunity by another.”

But let’s imagine, just for a few seconds, that we could come to a consensus about what constitutes healthy-diet-for-most and healthy-exercise-for-most. Let’s make it even more fun and make Michael Pollan and Alice Waters the supreme arbiters of what almost-everyone should eat and how almost-everyone should spend their leisure time. Since everyone in their world has plenty of leisure time, let’s imagine everyone else will be given the same gift, of not having to work more than 35 hours a week to cover basic expenses, and will at the same time have their food budgets increased to the point where they can afford the very best of everything. (Oh, what the heck, let’s throw in enough of a housing budget so everyone will live in California and have a year-round vegetable garden, too, since we’re playing with Monopoly scratch and it’s a really BIG state that should easily accommodate a population of 300 million and counting. No? Too much? Michael and Alice have that, and we’re playing that everyone has to live like they do, and they couldn’t do it in North Dakota in January. I dare them to try.) Oh, and while we’re at it, we will rezone everything so that everyone can walk or bike to work (assuming the universal physical ability to do so with a belly full of healthy grub, since they assume that).

Does anyone have any freaking idea how expensive that’s going to be?

Not, mind you, that I think it’s a bad idea for everyone to have that much leisure time and that much great food and that much sunshine and fabulous topsoil. If nothing else, the reduction in stress would be a boon to people’s mental health, and we know that mental health impacts physical health, and both mental and physical health count towards health-care expenses, not to mention overall quality of life. But you can build all the sidewalks you want, and it’s not going to matter unless people can work a lot less and a lot less hard to get by. You can build all the public parks you want to compete with McDonald’s Playlands, and it’s not going to matter if people don’t feel safe going there or letting their kids go there. (Not to mention the fact that if you’re a kid who’s been hassled even once for your weight on a public playground — and what fat kid hasn’t? — you’re not going to want to go back there unless you’re forced to. So without ratcheting down the fatphobia in society by a lot, there aren’t going to be a lot of fat kids playing outdoors.)

Furthermore, none of that stuff is going to make the vast majority of people go from “obese” to “not obese,” unless their “obesity” was very borderline to begin with. (It’s also not going to prevent “not obese” people from becoming “obese” unless you’re also going to outlaw being on a diet in fourth grade like half of all 9-year-old girls are, which I could actually go for, AND also outlaw all medications that have weight gain as a side effect, which I couldn’t, while simultaneously finding a safe and effective cure for congenital insulin resistance. And maybe we’d better throw in a little gene splicing, too, while we’re at it.) And as we know, those of us who believe in HAES are still considered kooks, so once five years have gone by and almost everyone who was fat before is still fat, one of two things happens: They give up, figuring they’ve wasted enough money already, or they do it harder (as in forcing people to exercise harder and harder and eat barrels full of veggies and less and less of everything else). I can only guess which direction they’ll go in.

Either way, it’s going to be unbelievably very extremely scary expensive to do all that for absolutely every American. (Not to mention that preventative care, which we’d presumably be getting a lot more of if we get more people covered, makes people live longer. A longer life is almost always a more expensive life.) We might be able to evolve that way over a century, save for the moving-everyone-to-California part, but those of us who are middle-aged now won’t likely live to see it. They’re going to have to deal with our flawed bodies and our nasty habits the way they are, seeing as we’ll be entering our Medicare years dealing with the sequelae, such as they are, of both. (And if you’d told me in high school that drinking a milkshake would one day be considered the self-destructo-equivalent of freebasing, I’d have thought you were having a pretty good freebase hallucination yourself.)

And speaking of which, I love how we’re simultaneously told that we big fatty mcwhaleypantses won’t live to see our 70th birthdays and that we are also going to bankrupt Medicare in ways we would not if we switched bodies (and by implication, personal habits) with our slimmer (and allegedly much longer-lived) peers. So which is it? Am I going to live long enough to clean out the treasury, or aren’t I? To be honest with you, I don’t much care if I do or not. I don’t even know if I could deal with having chemo and radiation without having a total meltdown, let alone deal with people sticking instruments into me all day long while simultaneously not being able to have kitty cats around or wake up and see my sweetie’s sweet face, and all the healthy habits on earth aren’t going to guarantee that I won’t end up that way eventually. I once did data entry of patient-care info as a temp for a nursing home, and I swear some of the machinations they had to put people through to get a few grams of crap out of them were unbelievable. Give Dulcolax, and if Dulcolax doesn’t work, try more Dulcolax. If more Dulcolax doesn’t work, try a Fleet’s enema. If the Fleet’s enema doesn’t work, try a suppository with a lighted fuse on the end of it. And get catheterized urine samples too while you’re at it. ARRRGH. I bet I’d be a very bad autie under those circumstances.

What I do care about is, am I going to have the foundation ripped out from under me in the next 20 years, in a way that will shorten my life enough that I’ll never even see a Medicare card with my name on it? Because that’s a very real possibility. I know that my current state of mental health is an incredible gift; annoying medication side effects (and potential long-term sequelae thereof) notwithstanding, after a year of treatment I don’t even think of suicide at all anymore. The last time it happened, and it was so long ago I can’t even remember when, I was able to brush the thought away within minutes. I can actually work, albeit at a job where they tolerate my eccentric work habits and schedule. And it can all be taken away from me with a finger snap, if the drugs stop working and I can no longer work, or if someone decides that I’m getting too many perks and decides to slash my coverage. That kind of stress, of always being aware of the shark tank beneath my tightrope, can’t be good for my health, for any part of my body. Killing people — which a health care system that only covers the healthiest Americans inevitably will do more of — certainly makes them less “expensive.” But we want it both ways. We want everyone to live to be 95 years old and productive and happy and active right up to their last breath — and we also want to save money. And we think we can do all that by everyone being enough of a goody-goody that we’ll all just peacefully expire in our sleep, after having spent 30 years needing almost nothing in the way of drugs, hospitalizations, or surgeries. But bodies are expensive. Any bodies. The sooner America figures that out, the better.

Reply from Sandy to My Last Post

posted by meowser

Sandy from Junkfood Science just posted a long reply to my last post; since the thread had died by then, I thought I’d put it up top, because there are some issues she brings up that I wanted to tackle (and give other people a chance to also). This is the post in its entirety:

Arguments based on the past are irrelevant when we’re discussing healthcare REFORM. For everyone’s sake, the fat community desperately needs to understand the reality of what is being planned and put into place, the complete picture and consequences, and understand what words (like ‘quality’ of care) actually mean — not get caught up in what they’d like to see happen or what they think is right. Nor can anyone afford to believe media, anecdotes and social marketing. (RWJF interests, for example, have widely infiltrated online communities.)

The noncompliance examples given are spurious. What will label doctors noncompliant are pay-for-performance measures — those clinical guidelines and performance measures that make money for stakeholders (i.e. pharma). The medical literature has well documented that most all of these P4P measures are unsound and don’t actually improve patient outcomes or lower costs (and are all too often to the detriment of certain patients), yet the interests beind them have imbedded themselves in every level of the HHS and the CDC (see July 30th post). Under government managed care, the numbers of P4P measures have exploded and the consequences for doctors who fail to comply with them are steadily becoming more severe. Doctors who don’t do what the government says, already find their livelihood and licensure jeopardized (failure to comply is already on a schedule of increasing pay cuts, and negative ratings on their practices). Electronic medical records that are being required of every Medicaid/Medicare provider are being set up to monitor their compliance to P4P measures (tests ordered, prescriptions written, etc.) which will determine their pay, and automatically report their patients’s (our) medical information to the government to identify those for case management by government/insurance company. Medicare already pays doctors and hospitals 20-30% less than comparables, Medicaid pays 30-40% less, meaning fewer doctors and hospitals can afford to care for the poor. More importantly, out of necessity, care is restricted to what the government will cover.

Compounding the discrimination, they aim to pay doctors based on patient outcomes –- which means if you are fat or have a chronic disease and your health indices don’t meet guidelines, your doctor will receive less reimbursement –- doctors won’t be able to afford to take care of these patients and the patients will have increasing difficulty finding a doctor practice to accept them. Under their planned medical home model of government managed care, however, we won’t have the ability to just go to see any doctor to get the care we want. Instead, you’ll get the cheapest care because you’re costing the practice and hospital. Politicians are also looking at some troubling ways to ‘incentivize’ compliance among patients, calling it tough love. Look at what already happened to poor mothers on Medicaid in increasing places — noncompliance with healthy lifestyles contracts means no more government assistance or additional subsidized care needed for their special needs babies. There is nothing moral or compassionate about third-party health management.

You really don’t want your doctor having to answer to a third party payer (the government or government insurance plan), rather than provide the care he/she feels is best for you (especially if you are fat, aging, poor or have a disability). That also goes against every tenet of medical ethics. It’s why so many doctors and nurses have and will leave the profession rather than be forced to do that. Their conscience won’t let them be shills for pharmaceutical companies and political stakeholders or, worse, have to participate in things they know will hurt people.

Stakeholders are promoting bariatrics and weight loss interventions as saving the system money (while actually making THEM money) — they are not interested in the efficacy (soundness of the scientific evidence), long-range complications and deaths. Fat people are seen as undesirables in the prejudicial visions they have for a healthy perfect populace. But, the public largely believes obesity is a person’s fault and the obesity industry realized years ago that the public wouldn’t support paying for weight loss interventions for fat people – that’s why those same interests starting making it about their ‘health’ and turning to ‘obesity-related’ health indices, with a pill and lifestyle intervention for each. Another example of the need to understand what is going on: Did you know they are already eliminating funding for repeat hospitalizations for complications from the same diagnosis for all patients under government healthcare (Medicare/Medicaid)? This most affects elderly, about 20% of whom are rehospitalized after a medical incident due to complications. (And bariatric patients, of course.) Talking with ICU nurses last weekend, they were in tears because they saw that they were going to have to turn people away or give minimal care because the hospital was facing being unable to afford to provide it free and without compensation. And the hospital had already cut staffing, especially of the most experienced medical professionals, and they were being worked to death with mandatory overtime.

The most significant consequence of the clinical guidelines and pay for performance guidelines under managed care will be denying subsidized care to fat people who haven’t lost weight, to the disabled and to seniors; or providing suboptimum care. Such people are being said to be burdens on the system and not cost effective to expend much money on, under the comparative analysis method they are planning to use to prioritize healthcare spending. You need to understand how healthcare spending is planning to be allotted.

Most important: You are confusing health COVERAGE with heathCARE. As Big Liberty said, what will happen is that fat people and seniors who need care beyond the government’s free basic coverage, will have to find a way to pay for it themselves or suffer. Discrimination can be disguised as equitable.

The best hope for fat people and everyone getting older is a system that allows as many choices of plans and care providers as possible. Not one where the government eliminates their options.

First, Sandy, thanks for stopping by.

But I do think the past (especially the recent past) with regards to UHC is very relevant. You’re trying to tell us that we’re going to be the only country on the face of the earth where, if UHC is implemented, Big Brother is going to force us to live on plain broccoli and work out five hours a day and we’d better like it, when even current forms of U.S. government-sponsored health care, by all indications, are NOT like that. I have recent experience working at a VA Hospital; I did their medical records. Believe me, if they were only treating total goody-two-shoes whose abs you could bounce dimes off of, they wouldn’t treat anybody.

Also, all the problems you mentioned about third-party interference in care are going on right now. You’ve even written about it yourself! American doctors right now are experiencing more and more bean-counter interference from third parties (i.e. insurance companies). People kill themselves because they can’t get care approved by the bean counters.

This American for-profit health care wonderland where nobody interferes with individual doctor-patient decisions, and those decisions are always made in the patient’s best interests, doesn’t exist. (Just ask anyone who’s tried to get a birth control pill or Plan B scrip filled in the Bible Belt.) In fact, it’s likely it never really has; in the pre-HMO days, we (especially us hysterical wimmenz!) had to worry about sleazy doctors and hospitals goading us into accepting medically unnecessary surgeries and other treatments to line their pockets; now, in the name of preserving the ludicrously overprivileged lifestyle of insurance company executives, we are told that the care we’ve paid all our lives for might not be there at all when we need it, and that that’s just the way it is.

You (and also Big Liberty) seem to think all we need to do to get everyone completely covered without bean-counter interference is to allow everyone to purchase policies from out of state. Maybe I’m dense, in fact that’s probably a given, but maybe at least one of you could explain to me how that prevents the sort of rescission and cherry-picking or excluding coverage for preexisting conditions that we’re seeing now, and won’t lead to even more price-gouging and the sale of completely worthless junk policies from fly-by-night companies.

This rescission shit is serious. It’s not to be taken flippantly. Insurance companies actually have rescission quotas, a certain number of policies they have to find (or make up) a reason to kill each month in order to stay profitable. And if you’re on a group policy, they can slap surcharges on your company for your treatment so huge they have no choice but to either scrape together some reason to fire you, or sharply reduce coverage for everyone to make up for the surcharge. I worked for one company which, over a five-year-period, switched carriers four times, and finally wound up offering pretty much a total junk policy that would have cost so much out of pocket it wouldn’t have been worth signing up for. That’s what we poor old disabled fatties you claim to be beating the anti-UHC drum for are facing here, being totally fucked between now and Medicare.

Right now I have what I’d say is B-minus to C-plus coverage. I know it could be worse, and with trends in this country the way they are, and having experienced what I have, I can ill-afford to be smug about it. So what happens to me, someone who is increasingly difficult to employ because of size, age, and multiple disabilities, and isn’t eligible for state-run care or Medicaid, if my company lays me off, or drops or guts our coverage, and I can’t hook on anywhere that offers something better because this gutted care has become industry standard and everyone thinks I’m too high-maintenance? You think the free market will take care of me? How, when all carriers’ entire business, their whole reason for being, is set up to avoid people like me whenever possible?

OK, readers, I open the floor to you. (And once again, please stay on topic; I don’t want this thread to become open season on Sandy. As we used to say in “program,” principles before personalities.)

What Does Health Care Reform Really Mean to American Fatasses? Part 3: Fat and Compliance

posted by meowser

Part 1 is here.

Part 2 is here.

And thanks to Michelle for getting the ball rolling on the subject of “compliance” — that is, Following Doctors’ Orders (or else?).

In America (and I’m guessing most other countries too?), nobody is required by any law to do exactly what doctors tell them to do. Hell, nobody even has to see a doctor in the first place if they don’t want to, even if it means they’re delaying getting a problem checked out that will be more expensive to treat if they wait. And without violating any HIPAA regulations, I can tell you flat out after many years of creating medical records that people refuse recommended treatments all the time. I do a lot of ER reports, and the following scenario is extremely common: Patient presents to the emergency department. Doctor thinks patient should stay and have some tests run, maybe have some IV antibiotics or other medications. Patient says sie wants to go home. Doctor tells patient sie really should stay, and that sie runs the risk of dying or becoming much sicker if sie leaves. But patient is still permitted to sign out AMA (against medical advice) and go home if sie wishes.

And what do you think doctors tell patients when they do sign out AMA? “Okay, but don’t come back again if you get really sick, because you didn’t listen to me”? No. They say, “Return to the emergency department if there are any problems.” Because it would be completely ludicrous for them to say, “Well, asshole, you had your chance at proper medical treatment and you blew it,” right?

And yet, that’s what frequently happens to fat people who seek medical attention. They’re “ordered” to lose weight, more often than not they either fail to do so or gain back whatever they do manage to lose, and they’re told, “I can’t do a thing for you unless you lose all the weight I told you to lose and keep it off.” You’d think by now that more of them would get a clue that almost no one loses 50 or 75 or 100 or more pounds permanently through diet and exercise alone — except possibly for a few people who start out being extreme binge eaters and/or binge drinkers and don’t have a long dieting history, or who have made getting and staying thin their full-time job and never EVER cave in and eat anything “bad” or miss their two-hour (or longer) daily workouts even with the most wracking knee injury or virulent case of bubonic-boogie flu. And that’s just not reality for most of us. But the idea that most people have limited control over their weight hasn’t gained a whole lot of traction yet despite the staggering pile of evidence in its favor.

So we fatasses who remain fat — i.e. almost all of us — constantly run the risk of being labeled “noncompliant” by our doctors just because we exist. And the vast buttinsky contingent that exists here (though not, of course, exclusively here) just loves to bleat about how expensive we are compared to them because of our stubborn “refusal” to slim down. (Although I note with more than slight puzzlement that these are usually the exact same people who think their perfect habits are going to carry them through to their 100th birthdays — exactly how is it “inexpensive” to your fellow Americans to live to be 100?) They love to say things like, “Well, if you’re not following doctors’ orders, you deserve to have to wait your turn behind those of us who are trying to be good.”

To which I always say something like this: “If you’re going to rank people as a lower priority for care because of not following doctors’ orders, what on earth makes you think you won’t be next?“

I’m one of those radical fruitcakes who thinks “imperfect” people deserve health care just as much as the Goody-Twelve-Shoes Club does. Because let’s face it, even the Goody-Twelve-Shoes Club has people in it who have pasts. How can anyone know that those 10 years of chain-smoking, or hard drinking or drug abuse, won’t come back to haunt them later? I and my fat ass never did any of that, so nyaah, all you smug former party animals. The GTS Club thinks it’s reserving its bared fangs and spittly hissing for people who are still doing those things right now, but believe me, the people who used to do that stuff won’t be far behind if we start holding out on people for being “bad.”

Michelle’s post was about a doctor who was having a hissy-pissy because his dialysis patients were drinking water when they were thirsty against his orders. Yeah, that’s all it took to bend his antlers; he talks about them “chugging gallons of milk or juice” at home, but I’ll bet my next Hot Lips fruit soda that the offending amounts of liquid were much smaller than that. (The comments on that post are terrific too; highly recommended reading.) So he wants all patients to do exactly what their doctors tell them to do, and no backtalk? He really wants to go there? It got me thinking about a whole pile of potential behaviors, none of them especially outrageous, that could possibly get a patient labeled “noncompliant” under a system that makes “good behavior” a prerequisite for care:

- Smoking pot. (It always astounds me how many pot smokers who don’t smoke tobacco think the smoking-is-noncompliance stick will never be used on them. With THIS government? Hah.)

- Not wearing your compression stockings when it’s 100 degrees out and the air conditioner is busted.

- Eating something that’s not on your 1800-calorie diabetic, soft foods only, no seeds, 2 grams sodium, low cholesterol, low residue, low fat, low oxalate, low protein diet. (Yes, people are actually given diets that ridiculous to follow at home.)

- If female, not having children young so as to ward off postmenopausal breast cancer.

- Staying coupled to someone who keeps flaking on you when you need to be driven to and from appointments.

- Self-discontinuing a medication because you don’t like the side effects, or not filling a prescription because you don’t feel comfortable taking that drug, or forgetting to take the drug as scheduled.

- Not having mammograms or prostate exams or colonoscopies or DEXA scans (for bone mineral density) as often as your doctor recommends, for any reason.

- Playing with or helping out the kids or grandkids when the doctor has told you to rest.

I’m sure you can think of others.

Heck, I even think people who do stuff I personally find objectionable — like screwing around in the car instead of watching the road and getting into an accident, or yelling at their employees to the point of making them come down with stress-related illness — shouldn’t get down-triaged for care. Because people aren’t perfect, and no amount of withdrawing care is going to make them so.

But let’s get real. We’re never, ever going to have a health care system in America where everyone pays and only the GTS Club gets full care. Because in case nobody’s noticed, this country, more than any other, is crawling with celebrities and other wealthy people. Many of these people don’t have the world’s most perfect health habits, or aren’t what doctors would consider “ideal” weight. Can you imagine an NFL linebacker being refused care for being too hefty? I can’t. Sure, do that knee replacement on him! It’s not like he’ll beat up on it tackling people for a living or anything. And if they don’t consider him to be a waste of a perfectly good prosthesis, there’s no reason *I* should be if I ever wind up needing it, when all I’m going to do is walk on it.

Chain-smoking movie stars? Alcoholic rock stars? No problem, they can hop right on in. There’s no way on earth they won’t be able to, even under UHC. And there’s no way on earth they’ll be told, “Quit right now, or no health care for you.” If they ever were, they’d scream bloody murder. If Michael Jackson could find one doctor to remove his entire nose and another to give him fucking propofol to use at home (something no mere mortal would ever, ever be allowed to leave a hospital with), there’s probably no limit to what you could find a health care provider to do if you’ve got the scratch. Yeah, they’re really going to outlaw all that stuff here and enforce all those laws to the letter when they’re already not enforcing laws that already exist. And I’m Malibu freaking Barbie.

That’s why I’m not putting a lot of stock in the idea that under UHC, we fatasses are all going to be “ordered” to lose lots of weight for good, no matter what it takes, or not get care. As it stands right now, they’re saving buckets of dough by millions of us never going to doctors because we’re not allowed to or can’t take the abuse. Can you imagine the expense of having WLS performed on every single “obese” person? And all the followup care? It would make all our current “fat related health care expenses” look like Slurpee money. (Not to mention the fact that Shaq et al would just refuse.) There are about 300 million of us, and they can’t even prevent all the convenience store owners from selling cigarettes to 13-year-olds in a country this size, even with a federal law in place prohibiting it, because it would be too expensive to crack down on all of them round the clock. If the idea is to make everyone “compliant” to save money, they don’t even want to know how much that’s gonna cost them.

What Does Health Care Reform Really Mean to American Fatasses? Part 2: Working Us To Death

posted by meowser

Part 1 is here. (And everyone who commented on that post, thank you so much, it was great to read your stories. And if you haven’t left a comment yet and want to, feel free.)

Last year, Sara Robinson posted two articles, both of which I highly recommend, on “mythbusting Canadian health care” for the site Ourfuture.org. Robinson, who has dual citizenship in Canada and the U.S. and currently lives in British Columbia, spoke of her experiences in both systems in part I; in part II, she shoots down what she considers to be the most pernicious “free marketeer” myths surrounding both Canadian and other forms of universal health care. There’s plenty of great stuff there, but there’s one passage in the first article that particularly struck me, when she was talking about Canada’s attitudes towards health versus America’s:

[T]here’s a somewhat larger awareness that stress leads to big-ticket illnesses — and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed.

It got me thinking. How many health problems (of both body and mind) in this country stem from the fact that we work people to fucking death here? Because really, we do. Other than a lucky few with relatively cushy jobs, we work people to fucking death. Pretty much literally. And proudly. And anyone who can’t, or won’t, be worked to death is more or less just stood out at the curb with the broken highchairs.

Not, of course, that you have to have a full-time job (or, yikes, more than one, as many Americans must to pay for just the basics) to be worked to death. Full-time parents get worked to death — no highballs and bonbons here, you’d better be stuffing your child’s brain with learning and nurturing every damn second, or risk being royally snubbed. Ditto caregivers who are expected to be there for free to care for seriously ailing partners or family members, in addition to everything else they have to do to survive. People with disabilities get worked to death too, what with second shift for the sick and all.

Oh, and if you have a partial disability, rather than one that prevents you from working at all, you get virtually nothing but sneers for being lazy and wanting people to take care of you. It can’t possibly have anything to do with using up your spoons (or, if your disability has to do with brain function, colored spoons). No no no. If you can do something sometimes, you must be able to do it all the time, or you are a big faker! You know no one will believe you, much less give you any aid. So you try, and you try, and you try try try and try, and you still can’t make it through even half of the sixteen-hour action-packed day after day after day that’s expected of you as an American. Faker.

It’s even more festive when your particular disability doesn’t allow you to get a job with benefits OR qualify for free or reduced-cost health care, and therefore you don’t even know exactly what your disability is, much less how to manage it — only that you can’t hack it like you see everyone else doing. The only way you “deserve” health care in America is to be ready, willing, and able to be worked to death. Right now. And forever, or at least until nobody wants to employ your aging worn-out ass any longer.

That’s what happened to both of my in-laws when I was married. My FIL had a job for decades as a postal carrier, schlepping bags of mail over hill and dale, until his knees gave out for good. Did he ever have the nads to complain? Are you kidding? He thought he had it made, right up until the day when getting up for a glass of water became excruciating. My MIL had a government job that called for oodles of overtime; in theory she could have refused — or even retired, once she hit 65 — but didn’t dare. She did the OT, then rushed home to care for her sick husband, who was in the hospital every blasted week, it seemed, as a result of a septic illness that cost him 100 pounds in six months. Then she keeled over of a heart attack.

Was she, an aging fat woman, a big old drain on the health care system? Well, let’s put it this way. When the coroner first came out, he couldn’t put a cause of death on her certificate because she hadn’t received enough medical attention for anyone to know what was wrong with her. I had seen her lipid panel recently, though, and it was hella nasty (her brother had had a quadruple bypass at about the same age she was then, and both her parents had died young of heart attacks).

And she was out of breath just walking 50 feet on flat ground to her car. I begged her to go to the damn doctor. She said no, the last time she went all they did was tell her to lose weight and it would go away. My protestations that most fat people, even her age, don’t get out of breath walking to their cars unless something is really wrong with their lungs — and that therefore, her doctor’s answer was unacceptable — went unheeded. I even offered to go with her and make sure she got the attention she needed. Still no. She couldn’t. Her office needed her. Her husband needed her. Soon, though, there would be no “her” for anyone to need, and she just did not see it coming.

At her funeral, right around what would have been her 67th birthday, I cannot tell you how many people came up to me and said, “I had no idea she was under that much stress. If I did, I’d have offered to help her, maybe I could have watched her husband for her while she went to a movie or did something for herself. But she never said anything. She just smiled and pretended everything was fine.”

And these were people who had health coverage. Pretty danged decent health coverage, near as I could tell. But they were victims of the workaholic culture. Just keep pushing, pushing, pushing, pushing, pushing. Don’t let anyone know you’re breaking down even if you are. Do not whine, and do not foist any “drama” on people. (Except, of course, for the people closest to you or those beneath you at work, who you can feel free to take out your frustrations on. At which point they, too, will have to find a human dumping ground for their frustrations, and on and on and on.)

Then, of course, there are migrant workers, who live an average of 49 years — sacrificing almost three decades compared to “normal” lifespan to bring us the endless bags of veggies and fruits we demand to keep our middle-class bodies all healthy and stuff. Parasite, meet host. I swear, the next snotty yuppie who has the guff to go on and on in my presence about how “those people” (i.e. people who have the gall to earn less than $50,000 a year) Eat Soooo Much Junk is gonna get a fair trade banana stuck in hir ear. Which sie will have to go to an emergency room to remove, and thanks to down-triaging will have to sit there in the waiting room with a banana in hir ear for five hours while everyone else points and laughs. Especially migrant workers’ kids.

Then there was the matter of my having to leave a job because my officemate insisted on coming to work with every bug known to upright simians, even when everyone begged her to stay home. She said she couldn’t afford to stay home sick, even though we worked for the same company and got the same benefits and I knew nobody was allowed to cash out sick leave. This job was in a hospital complex, mind you, where we shared elevators with the patients, many of whom were little kids, or adults who were severely immune compromised. Catching a virus that seemed like nothing to her could have killed one of them. She knew. She did not care. She was convinced no one could do without her for even a day or two, that taking off work would put her in the poorhouse, and no exposure to reality would convince her otherwise. Work work work work work.

We hear all the time about lazy, lazy people — especially fatties! — who won’t get off their butts and do anything for themselves. Sure, they exist, but I think they’re pretty rare compared to all the people who are just trashed from all their responsibilities. Even the people I know with good jobs and money, especially if they have kids, they’re just wiped out nowadays. They’re in all kinds of pain. They need a four-week nap just to reset themselves, and they won’t ever get it. And the people with bad jobs and even less money are even more wiped out, by orders of magnitude.

And as Sara Robinson notes, doctors in America get worked to death too:

My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid — quietly, quickly, and without hassle.

Do we have it in us to change? I mean, I’m sure there are plenty of workaholics and super-double-busies in other countries too, but how many countries are there where a 35-hour a week job, with retirement at age 65, won’t ipso facto be enough to cover basic expenses? How many countries are there where, as Sara Robinson mentions, people are “working 60-hour weeks trying to hold onto a job that gives them insurance,” and therefore don’t have enough time to give their elderly relatives the attention they need? How many countries are there where people are expected to spend so much time in their cars, fuming in endless traffic jams, to get themselves and their kids where they’re going? I’m sure a lot of those people would love to live in more “walkable” communities, closer to their jobs, but we’ve made them such a scarce commodity that only the affluent can afford them.

Furthermore, in a country where being chronically sleep deprived and stressed out to the breaking point is the norm, and where fat people have the extra added stress of knowing that their bodies don’t measure up, and trying and trying and trying and failing over decades to force their weights down, getting fatter and sicker with every failure, and knowing that they will pay and pay and pay in every single area of life for falling short, how can we isolate fat alone as an independent cause of illness? If we concerned ourselves a lot less with people’s weights and a lot more with their stress levels, we’d probably all be a lot healthier, both physically and mentally. And then maybe the people who did get sick wouldn’t get so much resentment heaped upon them for “doing it to themselves.”

I got your health care cost containment and “preventative care” right here, Mr. President. Dare we all dream?

What Does Health Care Reform Really Mean to American Fatasses? Part One In A Series

posted by meowser

I would like to start a dialogue here about the potential impact of the health care reforms being discussed in the United States and what they might mean for fat people. And in the interest of not having one post that goes on for three months that only two people will read (sorry Rachel, I did my best!), I’m breaking it into multi-parts. My readers from outside the U.S., I hope you’ll stick around, because I would very much like your input on this.

I’m getting very concerned that the “our health care system is fine, shut up and quit whining because everyone hates government-run health care” crowd is taking over this discussion, without a whole lot of input from people who have actually experienced government-run health care, in all its myriad forms. It’s not all the same, you know. Even within the same country it’s not all the same. (What a concept, huh?)

Please note that I’m not specifically calling out Sandy here; I am to the left of her on this issue, but JFS is far from the only place I’ve run into anti-universal health care memes. They’re everywhere. Insurance companies are spending barrels of cash — OUR cash, that they’ve raked in through our premiums over the years — to fight any kind of real public option, much less actual single-payer delivery. I personally don’t see single-payer coming to America any time soon (it’s not even on the table right now), so it’s not like they’d be out of business. You’d think they would like to have a system in America similar to that of France or Germany — where, in a nutshell, government-run care covers the basics and various forms of private insurance cover the rest. The insurance companies wouldn’t have to get dinged $200 here and $200 there for dinky-shit things like Pap smears and bringing 5-year-olds to the emergency room after hours to get antibiotics for ear infections. (I’ll be examining the “let them eat emergency rooms” theme in a later post.) And people would still want their policies for when they needed more than basics.

But I suppose insurance companies in France and Germany don’t rake in the billionaire executive and shareholder bonanzas that we have here. One thing I’ve managed to figure out over the years is this: Once people get used to living the high life, they don’t give it up without a fight. And we, as a society, have given them the message over the years that it’s just fine to hang on to all that through any means necessary. If it means they get to pull shit like rescission — canceling people’s policies on technicalities because they’ve become too high maintenance for the insurance company’s taste — hey, it’s all good. If it means people become not just uninsurable but actually unemployable because of a serious illness — feh, who cares about those luz0rs? (I broke my Great Orange Satan boycott to read that story, and it was totally worth it; if you’d rather not give them the clicks, it’s also here. But do read it, and if you still think people being umbilically dependent on their jobs for their health care is a fine thing, tell me why you think something similar couldn’t possibly happen to you, or to whoever carries your policy.)

Is that what people are really being told by the insurance companies and their corporate-media toadies to be afraid of? That the super-rich health-care profiteers will cease to live like kings and have to live like mere TV starlets instead?

What, after all, was that anti-UHC ad that made the rounds the other day — the one where the Canadian woman who’d been down-triaged for surgery for a noncancerous but still dangerous brain cyst and had to come to America to get treated — all about? Now, granted, someone probably fucked up badly triaging her and if so, they deserved to get sacked immediately for their fuckup. (Of course, it’s not like insurance companies in America don’t fuck up things like that every day on purpose, but never mind.)

But that’s not really the issue here. She wasn’t making a comparison between Ontario health care (Canada’s UHC is run by individual provinces) and private American insurance. She didn’t have private American insurance. She plunked down US$100,000 in cash to have that operation done. The kind of money, IOW, that most Americans can’t possibly beg, borrow, or steal, much less just access from their personal checking accounts, to pay for an operation. All her story proves is that if you can whip out a checkbook that’s padded generously enough, you can buy anything you want. That’s not news. Is that what they are telling us to fear, fear, fear — that we won’t be able to play front-cutsies in line by slapping a big wad of cash on some hospital administrator’s desk? It’s hard to imagine an America where personal money will buy no influence over health-care priorities whatsoever, but it’s harder still to imagine an America where nearly everyone who thinks they’re going to be that rich someday actually gets there.

And as for the spectre of rationing, we are already rationing health care in America. We ration based on ability to pay — not as in less wealthy people get less, but as in less wealthy people, especially those between jobs, get NOTHING NOTHING NOTHING (unless they are indigent enough to qualify for Medicaid or their state’s equivalent, and increasingly, not even then). We ration based on preexisting conditions that have become the equivalent of insurance-company cooties-for-life.

And yes, we ration on the basis of weight. We do that in four ways: By denying fat people insurance coverage entirely or tacking surcharges on it so prohibitive as to make it unaffordable; by rendering fat people (especially over age 40) essentially unhireable because employers are increasingly unwilling to take a chance on our supposedly high-maintenance bodies; by scaring fat people away from doctors’ offices through flat-out abusive behavior; and by doctors telling us that the treatment we want will be withheld unless we slim down. (I’ll go more into the subject of rationing in a future post too.)

Now, given all that, do I think things could be a lot worse? Do I think it’s possible that what passes for health care reform in America could wind up being a total boondoggle, nothing more than a bailout for the insurance companies with no improvement in delivery of care? Do I think it’s possible it could lead to the government sticking its nose in our private lives where it doesn’t belong? Sure. I don’t believe “doing something” is automatically better than doing nothing. You can fuck up anything by underfunding and mismanagement and just plain old greed and corruption, whether the funding is public or private or a mix of both.

And here’s where my non-U.S. correspondents come in. I want you to give it to me straight, even if you think it’s not what I want to read. If you have experience with both U.S. and non-U.S. health care — as Deeleigh talked about here and here, and thanks, Deeleigh — that’s even better. I want you to tell me what you like and don’t like about your health care. I want you to tell me whether you think the relief of financial stress from not having to pay directly for care is offset by the stress of your tax burden and other quality of life measures.

And I want you to tell me if you’ve ever been denied care because you were fat. By that I’m not so much talking about the doctor being a giant dickcheese to you because of your weight, but actually denying you a procedure or other treatment you wanted until you lost X number of pounds (or, heavens forfend, got WLS). If you’d like to post anonymously, that’s fine. I won’t out you. You can also email your responses to me and I can post them without attribution if you would prefer that.

I’d also like to hear from you if you’ve experienced an American-based public health system — Medicare, Medicaid, VA, a state-run system, anything like that — and the same questions apply.

I’m also interested in hearing from health-care professionals everywhere on their specific experiences with this. Have you ever not been able to get a treatment approved for someone that you thought they really needed because of problems with a public provider?

And if this post inspires you to do a post on your own blog instead of posting in comments here, great! Feel free to drop links if they’re relevant to the topic.

Please note: I’m well aware that the discussion on this topic could get a bit heated, and I don’t expect an echo chamber where everyone just nods and agrees with me. I want real information based on real experience (not rumor), and I really, really want us to stick strictly to the exchange of ideas and exploration of issues. I’m telling myself this at least as much as I’m telling any of you reading this, but please let’s all stay away from things like flaming, personal insults, and ad-homs. (I especially do not want this to become a forum for Sandy-bashing, and Sandy, if you’re reading this, I hope you will participate in the discussion.) I work odd hours and sleep during much of the day and can’t be on this thread for much of the day (and if you are a first-time poster and your post doesn’t show up for a few hours, that could be why), but I will edit or remove any inappropriate material as soon as I get to it. Thanks.