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

meowser-48.jpg 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.

Posted in etc.. 16 Comments »

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

  1. wellroundedtype2 Says:

    Bravo.
    I’m doing the slow clap for you.
    There are so many aspects of this conundrum you nailed in this essay.

    Regarding the actual cost of health (let’s call that health care plus what it takes to stay in the best possible health for us, defined individually) — my take on that is — that’s something I want to invest in individually and collectively. I am all for a 35 hour (or less for those who need it) work week, more vacation time, and the best food we can afford to feed ourselves and each other. I’m for safer spaces to play and recreate.
    I don’t delude myself that any of these thinks will make fat people thin, especially when our economy is based on people buying many more calories than we need for survival (you put it brilliantly: “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.” — a side note, responses to this situation include: bulimia, paying more for less or “better” food, or, as I’ve seen weathier people do, buying high calorie food in large quantities but throwing most of it away.)
    There’s more I want to say, but it may turn into a post of its own, because this is just so meaty (or seitan-y, for the vegans out there). The one last thing I’ll say is that while “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” is true — I think people don’t mind financing their own perfect health to age 95, they don’t want to pay for other people’s imperfect health to whatever age they live to.
    Some days I can’t believe that the country I live in is so fucking middle-ages about this when every other country we would ordinarily expect to compete with (and many we wouldn’t) has figured this out.
    Your brain is amazing. You are amazing. You are a gift.

  2. meowser Says:

    **blush**
    Dude, it was worth it just to read that. Thank you for being here.

  3. buttercup Says:

    WRT2, I could not agree more.

    Also, this?

    “the shark tank beneath my tightrope”
    is sheer genius. What a perfect way to explain how so many of us feel.

  4. Lori Says:

    Brilliant post. Thank you.

  5. Cassi Says:

    I think you nailed it about Pollan and Waters. Whenever I read anyone going on about the perfect organic, slow food diet and how it’s what EVERYONE should eat, my mind immediately wonders… “uh, and exactly which 4 billion of us are you planning on knocking off?” Sure, small organic free range style farms are great, so is eating things that are local (usually defined by the 100 mile rule). I’m all for it, but if you put enough of those farms to feed each of the 10 million people living in NYC within a 100 mile radius of Manhattan, will they still be be small, slow or free range? And what do you do with the people who were living there before?

    • Rosa Says:

      i don’t want to derail the thread, because I completely support what Meowser is saying – but small scale food production is MORE efficient, calories-per-acre, than industrial food production.

      Manhattan may be a special case (though maybe not – there’s a surprising amount of green space within 100 miles of it already, and a LARGE amount of space dedicated just to cars) but the rest of us, even up here in the frozen north, are completely capable of feeding ourselves, it’s just that we need the public infrastructure to support it instead of each having to make a heroic effort. Just like a bunch of other things where public infrastructure is what it takes to make good choices, like health care.

      • Cassi Says:

        You may well be right about that, it’s just that when someone in a position of privilege states that if we’d all just “do what they do” all would be well, it gets my hackles up. Because often you can’t take the behavior of privilege and simply copy it exactly for all 6 billion of us (though as you point out, this might not be such a case). It’s sounds too much like the old “there’s no reason you can’t all graduate in the top third of your class” thing.

    • JM Says:

      I like that Pollan and Waters have been called out a little in your post. Pollan has some okay points (made more persuasively, IMO, by others before him; he’s more of a popularizer). And Waters has accomplished a lot as a chef (which is not the same as being an agronomist, consumer advocate, nutritionist, etc). I myself criticize industrial ag, but _for the ecological reason of needing to sustain our resources, not fat/thin reasons_.

      BUT … they are sooooo annoyingly smug! And their worshipful followers are worse. What grinds my gears the worst is the implicit selling of an environmental argument with, “If you’re ‘good to the earth’ you’ll be healtheee! [psst! and therefore thinnnn!]” Insulting and incorrect: (b) does not follow (a), nor does (c) follow (b). In fact, lots of people are like me: healthy *fat* environmentalists.

      Their obsession with the “purity of body” reminds me so much of puritanical — like the literal sense of the word — religious devotion. Like in Nathaniel Hawthorne, I sometimes get the impression that the Pollan-Waters acolytes think of fatness as the “wrongdoers’ ” own modern Scarlet Letters. (The Scarlet ‘F’! bwah ha ha ha!)

  6. DaisyDeadhead Says:

    If we taxed meat, we could pay for all of this stuff.

    Like, tax the fucking SHIT out of it. :D I’m just sayin!

    And don’t forget weed. More money for health, and weed for health, too.

    They have ample opportunities to make money, but no political will to carry it out…

    Great post, Ms Meowser!

  7. Lori Says:

    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.

    I love this, and I just want to say that if ten years ago somebody told me I’d witness conversations were adults who seemed otherwise reasonable were jumping all over themselves to agree that feeding children peanut butter and jelly sandwiches for lunch and cereal for breakfast was instilling unhealthy habits and filling them with “empty calories,” I would have laughed.

    • Rosa Says:

      Or that a nurse would agree with me when I defend giving my underweight child whole milk by saying “I mean, it’s not like you’ll be giving him whole milk when he’s TEN.”

      Because we know ten year olds drinking whole milk go straight to Hell, right?

  8. tomdegan Says:

    The other day, I received an interesting and very instructive e-mail from my brother Jeff who lives in France. He asked me to share it with the readers of my blog. I think I will share it with you also.

    “HELLO, AMERICA!

    “As an American who has been living in Europe for most of the last 20 years, one who has visited doctors numerous times in four different countries, whose two children were brought into this world in European hospitals (France and England), who has himself spent a week in a public British hospital, and who underwent an operation in a private British clinic, I think I can say a thing or two about health care in Europe.

    “Our out of pocket expenses for the births? Zero, even though in France my wife spent 5 days in the hospital after the birth, which is standard, by the way.

    “During the three years we lived in England, we never once paid for medicine for our children. Children get drugs for free in the UK. Visits to the GP are free for everybody.

    “My expenses for the week in the NHS hospital? Zero.

    “The cost of the operation in the private clinic? Zero, it was covered by my work insurance, as was the post-op physical therapy I needed.

    “In Western Europe you would never be forced to sell your home in order to pay for your medical bills, as happens all too often in America when catastrophic illness strikes and the insurance company decides that your condition was ‘pre-existing’.

    “The quality of the care? Mostly good. French hospitals are excellent, even the food is decent. The food at the NHS hospital was beyond awful, but then again most English food is pretty bad (though they do have great Indian food). At night, they were understaffed, but I am guessing that, apart from that place where Dr. House works, most American hospitals are understaffed at night, too.

    “In short, in the US, you pay more, get less, and die younger than we do in Europe. What part of that don’t you understand?

    “My fellow Americans, you have nothing to fear except those who would use fear to keep you enslaved to the myth of the might of the American health care system.”

    Jeff Degan

    What can I tell you? The guy is a Communist. Not only does he live in France, he actually likes it there. An eternal shame to our family’s good name. Let us boil down his seven paragraphs to their juicy essentials, shall we?

    HEALTH CARE IN THIS COUNTRY SUCKS.

    Here is (Excuse me, I meant to say, “Here was“) a golden opportunity for real reform and the idiotic Americans are screaming about socialism. Is it any wonder that we have become the laughingstock of the Western world?

    http://www.tomdegan.blogspot.com

    Tom Degan
    Goshen, NY

    PS – I love English food!

  9. Bobby G. Keith Says:

    To me this statement is the bottom line;

    “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.)”

    I see the whole topic like balancing a checkbook. Basically if you don’t have the money to write a check you can’t just pretend like you do and go on, you have to put money in the bank to cover it.

    Reading between the lines of this post what I hear is we need more leisure, more money to live on, healthier foods to eat and free health care. Is this the general feeling?

    If we have more leisure that means we make less money because companies rely on production. Less production equals less profit to spread around to the employees salaries and benefits (thus putting you on a thinner tight rope). The majority of the employers in this country are small businesses. Where are they going to get the money to pay, they can’t just write checks without a balance.

    The same thing with government, where are they going to get the money? It don’t grow on trees behind the White house. It comes out of your pocket and my pocket. Other countries do have nationalized health care but by reading the posts I have picked up on limitations like traveling long distance, waiting for needed medical service (even though some did not have to wait), Doctors not willing to accept $8 for their services (who can blame them). And although private insurance is available why does anyone need private insurance if the public option is so good? The main point here is government has to get the money from somewhere, (although admittedly they’ve been just printing what they need lately), and so far I think they get it from raising individual taxes and at the same time telling doctor their only going to pay them $8.

    I agree that our current system needs some major work like coming up with a way to eliminate pre-existing conditions and making it so that aspirin don’t cost a small fortune in emergency rooms. I would love to have the peace of mind that I can walk into a doctor anytime I want without selling the family farm but I think the consequences far out weigh the benefits of nationalized health care. I could go on but it’s too long already. Thanks for the excellent post meowser.

  10. Rosa Says:

    Bobby, the government will get the cash from taxes.

    Not that a public plan is even currently on the table. But where it is, the government raises taxes (universally charging less overall than we pay to the private companies we have) to cover health care costs.

    It’s interesting to see you saying we need to regulate insurers as if that doesn’t have a cost, when the insurance industry in the past has made very large estimates about how much regulations cost them. The “just do some reform on how insurance companies act” option is also not free.

  11. Catherine Says:

    In Memorial Hospital, New Orleans, after Hurricane Katrina, Emmett Everett, a 380-pound paraplegic patient who was alert, talking, and in good spirits died, allegedly as a result of a lethal dose of drugs administered by a doctor. Why? The doctor felt that, because of his size, his evacuation from the hospital would be too difficult and time-consuming for the medical personnel and rescue workers. A grand jury refused to indict the doctor. This is a long article, but please read it. Please blog about it. Please get this story out there. http://www.nytimes.com/2009/08/30/magazine/30doctors.html?_r=1&hpw


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