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.