posted by meowser
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.