Tuesday, September 15, 2009

Fat and the health care debate

Liberals: if you think that the solution to all our nation's health care problems, as well as the key to paying for a national health care plan, resides in getting rid of fat people, you are in good company: your president agrees. However, as much as I like Obama, he's just plain wrong about this. If he thinks we can "prevent obesity", he's got another think coming. And even supposing we could do that, if Obama thinks that eliminating fat people would eliminate all of our nation's medical problems and save us a trillion dollars, well, he's got even more thinking to do.

The facts are these: (1) You can't make fat people thin in the long term. (2) Making people thin doesn't necessarily make them healthy anyway -- in fact in many cases it does just the opposite. And (3) a national health care plan is going to be expensive, and rather than pretend like we can eliminate all the costs by forcing or guilting everyone into getting thin, we need to just suck it up and pay for the plan, even if that means raising taxes.

I have noticed a lot of anti-fat rhetoric associated with the health care debate. There's John Mackey's controversial WSJ editorial, and Michael Pollan's response in the New York Times, and Obama repeating his previous claims. And then there's Ashton Kutcher's statement on Bill Maher's show (which Maher of course did not call him out on): "Frankly, I don’t want to pay for the guy who’s getting a triple-bypass because he’s eating fast food all day and deep-fried snickers bars." (I should immediately point out that this quote doesn't single out fat people, just people who eat a non-Ashton Kutcher-approved diet. But I think it's not totally out of line to imagine a fat person as the stereotypical person that he had in mind with this statement.) But I've also seen it coming increasingly from ordinary people -- in debates on Facebook, for example, and in the comments that people make on some of the articles mentioned above.

Here is what I would like to say to everyone who favors universal health care: our message has to be consistent or we are doomed. It is totally hypocritical for a pro-choice liberal to declare that "a woman's body is her own" but then turn around and try to tell others what to eat and how much to exercise and how much body fat they are allowed to have. Universal health care means covering everybody, regardless of whose "fault" it is when they get sick. That is the whole point. If you keep talking about policing the way people live their lives as a way to drive down costs, you are playing right into the Republicans' fear-mongering about how Big Government takes away our freedom. We liberals need to get our thinking straight about this, or this whole health care thing is going nowhere.

P.S. Sorry for the comment moderation; I've been getting spam comments every day on my last post and I don't know how else to block them. I'll try to approve your comments quickly.

P.P.S. I just got wind of a new blog called Fat Habitat that may be of interest. It's about fat and sustainability. There aren't many posts yet (and the last one was pro-Michael Pollan before he made his recent anti-fat remarks, so it will be interesting to see how he's treated in the next post), but this will be one to watch.


Jen said...

I haven't heard the anti-fat comments relating to health care but have heard a lot of anti-old comments. I guess Obama wants a "perfect" society...like the one in Logan's Run.

Mary said...

I love a good Logan's Run reference! But I don't necessarily agree that Obama wants a perfect society -- that sounds a little too eugenics-y to me, given that I don't think his motives are sinister. I just think he really wants to pass a health care bill and he is kind of naively assuming that there is an easy way to cut costs so that we don't have to raise taxes.

Jen said...

I agree.

Anonymous said...

fat people spend more on health care...cause they aren't as healthy. does that make sense?

Mary said...

Actually no, it doesn't make sense -- I don't see how it bears on the post. I'm also not sure whether fat people, statistically speaking, spend more on health care than other people. And it's not true that fat people "aren't as healthy" -- especially if you mean this in a causal way (i.e., "being fat makes people less healthy").

Jen said...

I don't understand why weight is this huge issue (no pun intended). It seems like if you want to judge and isolate a group for health issues, you should pick smokers. Unless, of course, it's because they don't live as long...and have good lobbyists.

Mary said...

Well, I think if you asked a smoker they'd say they are plenty judged and isolated.

Anonymous said...

Obviously overweight people spend more on health care because 60% of Americans are either overweight or obese. It's an excuse to blame one group for a problem and tax them more to boot. The senate passed legislation making it legal for businesses to charge overweight employees more for the health insurance premiums.

Government guidelines in place now (see the U S Preventive Services Task Force Guidelines) urge physicians to be aggressive in getting their patient's to lose weight despite the shoddy evidence of any benefit. The NHLBI guidelines for the treatment of obesity tell physicians to use a stepwise approach based on BMI: diet and exercise, drugs, surgery. In the future, if health care reform takes a Big Brother approach, your failure to comply could result in punitive measures. If your physician were to disagree with these (and other) guidelines and offer another approach he would be labeled a "low quality" provider and compensation would be withheld. He would also be a magnet for lawyers.

Yes, we need reform. We need a system where doctors care for sick people (rather than labeling them with imaginary diseases) and people don't go broke because of unfortunate illnesses. But not a system where "pay for performance" is really a method of getting physicians to practice what the government decides is good medicine and "preventive medicine" is Big Brother telling us what to eat, how much to weigh, when to take a stain etc.

You can find good doctors now that shoot straight and ignore government BS. In the future such doctors may not exist because they might be illegal.