Meowser, treasure of the fatosphere that she is, has hit another one out of the park with the most recent essay in her "
What Does Health Care Reform Really Mean to American Fatasses?" series. She calls this the conclusion, but I hope it she will continue to write on the topic. The question she asks, "How Expensive Am I Really?" is blunt and right on target.
I've been really bothered by the slicing and segmenting of the U.S. population's health costs by BMI status.
To those who do this number crunching and publicizing, they don't see it as any different as identifying the costs associated with tobacco use, diabetes, heart disease, drug addiction, alcohol abuse or other ills. (And there are certainly ethical considerations pertaining to that work, too.) The "redlining" of health and life insurance policies has been done by insurance companies forever, and that is why women pay more, and fat people pay more (if they can get insurance at all).
We don't get a bill at the end of our life for all that we've cost society.
We might "pay as we go" to a certain extent (and there's really no justice in who pays how much -- some people -- generally poorer ones -- pay a much higher percentage of their net worth than others), but most of us who are employed and our employer pays our health insurance have been subsidizing the current system -- including those unable to pay. We pay for Medicare and Medicaid for those currently insured by those programs through our taxes. Our employer factors in our benefits with our salary and any other costs associated with employment as our "total package" and we are paying for our own health insurance, in essence, with lower wages. If I were to be employed as an independent contractor for the work I do, I think I would need to charge upwards of $100/hour to be able to afford to feed, clothe and insure my family. There are cost efficiencies to my employer purchasing health insurance and health care collectively. Is my employer losing money on me because I am so costly on the health insurance/health care side of things? I think my employer is getting a bargain, or at least a fair deal, because I'm uniquely qualified and productive in the specific work I do. Could they find someone less expensive (and possessing of a more socially acceptable body) to do as good a job as me? They had a chance to, and I was the candidate chosen.
The notion that I am "too expensive" because of my fatness has caused me considerable thinkiness, and some degree of pain. Given the circumstances of my life to date, the only way I could be less expensive would to have been successful in a suicide attempt earlier in my life. I will be slightly arrogant here for a moment and say that I think, on balance, my being here now benefits society at least as much as it costs society. But that's where this thinking about "who costs too much" leads. The only way I could have survivied to this moment is by being who I've been, which includes: fat, with type 2 diabetes, PCOS, infertility, pregnancy, birth, miscarriage, hypothyroid, depression, various and sundry acute illnesses and only by sheer luck not yet facing an immediately life-threatening illness or one that would limit my ability to provide for my family.
When I hear that I cost more because I'm fat, what I hear is that someone would prefer I not exist to save them money.
Now, I can hear the health economists saying "that's not what we meant! We just want to
raise awareness." In other words, "We want you to exist, but we just don't want you to be fat (and expensive)." Well, good luck with that. I've been in this life, this body, for 40 years and I haven't figured out how to both exist and not be fat, and god knows, I've tried. Ultimately for me, the choice was: Exist in this body, or don't exist at all.
I will refer here to the research on
Adverse Childhood Experiences (ACEs) and their impact on adult health. Even with none of the ACEs, my genetic endowment meant I was predisposed to certain of the conditions I now face. That genetic endowment also accounts for a good portion of what makes me valuable in the work I do. (I can only take some credit for my skills and abilities, recognizing that just as I'll never be a professional athlete or neurosurgeon or rocket scientist or renown artist, there are some things I do particularly well without really trying -- combined with the privilege I was born into that allowed me to be relatively highly educated and "do well" in spite of those ACEs).
I am more than happy to continue to pay taxes, copays, deductibles, cost-shares, for myself and my family, and pay toward those who aren't able to come up with the cash to cover those things. I think, when spent well, it's a great thing to spend money on. I don't need a nicer car, or nicer house, or more cash (although a more secure retirement, including how I'm going to be covered, health-wise, is something I think about). What I do need is to feel that the path I've been on, chosing life over the alternative, has been the right one. I know there are many people in my life (not the least of whom is SuperHeroPrincess) who would say I have chosen correctly. Those people who say things along the lines of "a fat life isn't worth living or paying for" are not going to be providing me with the reassurance I'm looking for, so I need to look elsewhere (and much closer to home). The ferocity of that "a fat life isn't worth living or paying for" perspective is scary, though, and for me, echos dehumanization that is a precursor of genocide. When it comes from people who are members of other groups commonly dehumanized in the U.S., I think it's a matter of perceiving competition for that status of humanity, scrabbled upon the backs and bodies of others (Dan Savage, I'm looking at you).
Comments (15)
If I were to be employed as an independent contractor for the work I do, I think I would need to charge upwards of $100/hour to be able to afford to feed, clothe and insure my family.
This entire essay is made of rule, but that especially. Chris gets paid a much higher hourly rate than I do, but he has to buy liability insurance and provide his own healthcare. At the moment, he's going nekkid, which freaks me out substantially, but I don't really blame him for not wanting to pay insurance-company extortion if he can get away with not doing it. I don't know if people realize that we're already paying out the schnozzole for our health care with depressed wages. And guess who's most likely to be stuck in the kind of job that pays stagnant wages? Yup. Marilyn Wann calculated once that fat hate costs us a million dollars each over the course of our lifetimes, and therefore, the hatebags owe us, not the other way around.
I know there are many people in my life (not the least of whom is SuperHeroPrincess) who would say I have chosen correctly.
That's a smart little girl. I'm glad you did, too. (I'll bet we're far from the only ones.)
(BTW, I still want to come up there to visit. Whenever is good for you. I'm going to Seattle for my birthday the last weekend of next month, but other than that I'm wide open.)
@Meowser1 - Thank you. Insomnia is good for something, sometimes. Your writing inspires me.
I've been missing you too, this summer has just flown by.
I have a couple of busy weekends but Labor Day isn't busy (yet).
SuperHeroPrincess would actually be perhaps a bit easier to manage on a trip this time -- she's been more outgoing to my grown-up friends and more adventurous lately. This is actually a really fun age (if an exhausting one) that she's at right now. She's goofy and funny and adorable and likes to be the center of attention (okay, who does that sound like?).
Quick funny story that for some reason makes me think of you. I was driving to work and my cell phone rang (I know, I shouldn't be answering it while I was driving) and it was Mr. Rounded calling with a quick question so I was off of the phone quickly. But when I answered the phone, it was damp and smelled of vanilla. So, I did what anyone would do, I licked my phone, and deduced that my vanilla soy yogurt had leaked out into my purse, but mostly just a tiny amount onto the phone. Disgusting, I know, but, I know exactly where my cell phone is at all times, so it's not swimming in germs I haven't already been exposed to.
Hey, long as you didn't get electrocuted, it's all good. (I'm sure I've tasted my share of nonfood items under similar circumstances.)
Labor Day is intriguing. I wonder how hard it would be to get a train reservation that day.
@Meowser1 - I don't have plans that whole weekend (yet).
Great post. I just commented on something like this on another blog, but I think we're totally missing the boat in the whole health care debate. A huge problem I'm having is that we're viewing health primarily as an end in itself. Why should we be healthy? So we'll live longer and cost less!
That's just so ass-backwards. Our health is there to serve us in meaningful pursuits--living, loving, serving, teaching, learning--rather than our purpose being simply to maximize our lifespans. I mean, I honestly think there are many people who would think that a person who is spending 3 hours every day at the gym and maintaining a "healthy" BMI is making better choices and better use of their time than a person spending 3 hours every day volunteering at a soup kitchen who happens to be fat. The size of our bodies is so much more important than what we are actually doing with them.
If I ever start blogging again, what I want to do is just showcase fat people who are out there doing positive things. Because I think that's what people need to see. The fat people they are saying don't deserve health care and cost too much to exist are not, despite what they may think, just sitting on their couches all day drinking bottles of corn syrup. They are teaching kids and providing health care (I'd say that at least 3/4 of the nurses at the practice I see my doctor at are fat, and probably 1/2 the doctors) and loving their families and doing business and helping others. It's just ridiculous that we can believe that two-freaking-thirds of the population is doing nothing but sitting on their fat asses all day using up resources thin people deserve.
@loriersea - I couldn't agree more with this:
"I honestly think there are many people who
would think that a person who is spending 3 hours every day at the gym
and maintaining a "healthy" BMI is making better choices and better use
of their time than a person spending 3 hours every day volunteering at
a soup kitchen who happens to be fat. The size of our bodies is so
much more important than what we are actually doing with them."
I don't know that it might not be a good idea to do something aerobic for 30 minutes and spending 2.5 hours in the soup kitchen (I'll assume there's lifting involved to satify the strength training aspect) and then some yoga with the soup kitchen's diners (I just mean it doesn't have to be either/or). I've often felt that instead of "biggest loser" and makeover shows -- glorifying people who do amazing everyday things would be so much better.
So, I have been following this fat=expensive debate for a few weeks. I am a fatty who never goes to the doctor (not good, but cheap ) cuz with my current insurance the rate go sky high if you use it. So, I really have no idea why I even pay for it (but that is another debate). Anyway, I am also a "numbers" person and I can follow the numbers of the (although you can figure them how ever you want to get the conclusion you want) calculation connected to the fat=expensive conclusion. But, I have to say something that is HORRIBLY un-PC, but since I have been trashed by every new magazine for being fat and I am expected to sit there and take it, it better be ok for someone to mention another medical stat that might piss other people off...african americans are more expensive on health care because they are more likely to suffer gun shot wounds, have substance abuse problems, and live in lower socio-economic conditions (bad diet, unsanitary conditions, etc). Is it true that every black person will suffer a gun shot wound or be addicted to crack? No, of course not, but by some numbers, they do suffer more of those conditions and they are therefor more expensive. But we are not allowed to talk about the numbers that might offend other groups. I am so SICK of being degraded and it be allowed and accepted! If a media person talked about the medical stats of old people, black people, or children and said that they cost more, they would be taken away in shackles. But, its ok to offend fat people- we hate them all anyway. The whole thing just pisses me off...what a great way to start the day!
@RosieJojo - So, the issue to me isn't that we ought to start calculating the costs associated with being a particular ethnic group, or gender, or queer but "why is it that CDC doesn't have cost caluclators for those things?"
The answer, to me, is the that if we did calculate those things, what would we do with that information? Those sorts of calculations fuel hatred and bigotry, that's why, because what would the solution be, exactly, to knowing that women workers were costing $X,XXX per year more than male workers, or a particular ethnic group would cost more to employ than any other group? There's no way that saying X group costs $X,000 per year more without human reasoning taking the next step to thinking, well, we would be better off without X group.
I think that the reason that people who say "I can't say X about X group the way that everyone talks about fat people" get called out is that even if you don't say it, that doesn't mean it's not being said, or acted, on by other people. It's not that fat hatred is any more acceptable than any other form of bigotry, it's expressed differently, and hasn't (yet) been classified as discrimination that can be "regulated." The bigotry doesn't go away once it becomes "illegal," there are just slightly better tools for fighting it (if enforcement is in place and there are supports for those who come forward to report it).
If there's any point in pointing out differences in health -- it's to highlight racism, sexism and the disparities caused by social determinants of health, not to increase discrimination against people who have worse health. And in some cases, hating on fat people is a way of hating on poorer people, less well educated people, people who haven't been able to express their upward mobility or class status through body size.
While I agree with your reply, I do think fat bigotry is more acceptable than any other form of bigotry because people who do it shrouded it in "its for their own good. We want to support a healthy lifestyle." Very few people will argue with that comment, ie very few people see the bigotry for what it is.
Hi there! I´m a fatty (171 cm, 96 kg) from Finland (one of those countries with universal health care for all). I´ve been reading these FA blogs for a few weeks now and it´s been really interesting. FA is quite a new concept around here, for a reason I don´t actually know. I guess we´re still in denial and desperately wanting to lose weight, me included.
Anyway, every time I read about how fat Americans are being discriminated against, not getting jobs and health insurance, one thing puzzles me: As the stats say that the great majority of American adults are overweight, doesn´t that in fact mean that the MINORITY is discriminating against the MAJORITY? Because that sounds a bit weird, if you ask me! How is that possible in a democratic country? Or are some of these 'overweight' people considered only 'moderately' overweight and thus not 'real fatties'?
Where I live everyone has health insurance. It´s not something you ever have to think about. It´s from cradle to grave. There´s no need to plan one´s life according to where you work and whether your employer pays for your health insurance or not. I once talked to a woman, an American, who wanted another baby with her husband but was worried that they could not afford it, because he might lose his job and then she´d have no insurance to pay for maternity care etc. To me that doesn´t sound like it´s The Land Of The Free so much...
Anyway, from our point of view (we´re a nation of 5 million people), fat may cost, but we simply CAN´T AFFORD not to treat people! With declining fertility rates and all that, we need people to stay as healthy as they can and WORK! Now I´m not saying it all comes down to money - human life has some worth per se, I hope - but we´re not as rich as you Americans, so we can´t allow private health insurance companies to rip us off. It´s common sense. (Sorry about ranting ;))
@RosieJojo - When you say this "fat bigotry is more acceptable than any
other form of bigotry because people who do it shrouded it in "its for
their own good. We want to support a healthy lifestyle." " -- I think that acceptability has to do with how much it is impacting you. I don't think fat bigotry is more acceptable than other forms of bigotry -- each form has it's own way of being expressed, and what is visible to me is what impacts me most directly.
When you say this "very few people see the bigotry for what it is." -- I agree with you. But I think that very few people really see other forms of bigotry for what they are, or are interested in changing their behavior in order to impact them.
@Laardileidi - I've often thought about this:
"As the stats say that the great majority of
American adults are overweight, doesn´t that in fact mean that the
MINORITY is discriminating against the MAJORITY? Because that sounds a
bit weird, if you ask me! How is that possible in a democratic country?"
Well, I think we could use a bit more democracy around here.
The minority often discriminates against the majority -- it happens all of the time.
It is hard to organize around being fat -- Charlotte Cooper had a great post about this -- as it's seen as a temporary state, and there's so much stigma that it's hard to attract allies. Nonetheless, organize we must. That's why I joined ASDAH.
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