, 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).